Cross validation of Actigraph derived accelerometer cut-points for assessment of sedentary behaviour and physical activity in children aged 8-11 years

To cross-validate previously calibrated Actigraph cut points in children. Twenty eight children (50%boys) aged between 8 and 11 years of age (9.4 ± 1.4 years) performed a series of 5 minute bouts of activity reflective of different levels of PA from sedentary behaviour (SB) to moderate to vigorous physical activity (MVPA); V˙ O2 was assessed using breath by breath indirect calorimetry and activity was assessed using Actigraph accelerometers worn on the hip and non-dominant wrist. The V˙ O2 values were then converted into age-specific METs (measured METs) and coded as SB, light PA and MVPA. Accelerometer data was analysed using previously calibrated cut-points at different epochs i.e. 5, 15 30 and 60 seconds. Receiver Operating Characteristic (ROC) curve analysis indicated that there was excellent discrimination of SB using the Evenson et al (15sec), Romanzini (15sec), Treuth et al (30sec), Freedson et al (60sec), Treuth et al (60sec) and Troiano et al (60sec) cut points. ROC analysis indicated poor discrimination for LPA irrespective of the cut-points used. Good discrimination of MVPA was evident for all existing cut-points using a 60sec epoch. There is considerable variation in the performance of existing cut-points for assessment of SB, LPA and MPA in children.N/

Calibration and Cross-Validation of Accelerometery for Estimating Movement Skills in Children Aged 8-12 Years

This study sought to calibrate triaxial accelerometery, worn on both wrists, waist and both ankles, during children’s physical activity (PA), with particular attention to object control motor skills performed at a fast and slow cadence, and to cross-validate the accelerometer cut-points derived from the calibration using an independent dataset. Twenty boys (10.1 ±1.5 years) undertook seven, five-minute bouts of activity lying supine, standing, running (4.5kmph−1) instep passing a football (fast and slow cadence), dribbling a football (fast and slow cadence), whilst wearing five GENEActiv accelerometers on their non-dominant and dominant wrists and ankles and waist. VO2 was assessed concurrently using indirect calorimetry. ROC curve analysis was used to generate cut-points representing sedentary, light and moderate PA. The cut-points were then cross-validated using independent data from 30 children (9.4 ± 1.4 years), who had undertaken similar activities whilst wearing accelerometers and being assessed for VO2. GENEActiv monitors were able to discriminate sedentary activity to an excellent level irrespective of wear location. For moderate PA, discrimination of activity was considered good for monitors placed on the dominant wrist, waist, non-dominant and dominant ankles but fair for the non-dominant wrist. Applying the cut-points to the cross-validation sample indicated that cut-points validated in the calibration were able to successfully discriminate sedentary behaviour and moderate PA to an excellent standard and light PA to a fair standard. Cut-points derived from this calibration demonstrate an excellent ability to discriminate children’s sedentary behaviour and moderate intensity PA comprising motor skill activity.N/

Fundamental movement skills and accelerometer-measured physical activity levels during early childhood: a systematic review

Early childhood is a key period for children to begin developing and practicing fundamental movement skills (FMS), while aiming to perform sufficient physical activity (PA). This study reviews the current evidence for the levels of achievement in FMS and PA measured using accelerometers among 4–5-year-old children and examines differences by gender. This review was conducted using the PRISMA framework. Keyword searches were conducted in Pubmed, Medline, Google Scholar and SPORTDiscus. Inclusion criteria included age: 4–5 years old; FMS measurement: Test of Gross Motor Development 2 and 3; PA measurement: objective methods; balance measurement: static single limb; study design: cross-sectional observational/descriptive, randomised control trials, intervention studies; language: English. Twenty-eight articles from twenty-one countries met the inclusion criteria and were split into either FMS and PA articles (n = 10) or balance articles (n = 18). Three articles showed children achieving 60 min of moderate to vigorous PA per day, two articles demonstrated significant differences between girls’ and boys’ performance of locomotor skills and five reported locomotor skills to be more proficient than object control skills at this age for both genders. Balance was measured in time (n = 12), points score (n = 3) or biomechanical variables (n = 3), displaying heterogeneity of not only measurement but also outcomes within these data, with static single limb balance held between 6.67 to 87.6 s within the articles. Four articles reported girls to have better balance than boys. There is little conclusive evidence of the current levels for FMS, PA and balance achievement in young children 4–5 years of age. The academic literature consistently reports low levels of FMS competence and mixed evidence for PA levels. Inconsistencies lie in balance measurement methodology, with broad-ranging outcomes of both low and high achievement at 4–5 years old. Further research is required to focus on increasing practice opportunities for children to improve their FMS, increase PA levels and establish sufficient balance ability. Consistent and comparable outcomes during early childhood through more homogenous methodologies are warranted.N/

Cross-validation of cut-points in preschool children using different accelerometer placements and data axes

The present study cross-validated various cut-points to assess physical activity and sedentary behaviour in preschoolers, using hip- and wrist-worn accelerometers and both vertical axis and vector magnitude data. Secondly, we examined the influence of epoch length on time estimates of physical activity and sedentary behaviour. Sixty-four preschoolers (34 girls) wore two accelerometers, on their right hip and dominant wrist, during 1 hour of free play. Preschoolers’ activities were observed by two trained researchers. Area under the curve (AUC) was calculated for the receiving operating characteristic (ROC) curves as a measure of precision. AUC ranges were 0.603–0.723 for sedentary behaviour, 0.472–0.545 for light physical activity and 0.503–0.661 for moderate-to-vigorous physical activity (MVPA), indicating poor to fair precision. Percentage of time classified as sedentary behaviour, light or MVPA according to observation and accelerometer data varied largely between cut-points, accelerometer placements and axes. The influence of epoch length on time estimates was minimal across cut-points, except for one hip-based vector magnitude cut-point. Across all accelerometer placements and data axes, no set of cut-points demonstrated adequate precision for sedentary behaviour, light physical activity and MVPA. The highly variable and omnidirectional activity pattern of preschoolers may explain the lack of adequate cut-points

Educators Perspectives on the Value of Physical Education, Physical Activity and Fundamental Movement Skills for Early Years Foundation Stage Children in England.

There is a lack of information available for physical education (PE) provision in the early years foundation stage (EYFS), prompting concern about what is currently delivered in schools and the values behind the approaches taken. Using semi-structured interviews, this study investigated educators’ perspectives on the value of PE and physical activity (PA) for EYFS children across England in relation to opportunities for, barriers to, and benefits of PA and PE. This study collected important stakeholder views and can help shape the impact and implementation of fundamental movement skills (FMS) and PA interventions at the EYFS.N/

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Examining accelerometer validity for estimating physical activity in pre-schoolers during free living activity

The present study examined the efficacy of accelerometers for the assessment of free play physical activity (PA) in pre–school-aged children with consideration of epoch length and wear location. Following ethics approval, parental informed consent, and child assent, 66 pre-schoolers aged 3-4 years (30 females and 36 males) wore an accelerometer (ActiGraph GT3X; sampling at 100 Hz) on their non-dominant wrist and their right hip during 1 hour of free play. Concurrently, direct observation, using the OSRAC-P, was used to determine sedentary behavior (SB), light (LPA), or moderate-to-vigorous (MVPA) intensity PA. For the ActiGraph, vertical axis counts and summed vector magnitude (VM) for hip, and VM for wrist, were downloaded using 5-, 10-, 15-, and 30-second epoch lengths. Accelerometer counts were averaged over each 30 seconds to match the observation periods. Receiver operating curve analysis was used to evaluate the ability of the ActiGraph to predict SB, LPA, and MVPA. SB and MVPA obtained from wrist- and hip-worn accelerometers demonstrated fair agreement with direct observation (AUC => 0.7). LPA determined by accelerometer had poor agreement with observed LPA, for both the hip and wrist placement (AUC = 0.53-0.56), with weak levels of specificity (0.34-0.43), although sensitivity was fair (0.74-0.84). This study is the first to examine accelerometer validity, considering wear location and epoch in pre-schoolers during free play, and suggests that the ActiGraph is a fair measure for SB and MVPA in pre-school children. Neither placement performed predominantly better irrespective of epochs or used count data (vertical axis, VM)

Improving Fundamental Movement Skills during Early Childhood: An Intervention Mapping Approach

The earlier in life that a child can begin mastering fundamental movement skills (FMS), the more positive their physical activity (PA) trajectories and health outcomes are. To achieve sufficient development in FMS, children must be guided with tuition and practice opportunities. Schools and educators provide an opportunity for interventions that improve health behaviours and outcomes for children. The aim of this study was to use intervention mapping (IM) to design a programme of school-based intervention to improve FMS for children aged 4–5 years old. Following the six steps of IM, with each step comprising three to five tasks that require the input of a planning group formed by key stakeholders, a programme of intervention was planned. Prior knowledge and primary and secondary evidence was used to support the development of the programme. A logic model of the problem as well as logic models of change, programme design, production, implementation, and evaluation were proposed or completed within the study. The results can be used to begin to implement an FMS-focussed intervention within school settings within England and propose a sustainable and realistic approach for helping children to develop FMS with the support of well-informed educators who are confident to deliver better FMS practice and PA opportunities