Tieteelliset perusteet varhaisvuosien fyysisen aktiivisuuden suosituksille

AbstractThe proposal to update the Recommendations for physical activity in early childhood education (Guides of the Ministry of Social Affairs and Health 2005:17) was made in the context of the national Joy in Motion programme, where the focus is on early childhood education. The update was started by compiling the most recent scientific knowledge to be used as the basis for preparing the recommendations for physical activity in early childhood. The aim was to set out recommendations that could be applied as broadly as possible. The update and drafting of the recommendations was done as part of the work of the Physical exercise to promote health and wellbeing steering group (TEHYLI), appointed and coordinated jointly by the Ministry of Education and Culture and Ministry of Social Affairs and Health. The steering group commented on and approved the multidisciplinary international group of experts specifically invited to carry out the task. The experts represented different fields of science and some of them were carrying out nationally funded research projects on physical activity and wellbeing among children under eight years of age. The group of experts started its work in January 2016 by compiling the most recent international and national research information on various themes relating to physical activity and exercise and comprehensive development and wellbeing in early childhood. This work produced two publications: Recommendations for physical activity in early childhood 2016 - Joy, play and doing together (Ministry of Education and Culture 2016:21) and Scientific justification for the recommendations for physical activity in early childhood. The recommendations for physical activity in early childhood inform about the amount and type of physical activity for the under eight-year-olds, roles of the physical, psychological and social environments, and planning and implementation of guided physical exercise and education on exercise as part of early childhood education. The scientific justification is intended for early childhood education, physical exercise and healthcare professionals, including teachers and researchers.TiivistelmäVarhaiskasvatukseen keskittyvän valtakunnallisen Ilo kasvaa liikkuen -ohjelman kehittelytyössätehtiin aloite Varhaiskasvatuksen liikunnan suositusten (Sosiaali- ja terveysministeriön oppaita2005:17) päivittämisestä. Päivittämisen lähtökohtana oli erityisesti uusimman tutkimusperustaisentieteellisen tiedon kokoaminen ja niiden pohjalta varhaisvuosien fyysisen aktiivisuudensuositusten laatiminen. Tavoitteena oli kirjata sellaiset suositukset, joita voitaisiin soveltaamahdollisimman laajalle kohdejoukolle. Suositusten päivittäminen ja valmistelu tapahtuivatosana opetus- ja kulttuuriministeriön sekä sosiaali- ja terveysministeriön yhdessä asettamanja koordinoiman Terveyttä ja hyvinvointia edistävän liikunnan (TEHYLI) -ohjausryhmäntyötä. TEHYLI-ohjausryhmä kommentoi ja hyväksyi tehtävään erikseen kutsutun monitieteisenkansallisen asiantuntijaryhmän. Asiantuntijat edustivat eri tieteenaloja ja osalla heistä olikansallista tutkimusrahoitusta saaneita tutkimusprojekteja alle kahdeksan vuotiaiden lastenliikunnasta ja hyvinvoinnista. Asiantuntijaryhmä aloitti työnsä tammikuussa 2016 kokoamallaeri teema-alueilta uusinta kansainvälistä ja kansallista tutkimustietoa varhaiskasvatusikäistenlasten fyysistä aktiivisuutta ja liikuntaa sekä kokonaisvaltaista kehitystä ja hyvinvointia selvittäneistätutkimuksista. Työskentely johti kahteen julkaisuun, joissa toisessa annetaan fyysisenaktiivisuuden suosituksia varhaisvuosille (Varhaisvuosien fyysisen aktiivisuuden suositukset2016. Iloa, leikkiä ja yhdessä tekemistä. Opetus- ja kulttuuriministeriö 2016:21) sekä tähänsuositusten tieteelliset perusteet sisältävään julkaisuun. Varhaisvuosien fyysisen aktiivisuudensuositukset antavat ohjeita alle kahdeksanvuotiaiden lasten fyysisen aktiivisuuden määrästäja laadusta, fyysisen, psyykkisen ja sosiaalisen ympäristön rooleista sekä ohjatun liikunnanja liikuntakasvatuksen suunnittelusta ja toteuttamisesta osana varhaiskasvatusta. Suositustentieteelliset perusteet on tarkoitettu erityisesti varhaiskasvatus-, liikunta- ja terveydenhuollonammattilaisten, kuten opettajien ja tutkijoiden käyttöön.</p

Cardiopulmonary Exercise Testing in Pediatrics

Aerobic fitness is an important determinant of overall health. Higher aerobic fitness has been associated with many health benefits. Because myocardial ischemia is rare in children, indications for exercise testing differ in children compared to adults. Pediatric exercise testing is imperative to unravel the physiological mechanisms of a reduced aerobic fitness and to evaluate intervention effects in children and adolescents with a chronic disease or disability. Cardiopulmonary exercise testing includes the measurement of respiratory gas exchange and is the gold standard for determining aerobic fitness, as well as for examining the integrated physiological responses to exercise in pediatric medicine. As the physiological responses to exercise change during growth and development, appropriate pediatric reference values are essential for an adequate interpretation of the cardiopulmonary exercise test

Associations between cardiorespiratory fitness, motor competence, and adiposity in children

We investigated the associations of motor competence (MC) with peak oxygen uptake (V.O-2peak), peak power output (W-max), and body fat percentage (BF%) and whether measures of cardiorespiratory fitness (CRF) modify the associations between MC and BF%. Altogether, 35 children (aged 7-11 years) in the CHIPASE Study and 297 in PANIC Study (aged 9-11 years) participated in the study. MC was assessed using KTK and modified Eurofit tests. V.O-2peak and W-max were measured by maximal exercise test on a cycle ergometer and scaled by lean mass (LM) or body mass (BM). BF% was assessed either by bioimpedance (CHIPASE) or DXA (PANIC). MC was not associated with V.O-2peak/LM (standardized regression coefficient beta = 0.073-0.188, P > .083). V.O-2peak/BM and W-max/LM and BM were positively associated with MC (beta = 0.158-0.610, P .381), was inversely associated with BF%. Furthermore, the associations of MC with BF% were not modified by CRF. These results suggest that the positive associations between MC and CRF scaled by BM are a function of adiposity and not peak aerobic power and that CRF is not modifying factor in the associations of MC and BF%.Peer reviewe

Associations of physical activity, sedentary time, and cardiorespiratory fitness with heart rate variability in 6- to 9-year-old children: the PANIC study

Abstract: Purpose: To study the associations of physical activity (PA), sedentary time (ST), and cardiorespiratory fitness (CRF) with heart rate variability (HRV) in children. Methods: The participants were a population sample of 377 children aged 6–9 years (49% boys). ST, light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA), and PA energy expenditure (PAEE) were assessed using a combined heart rate and movement sensor, maximal power output per kilograms of lean body mass as a measure of CRF by maximal cycle ergometer exercise test, and HRV variables (SDNN, RMSSD, LF, and HF) using 5 min resting electrocardiography. Data were analysed by linear regression adjusted for years from peak height velocity. Results: In boys, ST was inversely associated (β = − 0.185 to − 0.146, p ≤ 0.049) and MVPA, VPA, PAEE, and CRF were directly associated (β = 0.147 to 0.320, p ≤ 0.048) with HRV variables. CRF was directly associated with all HRV variables and PAEE was directly associated with RMSSD after mutual adjustment for ST, PAEE, and CRF (β = 0.169 to 0.270, p ≤ 0.046). In girls, ST was inversely associated (β = − 0.382 to − 0.294, p < 0.001) and LPA, MPA, VPA, MVPA, and PAEE were directly associated with HRV variables (β = 0.144 to 0.348, p ≤ 0.049). After mutual adjustment for ST, PAEE, and CRF, only the inverse associations of ST with HRV variables remained statistically significant. Conclusions: Higher ST and lower PA and CRF were associated with poorer cardiac autonomic nervous system function in children. Lower CRF in boys and higher ST in girls were the strongest correlates of poorer cardiac autonomic function

The Positive Relationship between Moderate-to-Vigorous Physical Activity and Bone Mineral Content Is Not Mediated by Free Leptin Index in Prepubertal Children: The PANIC Study.

PURPOSE: Moderate-to-vigorous physical activity (MVPA) positively influences bone mineral content (BMC) in prepubertal children, but it is unknown whether this relationship is partially mediated by free leptin index. The aim of this study was to examine whether the relationship between MVPA and total body less head (TBLH) BMC is mediated or moderated by free leptin index in prepubertal children. METHODS: We performed a cross-sectional analysis on 401 children (194 girls) from baseline examinations of the Physical Activity and Nutrition in Childhood Study. We applied the four-way decomposition mediation analysis method to assess whether free leptin index, measured from fasted blood samples, mediated the relationship between accelerometer-measured MVPA and TBLH BMC measured by dual-energy X-ray absorptiometry. RESULTS: MVPA had a positive controlled direct effect on TBLH BMC in girls and boys (β = 0.010 to 0.011, p 0.05). CONCLUSION: Our study indicates that MVPA positively influences TBLH BMC through pathways not related to free leptin index in predominantly normal-weight prepubertal children, likely primarily through mechanical loading. The relationships between MVPA, free leptin index and TBLH BMC may be influenced by other factors such as pubertal status and adiposity, so it is unknown whether these observations extend to overweight and obese children at different stages of puberty

The Positive Relationship between Moderate-to-Vigorous Physical Activity and Bone Mineral Content Is Not Mediated by Free Leptin Index in Prepubertal Children: The PANIC Study.

PurposeModerate-to-vigorous physical activity (MVPA) positively influences bone mineral content (BMC) in prepubertal children, but it is unknown whether this relationship is partially mediated by free leptin index. The aim of this study was to examine whether the relationship between MVPA and total body less head (TBLH) BMC is mediated or moderated by free leptin index in prepubertal children.MethodsWe performed a cross-sectional analysis on 401 children (194 girls) from baseline examinations of the Physical Activity and Nutrition in Childhood Study. We applied the four-way decomposition mediation analysis method to assess whether free leptin index, measured from fasted blood samples, mediated the relationship between accelerometer-measured MVPA and TBLH BMC measured by dual-energy X-ray absorptiometry.ResultsMVPA had a positive controlled direct effect on TBLH BMC in girls and boys (β = 0.010 to 0.011, p p > 0.05).ConclusionOur study indicates that MVPA positively influences TBLH BMC through pathways not related to free leptin index in predominantly normal-weight prepubertal children, likely primarily through mechanical loading. The relationships between MVPA, free leptin index and TBLH BMC may be influenced by other factors such as pubertal status and adiposity, so it is unknown whether these observations extend to overweight and obese children at different stages of puberty

Cross-Sectional Associations of Objectively-Measured Physical Activity and Sedentary Time with Body Composition and Cardiorespiratory Fitness in Mid-Childhood: The PANIC Study.

$\textit{Background}$ The minimum intensity of physical activity (PA) that is associated with favourable body composition and cardiorespiratory fitness (CRF) remains unknown. $\textit{Objective}$ To investigate cross-sectional associations of PA and sedentary time (ST) with body composition and CRF in mid-childhood. $\textit{Methods}$ PA, ST, body composition and CRF were measured in a population-based sample of 410 children (aged 7.6 ± 0.4 years). Combined heart-rate and movement sensing provided estimates of PA energy expenditure (PAEE, kJ/kg/day) and time (min/day) at multiple fine-grained metabolic equivalent (MET) levels, which were also collapsed to ST and light PA (LPA), moderate PA (MPA) and vigorous PA (VPA). Fat mass index (FMI, kg/ m$^2$ ), trunk fat mass index (TFMI, kg/m$^2$ ) and fat-free mass index (FFMI, kg/m$^{2.5}$) were derived from dual-energy X-ray absorptiometry. Maximal workload from a cycle ergometer test provided a measure of CRF (W/kg FFM). Linear regression and isotemporal substitution models were used to investigate associations. $\textit{Results}$ The cumulative time above 2 METs (221 J/min/ kg) was inversely associated with FMI and TFMI in both sexes ($p$<0.001) whereas time spent above 3 METs was positively associated with CRF ($p\leq$0.002); CRF increased and adiposity decreased dose-dependently with increasing MET levels. ST was positively associated with FMI and TFMI ($p$<0.001) but there were inverse associations between all PA categories (including LPA) and adiposity ($p\leq$0.002); the magnitude of these associations depended on the activity being displaced in isotemporal substitution models but were consistently stronger for VPA. PAEE, MPA and to a greater extent VPA, were all positively related to CRF ($p\leq$0.001). $\textit{Conclusions}$ PA exceeding 2 METs is associated with lower adiposity in mid-childhood, whereas PA of 3 METs is required to benefit CRF. VPA was most beneficial for fitness and fatness, from a time-for-time perspective, but displacing any lower-for-higher intensity may be an important first-order public health strategy. Clinical trial registry number (website): NCT01803776 (https://clinicaltrials.gov/ct2/show/NCT01803776).This work has been financially supported by Grants from the Ministry of Social Affairs and Health of Finland, the Ministry of Education and Culture of Finland, the University of Eastern Finland, the Finnish Innovation Fund Sitra, the Social Insurance Institution of Finland, the Finnish Cultural Foundation, the Juho Vainio Foundation, the Foundation for Paediatric Research, the Paulo Foundation, the Paavo Nurmi Foundation, the Diabetes Research Foundation, the city of Kuopio, Kuopio University Hospital (EVO Funding Number 5031343), the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding, the UK Medical Research Council [Grant MC_UU_12015/3], the Wellcome Trust [Grant 074296/Z/04/Z], the British Heart Foundation [Intermediate Basic Science Research Fellowship Grant FS/12/58/29709 to KWi], and the UK Clinical Research Collaboration Public Health Research [Grant RES-590-28- 0002]

Cross-Sectional Associations of Objectively-Measured Physical Activity and Sedentary Time with Body Composition and Cardiorespiratory Fitness in Mid-Childhood: The PANIC Study.

BACKGROUND: The minimum intensity of physical activity (PA) that is associated with favourable body composition and cardiorespiratory fitness (CRF) remains unknown. OBJECTIVE: To investigate cross-sectional associations of PA and sedentary time (ST) with body composition and CRF in mid-childhood. METHODS: PA, ST, body composition and CRF were measured in a population-based sample of 410 children (aged 7.6 ± 0.4 years). Combined heart-rate and movement sensing provided estimates of PA energy expenditure (PAEE, kJ/kg/day) and time (min/day) at multiple fine-grained metabolic equivalent (MET) levels, which were also collapsed to ST and light PA (LPA), moderate PA (MPA) and vigorous PA (VPA). Fat mass index (FMI, kg/m2), trunk fat mass index (TFMI, kg/m2) and fat-free mass index (FFMI, kg/m2.5) were derived from dual-energy X-ray absorptiometry. Maximal workload from a cycle ergometer test provided a measure of CRF (W/kg FFM). Linear regression and isotemporal substitution models were used to investigate associations. RESULTS: The cumulative time above 2 METs (221 J/min/kg) was inversely associated with FMI and TFMI in both sexes (p < 0.001) whereas time spent above 3 METs was positively associated with CRF (p ≤ 0.002); CRF increased and adiposity decreased dose-dependently with increasing MET levels. ST was positively associated with FMI and TFMI (p < 0.001) but there were inverse associations between all PA categories (including LPA) and adiposity (p ≤ 0.002); the magnitude of these associations depended on the activity being displaced in isotemporal substitution models but were consistently stronger for VPA. PAEE, MPA and to a greater extent VPA, were all positively related to CRF (p ≤ 0.001). CONCLUSIONS: PA exceeding 2 METs is associated with lower adiposity in mid-childhood, whereas PA of 3 METs is required to benefit CRF. VPA was most beneficial for fitness and fatness, from a time-for-time perspective, but displacing any lower-for-higher intensity may be an important first-order public health strategy. Clinical trial registry number (website): NCT01803776 ( https://clinicaltrials.gov/ct2/show/NCT01803776 ).This work has been financially supported by Grants from the Ministry of Social Affairs and Health of Finland, the Ministry of Education and Culture of Finland, the University of Eastern Finland, the Finnish Innovation Fund Sitra, the Social Insurance Institution of Finland, the Finnish Cultural Foundation, the Juho Vainio Foundation, the Foundation for Paediatric Research, the Paulo Foundation, the Paavo Nurmi Foundation, the Diabetes Research Foundation, the city of Kuopio, Kuopio University Hospital (EVO Funding Number 5031343), the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding, the UK Medical Research Council [Grant MC_UU_12015/3], the Wellcome Trust [Grant 074296/Z/04/Z], the British Heart Foundation [Intermediate Basic Science Research Fellowship Grant FS/12/58/29709 to KWi], and the UK Clinical Research Collaboration Public Health Research [Grant RES-590-28- 0002]

Adiposity, physical activity and neuromuscular performance in children.

We investigated the associations of body fat percentage (BF%), objectively assessed moderate-to-vigorous physical activity (MVPA) and different types of physical activity assessed by a questionnaire with neuromuscular performance. The participants were 404 children aged 6-8 years. BF% was assessed using dual-energy x-ray absorptiometry and physical activity by combined heart rate and movement sensing and a questionnaire. The results of 50-m shuttle run, 15-m sprint run, hand grip strength, standing long jump, sit-up, modified flamingo balance, box-and-block and sit-and-reach tests were used as measures of neuromuscular performance. Children who had a combination of higher BF% and lower levels of physical activity had the poorest performance in 50-m shuttle run, 15-m sprint run and standing long jump tests. Higher BF% was associated with slower 50-m shuttle run and 15-m sprint times, shorter distance jumped in standing long jump test, fewer sit-ups, more errors in balance test and less cubes moved in box-and-block test. Higher levels of physical activity and particularly MVPA assessed objectively by combined accelerometer and heart rate monitor were related to shorter 50-m shuttle run and 15-m sprint times. In conclusion, higher BF% and lower levels of physical activity and particularly the combination of these two factors were associated with worse neuromuscular performance.This is the author accepted manuscript. The final version is available from Taylor & Francis via http://dx.doi.org/10.1080/02640414.2015.113480

Cardiorespiratory Fitness, Physical Activity, and Insulin Resistance in Children

Purpose: Few studies have investigated the independent and joint associations of cardiorespiratory fitness (CRF) and body fat percentage (BF%) with insulin resistance in children. We investigated the independent and combined associations of CRF and BF% with fasting glycaemia and insulin resistance and their interactions with physical activity (PA) and sedentary time among 452 children aged 6–8 years. Methods: We assessed CRF with a maximal cycle ergometer exercise test and used allometrically scaled maximal power output (Wmax) for lean body mass (LM1.13) and body mass (BM1) as measures of CRF. BF% and LM were measured by dual-energy X-ray absorptiometry, fasting glycaemia by fasting plasma glucose, and insulin resistance by fasting serum insulin and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). PA energy expenditure (PAEE), moderate-to-vigorous PA (MVPA), and sedentary time were assessed by combined movement and heart rate sensor. Results: Wmax/LM1.13 was not associated with glucose (β=0.065, 95% CI=-0.031 to 0.161), insulin (β=-0.079, 95% CI=-0.172 to 0.015), or HOMA-IR (β=-0.065, 95% CI=-0.161 to 0.030). Wmax/BM1 was inversely associated with insulin (β=-0.289, 95% CI=-0.377 to -0.200) and HOMA-IR (β=-0.269, 95% CI=-0.359 to -0.180). BF% was directly associated with insulin (β=0.409, 95% CI=0.325 to 0.494) and HOMA-IR (β=0.390, 95% CI=0.304 to 0.475). Higher Wmax/BM1, but not Wmax/LM1.13, was associated with lower insulin and HOMA-IR in children with higher BF%. Children with higher BF% and who had lower levels of MVPA or higher levels of sedentary time had the highest insulin and HOMA-IR. Conclusion: Children with higher BF% together with less MVPA or higher levels of sedentary time had the highest insulin and HOMA-IR. CRF appropriately controlled for body size and composition using LM was not related to insulin resistance among children.SB was supported by UK Medical Research Council (MC_UU_12015/3) and the NIHR Biomedical Research Centre Cambridge [IS-BRC-1215-20014]