Anthony D. Okely

Fundamental movement skills in children and adolescents : review of associated health benefits

The mastery of fundamental movement skills (FMS) has been purported as contributing to children’s physical, cognitive and social development and is thought to provide the foundation for an active lifestyle. Commonly developed in childhood and subsequently refined into context- and sport-specific skills, they include locomotor (e.g. running and hopping), manipulative or object control (e.g. catching and throwing) and stability (e.g. balancing and twisting) skills. The rationale for promoting the development of FMS in childhood relies on the existence of evidence on the current or future benefits associated with the acquisition of FMS proficiency. The objective of this systematic review was to examine the relationship between FMS competency and potential health benefits in children and adolescents. Benefits were defined in terms of psychological, physiological and behavioural outcomes that can impact public health. A systematic search of six electronic databases (EMBASE, OVID MEDLINE, PsycINFO, PubMed, Scopus and Sport- Discus®) was conducted on 22 June 2009. Included studies were crosssectional, longitudinal or experimental studies involving healthy children or adolescents (aged 3–18 years) that quantitatively analysed the relationship between FMS competency and potential benefits. The search identified 21 articles examining the relationship between FMS competency and eight potential benefits (i.e. global self-concept, perceived physical competence, cardio-respiratory fitness [CRF], muscular fitness, weight status, flexibility, physical activity and reduced sedentary behaviour). We found strong evidence for a positive association between FMS competency and physical activity in children and adolescents. There was also a positive relationship between FMS competency and CRF and an inverse association between FMS competency and weight status. Due to an inadequate number of studies, the relationship between FMS competency and the remaining benefits was classified as uncertain. More longitudinal and intervention research examining the relationship between FMS competency and potential psychological, physiological and behavioural outcomes in children and adolescents is recommended.

Methodological considerations in using accelerometers to assess habitual physical activity in children aged 0–5 years

This paper reviews the evidence behind the methodological decisions accelerometer users make when assessing habitual physical activity in children aged 0-5 years. The purpose of the review is to outline an evidence-guided protocol for using accelerometry in young children and to identify gaps in the evidence base where further investigation is required. Studies evaluating accelerometry methodologies in young children were reviewed in two age groups (0-2 years and 3-5 years) to examine: (i) which accelerometer should be used, (ii) where the accelerometer should be placed, (iii) which epoch should be used, (iv) how many days of monitoring are required, (v) how many minutes of monitoring per day are required, (vi) how data should be reduced, (vii) which cut-point definitions for identifying activity intensity should be used, and (viii) which physical activity outcomes should be reported and how. Critique of the available evidence provided a basis for the development of a recommended users protocol in 3-5-year olds, although several issues require further research. Because of the absence of methodological studies in children under 3 years, a protocol for the use of accelerometers in this age range could not be specified. Formative studies examining the utility, feasibility and validity of accelerometer-based physical activity assessments are required in children under 3 years of age. Recommendations for further research are outlined, based on the above findings, which, if undertaken, will enhance the accuracy of accelerometer-based assessments of habitual physical activity in young children.

The reliability and validity of the physical activity questions in the WHO health behaviour in schoolchildren (HBSC) survey: a population study

Objective—To assess the test-retest reliability and validity of the physical activity questions in the World Health Organisation health behaviour in schoolchildren (WHO HBSC) survey. Methods—In the validity study, the Multistage Fitness Test was administered to a random sample of year 8 (mean age 13.1 years; n = 1072) and year 10 (mean age 15.1 years; n = 954) high school students from New South Wales (Australia) during February/March 1997. The students completed the self report instruments on the same day. An independent sample of year 8 (n = 121) and year 10 (n = 105) students was used in the reliability study. The questionnaire was administered to the same students on two occasions, two weeks apart, and test-retest reliability was assessed. Students were classified as either active or inadequately active on their combined responses to the questionnaire items. Kappa and percentage agreement were assessed for the questionnaire items and for a two category summary measure. Results—All groups of students (boys and girls in year 8 and year 10) classified as active (regardless of the measure) had significantly higher aerobic fitness than students classified as inadequately active. As a result of highly skewed binomial distributions, values of kappa were much lower than percentage agreement for test-retest reliability of the summary measure. For year 8 boys and girls, percentage agreement was 67% and 70% respectively, and for year 10 boys and girls percentage agreement was 85% and 70% respectively. Conclusions—These brief self report questions on participation in vigorous intensity physical activity appear to have acceptable reliability and validity. These instruments need to be tested in other cultures to ensure that the findings are not specific to Australian students. Further refinement of the measures should be considered.

The reliability and validity of the Adolescent Physical Activity Recall Questionnaire.

PURPOSE This study assessed the test-retest reliability and validity of the Adolescent Physical Activity Recall Questionnaire (APARQ) among 13- and 15-yr-old Australians. METHODS Two studies were conducted using the same instrument. Self-reported participation in organized and nonorganized physical activity was summarized into four measures: a three-category measure of activity, a two-category measure, and estimated energy expenditure expressed as a continuous variable and as quintiles. The reliability study (N = 226) assessed strength of agreement for all measures between responses to two administrations of the questionnaire. The validity study (N = 2026) assessed the relationship between the APARQ and performance on the Multistage Fitness Test (MFT). RESULTS Reliability study: for the three-category measure, percent agreement ranged 67-83% and weighted kappa ranged 0.33-0.71. For the two-category measure, percent agreement ranged 76-90% and kappa ranged 0.25-0.74. For energy expenditure expressed as a continuous variable, the intraclass correlations coefficients were generally greater than 0.6 for grade 10 students, but most were below 0.5 for grade 8 students. Validity study: for the three-category measure, mean laps were higher in the adequately and vigorously active categories than the inactive category for girls, but only the mean laps in the vigorously active and inactive categories were significantly different for boys. For the two-category measure, mean laps were higher in the active category than the inactive category for all groups. Correlations between energy expenditure and MFT laps were 0.15, 0.21, 0.14, and 0.39 for grade 8 boys, grade 8 girls, grade 10 boys, and grade 10 girls, respectively. CONCLUSION The APARQ has acceptable to good reliability and acceptable validity, but further validation using other methods and in other population groups is required.

Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years).

The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years). These national guidelines were created in response to an urgent call from public health, health care, child care, and fitness practitioners for healthy active living guidance for the early years. The guideline development process was informed by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and the evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The recommendations are informed by evidence from a systematic review that examined the relationships between physical activity and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged <1 year; toddlers aged 1-2 years; preschoolers aged 3-4 years). The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from an extensive on-line consultation process with input from over 900 domestic and international stakeholders, end-users, and key informants. The final guideline recommendations state that for healthy growth and development, infants (aged <1 year) should be physically active several times daily - particularly through interactive floor-based play. Toddlers (aged 1-2 years) and preschoolers (aged 3-4 years) should accumulate at least 180 min of physical activity at any intensity spread throughout the day, including a variety of activities in different environments, activities that develop movement skills, and progression toward at least 60 min of energetic play by 5 years of age. More daily physical activity provides greater benefits.

Tracking Physical Activity and Sedentary Behavior in Childhood: A Systematic Review

CONTEXT To date, no reviews have investigated the evidence of tracking of physical activity and sedentary behavior specifically during early childhood (aged 0-5.9 years) or from early childhood to middle childhood (aged 6-12 years). It is important to review the evidence of tracking of these behaviors to determine their stability during the foundational early years of life. EVIDENCE ACQUISITION A literature search of studies was conducted in seven electronic databases (January 1980 to April 2012). Studies were compared on methodologic quality and evidence of tracking of physical activity or sedentary behavior. Tracking was defined as the stability (or relative ranking within a cohort) of behaviors, such as physical activity and sedentary behavior, over time. EVIDENCE SYNTHESIS Eleven studies met the inclusion criteria. All studies reporting physical activity outcomes had high methodologic quality; 71% of studies reporting sedentary behavior outcomes had high methodologic quality. Of the tracking coefficients for physical activity, 4% were large, 60% were moderate, and 36% were small. Of the tracking coefficients for sedentary behavior, 33% were large, 50% were moderate, and 17% were small. Overall, there was evidence of moderate tracking of physical activity during early childhood, and from early childhood to middle childhood, and of moderate-to-large tracking of sedentary behavior during early childhood and from early childhood to middle childhood. CONCLUSIONS This review highlights the importance of establishing recommended levels of physical activity and sedentary behavior during the early years of life. Based on this review, the following recommendations are made: (1) early childhood should be targeted as a critical time to promote healthy lifestyle behaviors through methodologically sound prevention studies; and (2) future tracking studies should assess a broad range of sedentary behaviors using objective measures.

Physical activity during school recess: a systematic review

CONTEXT Interest has increased in examining the physical activity levels of young people during school recess. Identifying correlates of their recess physical activity behaviors is timely, and would inform school-based physical activity programming and intervention development. The review examined the correlates of childrens and adolescents physical activity during school recess periods. EVIDENCE ACQUISITION A systematic search of six electronic databases, reference lists, and personal archives identified 53 studies (47 focused on children) published between January 1990 and April 2011 that met the inclusion criteria. Data were analyzed in 2011. Correlates were categorized using the social-ecological framework. EVIDENCE SYNTHESIS Forty-four variables were identified across the four levels of the social-ecological framework, although few correlates were studied repeatedly at each level. Positive associations were found of overall facility provision, unfixed equipment, and perceived encouragement with recess physical activity. Results revealed that boys were more active than girls. CONCLUSIONS Providing access to school facilities, providing unfixed equipment, and identifying ways to promote encouragement for physical activity have the potential to inform strategies to increase physical activity levels during recess periods.

Preschoolers' physical activity, screen time, and compliance with recommendations.

PURPOSE Little evidence exists about the prevalence of adequate levels of physical activity and of appropriate screen-based entertainment in preschool children. Previous studies have generally relied on small samples. This study investigates how much time preschool children spend being physically active and engaged in screen-based entertainment. The study also reports compliance with the recently released Australian recommendations for physical activity (≥3 h·d(-1)) and screen entertainment (≤1 h·d(-1)) and the National Association for Sport and Physical Education physical activity guidelines (≥2 h·d(-1)) and American Academy of Pediatrics screen-based entertainment recommendations (≤2 h·d(-1)) in a large sample of preschool children. METHODS Participants were 1004 Melbourne preschool children (mean age = 4.5 yr, range = 3-5 yr) and their families in the Healthy Active Preschool Years study. Physical activity data were collected by accelerometry during an 8-d period. Parents reported their childs television/video/DVD viewing, computer/Internet, and electronic game use during a typical week. A total of 703 (70%) had sufficient accelerometry data, and 935 children (93%) had useable data on time spent in screen-based entertainment. RESULTS Children spent 16% (approximately 127 min·d(-1)) of their time being physically active. Boys and younger children were more active than were girls and older children, respectively. Children spent an average of 113 min·d(-1) in screen-based entertainment. Virtually no children (<1%) met both the Australian recommendations and 32% met both the National Association for Sport and Physical Education and American Academy of Pediatrics recommendations. CONCLUSIONS The majority of young children are not participating in adequate amounts of physical activity and in excessive amounts of screen-based entertainment. It is likely that physical activity may decline and that screen-based entertainment may increase with age. Compliance with recommendations may be further reduced. Strategies to promote physical activity and reduce screen-based entertainment in young children are required.

Efficacy of Interventions to Improve Motor Development in Young Children: A Systematic Review

OBJECTIVE: The objective of this study was to systematically review evidence from controlled trials on the efficacy of motor development interventions in young children. METHODS: A literature search of interventions was conducted of 14 electronic databases. Three reviewers independently evaluated studies to determine whether they met the inclusion criteria. Studies were compared on 5 components: design, methodologic quality, intervention components, efficacy, and alignment with the Consolidated Standard of Reporting Trials (CONSORT) and Transparent Reporting of Evaluation with Nonrandomized Designs (TREND) statements. RESULTS: Seventeen studies met the inclusion criteria. More than half (65%) were controlled trials and delivered at child care settings or schools (65%). Three studies had high methodologic quality. Studies were ∼12 weeks in duration and delivered by teachers, researchers, and students. Parents were involved in only 3 studies. Nearly 60% of the studies reported statistically significant improvements at follow-up. Three studies aligned with the CONSORT and TREND statements. CONCLUSIONS: This review highlights the limited quantity and quality of interventions to improve motor development in young children. The following recommendations are made: (1) both teachers and researchers should be involved in the implementation of an intervention; (2) parental involvement is critical to ensuring transfer of knowledge from the intervention setting to the home environment; and (3) interventions should be methodologically sound and follow guidelines detailed in the CONSORT or TREND statement.

A hitchhiker's guide to assessing young people's physical activity: Deciding what method to use

Researchers and practitioners interested in assessing physical activity in children are often faced with the dilemma of what instrument to use. While there is a plethora of physical activity instruments to choose from, there is currently no guide regarding the suitability of common assessment instruments. The purpose of this paper is to provide a users guide for selecting physical activity assessment instruments appropriate for use with children and adolescents. While recommendations regarding specific instruments are not provided, the guide offers information about key attributes and considerations for the use of eight physical activity assessment approaches: heart rate monitoring; accelerometry; pedometry; direct observation; self-report; parent report; teacher report; and diaries/logs. Attributes of instruments and other factors to be considered in the selection of assessment instruments include: population (age); sample size; respondent burden; method/delivery mode; assessment time frame; physical activity information required (data output); data management; measurement error; cost (instrument and administration) and other limitations. A decision flow chart has been developed to assist researchers and practitioners to select an appropriate method of assessing physical activity. Five real-life scenarios are presented to illustrate this process in light of key instrument attributes. It is important that researchers, practitioners and policy makers understand the strengths and limitations of different methods of assessing physical activity, and are guided on selection of the most appropriate instrument/s to suit their needs.