Brian W. Timmons

Systematic review of physical activity and health in the early years (aged 0–4 years)

The early years represent a critical period for promoting physical activity. However, the amount of physical activity needed for healthy growth and development is not clear. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, we aimed to present the best available evidence to determine the relationship between physical activity and measures of adiposity, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardiometabolic health indicators in infants (1 month - 1 year), toddlers (1.1-3.0 years), and preschoolers (3.1-4.9 years). Online databases, personal libraries, and government documents were searched for relevant studies. Twenty-two articles, representing 18 unique studies and 12 742 enrolled participants, met inclusion criteria. The health indicators of interest were adiposity (n = 11), bone and skeletal health (n = 2), motor development (n = 4), psychosocial health (n = 3), cognitive development (n = 1), and cardiometabolic health indicators (n = 3); these indicators were pre-specified by an expert panel. Five unique studies involved infants, 2 involved toddlers, and 11 involved preschoolers. In infants, there was low- to moderate-quality evidence to suggest that increased or higher physical activity was positively associated with improved measures of adiposity, motor skill development, and cognitive development. In toddlers, there was moderate-quality evidence to suggest that increased or higher physical activity was positively associated with bone and skeletal health. In preschoolers, there was low- to high-quality evidence on the relationship between increased or higher physical activity and improved measures of adiposity, motor skill development, psychosocial health, and cardiometabolic health indicators. There was no serious inconsistency in any of the studies reviewed. This evidence can help to inform public health guidelines. (PROSPERO registration: CRD42011001243).

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.

Systematic review of sedentary behaviour and health indicators in the early years (aged 0-4 years).

Accumulating evidence suggests that young children spend excessive time being sedentary. The purpose of this systematic review was to determine the relationship between sedentary behaviours and health indicators during the early years (ages 0-4 years). Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, this review aimed to present the best available evidence on the threshold of sedentary behaviour associated with healthy measures of adiposity, bone health, motor skill development, psychosocial health, cognitive development, and cardiometabolic health indicators in infants, toddlers, and preschoolers. Online databases, personal libraries, and government documents were searched for relevant studies. Studies that included an intervention (or experimental) group or prospective analysis were included. Twenty-one unique studies, representing 23 papers and 22 417 participants, met inclusion criteria; 7 studies included information on infants, 13 on toddlers, and 10 on preschoolers. Of these, 11, 6, and 8 studies reported data on adiposity, psychosocial health, and cognitive development, respectively. No included study reported on motor skill development, bone, or cardiometabolic health indicators. In conclusion, this review found low- to moderate-quality evidence to suggest that increased television viewing is associated with unfavourable measures of adiposity and decreased scores on measures of psychosocial health and cognitive development. No evidence existed to indicate that television viewing is beneficial for improving psychosocial health or cognitive development. In several instances a dose-response relationship was evident between increased time spent watching television and decreased psychosocial health or cognitive development. This work may be used as evidence to inform public health guidelines. (PROSPERO registration: CRD4011001280.).

Physical activity and sedentary behavior during the early years in Canada: a cross-sectional study

BackgroundPhysical activity and sedentary behavior habits are established during early childhood, yet only recently has objectively measured data been available on children aged 5 years and younger. This study presents data on the physical activity and sedentary behaviors of Canadian children aged 3–5 years.MethodsData were collected as part of the Canadian Health Measures Survey between 2009 and 2011. A nationally-representative sample (n = 459) of children aged 3–5 years wore Actical accelerometers during their waking hours for 7 consecutive days. Data were collected in 60-sec epochs and respondents with ≥4 valid days were retained for analysis. Parents reported their child’s physical activity and screen time habits in a questionnaire.ResultsEighty-four percent of 3–4 year old children met the physical activity guideline of 180 minutes of total physical activity every day while 18% met the screen time target of <1 hour per day. Fourteen percent of 5 year old children met the physical activity guideline of 60 minutes of daily moderate-to-vigorous physical activity (MVPA) while 81% met the screen time target of <2 hours per day. Children aged 3–4 years accumulated an average of 352 min/d of total physical activity and 66 minutes of MVPA while 5 year old children accumulated an average of 342 min/d of total physical activity and 68 minutes of MVPA. Children were sedentary for approximately half of their waking hours and spent an average of 2 hours per day in front of screens. Only 15% of 3–4 year olds and 5% of 5 year olds are meeting both the physical activity and sedentary behavior guidelines.ConclusionsPromoting physical activity while reducing sedentary behavior is important at all stages of life. The findings of the present study indicate that there remains significant room for improvement in these behaviors among young Canadian children.

Canadian Sedentary Behaviour 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 Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years). These national guidelines are in response to a call from health and health care professionals, child care providers, and fitness practitioners for guidance on sedentary behaviour in the early years. The guideline development process followed the Appraisal of Guidelines for Research Evaluation (AGREE) II framework. The recommendations are informed by evidence from a systematic review that examined the relationships between sedentary behaviour (predominantly screen time) 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). Evidence from the review was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from extensive on-line consultations with input from >900 domestic and international stakeholders, end-users, and key informants. The final guidelines state: for healthy growth and development, caregivers should minimize the time infants (aged <1 year), toddlers (aged 1-2 years), and preschoolers (aged 3-4 years) spend being sedentary during waking hours. This includes prolonged sitting or being restrained (e.g., stroller, high chair) for more than 1 h at a time. For those under 2 years, screen time (e.g., TV, computer, electronic games) is not recommended. For children 2-4 years, screen time should be limited to under 1 h per day; less is better.

Effect of dietary protein content during recovery from high-intensity cycling on subsequent performance and markers of stress, inflammation, and muscle damage in well-trained men

Nutrition is an important aspect of recuperation for athletes during multi-day competition or hard training. Post-exercise carbohydrate is likely to improve recovery, but the effect of protein is equivocal. The objective of this study was to determine the effect of post-exercise dietary protein content imposed over a high-carbohydrate background on subsequent performance. Using a crossover design, 12 cyclists completed 3 high-intensity rides over 4 days. Day 1 comprised 2.5 h intervals, followed by repeat-sprint performance tests on days 2 (15 h post) and 4 (60 h post), interspersed with a rest day. During 4 h recovery on days 1 and 2, cyclists ingested either 1.4 g.kg(-1).h(-1) carbohydrate, 0.7 g.kg(-1).h(-1) protein and 0.26 g.kg(-1).h(-1) fat (protein-enriched) or 2.1 g.kg(-1).h(-1) carbohydrate, 0.1 g.kg(-1).h(-1) protein, and equal fat (control). At other times, cyclists ingested a standardized high-carbohydrate diet. Anabolism was gauged indirectly by nitrogen balance, stress and inflammation via cortisol and cytokines, skeletal-muscle membrane disruption by creatine kinase, and oxidative stress by malonyl dealdehyde. Sprint mean power was not clearly different on day 2 (0.0%; 95%CL: +/-3.9%), but on day 4 it was 4.1% higher (+/-4.1%) in the protein-enriched condition relative to control. Reduced creatine kinase was possible (26%; +/-30%) but effects on oxidative stress, inflammatory markers, and cortisol were inconclusive or trivial. Overnight nitrogen balance was positive in the protein-enriched condition on day 1 (249+/-70 mg N.kg FFM(-1); mean+/-SD), but negative (-48+/-26 mg N.kg FFM(-1)) in the control condition. A nutritive effect of post-exercise protein content was not discernible short term (15 h), but a delayed performance benefit (60 h) was observed following protein-enriched high-carbohydrate ingestion.

Fat oxidation rate and the exercise intensity that elicits maximal fat oxidation decreases with pubertal status in young male subjects

The range of exercise intensities that elicit high fat oxidation rates (FOR) in youth and the influence of pubertal status on peak FOR are unknown. In a longitudinal design, we compared FOR over a range of exercise intensities in a small cohort of developing prepubertal male subjects. Five boys all at Tanner stage 1 (ages 11-12 yr) and nine men (ages 20-26 yr) underwent an incremental cycle ergometry test to volitional exhaustion. FOR curves were determined from indirect calorimetry during the final 30 s of each increment. The same protocol was duplicated annually in the boys as they progressed through puberty. The peak FOR was considerably higher (P<0.05) in boys at Tanner 1 (8.6+/-1.5 mg.kg lean body mass(-1).min(-1)) (mean+/-SD) compared with men (4.2+/-1.1 mg.kg lean body mass(-1).min(-1)). FOR dropped as boys developed through puberty (Tanner 2/3 peak rate=7.6+/-0.6 mg.kg lean body mass(-1).min(-1); Tanner 4 peak rate=5.4+/-1.8 mg.kg lean body mass(-1).min(-1), main effect of Tanner stage; P<0.05) to the levels found in men (not significant). The exercise intensity that elicited peak FOR was higher in the boys at Tanner 1 [56+/-6% peak aerobic power (VO2 peak)] than in men (31+/-4% VO2 peak) (P<0.001). This value tended to decrease by Tanner stage 4 (45+/-10% VO2 peak, main effect of Tanner stage; P=0.06). We conclude that, compared with men, prepubertal boys have higher relative FOR throughout a wide range of exercise intensities and that FOR drops as boys develop through puberty.

Influence of age and pubertal status on substrate utilization during exercise with and without carbohydrate intake in healthy boys

Substrate utilization during exercise is known to differ between children and adults, but whether these differences are related to pubertal status is unclear. The objective of this study was to investigate the effects of pubertal status on endogenous (CHOendo) and orally ingested exogenous (CHOexo) carbohydrate and fat oxidation rates during exercise. Twenty boys at the same chronological age (12 y) were divided into three pubertal groups (pre-pubertal, PP: n=7; early-pubertal, EP: n=7; mid- to late-pubertal, M-LP: n=6) and consumed either a placebo or 13C-enriched 6% CHO drink while cycling for 60 min at approximately 70% of their maximal aerobic power (VO2 max). Another group of 14-year-old boys (pubertal, n=9) completed all procedures. Substrate utilization was calculated for the final 15 min of exercise using indirect calorimetry and stable isotope methodology. CHOexo decreased fat (p<0.001) and increased total CHO (p<0.001) oxidation, irrespective of group. Fat oxidation was higher (p=0.01) in younger boys than in older boys, but similar (p>or=0.33) among PP, EP, and M-LP boys. CHOexo contributed to approximately 30% of energy expenditure (EE) in PP and EP, but to only 24% in M-LP (p=0.02), which was identical to the older boys (24%). CHOexo oxidation rate as a percentage of EE was inversely related to testosterone levels (r=-0.51, p=0.005, n=29). It was concluded that reliance on CHOexo during exercise is particularly sensitive to pubertal status, with the highest oxidation rates observed in pre- and early-pubertal boys, independent of chronological age.

Accelerometry: a feasible method to quantify physical activity in ambulatory and nonambulatory adolescents with cerebral palsy.

Objective. To determine the feasibility of physical activity monitoring in adolescents with cerebral palsy (CP). Methods. A convenience sample of ambulatory and non-ambulatory adolescents (N = 23; 17 males, 6 females; mean age 13.5 y, SD 2.6 y; Gross Motor Function Classification System (GMFCS) distribution: n = 9 Level I, n = 5 Level II, n = 5 Level III, n = 4 Level IV) was recruited. Physical activity (PA) was objectively assessed using the ActiGraph GT1M activity monitor. Discomfort or adverse effects of wearing the accelerometers were recorded by participants. Levels of physical activity were determined as total PA, light PA (LPA), moderate PA (MPA), moderate-to-vigorous (MVPA), and vigorous PA (VPA) using cut-points recently validated for CP. Results. Most participants showed little reluctance. Mean daily MVPA for all participants was 30.7 minutes (SD 30.3), which corresponded to 2.7 (SD 2.4) minutes of MVPA per hour or 4.5% (SD 3.9) of the total monitoring time. Total PA and MVPA were greatest in ambulatory youth (GMFCS levels I and II) compared with youth who use a walking aid or wheelchair (GMFCS levels III and IV) (P < 0.05). Conclusion(s). The results support the use of the accelerometer as a feasible and useful measure of activity in ambulatory and nonambulatory adolescents with CP.

Immune responses to strenuous exercise and carbohydrate intake in boys and men.

Few studies describe immune responses to exercise in children, compared with adults, and none have investigated the influence of carbohydrate (CHO) intake. We hypothesized less perturbation and a faster recovery of the immune system with exercise in children, regardless of supplemental energy. Twelve boys (9.8 ± 0.1 y) and 10 men (22.1 ± 0.5 y) cycled for 60 min at 70% VO2max while drinking 6% CHO (CHO-T) or flavored water (FW-T). Blood samples were collected before (PRE), immediately after (POST), and 60 min after (REC) exercise. Boys, compared with men, had smaller (p < 0.05) increases in total leukocytes (28%versus 38%), natural killer (NK) cells (78%versus 236%), and NK T cells (42%versus 128%) at POST, averaged across beverage trials. Exercise did not increase tumor necrosis factor-α (TNF-α), but significantly (p < 0.05) increased IL-6 in men (189%), but not in boys (11%). In both trials, lymphocytes and T cells at REC were suppressed (p < 0.05), relative to PRE, in men (−21%), but not in boys (4%). IL-6 remained elevated (p < 0.001) in men at REC, with no change from POST in boys. In boys, but not in men, CHO significantly (p < 0.05) attenuated increases in neutrophil, lymphocyte, and NK cell counts at POST. Neutrophils at REC in CHO-T were lower (p < 0.05) than in FW-T in men (∼25%) and in boys (∼17%). CHO had no effect on TNF-α or IL-6 in either group. Our results indicate a distinct pattern of the immune response to exercise and CHO intake in boys, compared with men.