Physical activity and gross motor skills in rural South African preschool children

Background: Global levels of overweight and obesity in preschool-aged children have increased dramatically in the last two decades, with most overweight and obese children younger than five years living in low- and middle-income countries (LMICs). Statistics from the 2013 South African National Health and Nutrition Examination Survey (SANHANES-1) confirm that levels of overweight and obesity are high in South African preschool-aged children, with prevalence rates of overweight and obesity up to 18.2% and 4.7%, respectively. This increasing problem of overweight and obesity in South African preschoolaged children highlights the need for intervening in this age group. Overweight and obesity interventions in preschool children typically include one or more of the following behaviours: physical activity, sedentary behaviour and screen time. Aim and objectives: The aim of this study was to characterise the preschool environment in rural South Africa, and to explore physical activity, gross motor skill proficiency, sedentary behaviour and screen time in rural South African preschool-aged children. Additionally, aims of this study were to explore the associations between gross motor skills, body composition and physical activity; and to assess compliance with current physical activity and sedentary behaviour guidelines. Methods: Preschool-aged children (3-5 years old, n=131) were recruited from three Preschools and two Grade R (reception year) settings in Agincourt, a rural village in north eastern South Africa. In order to gain an understanding of the Preschool and Grade R settings, an observation of the preschool environments was conducted using a tool adapted from the Outdoor Play Environmental Categories scoring tool, Environmental and Policy Assessment and Observation instrument, and the Early Learning Environments for Physical Activity and Nutrition Environments Telephone Survey. Each child’s height and weight was measured. Physical activity and sedentary behaviour were measured objectively using a hip-worn ActiGraph GT3X+ accelerometer for 7 days (24 hours, only removed for water-based activities). Gross motor skills were assessed using the Test for Gross Motor Development–Version 2 (TGMD-2). Physical activity and sedentary behaviour, including the contextual information for these behaviours, during the preschool day (08h00 until ±12h00) were measured using the Observational System for Recording Physical Activity in Children (Preschool Version). A separate sample of parents/caregivers were recruited (n=143) to complete a questionnaire that was adapted from the Healthy Active Preschool Years questionnaire and Preschool Physical Activity Questionnaire. Parents reported on their child’s screen time, and on factors within the home and community contexts in which physical activity and sedentary behaviours occur. Results: In terms of the environment, the Preschools and Grade R settings differed in that fixed play equipment only featured in the Preschool settings. Grade R settings had more open space in which to play. All Preschool and Grade R settings provided children with limited portable play equipment, and none of the schools had access to screens. Although all children recruited for the study were preschool-aged, the Grade R children were significantly older than the Preschool children (5.6±0.3years vs. 4.4±0.4 years, p <0.05). According to IOTF cut-offs, the prevalence of overweight/obesity was low (5.0%) in the sample, and 68.1% of children were classified as normal weight. On average, children spent 477.2±77.3 minutes in light- to vigorous-intensity physical activity (LMVPA) per day, and 93.7±52.3 minutes in moderate- to vigorous-intensity physical activity (MVPA). In terms of the new current guidelines (180min/day LMVPA, including 60min of MVPA, described as ‘energetic play’), and using average daily average of LMVPA and MVPA, 78.2% met current guidelines. Observed and objectively measured sedentary behaviour results revealed that children were more sedentary during preschool time (between 08:00 to 12:00) compared to the afternoons. Overall, boys were significantly more physically active than girls; and Preschool children did more physical activity during preschool time than Grade R children (all p< 0.05). Over 90% of the sample achieved an ‘average’ or better ranking for gross motor skill proficiency. The Grade R children were significantly more proficient than the Preschool children for all gross motor skill components (raw scores and standardised scores). Overall, boys achieved significantly better object control raw scores than the girls, and displayed greater proficiency than the girls in the strike (p=0.003), stationary dribble (p< 0.001) and kick (p< 0.001). None of the preschool or Grade R settings had access to screens such as televisions or iPads, and parent-reported screen time was low for the total sample (0.5±0.3hr/day). The majority of the sample (97.9%) met current screen time guidelines (<1 hour per day). Parents (82.5%) reported that they believed that their child did sufficient PA for their health, but 81.8% also reported believing that television time would not affect their child’s health. Parent responses revealed neighbourhood safety as a potential barrier to being physically active in the community. Conclusions: Rural preschool-aged children in South Africa appear to be engaged in adequate amounts of physical activity, particularly LMVPA, and are adequately proficient in gross motor skills. The children did not engage in excessive amounts of screen time. Overweight and obesity were not prevalent in this sample of rural preschool-aged children, and therefore it would appear that an intervention to reduce or prevent obesity by increasing physical activity, improving gross motor skills and reducing screen time is unnecessary. Rather, interventions that facilitate the increase in levels of MVPA in order to meet current physical activity guidelines are warranted. Additionally, it is essential that the high levels of physical activity (LMVPA) and good foundation of gross motor skills observed in this sample are promoted in an effort to maintain them throughout childhood. Future research may want to determine whether these activities (high levels of LMVPA, low levels of screen time) track throughout childhood and into adolescence

Self-reported measures versus objective measures of physical activity and sedentary behaviour : impacts of cardiovascular fitness and physical activity

Includes abstract.Includes bibliographical references.Physical activity (PA) and sedentary behaviour (SB) can be quantified with both self-report and objective measures, using questionnaires and accelerometers, respectively. There is a paucity of research investigating the possible influence that cardiorespiratory fitness and PA might have on the accuracy of self-reported of PA and SB. This is especially important with the increasing evidence around the risks of SB, independent of PA. The aim of this research study is to describe the difference between self-reported measures of moderate PA, vigorous PA and SB against their objectively measured counterparts. The secondary aim is to identify factors influencing the error in self-report measures; including cardiorespiratory fitness and levels of PA

Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions

Introduction The benefits of physical activity for people living with long-term conditions (LTCs) are well established. However, the risks of physical activity are less well documented. The fear of exacerbating symptoms and causing adverse events is a persuasive barrier to physical activity in this population. This work aimed to agree clear statements for use by healthcare professionals about medical risks of physical activity for people living with LTCs through expert consensus. These statements addressed the following questions: (1) Is increasing physical activity safe for people living with one or more LTC? (2) Are the symptoms and clinical syndromes associated with common LTCs aggravated in the short or long term by increasing physical activity levels? (3) What specific risks should healthcare professionals consider when advising symptomatic people with one or more LTCs to increase their physical activity levels? Methods Statements were developed in a multistage process, guided by the Appraisal of Guidelines for Research and Evaluation tool. A patient and clinician involvement process, a rapid literature review and a steering group workshop informed the development of draft symptom and syndrome-based statements. We then tested and refined the draft statements and supporting evidence using a three-stage modified online Delphi study, incorporating a multidisciplinary expert panel with a broad range of clinical specialties. Results Twenty-eight experts completed the Delphi process. All statements achieved consensus with a final agreement between 88.5%–96.5%. Five ‘impact statements’ conclude that (1) for people living with LTCs, the benefits of physical activity far outweigh the risks, (2) despite the risks being very low, perceived risk is high, (3) person-centred conversations are essential for addressing perceived risk, (4) everybody has their own starting point and (5) people should stop and seek medical attention if they experience a dramatic increase in symptoms. In addition, eight symptom/syndrome-based statements discuss specific risks for musculoskeletal pain, fatigue, shortness of breath, cardiac chest pain, palpitations, dysglycaemia, cognitive impairment and falls and frailty. Conclusion Clear, consistent messaging on risk across healthcare will improve people living with LTCs confidence to be physically active. Addressing the fear of adverse events on an individual level will help healthcare professionals affect meaningful behavioural change in day-to-day practice. Evidence does not support routine preparticipation medical clearance for people with stable LTCs if they build up gradually from their current level. The need for medical guidance, as opposed to clearance, should be determined by individuals with specific concerns about active symptoms. As part of a system-wide approach, consistent messaging from healthcare professionals around risk will also help reduce cross-sector barriers to engagement for this population.Output Status: Forthcoming/Available Onlin

Physical activity in early childhood education and care settings in a low-income, rural South African community : an observational study

Introduction: Research has not been conducted on physical activity in early child education and care (ECEC) settings in low- income, rural communities in South Africa. This study aimed to describe the physical activity environment of these settings and identify child and contextual factors associated with physical activity in these settings. By understanding physical activity in this environment, it will be possible to identify context-specific opportunities, including with teachers, to overcome potential challenges and maximise physical activity in a low- and middle- income country setting. Methods: The study was conducted in rural Bushbuckridge, Mpumalanga in 2014. Preschool-aged children (n=55) were recruited from five ECEC settings, including three preschools and two primary schools, where preschool-aged children are in their reception year, grade R. Preschool environment characteristics were assessed using an observational tool adapted from existing tools. Children's physical activity was assessed using the Observational System for Recording Physical Activity in Children- Preschool Version. Differences between preschool and grade R settings were assessed using chi(2) analyses, and multinomial logistic regression analysis was used to determine factors associated with physical activity in the ECEC settings. Results: The physical activity environment differed between preschool and grade R ECEC settings in terms of space (preschoolp&lt;0.001) and fixed equipment (preschool&gt;grade R, p&lt;0.001). On average, children spent 28.7% of their day in the ECEC settings engaged in physical activity, of which 22.3% was moderate- to vigorous-intensity physical activity (MVPA). Children spent the greatest proportion of the day in sedentary activities (69.9%) and this differed significantly between preschool (63.2%) and grade R children (81.3%, p&lt; 0.001). Preschool children were significantly more active than grade R children, and spent greater proportions of time in light-intensity physical activity (8.6% v 2.7%, p&lt;0.001) and MVPA (25.4% v 15.3%, p&lt;0.001). Irrespective of ECEC setting, children were significantly more likely to participate in MVPA if they were outdoors (p=0.001), and significantly less likely to do MVPA if they were overweight/obese (p=0.006). Conclusion: These findings provide insight into child-level and contextual factors associated with preschool-aged children's physical activity within ECEC settings in a low-income, rural community in South Africa. Particularly, the physical and social features of ECEC settings are important in the promotion of physical activity. Findings from this study suggest that it is necessary to upskill and encourage teachers in ECEC settings to maximise opportunities for physical activity in rural low-income communities in South Africa