Associations between physical activity, pain, injuries and joint loading in children, and how these factors may affect recommendations regarding the type of physical activity that children should perform whilst taking environmental and personal barriers into consideration

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonPhysical activity recommendations advise children to engage in weight bearing activities to optimise bone health. However, in certain populations, e.g. children with overweight and obesity, weight bearing activities may lead to increased joint loading and consequently, lower limb pain. Cycling, as a non-weight bearing activity, may generate less joint loading and potentially less pain than weight bearing activities. Understanding the interactions between joint loading, pain and activity may help to make recommendations regarding physical activity for children. However, even if cycling is favourable to weight bearing activity in terms of joint loading and pain, other barriers to participation in cycling, such as the environmental and personal factors, may exist. Therefore, the overall goal of this thesis was to investigate associations between physical activity, pain, injuries and, joint loading in children, and how these factors may affect recommendations regarding the type of physical activity that children should perform whilst taking environmental and personal barriers into consideration. The thesis used a multimethod research design with a QUAN → qual combination and a deductive theoretical drive. Findings indicated that there is no evidence that moderate physical activity and vigorous physical activity, respectively, are associated with pain and injuries in children. Findings also indicated that, at similar physiological loads, joint loading is less during cycling than during walking among children, but there is no difference in pain between walking and cycling. Lastly, barriers such as parental concerns regarding safety, limited resources, the environment including traffic and weather, and lack of infrastructure prevent children from using a bicycle to actively commute. Together, these findings provide information to support health professionals when making physical activity recommendations for children. While cycling may be more suitable than weight bearing activities for some children because of reduced joint loading, environmental and personal barriers to cycling should be considered when making recommendations

Percepção de pais e escolares quanto à prática de atividade física habitual

Um estilo de vida fisicamente ativo parece estar associado à saúde física e mental, maior bem-estar e qualidade de vida. Durante a infância e adolescência, a atividade física habitual tem sido apontada como importante componente, sobretudo, para evitar doenças na idade adulta. No entanto, tal componente pode sofrer modificações negativas ainda nessa faixa etária e modeladores sociais e comportamentais têm sido apontados como importantes variáveis influenciadoras nessa atividade. Logo, o objetivo deste estudo foi investigar a percepção de escolares e de pais quanto à prática de atividade física habitual. O estudo utilizou delineamento transversal e metodologia correlacional. A amostra foi constituída por 306 escolares, do sexo masculino e feminino, com idade compreendida entre 8 e 14 anos devidamente matriculados e cursando entre a 3ª e 8a séries do Ensino Fundamental de uma escola da Rede Pública de Ensino da cidade de Londrina-PR. As características gerais foram descritas em média e desvio padrão. Para as variáveis categóricas, foram calculadas prevalências e intervalos de confiança de 95% (IC95%). O teste Qui-quadrado analisou possíveis associações entre as variáveis independentes e dependentes. A Regressão de Poisson foi utilizada para construir um modelo para as associações observadas. Os resultados indicaram que o escore médio da atividade física habitual dos escolares foi de 2,2 pontos (PAQ-C) e a assistência à televisão foi de 2,7 horas/dia. A prevalência de inatividade física nos escolares foi de 86,6%. Variáveis associadas com a atividade física de escolares foram: sexo (X2=5,650; P=0,017), percepção do escolar sobre a atividade física (X2=4,795; P=0,029) e a quantidade de automóveis (X2=6,084; P=0,014). O estado nutricional esteve associado com a percepção do escolar sobre atividade física (X2=8,472; P=0,004) e a quantidade de televisores em casa (X2=6,831; P=0,009). A atividade física foi menor no sexo feminino (RP=0.95 [0.92-0.99]) e naqueles que possuem menos automóveis (RP= 0.92 [0.85-1.00]). Esta prevalência também foi maior em escolares conscientemente ativos (RP=1.07 [1.03-1.10]) e daqueles com responsáveis com elevada percepção sobre a atividade física de escolares (RP=1.05 [1.02-1.08]). A obesidade em escolares foi menor naqueles com responsáveis solteiros (RP=0.93 [0.89-0.99]), maior em escolares conscientemente ativos (RP=1.12 [1.01-1.24]) e em escolares que possuem muitos televisores em casa (RP=1.08 [1.01-1.14]). Os resultados sugerem que escolares desta amostra, superestimam os níveis reais da atividade física habitual. A percepção dos responsáveis sobre a atividade física dos escolares também foi considerada elevada e superestima a atividade física habitual dos escolares.A physically active lifestyle appears to be associated with physical and mental health, greater well-being and quality of life. During childhood and adolescence, physical activity has been identified as an important component, especially to prevent diseases in adulthood. However, this negative component can be modified and social modeling has been suggested as important variables influencing the activity. Therefore, the aim of this study was to investigate the perception of schoolchildren and parents about the practice of habitual physical activity . The study used cross-sectional design and correlational methodology. The sample consisted of 306 male and female students in the age range between 8 and 14 years, enrolled and studying the 3rd to 8th grades of elementary school, from a school of Public School in the city of Londrina, Paraná. The general characteristics were described as mean and standard deviation. For categorical variables, were calculated the prevalence rates and confidence intervals of 95% (95%CI). The chi-square examined possible associations between the independent and dependent variables. The Poisson regression was used to construct a model for the observed associations. The results indicated that the mean score of physical activity of children was 2.2 points (PAQ-C) and television viewing was 2.7 hours / day. The prevalence of physical inactivity among children was 86.6%. Variables associated with physical activity of schoolchildren were gender (X2=5.650, P=0.017), awareness of the school on physical activity (X2=4.795, P=0.029) and the amount of cars (X2=6.084, P=0.014). The nutritional status was associated with awareness of school physical activity (X2=8.472, P=0.004) and number of televisions at home (X2=6.831, P=0.009). Physical activity was lower in females (PR=0.95 [0.92-0.99]) and those with fewer cars (PR=0.92 [0.85-1.00]). This prevalence was also higher in school consciously active (PR=1.07 [1:03 to 1:10]) and with those responsible with high perception of physical activity in school (PR=1.05 [1:02 to 1:08]). Obesity in children was lower for those with responsible single (PR=0.93 [0.89-0.99]), more consciously active in school (PR=1.12 [1:01 to 1:24]) and in schools that have many TVs in the home (PR=1.08 [1:01 to 1:14]). The results suggest that students in this sample overestimate the actual levels of physical activity. The perception of responsibility on the students' physical activity was also considered high and overestimates the habitual physical activity of schoolchildren

The feasibility of cycling as a form of active commuting among children from a parental perspective: a qualitative study

The way children commute to and from school has been described in the literature as passive or active commuting. Active commuting among children in England is low, with the most recent evidence available indicating that between 2% and 8% of children cycle to school. Encouraging active commuting by bicycle among children may be a particular way to increase participation in cycling. Evidence reports that parents influence their children’s attitudes and interests both directly and indirectly; levels of physical activity of a child, for instance, can be shaped via socialisation. Therefore, the aim of the present study was to explore the barriers to children cycling as a means of active commuting. The study used qualitative methods for collecting and analysing data with a diagnostic perspective. A total of eighteen parents, ten mothers and eight fathers, participated in the interviews. Children, eleven girls and seven boys, were aged eight to twelve years. Children’s mean age was 10.2 ± 1.6 years. Children’s primary modes of transport to school were by car (55.6%), walking (33.3%) and by bus (5.6%). Overall, a series of factors seem to prevent parents from supporting their children to actively commute to school. Parents fear their children being exposed to crime and bad weather conditions while actively commuting to school. The absence of cycling lanes and long or short distances from school are further issues preventing parents from supporting their children to cycle to school. </p

Physical activity and screen time in children and adolescents in a medium size town in the South of Brazil

Abstract Objective: To analyze the associations between sex and age with behaviour related to physical activity practice and sedentary behaviour in children and adolescents. Methods: A cross-sectional study with 480 (236 boys) subjects enrolled in a public school in the city of Londrina, in the south of Brazil, aged 8–17 years. Measures of physical activity, sports practice and screen times were obtained using the Physical Activity Questionnaire for Older Children. The Mann–Whitney U test was used to compare variables between boys and girls. The Chi squared test was used for categorical analysis and Poisson regression was used to identify prevalence. Results: Girls (69.6%; PR=1.05 [0.99–1.12]) spent more time with sedentary behaviour than boys (62.2%). Boys (80%; PR=0.95 [0.92–0.98]) were more physically active than girls (91%). Older students aged 13–17 showed a higher prevalence of physical inactivity (91.4%; PR=1.06 [1.02–1.10]) and time spent with sedentary behaviour of ≥2h/day (71.8%; PR=0.91 [0.85–0.97]) when compared to younger peers aged 8–12 (78.7 and 58.5%, respectively). Conclusions: The prevalence of physical inactivity was higher in girls. Older students spent more screen time in comparison to younger students

AULAS DE EDUCAÇÃO FÍSICA E DESFECHOS RELACIONADOS À SAÚDE EM ESTUDANTES BRASILEIROS

RESUMO Objetivo: O objetivo do presente estudo foi analisar a associação entre participação e atividade física durante as aulas de Educação Física com desfechos relacionados à saúde em estudantes brasileiros. Métodos: 681 estudantes brasileiros (50,5% do sexo feminino) com idades de 10 a 17 anos participaram desse estudo transversal. As variáveis independentes analisadas foram a participação e a atividade física durante as aulas de Educação Física, ambas estimadas por meio de um questionário autorrelatado. Os desfechos foram a aptidão cardiorrespiratória (teste de Shuttle Run de 20 m), força muscular (push-up test), sobrepeso e obesidade (índice de massa corporal) e pressão arterial elevada. A análise estatística foi realizada por meio da regressão de Poisson para estimar a razão de prevalência (RP) e os intervalos de confiança de 95% (IC95%) ajustados para as variáveis de confusão (idade, sexo, escolaridade dos pais, atividade física e comportamento sedentário), considerando a amostragem complexa. Resultados: A participação nas aulas de Educação física não se associou com nenhum dos desfechos estudados. Ser ativo durante as aulas de Educação física associou-se com o atendimento do critério de saúde para aptidão cardiorrespiratória (RP=1,34, IC95% 1,16-1,55) e força muscular (RP=1,36 IC95% 1,09-1,71). O mesmo não ocorreu para sobrepeso (RP=1,04, IC95% 0,95-1,14), obesidade (RP=1,02, IC95% 0,91-1,05) e pressão arterial elevada (RP=0,98, IC95% 0,90-1,06). Conclusões: Estudantes que relataram ser ativos nas aulas apresentaram maior probabilidade de atender aos critérios de saúde para aptidão cardiorrespiratória e força muscular. No entanto, as aulas tradicionalmente oferecidas no Brasil não protegem os estudantes do sobrepeso, obesidade ou pressão arterial elevada

PROPOSAL AND TEST-RETEST RELIABILITY OF A SCALE FOR CERVICAL, THORACIC, AND LUMBAR SPINE PAIN IN BRAZILIAN YOUNG PEOPLE

ABSTRACT Objective: To propose and analyze the test-retest reliability of an instrument to verify the presence and intensity of pain in the cervical, thoracic and lumbar spine in Brazilian young people. Methods: This reliability study enrolled a sample of 458 participants (13 to 20 years). Two groups were formed for each sex according to the range of days for the test-retest (10±3 and 28±2 days). For analysis of spinal pain, a drawing of the human body with cervical, thoracic and lumbar spine areas delimited was presented. The following question was presented: during a normal day, do you feel pain in any of these regions of your spine? If so, what is the intensity from 0 to 10 (mark on the line)? The starting point, with the number 0, corresponded to no pain, and the number 10 to severe pain. The agreement of frequency and of intensity of pain was verified by Kappa test and Bland-Altman plot, respectively. Results: Intraclass correlation coefficients ranged from 0.71 (confidence interval of 95% - 95%CI - 0.59-0.79) to 0.94 (95%CI 0.90-0.96). The results concerning the agreement of pain scores showed the mean differences to be close to 0, and the largest mean difference was -0.40 (95%CI -5.14-4.34). The agreement in reported pain ranged from 72.2 (Kappa 0.43; 95%CI 0.28-0.58) to 90.1% (Kappa 0.76; 95%CI 0.60-0.92). Conclusions: This instrument was shown to be a reliable manner to verify the pain in different regions of the spine in Brazilian young people

Asociación entre diferentes indicadores socioeconómicos con la actividad física y aptitud física relacionada con la salud en adolescentes

Objetivo O objetivo desse estudo foi analisar a associação entre diferentes indicadores socioeconômicos com a atividade física e aptidão física relacionada à saúde em adolescentes.Métodos Participaram do estudo 716 adolescentes de ambos os sexos de 10 a 18 anos (46,8 % do sexo masculino), que responderam a um questionário com objetivo de estimar a atividade física habitual, a condição socioeconômica e realizaram dois testes de aptidão física relacionada à saúde. Os indicadores socioeconômicos analisados foram: Escolaridade paterna, materna, número de TVs, banheiros, automóveis, empregadas mensalistas, geladeiras e congeladores.Resultados Foram encontradas associações positivas entre escolaridade paterna (RP=1,61, 1,27-2,10 e RP=1,41, 1,10-1,83) e empregadas mensalistas (RP=1,97, 1,04-3,81 e 1,92, 1,05-3,52) com a atividade física recomendada e atividade física no tempo livre, respectivamente. O número de automóveis (RP=1,48, 1,02-2,19)e de congeladores (RP=1,88, 1,12-3,18) se associaram positivamente e o número de TVs negativamente (RP=0,75, 0,63-0,89) com a atividade física no tempo livre. O número de TVs (RP=0,80, 0,67-0,96) e de automóveis (RP=0,70, 0,55-0,89) se associaram negativamente com a aptidão cardiorrespiratória enquanto que a escolaridade paterna (RP=1,17, 1,00-1,37) e número de banheiros (RP=1,25, 1,02-1,54) se associaram positivamente com a força muscular. Conclusão A atividade física e a aptidão física relacionada à saúde se associaram com a condição socioeconômica. No entanto, as associações são dependentes do indicador socioeconômico analisado. Estudos que utilizaram diferentes indicadores socioeconômicos devem ser analisados com cautela