Socio-cultural determinants of adiposity and physical activity in preschool children: A cross-sectional study

BACKGROUND: Both individual socio-cultural determinants such as selected parental characteristics (migrant background, low educational level and workload) as well as the regional environment are related to childhood overweight and physical activity (PA). The purpose of the study was to compare the impact of distinct socio-cultural determinants such as the regional environment and selected parental characteristics on adiposity, PA and motor skills in preschool children. METHODS: Forty preschools (N = 542 children) of two culturally different urban regions (German and French speaking part of Switzerland) participated in the study (Ballabeina Study). Outcome measures included adiposity (BMI and skinfold thickness), objectively measured sedentary activities and PA (accelerometers) and agility performance (obstacle course). Parental characteristics (migrant status, educational level and workload) were assessed by questionnaire. RESULTS: Children from the French speaking areas had higher adiposity, lower levels of total and of more intense PA, were more sedentary and less agile than children from the German speaking regions (percent differences for all outcome parameters except for BMI ≥10%; all p ≤ 0.04). Differences in skinfold thickness, sedentary activities and agility, but not in PA, were also found between children of Swiss and migrant parents, though they were ≤8% (p ≤ 0.02). While paternal workload had no effect, maternal workload and parental education resulted in differences in some PA measures and/or agility performance (percent differences in both: ≤9%, p ≤ 0.008), but not in adiposity or sedentary activities (p = NS). Regional differences in skinfold thickness, PA, sedentary activities and agility performance persisted after adjustment for parental socio-cultural characteristics, parental BMI and, where applicable, children's skinfolds (all p ≤ 0.01). CONCLUSIONS: The regional environment, especially the broader social environment, plays a prominent role in determining adiposity, PA and motor skills of young children and should be implicated in the prevention of obesity and promotion of PA in children

Relationship of aerobic fitness and motor skills with memory and attention in preschoolers (Ballabeina): A cross-sectional and longitudinal study

BACKGROUND: The debate about a possible relationship between aerobic fitness and motor skills with cognitive development in children has recently re-emerged, because of the decrease in children's aerobic fitness and the concomitant pressure of schools to enhance cognitive performance. As the literature in young children is scarce, we examined the cross-sectional and longitudinal relationship of aerobic fitness and motor skills with spatial working memory and attention in preschool children. METHODS: Data from 245 ethnically diverse preschool children (mean age: 5.2 (0.6) years, girls: 49.4%) analyzed at baseline and 9 months later. Assessments included aerobic fitness (20 m shuttle run) and motor skills with agility (obstacle course) and dynamic balance (balance beam). Cognitive parameters included spatial working memory (IDS) and attention (KHV-VK). All analyses were adjusted for age, sex, BMI, migration status, parental education, native language and linguistic region. Longitudinal analyses were additionally adjusted for the respective baseline value. RESULTS: In the cross-sectional analysis, aerobic fitness was associated with better attention (r=0.16, p=0.03). A shorter time in the agility test was independently associated with a better performance both in working memory (r=-0.17, p=0.01) and in attention (r=-0.20, p=0.01). In the longitudinal analyses, baseline aerobic fitness was independently related to improvements in attention (r=0.16, p=0.03), while baseline dynamic balance was associated with improvements in working memory (r=0.15, p=0.04). CONCLUSIONS: In young children, higher baseline aerobic fitness and motor skills were related to a better spatial working memory and/or attention at baseline, and to some extent also to their future improvements over the following 9 months. TRIAL REGISTRATION: clinicaltrials.gov NCT0067454

Physical fitness in preschool children : correlates and intervention effects

Summary: Children’s physical fitness has decreased over the last decades. At the same time, the prevalence of overweight and obesity in children has increased dramatically. For public health, these trends are alarming because overweight and a decrease in aerobic fitness are already in children associated with increased cardiovascular risks. In addition, the interaction between poor fitness, low physical activity and high BMI leads to a vicious circle. Preschool time corresponds to the time of the adiposity re-bound, a critical period for the development of overweight and obesity. Therefore, the preschool set-ting seems to be particularly relevant in the establishment of a healthy lifestyle and a healthy weight. This research is based on the Ballabeina Study, a multidimensional lifestyle intervention aimed at in-creasing aerobic fitness and reducing BMI in preschool children. The cluster-randomized trial was conducted in German and French speaking regions of Switzerland with a high migrant population. The intervention targeted four lifestyle behaviors during one school year: an increase in physical activity, a balanced nutrition, sufficient sleep and a reduction in media use. For this thesis, cross-sectional and longitudinal measures of physical fitness (aerobic fitness, agility, static balance and dynamic balance), body composition (BMI, BMI-group and body fat) and cognition (attention and spatial working memory) were assessed and analyzed. In addition, the effects of the intervention on physical fitness in pre-school children were evaluated. The thesis first describes the study design. The following publications focus on the physical fitness of preschoolers, on correlates and intervention effects. The cross-sectional results showed that already in preschoolers, normal weight children performed significantly better in different dynamic fitness tests assessing aerobic fitness, agility and dynamic balance compared to their overweight counterparts. The differences in aerobic fitness and agility were more pronounced in older preschoolers compared to the younger ones. In the longitudinal analysis, the relationship between aerobic fitness, agility and balance with memory and attention was investi-gated. Higher baseline physical fitness was related to a better spatial working memory and attention at baseline, and to some extent also to their future improvements over the following 9 months. Contrary to this finding, higher baseline memory and attention levels were not associated with improvements in aerobic fitness or motor skills over the following 9 months. The dominant direction regarding the longi-tudinal association between measures was the relationship of physical fitness with future cognitive performance. The study also showed that the Ballabeina intervention was successful in increasing aerobic fitness and agility but not balance in the general population. Subgroup analysis revealed that overweight and low fit children benefitted at least equally from the intervention compared to their nor-mal weight and normal fit peers. This research has shown that physical fitness can be increased in children over one school year with a multilevel and multidimensional lifestyle intervention. Although coordination was not improved as a result of the intervention, the findings of this study are of great value, because aerobic fitness is the Physical fitness in preschool children: correlates and intervention effects physical fitness component that is most strongly associated with health related outcomes. This re-search was also able to show, that differences in physical fitness between normal weight and over-weight children are more pronounced in older compared to younger preschoolers. It seems that the vicious circle of overweight and low physical fitness begins to manifest itself at this age. Therefore it is important to start with interventions already in preschoolers and to support children with low physical fitness starting at a young age. This might help to reduce the ongoing epidemiological trend of over-weight and low fitness in children and the development of cardiovascular risk factors in the coming years. It is encouraging that overweight and low fit children can benefit equally from the intervention compared to their normal weight and normal fit peers. With respect to the cognitive abilities, our data was able to contribute to the emerging field of brain fitness and highlights the importance of promoting physical education in school. In conclusion, Ballabeina offers an effective school-based intervention program to increase fitness and reduce adiposity in both, the general population as well as the risk roups of overweight and/or low fit children. ---------- Zusammenfassung: In den letzten Jahrzehnten konnte ein Rückgang der körperlichen Leistungsfähigkeit bei Kindern beo-bachtet werden. In der gleichen Zeit stieg die Prävalenz von Übergewicht und Adipositas an. Für die öffentliche Gesundheit sind diese Trends beunruhigend, weil eine tiefe Fitness und Adipositas bereits im Kindesalter mit erhöhten kardiovaskulären Risiken im Zusammenhang stehen. Dazu kommt, dass eine schlechte Fitness, eine tiefe körperliche Aktivität und Übergewicht sich gegenseitig beeinflussen und zu einem Teufelskreis führen können. Das Kindergartenalter ist eine kritische Zeit für die Entwick-lung von kindlichem Übergewicht, deshalb scheint der Kindergarten in der Vermittlung eines gesunden Lebensstils von besonderer Bedeutung zu sein. Diese Forschungsarbeit basiert auf der Ballabeina Studie, einer Lebensstilintervention zur Steigerung der aeroben Fitness und zur Reduktion des BMI bei Kindergartenkindern. Die «cluster»-randomisierte Studie wurde in der deutsch- und der französischsprachigen Region der Schweiz durchgeführt. Die städtischen Settings waren geprägt durch einen hohen Anteil an Kindern mit einem Migrationshin-tergrund. Die einjährige Intervention zielte ab auf der Vermittlung von vier Lebensstilverhalten: mehr körperliche Aktivität, ausgewogenere Ernährung, weniger Medienkonsum und ein gesundes Schlaf-verhalten. Für die vorliegende Arbeit wurden Querschnitts- und Longitudinaldaten zur körperlichen Fitness (aerobe Fitness, Agilität, statisches und dynamisches Gleichgewicht), zur Körperzusammen-setzung (BMI, Gewichtsstatus und Anteil Körperfett) und zur Kognition (Aufmerksamkeit und visuelles Arbeitsgedächtnis) erfasst und ausgewertet. Zusätzlich wurde der Interventionseffekt auf die körperli-che Fitness der Kinder evaluiert. Die erste Publikation beschreibt das Studiendesign. Die darauf fol-genden Arbeiten konzentrieren sich auf die körperliche Fitness von Kindergartenkindern, auf Korrelati-onen und Interventionseffekte. Die Resultate der Querschnittanalyse zeigten, dass normalgewichtige Kinder in verschiedenen dyna-mischen Fitnessparametern bereits im Kindergarten signifikant bessere Leistungen zeigen als über-gewichtige Kinder. Bei den älteren Kindergartenkindern waren die Unterschiede in der aeroben Fit-ness und im Hindernislauf (Agilität) grösser als bei den jüngeren. In den Längsschnittanalysen wurden die Zusammenhänge zwischen aerober Fitness, Agilität und Gleichgewicht untersucht. Bessere kör-perliche Fitness zu Beginn der Studie stand im Zusammenhang mit einem besseren visuellen Arbeits-gedächtnis und mit einer gesteigerten Aufmerksamkeit ebenfalls zu Beginn der Studie aber zum Teil auch mit einer besseren kognitiven Leistung neun Monate später. Dagegen standen die Gedächtnis- und Aufmerksamkeitsleistung zu Beginn der Studie nicht im Zusammenhang mit der späteren körper-lichen Fitness. Das bedeutet, dass der positive Zusammenhang zwischen der körperlichen Fitness und der späteren kognitiven Leistung die dominante Richtung dieser Verbindung ist. Die Analyse der Interventionsstudie zeigte positive Effekte in der Erhöhung der aeroben Leistungsfähigkeit und der Agilität, aber keine Verbesserung des Gleichgewichts. In der Analyse der Untergruppen konnte ge- Physical fitness in preschool children: correlates and intervention effects zeigt werden, dass übergewichtige Kinder und Kinder mit einer tiefen Fitness mindestens gleich stark von der Intervention profitierten, wie ihre normalgewichtigen und fitten Altersgenossen. Diese Arbeit zeigt, dass die körperliche Fitness bei Kindern mit einem intensiven und vielseitigen ein-jährigen Programm signifikant gesteigert werden kann. Obwohl in der Koordination keine Interventi-onseffekte erzielt werden konnten, sind diese Resultate bedeutend, weil die aerobe Fitness für die Gesundheit die wichtigste Fitnesskomponente darstellt. Die Unterschiede in der Fitness zwischen den Normalgewichtigen und den Übergewichtigen waren bei den älteren Kindern verglichen mit den jünge-ren grösser. Übergewicht und reduzierte Fitness scheinen sich also bereits im Kindergartenalter in einem Teufelskreis zu manifestieren. Deshalb ist es wichtig bereits im Kingergarten mit Interventionen zu starten und Kindern mit einer tiefen Fitness möglichst früh Unterstützung zu bieten. Es ist erfreu-lich, dass gezeigt werden konnte, dass von der Lebensstilintervention auch übergewichtige Kinder und Kinder mit einer tiefen Fitness profitieren können. Die Daten in Bezug auf die kognitiven Fähigkeiten tragen zum noch wenig untersuchten Feld der «brain fitness» bei und unterstreichen den Nutzen der Bewegungsförderung im Kindesalter. Zusammengefasst bietet Ballabeina eine effektive Schulinter-vention zur Steigerung der körperlichen Fitness und zur Reduktion von Adipositas. Die Intervention war erfolgreich in der allgemeinen Bevölkerung, erreichte aber auch übergewichtige Kinder oder Kin-der mit einer tiefen Fitness, die zur kardiovaskulären Risikogruppe gehören

Effect of a lifestyle intervention on adiposity and fitness in socially disadvantaged subgroups of preschoolers: a cluster-randomized trial (Ballabeina)

OBJECTIVE: A multidimensional lifestyle intervention performed in 652 preschoolers (72% of migrant, 38% of low educational level (EL) parents) reduced body fat, but not BMI and improved fitness. The objective of this study is to examine whether the intervention was equally effective in children of migrant and/or low EL parents. METHODS: Cluster-randomized controlled single blinded trial, conducted in 2008/09 in 40 randomly selected preschools in Switzerland. The culturally tailored intervention consisted of a physical activity program and lessons on nutrition, media use and sleep. Primary outcomes included BMI and aerobic fitness. Secondary outcomes included %body fat, waist circumference and motor agility. RESULTS: Children of migrant parents benefitted similarly from the intervention compared to their counterparts (p for interaction≥ 0.09). However, children of low EL parents benefitted less, although these differences did not reach statistical significance (p for interaction≥ 0.06). Average intervention effect sizes for BMI were -0.10, -0.05, -0.11 and 0.04 kg/m(2) and for aerobic fitness were 0.55, 0.20, 0.37 and -0.05 stages for children of non-migrant, migrant, middle/high EL and low EL parents, respectively. CONCLUSIONS: This intervention was similarly effective among preschoolers of migrant parents compared to their counterparts, while children of low EL parents benefitted less

Bodyweight and migration-related differences in motor abilities in preschool children "Ballabeina"

Introduction: Motor abilities in schoolchildren have been decreasing in the last two decades (Bös, 2003, Tomkinson et al., 2003). This may be related to the dramatic increase in overweight and adiposity during the same time period. Children of migrant background are especially affected (Lasserre et al., 2007). But little is known about the relationship between BMI and migration background and motor abilities in preschool children. Methods/Design We carried out a cross-sectional analysis with 665 children (age 5.1 ± 0.6 years; 49.8 % female) of 40 randomly selected kindergarten classes from German and French speaking regions in Switzerland with a high migrant background. We investigated BMI, cardiorespiratory fitness (20 m shuttle run), static (displacement of center of pressure (COP)) and dynamic (balancing forward on a beam) postural control and overall fitness (obstacle course). Results: Of the children, 9.6 % were overweight, 10.5 % were obese (Swiss national percentiles) and 72.8 % were of migrant background (at least one parent born outside of Switzerland). Mean BMI from children of non-migrant background was 15.5 ± 1.1 kg/m2, while migrant children had a mean BMI of 15.8 ± 1.7 kg/m2 (p=0.08). Normal-weight children performed better in cardiorespiratory fitness (3.1 ± 1.4 vs. 2.6 ± 1.1 stages, p<0.001), overall fitness (18.9 ± 4.4 vs. 20.8 ± 4.6 sec, p<0.001) and in dynamic balance (4.9 ± 3.5 vs. 3.8 ± 2.5 steps, p<0.001) compared to overweight and obese children, while the latter had less postural sway (COP: 956 ± 302 vs. 1021 ± 212 mm, p=0.008). There was a clear inverse dose-response relationship between weight status and dynamic motor abilities. There were no significant differences in most tested motor abilities between non-migrant and migrant. The latter performed less well in only one motor test (overall fitness: 20.2 ± 5.2 vs. 18.3 ± 3.5 sec, p<0.001). These findings persisted after adjustment for BMI. Conclusion In preschool children, differences in motor abilities are already present between normal weight and overweight/obese children. However, migrant children demonstrate similar motor abilities compared to non-migrant children for almost all tests, despite their slightly higher BMI