Determinants of Childhood Adiposity: Evidence from the Australian LOOK Study

BACKGROUND To contribute to the current debate as to the relative influences of dietary intake and physical activity on the development of adiposity in community-based children. METHODS Participants were 734 boys and girls measured at age 8, 10 and 12 years for percent body fat (dual emission x-ray absorptiometry), physical activity (pedometers, accelerometers); and dietary intake (1 and 2-day records), with assessments of pubertal development and socioeconomic status. RESULTS Cross-sectional relationships revealed that boys and girls with higher percent body fat were less physically active, both in terms of steps per day and moderate and vigorous physical activity (both sexes p<0.001 for both measures). However, fatter children did not consume more energy, fat, carbohydrate or sugar; boys with higher percent body fat actually consumed less carbohydrate (p = 0.01) and energy (p = 0.05). Longitudinal analysis (combined data from both sexes) was weaker, but supported the cross-sectional findings, showing that children who reduced their PA over the four years increased their percent body fat (p = 0.04). Relationships in the 8 year-olds and also in the leanest quartile of all children, where adiposity-related underreporting was unlikely, were consistent with those of the whole group, indicating that underreporting did not influence our findings. CONCLUSIONS These data provide support for the premise that physical activity is the main source of variation in the percent body fat of healthy community-based Australian children. General community strategies involving dietary intake and physical activity to combat childhood obesity may benefit by making physical activity the foremost focus of attention.The financial support provided by the Commonwealth Education Trust (London, UK) was vital to the completion of this work, and the authors thank the Board of Trustees for supporting them over several years. The authors also thank members of The Canberra Hospital Salaried Staff Specialists Private Practice Fund for their financial contribution to the study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Longitudinal patterns of physical activity in children aged 8 to 12 years: the LOOK study

BACKGROUND Data on longitudinal monitoring of daily physical activity (PA) patterns in youth over successive years is scarce but may provide valuable information for intervention strategies aiming to promote PA. METHODS Participants were 853 children (starting age ~8 years) recruited from 29 Australian elementary schools. Pedometers were worn for a 7-day period each year over 5 consecutive years to assess PA volume (steps per day) and accelerometers were worn concurrently in the final 2 years to assess PA volume (accelerometer counts (AC) per day), moderate and vigorous PA (MVPA), light PA (LPA) and sedentary time (SED). A general linear mixed model was used to examine daily and yearly patterns. RESULTS A consistent daily pattern of pedometer step counts, AC, MVPA and LPA emerged during each year, characterised by increases on school days from Monday to Friday followed by a decrease on the weekend. Friday was the most active and Sunday the least active day. The percentage of girls and boys meeting international recommendations of 11,000 and 13,000 steps/day respectively on a Monday, Friday and Sunday were 36%, 50%, 21% for boys and 35%, 45%, 18% for girls. The equivalent percentages meeting the recommended MVPA of >60 min/day on these days were 29%, 39%, 16% for boys and 15%, 21%, 10% for girls. Over the 5 years, boys were more active than girls (mean steps/day of 10,506 vs 8,750; p<0.001) and spent more time in MVPA (mean of 42.8 vs 31.1 min/day; p<0.001). Although there was little evidence of any upward or downward trend in steps/day from age 8 to 12 years, there was a trend toward lower MVPA, LPA and a corresponding increase in SED from age 11 to 12 years. CONCLUSION A weekly pattern of PA occurred in children as young as age 8 on a day by day basis; these patterns persisting through to age 12. In addition to supporting previous evidence of insufficient PA in children, our data, in identifying the level and incidence of insufficiency on each day of the week, may assist in the development of more specific strategies to increase PA in community based children

Longitudinal patterns of physical activity in children aged 8 to 12 years: The LOOK study

BACKGROUND: Data on longitudinal monitoring of daily physical activity (PA) patterns in youth over successive years is scarce but may provide valuable information for intervention strategies aiming to promote PA. METHODS: Participants were 853 children (starting age ~8 years) recruited from 29 Australian elementary schools. Pedometers were worn for a 7-day period each year over 5 consecutive years to assess PA volume (steps per day) and accelerometers were worn concurrently in the final 2 years to assess PA volume (accelerometer counts (AC) per day), moderate and vigorous PA (MVPA), light PA (LPA) and sedentary time (SED). A general linear mixed model was used to examine daily and yearly patterns. RESULTS: A consistent daily pattern of pedometer step counts, AC, MVPA and LPA emerged during each year, characterised by increases on school days from Monday to Friday followed by a decrease on the weekend. Friday was the most active and Sunday the least active day. The percentage of girls and boys meeting international recommendations of 11,000 and 13,000 steps/day respectively on a Monday, Friday and Sunday were 36%, 50%, 21% for boys and 35%, 45%, 18% for girls. The equivalent percentages meeting the recommended MVPA of >60 min/day on these days were 29%, 39%, 16% for boys and 15%, 21%, 10% for girls. Over the 5 years, boys were more active than girls (mean steps/day of 10,506 vs 8,750; p<0.001) and spent more time in MVPA (mean of 42.8 vs 31.1 min/day; p<0.001). Although there was little evidence of any upward or downward trend in steps/day from age 8 to 12 years, there was a trend toward lower MVPA, LPA and a corresponding increase in SED from age 11 to 12 years. CONCLUSION: A weekly pattern of PA occurred in children as young as age 8 on a day by day basis; these patterns persisting through to age 12. In addition to supporting previous evidence of insufficient PA in children, our data, in identifying the level and incidence of insufficiency on each day of the week, may assist in the development of more specific strategies to increase PA in community based children

Physical Education and Blood Lipid Concentrations in Children: The LOOK Randomized Cluster Trial

BACKGROUND AND OBJECTIVES Elevated blood lipids during childhood are predictive of dyslipidemia in adults. Although obese and inactive children have elevated values, any potentially protective role of elementary school physical education is unknown. Our objective was to determine the effect of a modern elementary school physical education (PE) program on the blood lipid concentrations in community-based children. METHODS In this cluster-randomized controlled trial, 708 healthy children (8.1±0.3 years, 367 boys) in 29 schools were allocated to either a 4-year intervention program of specialist-taught PE (13 schools) or to a control group of the currently practiced PE conducted by generalist classroom teachers. Fasting blood lipids were measured at ages 8, 10, and 12 years and intervention and control class activities were recorded. RESULTS Intervention classes included more fitness work and more moderate and vigorous physical activity than control classes (both p3.36mmol.L(-1),130 mg/dL) was lower in the intervention than control group (14% vs. 23%, p = 0.02). There was also an intervention effect on mean LDL-C across all boys (reduction of 9.6% for intervention v 2.8% control, p = 0.02), but not girls (p = 0.2). The intervention effect on total cholesterol mirrored LDL-C, but there were no detectable 4-year intervention effects on high-density lipoprotein cholesterol or triglycerides. CONCLUSIONS The PE program delivered by specialist teachers over four years in elementary school reduced the incidence of elevated LDL-C in boys and girls, and provides a means by which early preventative practices can be offered to all children. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ANZRN12612000027819 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347799.Sources of funding were The Commonwealth Education Trust (New Zealand House, London, UK) (http://www.commonwealth.org.uk/) and the Canberra Hospital Salaried Staff Specialists Fund (http://healthresearch.anu.edu.au/documents/PPFVACATION/ppf-major-info-2012.pdf). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Effects of Changes in Adiposity and Physical Activity on Preadolescent Insulin Resistance: The Australian LOOK Longitudinal Study

BACKGROUND In a previous longitudinal analysis of our cohort as 8 to 10 year-olds, insulin resistance (IR) increased with age, but was not modified by changes in percent body fat (%BF), and was only responsive to changes in physical activity (PA) in boys. We aimed to determine whether these responses persisted as the children approached adolescence. METHODS In this prospective cohort study, 256 boys and 278 girls were assessed at ages 8, 10 and 12 years for fasting blood glucose and insulin, %BF (dual energy X-ray absorptiometry); PA (7-day pedometers), fitness (multistage run); and pubertal development (Tanner stage). RESULTS From age 8 to 12 years, the median homeostatic model of IR (HOMA-IR) doubled in boys and increased 250% in girls. By age 12, 23% of boys and 31% of girls had elevated IR, as indicated by HOMA-IR greater than 3. Longitudinal relationships, with important adjustments for covariates body weight, PA, %BF, Tanner score and socioeconomic status showed that, on average, for every 1 unit reduction of %BF, HOMA-IR was lowered by 2.2% (95% CI 0.04-4) in girls and 1.6% (95% CI 0-3.2) in boys. Furthermore, in boys but not girls, HOMA-IR was decreased by 3.5% (95%CI 0.5-6.5) if PA was increased by 2100 steps/day. CONCLUSION Evidence that a quarter of our apparently healthy 12 year-old Australians possessed elevated IR suggests that community-based education and prevention strategies may be warranted. Responsiveness of IR to changes in %BF in both sexes during late preadolescence and to changes in PA in the boys provides a specific basis for targeting elevated IR. That body weight was a strong covariate of IR, independent of %BF, points to the importance of adjusting for weight in correctly assessing these relationships in growing children.Financial support was provided by the Commonwealth Education Trust (London, UK), the Board of Trustees and The Canberra Hospital Salaried Staff Specialists Private Practice Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Outcomes of a four-year specialist-taught physical education program on physical activity: a cluster randomized controlled trial, the LOOK study

BackgroundThe objective of this study was to investigate the effect of a 4-year specialist-taught Physical Education (PE) program on physical activity (PA) among primary school children.MethodsA 4-year cluster randomised controlled trial was conducted in children (initially aged 8 years) from 29 primary schools (13 Intervention, 16 Control). Intervention students (N&thinsp;=&thinsp;457) received 2&thinsp;&times;&thinsp;45 min PE lessons per week from specialist-trained PE teachers (68 lessons per year, 272 lessons over 4 years). Control group students (N&thinsp;=&thinsp;396) received usual practice PE from generalist classroom teachers. PA during PE lessons was examined using the System for Observing Fitness Instruction Time (SOFIT). Pedometers (steps/day) were worn for 7 days each year, and accelerometers were worn concurrently in the final two years to assess moderate to vigorous (MVPA) and sedentary activity. Linear and generalized mixed models were used to determine differences in Intervention and Control student PA and the proportion of students meeting PA guidelines.ResultsThe intervention increased SOFIT-observed student MVPA during PE lessons by 6.5 mins (16.7 v 10.2, p&thinsp;&lt;&thinsp;0.001). Within intervention schools, participants increased their whole-day step counts (boys&thinsp;=&thinsp;449 [CI,140 to 756]; girls&thinsp;=&thinsp;424 [CI,222 to 626]) and minutes of MVPA (boys&thinsp;=&thinsp;8.0 [CI,6.8 to 9.2]; girls&thinsp;=&thinsp;3.5 [CI,1.7 to 5.4]) on PE days. However, compared to the Control group the Intervention did not: increase habitual steps/day or MVPA when averaged over 7 days; elicit greater improvements in these measures over time; or increase the odds of meeting step/day or MVPA recommendations. At age 11 years Intervention group boys were 20 mins less sedentary per day (380 [CI,369 to 391] vs 360 [CI,350 to 369]) and this effect was sustained at age 12 years.ConclusionsWell-designed specialist-taught PE can improve student PA during PE lessons. However for PE to be a significant contributor to improving habitual PA in pre-adolescent children, daily classes are likely to be required, and even this would need to be supplemented with a wider multicomponent strategy. Our finding of a reduction in sedentary time among Intervention boys warrants further investigation into the potential role PE could play in influencing sedentary behaviour.<br /

Cross-Sectional Associations of Total Daily Volume and Activity Patterns across the Activity Spectrum with Cardiometabolic Risk Factors in Children and Adolescents

Sedentary and physical activity patterns (bouts/breaks) may be important for cardiometabolic health in early life. This study aimed to examine cross-sectional associations of total daily volume and patterns across the activity spectrum with cardiometabolic risk factors in youth aged 7–13 years. Objectively measured accelerometer and cardiometabolic risk factor data were pooled from two studies (n = 1219; 69% valid accelerometry). Total daily volume of sedentary time and light-, moderate-, and vigorous-intensity physical activity was determined. Time in sustained bouts and median bout lengths of all intensities and breaks in sedentary time were also calculated. Outcomes included body mass index, waist circumference, blood pressure, blood lipids, and a cardiometabolic summary score. Regression models revealed beneficial associations between total daily volumes of moderate- and vigorous-intensity physical activity and cardiometabolic risk. Time spent in ≥1 min vigorous-intensity physical activity bouts was beneficially associated with cardiometabolic risk, yet this disappeared after adjusting for total vigorous-intensity physical activity and confounders. Time accumulated in light- (≥1 min; ≥5 min) and moderate-intensity (≥1 min) physical activity bouts was detrimentally associated with cardiometabolic risk. Total daily volume and activity patterns may have implications for cardiometabolic risk early in life. Sporadic physical activity may be more beneficial for health than sustained physical activity

Activity Accumulation and Cardiometabolic Risk in Youth

Introduction This cross-sectional study aimed to: i) identify and characterize youth according to distinct physical activity (PA) and sedentary (SED) accumulation patterns; and ii) investigate associations of these derived patterns with cardiometabolic risk factors.Methods ActiGraph accelerometer data from 7-13 year olds from two studies were pooled (n=1,219; 843 [69%] with valid accelerometry included in analysis). Time accumulated in ≥5-min and ≥10-min SED bouts, ≥1-min and ≥5-min bouts of light (LPA), and ≥1-min bouts of moderate (MPA) and vigorous (VPA) PA were calculated. Frequency of breaks in SED were also obtained. Latent profile analysis was used to identify groups of participants based on their distinct accumulation patterns. Linear and logistic regression models were used to test associations of group accumulation patterns with cardiometabolic risk factors, including adiposity indicators, blood pressure and lipids. Total PA and SED time were also compared between groups.Results Three distinct groups were identified: “Prolonged sitters” had the most time in prolonged SED bouts and the least time in VPA bouts; “Breakers” had the highest frequency of SED breaks and lowest engagement in sustained bouts across most PA intensities; “Prolonged movers” had the least time accumulated in SED bouts and the most in PA bouts across most intensities. Whilst “Breakers” engaged in less time in PA bouts compared to other groups, they had the healthiest adiposity indicators. No associations with the remaining cardiometabolic risk factors were found.Conclusion Youth accumulate their daily activity in three distinct patterns (prolonged sitters, breakers and prolonger movers), with those breaking up sitting and most time in sporadic PA across the day having a lower adiposity risk. No relationships with other cardiometabolic risk factors were identified

Child and Parent Physical Activity, Sleep, and Screen Time During COVID-19 and Associations With Mental Health:Implications for Future Psycho-Cardiological Disease?

The COVID-19 pandemic has afforded the opportunity for some to improve lifestyle behaviours, while for others it has presented key challenges. Adverse changes in global lifestyle behaviours, including physical activity, sleep, and screen time can affect proximal mental health and in turn distal cardiovascular outcomes. We investigated differences in physical activity, sleep, and screen time in parents and children during early stages of the COVID-19 pandemic in Australia compared to pre-COVID-19 national data; and estimated associations between these movement behaviours with parent and child mental health. Cross-sectional baseline data from the COVID-19 Pandemic Adjustment Study (CPAS; N = 2,365) were compared to nationally representative pre-pandemic data from the Longitudinal Study of Australian Children (LSAC; N = 9,438). Participants were parents of children aged ≤ 18 years, residing in Australia. Parents provided self-report measures of mental health, physical activity and sleep quality, and reported on child mental health, physical activity and screen time. Children in CPAS had significantly more sleep problems and more weekend screen time. Their parents had significantly poorer sleep quality, despite increased weekly physical activity. Children's sleep problems were significantly associated with increased mental health problems, after accounting for socioeconomic status, physical activity, and screen time. Poorer parent sleep quality and lower levels of physical activity were significantly associated with poorer mental health. Monitoring this cohort over time will be important to examine whether changes in movement behaviour are enduring or naturally improve with the easing of restrictions; and whether these changes have lasting effects on either parent or child mental health, and in turn, future risk for CVD