Energy Cost of Common Physical Activities in Preschoolers

BACKGROUND: To determine the energy cost of common physical activities in preschoolers and to compare it with the Compendium of Energy Expenditure for Youth (CEEY). METHODS: In total, 42 children [age: 4.8 (0.8) y; body mass index: 15.3 (2.0) kg/m2; 22 boys] completed 13 common physical activities covering sedentary to vigorous intensities, while energy expenditure (EE) was measured continuously by indirect calorimetry. Activity-specific metabolic equivalents (AME) were calculated as the EE observed during each single activity divided by the EE during observed rest. Independent t tests were applied to analyze differences between boys and girls and between AME and CEEY. RESULTS: No significant differences in AME were observed between girls and boys. Except for playing hide-and-seek, all indoor activities revealed significantly higher energy costs compared with those stated in the compendium. Significant differences in outdoor activities were found for riding a tricycle [5.67 (95% confidence interval, 4.94–6.4) AME vs 6.2 metabolic equivalents, riding a bike, P < .05] and for fast walking [5.42 (95% confidence interval, 4.84–6.0) AME vs 4.6 metabolic equivalents, P < .05]. CONCLUSIONS: Applying the CEEY to preschoolers will lead to a substantial underestimation of EE. Therefore, we recommend that a CEEY for preschool children be developed if measurement of EE is not feasible

Accelerometry-Based Prediction of Energy Expenditure in Preschoolers

PURPOSE: Study purposes were to develop energy expenditure (EE) prediction models from raw accelerometer data and to investigate the performance of three different accelerometers on five different wear positions in preschoolers. METHODS: Fourty-one children (54% boys; 3–6.3 years) wore two Actigraph GT3X (left and right hip), three GENEActiv (right hip, left and right wrist), and one activPAL (right thigh) while completing a semi-structured protocol of 10 age-appropriate activities. Participants wore a portable indirect calorimeter to estimate EE. Utilized models to estimate EE included a linear model (LM), a mixed linear model (MLM), a random forest model (RF), and an artificial neural network model (ANN). For each accelerometer, model, and wear position, we assessed prediction accuracy via leave-one-out cross-validation and calculated the root-mean-squared-error (RMSE). RESULTS: Mean RMSE ranged from 2.56–2.76 kJ/min for the RF, 2.72–3.08 kJ/min for the ANN, 2.83–2.94 kJ/min for the LM, and 2.81–2.92 kJ/min for the MLM. The GENEActive obtained mean RMSE of 2.56 kJ/min (left and right wrist) and 2.73 kJ/min (right hip). Predicting EE using the GT3X on the left and right hip obtained mean RMSE of 2.60 and 2.74 kJ/min. The activPAL obtained a mean RMSE of 2.76 kJ/min. CONCLUSION: These results demonstrate good prediction accuracy for recent accelerometers on different wear positions in preschoolers. The RF and ANN were equally accurate in EE prediction compared with (mixed) linear models. The RF seems to be a viable alternative to linear and ANN models for EE prediction in young children in a semi-structured setting

Protocol for a scoping review to identify and map intervention components of existing school-based interventions for the promotion of physical activity and cardiorespiratory fitness among school children aged 6–10 years old

INTRODUCTION: Physical inactivity is known as a leading cause of mortality and tracks from childhood to adulthood. Many types of school-based single-component and multicomponent interventions to promote physical activity (PA) have been undertaken and evaluated, with mixed findings overall. Enlarging the intervention areas beyond the school setting is a promising approach. WHO’s Health Promoting School (WHO HPS) framework is a holistic, setting-based approach where health is promoted through the whole school environment with links to other settings such as the home environment and wider community. In this paper, we outline our scoping review protocol to systematically review the published literature from the last 10 years to identify existing school-based interventions to promote PA and cardiorespiratory fitness among children aged 6–10 years old and to map intervention components according to the features of this framework. METHODS AND ANALYSIS: Arksey and O’Malley’s scoping review methodology framework will guide the conduct of this review. We will search Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sports Medicine & Education Index, Education Resources Information Centre and CENTRAL and hand search the reference lists of key studies to identify studies appropriate for inclusion. Any empirical study that evaluated the effectiveness of a school-based intervention promoting PA and/or cardiorespiratory fitness in children aged 6–10 years old will be included. Two reviewers will independently screen all abstracts and full texts for inclusion. One reviewer will extract general information, study characteristics and intervention contents to classify them according to the features of the WHO HPS framework. Results will be synthesised narratively. ETHICS AND DISSEMINATION: Findings will be disseminated in conference presentations and peer-reviewed publications. A condensed version of the results will be made available for the public. Stakeholder meetings will be arranged to discuss and disseminate the findings

Impact of the intervention program “JolinchenKids – fit and healthy in daycare” on energy balance related-behaviors: results of a cluster controlled trial

BACKGROUND: The purpose of this study was to evaluate the multi-component health promotion program, JolinchenKids – fit and healthy in daycare, designed to promote physical activity (PA), healthy eating, and mental wellbeing among 3- to 6-year-old preschoolers. METHODS: For this cluster controlled trial, 62 daycare facilities (DFs) from thirteen different federal states in Germany were recruited (31 intervention, 31 control DFs). Outcome measures were children’s habitual PA, fruits and vegetable consumption, consumption of unsweetened beverages and snacks with parents as raters. Study nurses assessed children’s body composition and motor skills. Data was collected at baseline and 12 months later. To track adherence to the implementation of intervention modules at individual DF groups, an implementation calendar was used from baseline to follow-up. Linear mixed models were used to investigate effects for survey, group and their interaction at the individual level while accounting for clustering. RESULTS: Samples of 831 (baseline) and 641 (follow-up) children aged 4.3 ± 0.8 and 5.2 ± 0.8 years were analysed. More than half of the intervention DFs chose the nutrition or PA module for the first year of implementation while an implementation level of > 50% was only achieved in less than a third. A significant intervention effect (survey × group interaction) was found for the standing long jump favouring children at intervention DFs (β = 3.08; 95% Confidence interval [CI]: (0.09; 6.07)). No significant intervention effects were found for time spent on PA, total screen time, dietary habits, and body composition, i.e. body-mass-index and percentage of body fat. CONCLUSIONS: Participation in JolinchenKids – fit and healthy in daycare led to improvements in some indicators for motor skills. However, other health outcomes and behaviours were not affected by program participation over the course of 1 year. TRIAL REGISTRATION: German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016)

Design and methods for a cluster-controlled trial conducted at sixty-eight daycare facilities evaluating the impact of “JolinchenKids – Fit and Healthy in Daycare”, a program for health promotion in 3- to 6-year-old children

BACKGROUND: The prevention of overweight and obesity during infancy is a highly relevant public health topic given the significant impact of childhood obesity on acute and chronic diseases, general health, and well-being in later stages of life. Apart from the family setting, daycare facilities (DFs) represent a key setting for health promotion among children under the age of six years. “JolinchenKids – Fit and Healthy in Daycare” is a multi-component program promoting physical activity (PA), healthy eating, and mental well-being in 3- to 6-year-old preschoolers at DFs, originally designed by the German health insurance AOK. To evaluate program effectiveness, a cluster-controlled trial involving 68 DFs is currently conducted. The objective of this article is to describe the background, study design, and aims of this trial. METHODS/DESIGN: Sixty-eight DFs across Germany will be recruited to take part in the study, half of them serving as intervention DFs and half of them as delayed intervention control DFs (which receive the program upon completion of the study). At each DF, height, weight, and body composition, as well as motor skills, will be assessed in twenty 3- to 6-year-old children. Children’s eating and PA habits, and mental well-being will be assessed via parental questionnaires. A subsample of children (i.e., at 24 DFs which are randomly selected within a geographic region) will be asked to wear accelerometers at their wrists to objectively measure PA over the course of seven days. To compare changes in body composition, motor skills, eating and PA habits, and mental well-being of children at intervention DFs with those observed among children at delayed intervention control DFs over one year, all measurements will take place at baseline and twelve months after the launch of the program at all DFs. DISCUSSION: This study investigates the influence of a health promotion program in the daycare setting on various outcomes, including body composition and objectively measured PA, in a nationwide sample of 3- to 6-year-old preschoolers. This study will provide evidence regarding the effectiveness of a multi-component program for health promotion in this setting and may provide insights into new strategies for preventing obesity in early life

Impact of “JolinchenKids—Fit and Healthy in Daycare” on Children’s Objectively Measured Physical Activity: A Cluster-Controlled Study

BACKGROUND: To evaluate a multicomponent health promotion program targeting preschoolers’ physical activity (PA). METHODS: PA of children from 23 German daycare facilities (DFs; 13 intervention DFs, 10 control DFs) was measured via accelerometry at baseline and after 12 months. Children’s sedentary time, light PA, and moderate to vigorous PA were estimated. Adherence was tracked with paper-and-pencil calendars. Mixed-model regression analyses were used to assess intervention effects. RESULTS: PA data were analyzed from 183 (4.2 [0.8] y, 48.1% boys) children. At follow-up, children in DF groups with more than 50% adherence to PA intervention components showed an increase of 9 minutes of moderate to vigorous PA per day (β = 9.28; 95% confidence interval [CI], −0.16 to 18.72) and a 19-minute decrease in sedentary time (β = −19.25; 95% CI, −43.66 to 5.16) compared with the control group, whereas children’s PA of those who were exposed to no or less than 50% adherence remained unchanged (moderate to vigorous PA: β = 0.34; 95% CI, −13.73 to 14.41; sedentary time: β = 1.78; 95% CI, −26.54 to 30.09). Notable effects were found in children with migration background. CONCLUSIONS: Only small benefits in PA outcomes were observed after 1 year. A minimum of 50% adherence to the intervention seems to be crucial for facilitating intervention effects

Wie wirksam sind schulbasierte Interventionen zur Prävention und/oder Reduktion von Substanzkonsum bei Schülern/-innen in Grund- und Sekundarschulen? Eine systematische Übersicht vorhandener Reviews

OBJECTIVE: The aim of this study is to provide a current overview of the effectiveness of school-based interventions on prevention and/or reduction of substance use among children and adolescents aged 5–19 years. METHODS: A systematic literature search was conducted in PubMed, Cochrane Library, Campbell Collaboration, NICE and ERIC. Systematic reviews and meta-analyses published between 2007 and 2013 were included in the analysis. 2 reviewers assessed the quality of the identified review articles and extracted the data. RESULTS: 14 review articles of moderate to good quality fulfilled the a-priori defined inclusion criteria. Capacity-promoting interventions, e. g., those focusing on strengthening self-confidence and peer resistance, show promising evidence of effectiveness. Multi-component and multi-level interventions are more suitable for the prevention of alcohol and cannabis consumption. Findings on the prevention of tobacco consumption are inconsistent. The effectiveness of knowledge-based interventions is limited. The long-term effectiveness of smoke-free competitions cannot be conclusively evaluated as the findings are discrepant. CONCLUSIONS: School-based interventions should include capacity-promoting components and should address further levels beyond the individual, for example, organisational changes of the school setting. Further research is needed, in particular on the effectiveness of multi-component and multi-level interventions for the prevention of tobacco consumption.ZIEL DER STUDIE: Aktuelle Übersicht über die Wirksamkeit von schulbasierten Interventionen zur Prävention und/oder Reduktion des Substanzkonsums bei Kindern und Jugendlichen zwischen 5 und 19 Jahren. METHODIK: Eine systematische Literaturrecherche wurde in den Datenbanken PubMed, Cochrane Library, Campbell Collaboration, NICE und ERIC durchgeführt. Eingeschlossen wurden systematische Reviews und Meta-Analysen, die zwischen 2007 und 2013 publiziert wurden. 2 Reviewerinnen bewerteten die Qualität der identifizierten Übersichtsarbeiten und extrahierten die Daten. ERGEBNISSE: 14 Übersichtsarbeiten von moderater bis guter Qualität erfüllten die a priori definierten Einschlusskriterien. Fähigkeitsfördernde Interventionen, die z. B. auf eine Stärkung des Selbstbewusstseins und die Peerresistenz abzielen, zeigen vielversprechende Wirksamkeitshinweise. Mehrkomponenten- und Mehrebenen-Interventionen eignen sich vor allem zur Prävention von Alkohol- und Cannabiskonsum. Zur Prävention von Tabakkonsum ist die Studienlage inkonsistent. Die Wirksamkeit von wissensbasierten Interventionen ist begrenzt. Die langfristige Wirksamkeit von Rauchfrei-Wettbewerben ist aufgrund diskrepanter Ergebnisse nicht abschließend zu bewerten. SCHLUSSFOLGERUNGEN: Schulbasierte Interventionen sollten fähigkeitsfördernde Komponenten enthalten und über das Individualverhalten hinaus weitere Ebenen, wie organisationale Veränderungen des Settings Schule, adressieren. Weiterer Forschungsbedarf besteht vor allem zur Wirksamkeit von Mehrkomponenten- und Mehrebenen-Interventionen zur Prävention des Tabakkonsums

Identifying Evidence-Informed Physical Activity Apps: Content Analysis

BACKGROUND: Regular moderate to vigorous physical activity is essential for maintaining health and preventing the onset of chronic diseases. Both global rates of smartphone ownership and the market for physical activity and fitness apps have grown rapidly in recent years. The use of physical activity and fitness apps may assist the general population in reaching evidence-based physical activity recommendations. However, it remains unclear whether there are evidence-informed physical activity apps and whether behavior change techniques (BCTs) previously identified as effective for physical activity promotion are used in these apps. OBJECTIVE: This study aimed to identify English and German evidence-informed physical activity apps and BCT employment in those apps. METHODS: We identified apps in a systematic search using 25 predefined search terms in the Google Play Store. Two reviewers independently screened the descriptions of apps and screenshots applying predefined inclusion and exclusion criteria. Apps were included if (1) their description contained information about physical activity promotion; (2) they were in English or German; (3) physical activity recommendations of the World Health Organization or the American College of Sports Medicine were mentioned; and (4) any kind of objective physical activity measurement was included. Two researchers downloaded and tested apps matching the inclusion criteria for 2 weeks and coded their content using the Behavioral Change Technique Taxonomy v1 (BCTTv1). RESULTS: The initial screening in the Google Play Store yielded 6018 apps, 4108 of which were not focused on physical activity and were not in German or English. The descriptions of 1216 apps were further screened for eligibility. Duplicate apps and light versions (n=694) and those with no objective measurement of physical activity, requiring additional equipment, or not outlining any physical activity guideline in their description (n=1184) were excluded. Of the remaining 32 apps, 4 were no longer available at the time of the download. Hence, 28 apps were downloaded and tested; of these apps, 14 did not contain any physical activity guideline as an app feature, despite mentioning it in the description, 5 had technical problems, and 3 did not provide objective physical activity measurement. Thus, 6 were included in the final analyses. Of 93 individual BCTs of the BCTTv1, on average, 9 (SD 5) were identified in these apps. Of 16 hierarchical clusters, on average, 5 (SD 3) were addressed. Only BCTs of the 2 hierarchical clusters “goals and planning” and “feedback and monitoring” were identified in all apps. CONCLUSIONS: Despite the availability of several thousand physical activity and fitness apps for Android platforms, very few addressed evidence-based physical activity guidelines and provided objective physical activity measurement. Furthermore, available descriptions did not accurately reflect the app content and only a few evidence-informed physical activity apps incorporated several BCTs. Future apps should address evidence-based physical activity guidelines and a greater scope of BCTs to further increase their potential impact for physical activity promotion

What Works in Community-Based Interventions Promoting Physical Activity and Healthy Eating? A Review of Reviews

Chronic diseases, such as type II diabetes, are on the rise worldwide. There is consistent evidence that physical activity and healthy eating are important lifestyle factors which affect the risk for chronic diseases. Community-based interventions are of particular public health interest as they reach target groups in their natural living environment and may thus achieve high population-level impacts. We conducted a systematic literature search to assess the effectiveness of community-based interventions to promote physical activity and healthy eating. Specifically, we searched for promising intervention strategies in this setting. We narratively summarized the results of 18 systematic reviews. Among children and adolescents, we found moderate evidence for effects on weight change in primary school-aged children for interventions containing a school component. The evidence for interventions aimed at general adult populations was inconclusive. Self-monitoring, group-based components, and motivational signs to encourage stair use were identified as promising strategies to increase physical activity. Among adults at risk for type II diabetes, evidence was found for beneficial effects on weight change and diabetes incidence. However, interventions for this group were not integrated in more comprehensive community-based approaches