| 1. |
- Chen, C., et al.
(författare)
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Increasing Childrens physical Activity by Policy (CAP) in preschools within the Stockholm region : study protocol for a pragmatic cluster-randomized controlled trial
- 2022
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Ingår i: Trials. - : BMC. - 1745-6215. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Systematic reviews suggest that preschool environmental/organizational changes may be effective in increasing physical activity (PA) levels of preschool children, but evidence is scarce regarding feasible, effective, and equitable interventions that can be scaled up. Specifically, it is essential to understand whether introducing a multicomponent organizational change in terms of policy in the preschool context may be beneficial for childrens PA levels and concomitant health outcomes. To bridge this knowledge gap, our main aim is to examine the feasibility and effectiveness of a policy package in increasing PA levels in preschool children, using a large-scale pragmatic cluster-randomized controlled trial. Methods: This proposed study is a pragmatic cluster-randomized controlled trial with two conditions (intervention and control with a 1:1 ratio) with preschools as clusters and the unit of randomization. We aim to recruit approximately 4000 3-5-year-old children from 90 preschools and retain more than 2800 children from 85 preschools to provide adequate statistical power for the analyses. The intervention to implement is a co-created, multicomponent policy package running for 6 months in preschools randomized to intervention. Change in accelerometer measured PA levels in children between intervention and control from pre- and post-intervention will be the primary outcome of the study, while secondary outcomes include health outcomes such as musculoskeletal fitness, psychosocial functioning, and absence due to illness in children among others. Implementation will be studied carefully using both quantitative (dose, fidelity) and qualitative (interview) methodologies. The change in primary and secondary outcomes, from pre- to post-intervention, will be analyzed with linear mixed-effect models (to allow both fixed and random effects) nested on a preschool level. Discussion: This is a large-scale co-creation project involving the City of Stockholm, childcare stakeholders, preschool staff, and the research group with the potential to influence more than 30,000 preschool children within the Stockholm area. The study will add reliable evidence for the implementation of PA policies at the organizational level of preschools and clarify its potential effect on objectively measured PA and health markers in children.
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| 2. |
- Hidalgo Migueles, Jairo Hidalgo, et al.
(författare)
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GRANADA consensus on analytical approaches to assess associations with accelerometer-determined physical behaviours (physical activity, sedentary behaviour and sleep) in epidemiological studies
- 2022
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 56:7, s. 376-384
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Tidskriftsartikel (refereegranskat)abstract
- The inter-relationship between physical activity, sedentary behaviour and sleep (collectively defined as physical behaviours) is of interest to researchers from different fields. Each of these physical behaviours has been investigated in epidemiological studies, yet their codependency and interactions need to be further explored and accounted for in data analysis. Modern accelerometers capture continuous movement through the day, which presents the challenge of how to best use the richness of these data. In recent years, analytical approaches first applied in other scientific fields have been applied to physical behaviour epidemiology (eg, isotemporal substitution models, compositional data analysis, multivariate pattern analysis, functional data analysis and machine learning). A comprehensive description, discussion, and consensus on the strengths and limitations of these analytical approaches will help researchers decide which approach to use in different situations. In this context, a scientific workshop and meeting were held in Granada to discuss: (1) analytical approaches currently used in the scientific literature on physical behaviour, highlighting strengths and limitations, providing practical recommendations on their use and including a decision tree for assisting researchers decision-making; and (2) current gaps and future research directions around the analysis and use of accelerometer data. Advances in analytical approaches to accelerometer-determined physical behaviours in epidemiological studies are expected to influence the interpretation of current and future evidence, and ultimately impact on future physical behaviour guidelines.
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| 3. |
- Hidalgo Migueles, Jairo Hidalgo, et al.
(författare)
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Revisiting the cross-sectional and prospective association of physical activity with body composition and physical fitness in preschoolers : A compositional data approach
- 2022
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Ingår i: Pediatric Obesity. - : Wiley. - 2047-6302 .- 2047-6310. ; 17:8
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Tidskriftsartikel (refereegranskat)abstract
- Background Information is limited for the benefits of physical activity (PA) in preschoolers. Previous research using accelerometer-assessed PA may be affected for multicollinearity issues. Objectives This study investigated the cross-sectional and prospective associations of sedentary behaviour (SB) and PA with body composition and physical fitness using compositional data analysis. Methods Baseline PA and SB were collected in 4-year-old (n = 315) using wrist-worn GT3X+ during seven 24 h-periods. Body composition (air-displacement plethysmography) and physical fitness (PREFIT test battery) were assessed at baseline and at the 12-month follow-up. Results Increasing vigorous PA at expenses of lower-intensity behaviours for 4-year-old was associated with body composition and physical fitness at cross-sectional and longitudinal levels. For example, reallocating 15 min/day from lower intensities to vigorous PA at baseline was associated with higher fat-free mass index (+0.45 kg/m(2), 95% confidence intervals [CI]: 0.18-0.72 kg/m(2)), higher upper-body strength (+0.6 kg, 95% CI: 0.1-1.19 kg), higher lower-body strength (+8 cm, 95% CI: 3-13 cm), and shorter time in completing the motor fitness test (-0.4 s, 95% CI: -0.82 to [-0.01] s) at the 12-month follow-up. Pairwise reallocations of time indicated that the behaviour replaced was not relevant, as long as vigorous PA was increased. Conclusions More time in vigorous PA may imply short- and long-term benefits on body composition and physical fitness in preschoolers. These findings using compositional data analysis corroborate our previously published results using isotemporal substitution models.
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| 4. |
- Leppänen, Marja H., et al.
(författare)
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Comparing estimates of physical activity in children across different cut-points and the associations with weight status
- 2022
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : John Wiley & Sons. - 0905-7188 .- 1600-0838. ; 32:6, s. 971-983
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to compare sedentary time (SED) and intensity-specific physical activity (PA) estimates and the associations of SED and PA with body mass index (BMI) and waist circumference (WC) using three different sets of cut-points in preschool-aged children. A total of 751 children (4.7 ± 0.9 years, boys 52.7%) wore an ActiGraph GT3X+BT accelerometer on their hip for 7 days (24 h). Euclidean norm −1 G with negative values rounded to zero (ENMO) and activity counts from vertical axis (VACounts) and vector magnitude (VMCounts) were derived. Estimates of SED and light, moderate, vigorous, and moderate-to-vigorous PA (MVPA) were calculated for commonly used cut-points by Hildebrand et al., Butte et al., and Evenson et al. Furthermore, the prevalence of meeting the PA recommendation, 180 min/day of which at least 60 min/day being MVPA, were assessed for the cut-points. Multilevel mixed analysis was used to examine associations of SED and PA with BMI and WC. In accordance with the results, SED and PA intensity estimates differed largely across cut-points (i.e., SED = 22–341 min/day; light PA = 52–257 min/day; moderate PA = 5–18 min/day; vigorous PA = 7–17 min/day; MVPA = 13–35 min/day), and the prevalence of children meeting the PA recommendation varied from 4% to 70%. Associations of SED and PA with BMI or WC varied between the cut-points. Our results indicate that SED and PA estimates in preschool-aged children between studies using these cut-points are poorly comparable. Methods facilitating accelerometer-derived PA estimate comparison between studies are highly warranted.
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| 5. |
- Ortega, Francisco B., et al.
(författare)
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Effects of an Exercise Program on Brain Health Outcomes for Children With Overweight or Obesity The ActiveBrains Randomized Clinical Trial
- 2022
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Ingår i: JAMA Network Open. - : American Medical Association. - 2574-3805. ; 5:8
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Pediatric overweight and obesity are highly prevalent across the world, with implications for poorer cognitive and brain health. Exercise might potentially attenuate these adverse consequences. OBJECTIVES To investigate the effects of an exercise program on brain health indicators, including intelligence, executive function, academic performance, and brain outcomes, among children with overweight or obesity and to explore potential mediators and moderators of the main effects of exercise. DESIGN, SETTING, AND PARTICIPANTS All preexercise and postexercise data for this 20-week randomized clinical trial of 109 children aged 8 to 11 years with overweight or obesity were collected from November 21, 2014, to June 30, 2016, with neuroimaging data processing and analyses conducted between June 1, 2017, and December 20, 2021. All 109 children were included in the intention-to-treat analyses; 90 children (82.6%) completed the postexercise evaluation and attended 70% or more of the recommended exercise sessions and were included in per-protocol analyses. INTERVENTIONS All participants received lifestyle recommendations. The control group continued their usual routines, whereas the exercise group attended a minimum of 3 supervised 90-minute sessions per week in an out-of-school setting. MAIN OUTCOMES AND MEASURES Intelligence, executive function (cognitive flexibility, inhibition, and working memory), and academic performance were assessed with standardized tests, and hippocampal volume was measured with magnetic resonance imaging. RESULTS The 109 participants included 45 girls (41.3%); participants had a mean (SD) body mass index of 26.8 (3.6) and a mean (SD) age of 10.0 (1.1) years at baseline. In per-protocol analyses, the exercise intervention improved crystallized intelligence, with the exercise group improving from before exercise to after exercise (mean z score, 0.62 [95% CI, 0.44-0.80]) compared with the control group (mean z score, -0.10 [95% CI, -0.28 to 0.09]; difference between groups, 0.72 SDs [95% CI, 0.46-0.97]; P < .001). Total intelligence also improved significantly more in the exercise group (mean z score, 0.69 [95% CI, 0.48-0.89]) than in the control group (mean z score, 0.07 [95% CI, -0.14 to 0.28]; difference between groups, 0.62 SDs [95% CI, 0.31-0.91]; P < .001). Exercise also positively affected a composite score of cognitive flexibility (mean z score: exercise group, 0.25 [95% CI, 0.05-0.44]; control group, -0.17 [95% CI, -0.39 to 0.04]; difference between groups, 0.42 SDs [95% CI, 0.13-0.71]; P = .005). These main effects were consistent in intention-to-treat analyses and after multiple-testing correction. There was a positive, small-magnitude effect of exercise on total academic performance (mean z score: exercise group, 0.31 [95% CI, 0.18-0.44]; control group, 0.10 [95% CI, -0.04 to 0.24]; difference between groups, 0.21 SDs [95% CI, 0.01-0.40]; P = .03), which was partially mediated by cognitive flexibility. Inhibition, working memory, hippocampal volume, and other brain magnetic resonance imaging outcomes studied were not affected by the exercise program. The intervention increased cardiorespiratory fitness performance as indicated by longer treadmill time to exhaustion (mean z score: exercise group, 0.54 [95% CI, 0.27-0.82]; control group, 0.13 [95% CI, -0.16 to 0.41]; difference between groups, 0.42 SDs [95% CI, 0.01-0.82]; P = .04), and these changes in fitness mediated some of the effects (small percentage of mediation [approximately 10%-20%]). The effects of exercise were overall consistent across the moderators tested, except for larger improvements in intelligence among boys compared with girls. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, exercise positively affected intelligence and cognitive flexibility during development among children with overweight or obesity. However, the structural and functional brain changes responsible for these improvements were not identified.
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| 6. |
- Sandborg, Johanna, et al.
(författare)
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Physical Activity, Body Composition, and Cardiometabolic Health during Pregnancy: A Compositional Data Approach
- 2022
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Ingår i: Medicine & Science in Sports & Exercise. - : LIPPINCOTT WILLIAMS & WILKINS. - 0195-9131 .- 1530-0315. ; 54:12, s. 2054-2063
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to examine the cross-sectional and longitudinal associations of 24-h movement behaviors (sleep, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)) with body composition and cardiometabolic health in i) early and ii) late pregnancy (gestational weeks 14 and 37). Methods: This observational study utilized cross-sectional (n = 273) and longitudinal data (n = 242) from the HealthyMoms trial. Time spent in movement behaviors over seven consecutive 24-h periods (ActiGraph wGT3x-BT accelerometer), body composition (Bod Pod), and cardiometabolic health indicators (glucose levels, homeostatic model for insulin resistance (HOMA-IR), systolic and diastolic blood pressure, metabolic syndrome (MetS) score) were measured in early and late pregnancy. Results: In early pregnancy, reallocating time to MVPA from LPA, SB, and sleep was associated with lower MetS score (adjusted gamma = -0.343, P = 0.002). Correspondingly, reallocating time to LPA from SB and sleep in early pregnancy was associated with lower body weight (adjusted gamma = -5.959, P = 0.047) and HOMA-IR (adjusted gamma = -0.557, P = 0.031) at the same time point. Furthermore, reallocating time to LPA from SB and sleep in early pregnancy was associated with lower fat mass index (adjusted gamma = -0.668, P = 0.028), glucose levels (adjusted gamma = -0.315, P = 0.006), HOMA-IR (adjusted gamma = -0.779, P = 0.004), and MetS score (adjusted gamma = -0.470, P = 0.027) in late pregnancy. The changes in behaviors throughout pregnancy were not associated with body weight, body composition, and MetS score in late pregnancy. Conclusions: Our results demonstrated that increasing LPA or MVPA while reducing SB and sleep was associated with lower weight and more favorable cardiometabolic health in early pregnancy. In contrast, LPA in early pregnancy seems to be a stimulus of enough intensity to improve body composition and cardiometabolic health indicators in late pregnancy.
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| 7. |
- Torres-Lopez, Lucia V, et al.
(författare)
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Associations of Sleep-Related Outcomes with Behavioral and Emotional Functioning in Children with Overweight/Obesity
- 2022
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Ingår i: The Journal of Pediatrics. - : Elsevier. - 0022-3476 .- 1097-6833. ; 246, s. 170-178.e2
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the associations of parent-reported sleep-disordered breathing (SDB) and device-assessed sleep behaviors with behavioral and emotional functioning in pediatric patients with overweight/obesity. Study design A total of 109 children with overweight/obesity (mean age, 10.0 +/- 1.1 years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (ie, snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (ie, wake time, sleep onset time, total time in bed, total sleep time, and waking after sleep onset) were estimated using wrist-worn accelerometers. We used the Behavior Assessment System for Children, second edition to assess behavioral and emotional functioning (ie, clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat, and somatization; adaptive scale: adaptability, social skills, and leadership). Results SDB was positively associated with all clinical scale variables (all beta > 0.197, P <=.041) and with lower adaptability and leadership (all beta < -0.226, P < .021). Specifically, the PSQ subscale relating to daytime sleepiness was associated with higher attention problems, depression, anxiety, and retreat (all beta > 0.196, P .045) and lower adaptability (beta = -0.246, P = .011). The inattention/hyperactivity subscale was significantly associated with the entire clinical and adaptive scales (all beta > vertical bar 0.192 vertical bar, P <= .046) except for somatization. The snoring subscale and device-assessed sleep behaviors were not related to any behavioral or emotional functioning variables. Conclusions Our study suggests that SDB symptoms, but not device-assessed sleep behaviors, are associated with behavioral and emotional functioning in children with overweight/obesity. Specifically, daytime sleepiness, a potential SDB symptom, was related to higher attention problems, depression, anxiety, and retreat and lower adaptability.
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| 8. |
- Torres-Lopez, Lucia V, et al.
(författare)
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Does sleep-disordered breathing add to impairments in academic performance and brain structure usually observed in children with overweight/obesity?
- 2022
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Ingår i: European Journal of Pediatrics. - : Springer. - 0340-6199 .- 1432-1076. ; 181, s. 2055-2065
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Tidskriftsartikel (refereegranskat)abstract
- Approximately 4-11% of children suffer from sleep-disordered breathing (SDB), and children with obesity are at increased risk. Both obesity and SDB have been separately associated with poorer brain health, yet whether SDB severity affects brain health in children with obesity remains unanswered. This study aimed to examine associations of SDB severity with academic performance and brain structure (i.e., total brain and gray and white matter volumes and gray matter volume in the hippocampus) in children with overweight/obesity. One hundred nine children aged 8-12 years with overweight/obesity were included. SDB severity and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity) were evaluated via the Pediatric Sleep Questionnaire (PSQ), and academic performance was evaluated with the Woodcock-Munoz standardized test and school grades. Brain structure was assessed by magnetic resonance imaging. SDB severity was not associated with academic performance measured by the standardized test (all vertical bar beta vertical bar> 0.160, P > 0.076), yet it was associated with the school grade point average (beta = -0.226, P = 0.007) and natural and social science grades (beta = -0.269, P = 0.024). Intention/hyperactivity seemed to drive these associations. No associations were found between SDB severity and the remaining school grades (all beta < -0.188, P > 0.065) or brain volumes (all P > 0.05). Conclusion: Our study shows that SDB severity was associated with lower school grades, yet it was not associated with the standardized measurement of academic performance or with brain volumes in children with overweight/obesity. SDB severity may add to academic problems in children beyond the effects contributed by overweight/obesity status alone.
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