Increasing Children’s physical Activity by Policy (CAP) in preschools within the Stockholm region: study protocol for a pragmatic cluster‑randomized controlled trial

Background: Systematic reviews suggest that preschool environmental/organizational changes may be effective in increasing physical activity (PA) levels of preschool children, but evidence is scarce regarding feasible, effective, and equitable interventions that can be scaled up. Specifically, it is essential to understand whether introducing a multicomponent organizational change in terms of policy in the preschool context may be beneficial for children’s PA levels and concomitant health outcomes. To bridge this knowledge gap, our main aim is to examine the feasibility and effectiveness of a policy package in increasing PA levels in preschool children, using a large-scale pragmatic cluster-randomized controlled trial. Methods: This proposed study is a pragmatic cluster-randomized controlled trial with two conditions (intervention and control with a 1:1 ratio) with preschools as clusters and the unit of randomization. We aim to recruit approximately 4000 3–5-year-old children from 90 preschools and retain more than 2800 children from 85 preschools to provide adequate statistical power for the analyses. The intervention to implement is a co-created, multicomponent policy package running for 6 months in preschools randomized to intervention. Change in accelerometer measured PA levels in children between intervention and control from pre- and post-intervention will be the primary outcome of the study, while secondary outcomes include health outcomes such as musculoskeletal fitness, psychosocial functioning, and absence due to illness in children among others. Implementation will be studied carefully using both quantitative (dose, fidelity) and qualitative (interview) methodologies. The change in primary and secondary outcomes, from pre- to post-intervention, will be analyzed with linear mixed-effect models (to allow both fixed and random effects) nested on a preschool level. Discussion: This is a large-scale co-creation project involving the City of Stockholm, childcare stakeholders, preschool staff, and the research group with the potential to influence more than 30,000 preschool children within the Stockholm area. The study will add reliable evidence for the implementation of PA policies at the organizational level of preschools and clarify its potential effect on objectively measured PA and health markers in children.Karolinska InstitutetHealth and Medical Care Administration (Halso-och sjukvardsforvaltningen, Region Stockholm)Swedish Research Council for Sport Scienc

Quantification of acceleration as activity counts in ActiGraph wearable

Digital clinical measures based on data collected by wearable devices have seen rapid growth in both clinical trials and healthcare. The widely-used measures based on wearables are epoch-based physical activity counts using accelerometer data. Even though activity counts have been the backbone of thousands of clinical and epidemiological studies, there are large variations of the algorithms that compute counts and their associated parameters—many of which have often been kept proprietary by device providers. This lack of transparency has hindered comparability between studies using different devices and limited their broader clinical applicability. ActiGraph devices have been the most-used wearable accelerometer devices for over two decades. Recognizing the importance of data transparency, interpretability and interoperability to both research and clinical use, we here describe the detailed counts algorithms of five generations of ActiGraph devices going back to the first AM7164 model, and publish the current counts algorithm in ActiGraph’s ActiLife and CentrePoint software as a standalone Python package for research use. We believe that this material will provide a useful resource for the research community, accelerate digital health science and facilitate clinical applications of wearable accelerometry.Swedish Research Council for Health, Working Life and Welfare (FORTE) 2021-00036United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) 5U01MH11692

Physical Activity, Body Composition, and Cardiometabolic Health during Pregnancy: A Compositional Data Approach

Purpose: The aim of this study was to examine the cross-sectional and longitudinal associations of 24-h movement behaviors (sleep, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)) with body composition and cardiometabolic health in i) early and ii) late pregnancy (gestational weeks 14 and 37). Methods: This observational study utilized cross-sectional (n = 273) and longitudinal data (n = 242) from the HealthyMoms trial. Time spent in movement behaviors over seven consecutive 24-h periods (ActiGraph wGT3x-BT accelerometer), body composition (Bod Pod), and cardiometabolic health indicators (glucose levels, homeostatic model for insulin resistance (HOMA-IR), systolic and diastolic blood pressure, metabolic syndrome (MetS) score) were measured in early and late pregnancy. Results: In early pregnancy, reallocating time to MVPA from LPA, SB, and sleep was associated with lower MetS score (adjusted γ = −0.343, P = 0.002). Correspondingly, reallocating time to LPA from SB and sleep in early pregnancy was associated with lower body weight (adjusted γ = −5.959, P = 0.047) and HOMA-IR (adjusted γ = −0.557, P = 0.031) at the same time point. Furthermore, reallocating time to LPA from SB and sleep in early pregnancy was associated with lower fat mass index (adjusted γ = −0.668, P = 0.028), glucose levels (adjusted γ = −0.315, P = 0.006),HOMA-IR (adjusted γ = −0.779, P = 0.004), and MetS score (adjusted γ = −0.470, P = 0.027) in late pregnancy. The changes in behaviors throughout pregnancy were not associated with body weight, body composition, andMetS score in late pregnancy. Conclusions: Our results demonstrated that increasing LPA or MVPA while reducing SB and sleep was associated with lower weight and more favorable cardiometabolic health in early pregnancy. In contrast, LPA in early pregnancy seems to be a stimulus of enough intensity to improve body composition and cardiometabolic health indicators in late pregnancy.Swedish Research Counci 2016-01147Swedish Research Council for Health, Working Life and Welfare (Forte) 2017-00088 2018-01410Bo and Vera Ax:son Johnsons' FoundationStrategic Research Area Health Care Science, Karolinska Institutet/Umea UniversitySwedish Society of MedicineKarolinska InstitutetLions ForskningsfondALF Grants, Region OEstergoetland LIO-893101 LIO-941191 M.

The effects of a lifestyle intervention (the HealthyMoms app) during pregnancy on infant body composition: Secondary outcome analysis from a randomized controlled trial

ALF Grants, Region Ostergotland, Grant/Award Numbers: LIO-893101, LIO-941191; Bo and Vera Ax:son Johnsons' Foundation; Karolinska Institutet; Lions Forskningsfond; The Strategic Research Area Health Care Science, Karolinska Institutet/Umea University; The Swedish Research Council, Grant/Award Number: 2016-01147; The Swedish Research Council for Health, Working Life and Welfare (Forte), Grant/Award Numbers: 2017-00088, 2018-01410; The Swedish Society of MedicineBackground: Pregnancy has been identified as a window for childhood obesity prevention. Although lifestyle interventions in pregnancy can prevent excessive gestational weight gain (GWG), little is known whether such interventions also affect infant growth and body composition. Objectives: To investigate (i) the effects of a 6-month lifestyle intervention (the HealthyMoms app) on infant body composition 1–2 weeks postpartum, and (ii) whether a potential intervention effect on infant body composition is mediated through maternal GWG. Methods: This is a secondary outcome analysis of the HealthyMoms randomized controlled trial. Air-displacement plethysmography was used to measure body composition in 305 healthy full-term infants. Results: We observed no statistically significant effect on infant weight (β = 0.004, p = 0.94), length (β = 0.19, p = 0.46), body fat percentage (β = 0.17, p = 0.72), or any of the other body composition variables in the multiple regression models (all p ≥ 0.27). Moreover,we observed nomediation effect through GWG on infant body composition. Conclusions: Our findings support that HealthyMoms may be implemented in healthcare to promote a healthy lifestyle in pregnant women without compromising offspring growth. Further research is required to elucidate whether lifestyle interventions in pregnancy also may result in beneficial effects on infant body composition and impact future obesity risk.ALF Grants, Region Ostergotland LIO-893101 LIO-941191Bo and Vera Ax:son Johnsons' FoundationKarolinska InstitutetLions ForskningsfondStrategic Research Area Health Care Science, Karolinska Institutet/Umea UniversitySwedish Research Council xEuropean Commission 2016-01147Swedish Research Council for Health, Working Life and Welfare (Forte) 2017-00088 2018-01410Swedish Society of Medicin

Associations of Sleep-Related Outcomes with Behavioral and Emotional Functioning in Children with Overweight/Obesity

Objective To evaluate the associations of parent-reported sleep-disordered breathing (SDB) and device-assessed sleep behaviors with behavioral and emotional functioning in pediatric patients with overweight/obesity. Study design A total of 109 children with overweight/obesity (mean age, 10.0 +/- 1.1 years) were included in this cross-sectional study. We used the Spanish version of the Pediatric Sleep Questionnaire (PSQ) to assess SDB and its subscales (ie, snoring, daytime sleepiness, and inattention/hyperactivity). Device-assessed sleep behaviors (ie, wake time, sleep onset time, total time in bed, total sleep time, and waking after sleep onset) were estimated using wrist-worn accelerometers. We used the Behavior Assessment System for Children, second edition to assess behavioral and emotional functioning (ie, clinical scale: aggressiveness, hyperactivity, behavior problems, attention problems, atypicality, depression, anxiety, retreat, and somatization; adaptive scale: adaptability, social skills, and leadership). Results SDB was positively associated with all clinical scale variables (all beta > 0.197, P 0.196, P .045) and lower adaptability (beta = -0.246, P = .011). The inattention/hyperactivity subscale was significantly associated with the entire clinical and adaptive scales (all beta > vertical bar 0.192 vertical bar, P <= .046) except for somatization. The snoring subscale and device-assessed sleep behaviors were not related to any behavioral or emotional functioning variables. Conclusions Our study suggests that SDB symptoms, but not device-assessed sleep behaviors, are associated with behavioral and emotional functioning in children with overweight/obesity. Specifically, daytime sleepiness, a potential SDB symptom, was related to higher attention problems, depression, anxiety, and retreat and lower adaptability.Spanish GovernmentEuropean Commission DEP2013-47540 DEP2016-79512-R DEP2017-91544-EXP RYC-2011-09011Spanish Government FPU17/04802 FJC2018-037925-I FPU15/02645University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence, Scientific Excellence Unit on Exercise and HealthConsejeria de Conocimiento, Investigacion y UniversidadesEuropean Commission B-CTS-355-UGR18 SOMM17/6107/UGRSAMID III network, RETICS - PNI + D + I 2017-2021 (Spain)ISCIII Sub-Directorate General for Research Assessment and PromotionEXERNET Research Network on Exercise and Health DEP2005-00046/ACTI 09/UPB/19 45/UPB/20 27/UPB/21European Commission 667302HL-PIVOT network Healthy Living for Pandemic Event ProtectionAndalusian Operational ProgrammeJunta de Andaluci

Equivalency of four research‑grade movement sensors to assess movement behaviors and its implications for population surveillance

We are grateful to the participants involved in the study. This study was conducted under the umbrella of the CoCA project supported by the European Union's 2020 research and innovation program (grant agreement #667302). JHM is supported by the Swedish Research Council for Health, Working Life and Welfare (2021-00036). CC-S is supported by a Grant from the Spanish Ministry of Science and Innovation (FJC2018-037925-I). LVT-L is supported by a grant from the Spanish Ministry of Science, Innovation and Universities (FPU17/04802). AVR is supported by the NIHR Leicester Biomedical Research Centre, and the Collaboration for leadership in Applied Health Research and Care (CLAHRC) East Midlands. Additional funding was obtained from the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Scientific Excellence Unit on Exercise and Health (UCEENS). Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades and European Regional Development Funds (ref. SOMM17/6107/UGR). In addition, funding was provided by the SAMID III network, RETICS, funded by the PN I + D+I 2017-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (ERDF) (Ref. RD16/0022), and the EXERNET Research Network on Exercise and Health (DEP2005-00046/ACTI; 09/UPB/19; 45/UPB/20; 27/UPB/21).The benefits of physical activity (PA) and sleep for health, accurate and objective population-based surveillance is important. Monitor-based surveillance has potential, but the main challenge is the need for replicable outcomes from different monitors. This study investigated the agreement of movement behavior outcomes assessed with four research-grade activity monitors (i.e., Movisens Move4, ActiGraph GT3X+, GENEActiv, and Axivity AX3) in adults. Twenty-three participants wore four monitors on the non-dominant wrist simultaneously for seven days. Open-source software (GGIR) was used to estimate the daily time in sedentary, light, moderate-to-vigorous PA (MVPA), and sleep (movement behaviors). The prevalence of participants meeting the PA and sleep recommendations were calculated from each monitor’s data. Outcomes were deemed equivalent between monitors if the absolute standardized difference and its 95% confidence intervals ( CI95%) fell within ± 0.2 standard deviations (SD) of the mean of the differences. The participants were mostly men (n = 14, 61%) and aged 36 (SD = 14) years. Pairwise confusion matrices showed that 83–87% of the daily time was equally classified into the movement categories by the different pairs of monitors. The between-monitor difference in MVPA ranged from 1 ( CI95%: − 6, 7) to 8 ( CI95%: 1, 15) min/day. Most of the PA and sleep metrics could be considered equivalent. The prevalence of participants meeting the PA and the sleep guidelines was 100% consistent across monitors (22 and 5 participants out of the 23, respectively). Our findings indicate that the various research-grade activity monitors investigated show high inter-instrument reliability with respect to sedentary, PA and sleep-related estimates when their raw data are processed in an identical manner. These findings may have important implications for advancement towards monitor-based PA and sleep surveillance systems.European Commission 667302Swedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) 2021-00036Spanish Government FJC2018-037925-I FPU17/04802NIHR Leicester Biomedical Research CentreNIHR Collaboration for leadership in Applied Health Research and Care (CLAHRC) East MidlandsUniversity of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of ExcellenceScientific Excellence Unit on Exercise and Health (UCEENS)European Commission SOMM17/6107/UGRSAMID III network, RETICS - PN I + D+I 2017-2021 (Spain)ISCIII- Sub-Directorate General for Research Assessment and PromotionEuropean Commission RD16/0022EXERNET Research Network on Exercise and Health DEP2005-00046/ACTI 09/UPB/19 45/UPB/20 27/UPB/2

Exercise, Mediterranean Diet Adherence or Both during Pregnancy to Prevent Postpartum Depression—GESTAFIT Trial Secondary Analyses

Targeting lifestyle behaviors during pregnancy is crucial to prevent the highly prevalent postpartum depression and its consequences. In these secondary analyses of an intervention trial to investigate the effects of concurrent exercise training on postpartum depression, we aimed to investigate the potential role of Mediterranean diet (MD) adherence on the exercise effects. A total of 85 pregnant women met the per-protocol criteria (exercise n = 46, control n = 39). The exercise program was delivered in 60 min sessions, 3 days/week, from the 17th gestational week until birth. Women's dietary habits were assessed with a food frequency questionnaire. The Mediterranean Food Pattern (an MD index) was derived from it to assess MD adherence. We used the Edinburgh Postnatal Depression Scale to assess postpartum depression. The postpartum depression score was not statistically different between control and exercise groups (p > 0.05). A higher consumption of fruits (beta = -0.242, p = 0.022), lower intake of red meat and subproducts (beta = 0.244, p = 0.020), and a greater MD adherence (beta = -0.236, p = 0.027) were associated with lower levels of postpartum depression. Greater adherence to the MD during pregnancy was associated with fewer depressive symptoms and a lower risk of postpartum depression. Postnatal depression was not reduced by prenatal exercise. Promoting fruit consumption while controlling the intake of red meat during pregnancy might prevent postnatal depression.Regional Ministry of Health of the Junta de Andalucia PI-0395-2016Research and Knowledge Transfer Fund (PPIT) 2016, Excellence Actions Programme: Scientific Units of Excellence (UCEES)Regional Ministry of Economy, Knowledge, Enterprises, and UniversityEuropean Regional Development Funds of the University of Granada SOMM17/6107/UGRSpanish Government FPU17/0371

Associations of Mediterranean diet with psychological ill‑being and well‑being throughout the pregnancy course: The GESTAFIT project

Purpose The relation between diet and maternal mental health during pregnancy might be relevant to prevent adverse materno-foetal outcomes. This study examined the association of Mediterranean diet (MD) adherence and MD components with mental health during pregnancy. Methods This secondary analysis of the GESTAFIT trial included longitudinal data from 152 pregnant women. Dietary habits were assessed with a food frequency questionnaire, and MD adherence was derived from it using the Mediterranean Food pattern. Psychological ill-being (i.e., negative affect, anxiety, and depression) and well-being (i.e., emotional intelligence, resilience, positive affect) were assessed with the Spanish version of well-established self-reported questionnaires. Cross-sectional (16th gestational week [g.w.]) and longitudinal associations (34th g.w.) between MD and mental health were studied using linear regression models. Results A greater MD adherence was inversely associated with negative affect and anxiety; and positively associated with emotional regulation, resilience and positive affect at the 16th and 34th g.w. (|β| ranging from 0.179 to 0.325, all p < 0.05). Additionally, a higher intake of whole grain cereals, fruits, vegetables, fish, olive oil and nuts, and a lower intake of red meat and subproducts and sweets were associated with lower negative affect, anxiety, depression and higher emotional regulation, resilience and positive affect throughout gestation (|β| ranging from 0.168 to 0.415, all p < 0.05). Conclusion A higher intake of whole grain cereals, fruits, vegetables, fish, olive oil and nuts, together with a lower intake of red meat and sweets, resulted in a higher MD adherence, which was associated with a better mental health during pregnancy.Universidad de Granada /CBUA The Regional Ministry of Health of the Junta de Andalucía (PI-0395–2016) The Research and Knowledge Transfer Fund (PPIT) 2016, Excellence Actions Programme: Scientific Units of Excellence (UCEES), and the Regional Ministry of Economy, Knowledge, Enterprises and University, European Regional Development Funds (SOMM17/6107/UGR) of the University of Granada. Spanish Ministry of Education, Culture and Sports (Grant number FPU17/03715). The Swedish Council for Health, Working Life and Welfare (2021-00036)

Physical activity, sedentary time, and fitness in relation to brain shapes in children with overweight/obesity: Links to intelligence

Funding information Additional support was obtained from the Alicia Koplowitz Foundation (grant number, ALICIAK-2018), University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise and Health (UCEES), the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades; and under the umbrella of the European Union's Horizon 2020 research and innovation programme (grant number, 667302); the SAMID III network, RETICS, funded by the; C.C.-S. is supported by a grant from the Spanish Ministry of Science and Innovation (grant number, FJC2018-037925-I) and by a grant from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement No 101028929.; IEC is supported by the Spanish Ministry of Science and Innovation (grant number, RYC2019-027287-I).; J.H.M. is supported by the Spanish Ministry of Education, Culture and Sport (grant number, FPU15/02645) and by the Swedish Research Council for Health, Working Life and Welfare (2012–00036).; J.V.-R. is supported by the Spanish Ministry of Science, Innovation and Universities (grant numbers, FJCI-2017-33396 & IJC2019-041916-I).; This project was funded by the Spanish Ministry of Economy and Competitiveness and the “Fondo Europeo de Desarrollo Regional (FEDER)” (grant numbers, DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, and RYC- 2011-09011)Objectives: To examine the association between physical activity, sedentary time, and physical fitness with the shapes of subcortical brain structures in children with overweight/obesity. Further, we analyzed whether differences in the shapes of subcortical brain structures were related to intelligence. We hypothesized that those children with higher physical activity levels, lower sedentary time, and better fitness, would show greater expansion of the brain regions analyzed, and these expansions would be associated with higher intelligence. Study design: 100 children (10.0 ± 1.1 years, 40 girls) were included in the analyses. Physical activity and sedentary time were measured by accelerometry, and physical fitness was evaluated by a fitness battery. Shapes of subcortical brain structures were assessed by magnetic resonance imaging. Intelligence was measured by the Kaufmann Brief Intelligence test. Results: Physical activity was related to expansion of the right/left pallidum, right/left putamen, and right thalamus (p < 0.05). Higher sedentary time was related to contraction of the left thalamus and right nucleus accumbens (p < 0.05). Higher levels of cardiorespiratory fitness were associated with expansion of the right amygdala (p = 0.022). Greater strength in the upper-limb was related to expansion of the right/left pallidum and the left nucleus accumbens (p < 0.038), and contraction of the left amygdala (p = 0.030). Better speed-agility was associated with expansion of the left nucleus accumbens (p = 0.036). Physical activity- and fitness-related expansion of the right pallidum was associated with higher intelligence (all p < 0.05). Conclusion: Physical activity, sedentary time, and physical fitness were significantly related to the shapes of subcortical brain structures, which in turn were related to intelligence in children with overweight/obesity. Keywords: brain shapes; cardiorespiratory fitness; cognitive performance; gray matter; moderate-to-vigorous; muscular strength; sedentarism; speed-agility.Alicia Koplowitz Foundation (grant number, ALICIAK-2018)University of Granada, Plan Propio de Investigación 2016Excellence actions: Units of Excellence, Unit of Excellence on Exercise and Health (UCEES), the Junta de Andalucía, Consejería de Conocimiento, Investigación y UniversidadesEuropean Union's Horizon 2020 research and innovation programme (grant number, 667302)SAMID III network, RETICSSpanish Ministry of Science and Innovation (grant number, FJC2018-037925-I)European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement No 101028929Spanish Ministry of Science and Innovation (grant number, RYC2019-027287-I)Spanish Ministry of Education, Culture and Sport (grant number, FPU15/02645)Swedish Research Council for Health, Working Life and Welfare (2012–00036)Spanish Ministry of Science, Innovation and Universities (grant numbers, FJCI-2017-33396 & IJC2019-041916-I)Spanish Ministry of Economy and Competitiveness and the “Fondo Europeo de Desarrollo Regional (FEDER)” (grant numbers, DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, and RYC- 2011-09011)Funding for open access charge: Universidad de Granada/CBU

Influence of an exercise intervention plus an optimal Mediterranean diet adherence during pregnancy on the telomere length of the placenta. The GESTAFIT project

We aimed to investigate whether the effects of exercise on placental relative telomere length (RTL) after delivery are modulated by the Mediterranean diet [MD] adherence in 65 pregnant women (control n = 34, exercise n = 31). No differences were found in placental RTL between the exercise and the control groups (p = 0.557). The interaction-term between exercise and MD adherence with placental RTL was significant (p = 0.001). Specifically, women in the exercise group showed longer placental RTL after birth compared to controls (referent group), only for those women with a high MD adherence (mean difference = 0.467, p=0.010). A concurrentexercise training plus an optimal MD adherence during pregnancy might prevent the placental RTL shorteningRegional Ministry of Health of the Junta de Andalucia PI -0395-2016Research and Knowledge Transfer Fund (PPIT) 2016Excellence Actions Programme: Scientific Units of Excellence (UCEES)European Commission 2021 - 00036Swedish Research Council for Health Working Life & Welfare (Forte) 101027215European Commission FPU17/03715Regional Ministry of Economy, Knowledge, Enterprises and Universit