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

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]

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]

A 2 year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC study

Funder: The NIHR Biomedical Research Centre in CambridgeFunder: Finnish Innovation Fund SitraFunder: Foundation for Paediatric ResearchFunder: Ministry of Social Affairs and Health of FinlandFunder: Yrjö Jahnsson FoundationFunder: Research Committee of the Kuopio University Hospital Catchment Area (State Research Funding)Funder: The city of KuopioFunder: The UK Medical Research CouncilFunder: Finnish Cultural FoundationFunder: Ministry of Education and Culture of FinlandFunder: Juho Vainio FoundationFunder: Paavo Nurmi FoundationFunder: Diabetes Research Foundation in FinlandFunder: Finnish Foundation for Cardiovascular ResearchFunder: Social Insurance Institution of FinlandAbstract: Aims/hypothesis: We studied for the first time the long-term effects of a combined physical activity and dietary intervention on insulin resistance and fasting plasma glucose in a general population of predominantly normal-weight children. Methods: We carried out a 2 year non-randomised controlled trial in a population sample of 504 children aged 6–9 years at baseline. The children were allocated to a combined physical activity and dietary intervention group (306 children at baseline, 261 children at 2-year follow-up) or a control group (198 children, 177 children) without blinding. We measured fasting insulin and fasting glucose, calculated HOMA-IR, assessed physical activity and sedentary time by combined heart rate and body movement monitoring, assessed dietary factors by a 4 day food record, used the Finnish Children Healthy Eating Index (FCHEI) as a measure of overall diet quality, and measured body fat percentage (BF%) and lean body mass by dual-energy x-ray absorptiometry. The intervention effects on insulin, glucose and HOMA-IR were analysed using the intention-to-treat principle and linear mixed-effects models after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The measures of physical activity, sedentary time, diet and body composition at baseline and 2 year follow-up were entered one-by-one as covariates into the models to study whether changes in these variables might partly explain the observed intervention effects. Results: Compared with the control group, fasting insulin increased 4.65 pmol/l less (absolute change +8.96 vs +13.61 pmol/l) and HOMA-IR increased 0.18 units less (+0.31 vs +0.49 units) over 2 years in the combined physical activity and dietary intervention group. The intervention effects on fasting insulin (regression coefficient β for intervention effect −0.33 [95% CI −0.62, −0.04], p = 0.026) and HOMA-IR (β for intervention effect −0.084 [95% CI −0.156, −0.012], p = 0.023) were statistically significant after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The intervention had no effect on fasting glucose, BF% or lean body mass. Changes in total physical activity energy expenditure, light physical activity, moderate-to-vigorous physical activity, total sedentary time, the reported consumption of high-fat (≥60%) vegetable oil-based spreads, and FCHEI, but not a change in BF% or lean body mass, partly explained the intervention effects on fasting insulin and HOMA-IR. Conclusions/interpretation: The combined physical activity and dietary intervention attenuated the increase in insulin resistance over 2 years in a general population of predominantly normal-weight children. This beneficial effect was partly mediated by changes in physical activity, sedentary time and diet but not changes in body composition. Trial registration: ClinicalTrials.gov NCT01803776 Graphical abstrac

The effects of a 2-year physical activity and dietary intervention on plasma lipid concentrations in children: the PANIC Study

Funder: Opetus- ja Kulttuuriministeriö; doi: http://dx.doi.org/10.13039/501100003126Funder: Sosiaali- ja Terveysministeriö; doi: http://dx.doi.org/10.13039/501100008487Abstract: Purpose: We studied the effects of a physical activity and dietary intervention on plasma lipids in a general population of children. We also investigated how lifestyle changes contributed to the intervention effects. Methods: We carried out a 2-year controlled, non-randomized lifestyle intervention study among 504 mainly prepubertal children aged 6–9 years at baseline. We assigned 306 children to the intervention group and 198 children to the control group. We assessed plasma concentrations of total, LDL, HDL, and VLDL cholesterol, triglycerides, HDL triglycerides, and VLDL triglycerides. We evaluated the consumption of foods using 4-day food records and physical activity using a movement and heart rate sensor. We analyzed data using linear mixed-effect models adjusted for age at baseline, sex, and pubertal stage at both time points. Furthermore, specific lifestyle variables were entered in these models. Results: Plasma LDL cholesterol decreased in the intervention group but did not change in the control group ( − 0.05 vs. 0.00 mmol/L, regression coefficient (β) = − 0.0385, p = 0.040 for group*time interaction). This effect was mainly explained by the changes in the consumption of high-fat vegetable oil-based spreads (β = − 0.0203, + 47% change in β) and butter-based spreads (β = − 0.0294, + 30% change in β), moderate-to-vigorous physical activity (β = − 0.0268, + 30% change in β), light physical activity (β = − 0.0274, + 29% change in β) and sedentary time (β = − 0.0270, + 30% change in β). The intervention had no effect on other plasma lipids. Conclusion: Lifestyle intervention resulted a small decrease in plasma LDL cholesterol concentration in children. The effect was explained by changes in quality and quantity of dietary fat and physical activity. Clinical Trial Registry Number: NCT01803776, ClinicalTrials.go