Kim Meredith-Jones

Upright water-based exercise to improve cardiovascular and metabolic health: A qualitative review

Research regarding the benefits of exercise for cardiovascular and metabolic health is extensive and well-documented. However, weight-bearing exercise may not be suitable for individuals with orthopaedic or musculoskeletal limitations, excess adiposity or other medical conditions. Water-based exercise may provide an attractive alternative to land-based exercise for achieving improved health and fitness in these populations. Although swimming is a popular form of water-based exercise it requires specific skills and is often undertaken at intensities that may not be safely prescribed in patient populations. Therefore upright, water-based exercise has been suggested as a viable water-based alternative. However, surprisingly little is known about the effects of upright water-based exercise on improvements in cardiovascular and metabolic health. Limited evidence from water-based studies indicate that regular deep or shallow water exercise can exert beneficial effects on cardiorespiratory fitness, strength, and body fat distribution. However, the impacts of water-based exercise on lipid profile, bodyweight, and carbohydrate metabolism are still unclear. Further studies are warranted to establish the effects of non-swimming, water-based exercise on cardiometabolic risks in humans.

School playgrounds and physical activity policies as predictors of school and home time activity

BackgroundPrevious work has suggested that the number of permanent play facilities in school playgrounds and school-based policies on physical activity can influence physical activity in children. However, few comparable studies have used objective measures of physical activity or have had little adjustment for multiple confounders.MethodsPhysical activity was measured by accelerometry over 5 recess periods and 3 full school days in 441 children from 16 primary schools in Dunedin, New Zealand. The number of permanent play facilities (swing, fort, slide, obstacle course, climbing wall etc) in each school playground was counted on three occasions by three researchers following a standardized protocol. Information on school policies pertaining to physical activity and participation in organized sport was collected by questionnaire.ResultsMeasurement of school playgrounds proved to be reliable (ICC 0.89) and consistent over time. Boys were significantly more active than girls (P < 0.001), but little time overall was spent in moderate-vigorous physical activity (MVPA). Boys engaged in MVPA for 32 (SD 17) minutes each day of which 17 (10) took place at school compared with 23 (14) and 11 (7) minutes respectively in girls. Each additional 10-unit increase in play facilities was associated with 3.2% (95% CI 0.0-6.4%) more total activity and 8.3% (0.8-16.3%) more MVPA during recess. By contrast, school policy score was not associated with physical activity in children.ConclusionThe number of permanent play facilities in school playgrounds is associated with higher physical activity in children, whereas no relationship was observed for school policies relating to physical activity. Increasing the number of permanent play facilities may offer a cost-effective long-term approach to increasing activity levels in children.

Using motivational interviewing for weight feedback to parents of young children

To determine whether a single session of motivational interviewing (MI) for feedback of a childs overweight status promotes engagement in treatment following screening.

Challenges and Emerging Technologies within the Field of Pediatric Actigraphy

Actigraphy as an objective measure of sleep and wakefulness in infants and children has gained popularity over the last 20 years. However, the field lacks published guidelines for sleep–wake identification within pediatric age groups. The scoring rules vary greatly and although sensitivity (sleep agreement with polysomnography) is usually high, a significant limitation remains in relation to specificity (wake agreement). Furthermore, accurate algorithm output and sleep–wake summaries usually require prior entry from daily logs of sleep–wake periods and artifact-related information (e.g., non-wear time), involving significant parent co-operation. Scoring criteria for daytime naps remains an unexplored area. Many of the problems facing accuracy of measurement are inherent within the field of actigraphy itself, particularly where sleep periods containing significant movements are erroneously classified as wake, and within quiet wakefulness when no movements are detected, erroneously classified as sleep. We discuss the challenges of actigraphy for pediatric sleep, briefly describe the technical basis and consider a number of technological approaches that may facilitate improved classification of errors in sleep–wake discrimination.

A Tailored Family-Based Obesity Intervention: A Randomized Trial

OBJECTIVE: To determine whether a 2-year family-based intervention using frequent contact and limited expert involvement was effective in reducing excessive weight compared with usual care. METHODS: Two hundred and six overweight and obese (BMI ≥85th percentile) children aged 4 to 8 years were randomized to usual care (UC) or tailored package (TP) sessions at university research rooms. UC families received personalized feedback and generalized advice regarding healthy lifestyles at baseline and 6 months. TP families attended a single multidisciplinary session to develop specific goals suitable for each family, then met with a mentor each month for 12 months, and every third month for another 12 months to discuss progress and provide support. Outcome measurements (anthropometry, questionnaires, dietary intake, accelerometry) were obtained at 0, 12, and 24 months. RESULTS: BMI at 24 months was significantly lower in TP compared with UC children (difference, 95% confidence interval: –0.34, –0.65 to –0.02), as was BMI z score (–0.12, –0.20 to –0.04) and waist circumference (–1.5, –2.5 to –0.5 cm). TP children consumed more fruit and vegetables (P = .038) and fewer noncore foods (P = .020) than UC children, and fewer noncore foods were available in the home (P = .002). TP children were also more physically active (P = .035). No differences in parental feeding practices, parenting, quality of life, child sleep, or behavior were observed. CONCLUSIONS: Frequent, low-dose support was effective for reducing excessive weight in predominantly mild to moderately overweight children over a 2-year period. Such initiatives could feasibly be incorporated into primary care.

The Effect of Water-Based Exercise on Glucose and Insulin Response in Overweight Women: A Pilot Study

OBJECTIVE The aim of this study was to investigate the effectiveness of a 12-week moderate intensity, water-based circuit-type training intervention on glucose and insulin responses in overweight women with normal or impaired glucose tolerance. METHODS Fifteen overweight women (body mass index [BMI] > 25 kg/m(2)) with normal glucose tolerance (NGT; n = 7) or impaired glucose tolerance (IGT; n = 8) were recruited for this study. All women completed a 12-week training intervention utilizing a combination of aerobic and resistance exercises in an aquatic environment, 3 days per week and 60 min per session at 70-75% mode-specific maximum heart rate. A standard 75-g oral glucose tolerance test (OGTT) was administered pre- and post-intervention, from which fasting and post-load plasma insulin and glucose levels were assessed. RESULTS Following the 12-week period, fasting insulin levels had decreased by 44% and 2-h glucose by 30.4% in the group with IGT. Waist circumference (WC) had decreased by 5.3% in this group at the end of the intervention. Only WC and waist-to-hip ratio (WHR) decreased (6.0% and 5.5%, respectively) following the intervention in the NGT group. CONCLUSIONS Moderate intensity, water-based circuit-type exercises appear to be an effective exercise modality to improve glucose and insulin response to a glucose challenge in overweight women with IGT.

24 h Accelerometry: impact of sleep-screening methods on estimates of sedentary behaviour and physical activity while awake

Abstract Although accelerometers can assess sleep and activity over 24 h, sleep data must be removed before physical activity and sedentary time can be examined appropriately. We compared the effect of 6 different sleep-scoring rules on physical activity and sedentary time. Activity and sleep were obtained by accelerometry (ActiGraph GT3X) over 7 days in 291 children (51.3% overweight or obese) aged 4–8.9 years. Three methods removed sleep using individualised time filters and two methods applied standard time filters to remove sleep each day (9 pm–6 am, 12 am–6 am). The final method did not remove sleep but simply defined non-wear as at least 60 min of consecutive zeros over the 24-h period. Different methods of removing sleep from 24-h data markedly affect estimates of sedentary time, yielding values ranging from 556 to 1145 min/day. Estimates of non-wear time (33–193 min), wear time (736–1337 min) and counts per minute (384–658) also showed considerable variation. By contrast, estimates of moderate-to-vigorous activity (MVPA) were similar, varying by less than 1 min/day. Different scoring methods to remove sleep from 24-h accelerometry data do not affect measures of MVPA, whereas estimates of counts per minute and sedentary time depend considerably on which technique is used.

What factors influence uptake into family-based obesity treatment after weight screening?

OBJECTIVES To determine what factors drive participation in a family-based weight management program for 4- to 8-year-old children following screening for overweight or obesity. STUDY DESIGN Children (n = 1093) attended a comprehensive screening appointment where parents completed questionnaires on demographics, motivation for healthy lifestyles, feeding practices, and beliefs about child size, prior to feedback about the childs weight. Parents of overweight or obese children (body mass index ≥85th percentile) attended a follow-up interview to assess reactions to feedback and willingness to participate in a 2-year intervention. RESULTS A total of 271 (24.8%) children were overweight or obese with 197 (72.7%) agreeing to the intervention. Socioeconomic status differed in intervention participants (n = 197) compared with non-participants (n = 74), whereas no differences were observed in parental feeding practices, ineffective parenting practices, or self-determined forms of motivation. However, fewer non-participating parents believed their child to be overweight (23% vs 49%, P < .001) or were concerned about it (16% vs 43%, P < .001), despite children having an average body mass index approximating the 95th percentile. Non-participating parents did not expect their child to be overweight (P = .002) and rated receiving this information as less useful (P = .008) than participating parents. CONCLUSION Preconceptions about child weight and reactions to feedback determined intervention uptake more than parenting or motivation for health. Many parents agreed to participate in the intervention despite not viewing their child as overweight.

The Association between Parent Diet Quality and Child Dietary Patterns in Nine- to Eleven-Year-Old Children from Dunedin, New Zealand

Previous research investigating the relationship between parents’ and children’s diets has focused on single foods or nutrients, and not on global diet, which may be more important for good health. The aim of the study was to investigate the relationship between parental diet quality and child dietary patterns. A cross-sectional survey was conducted in 17 primary schools in Dunedin, New Zealand. Information on food consumption and related factors in children and their primary caregiver/parent were collected. Principal component analysis (PCA) was used to investigate dietary patterns in children and diet quality index (DQI) scores were calculated in parents. Relationships between parental DQI and child dietary patterns were examined in 401 child-parent pairs using mixed regression models. PCA generated two patterns; ‘Fruit and Vegetables’ and ‘Snacks’. A one unit higher parental DQI score was associated with a 0.03SD (CI: 0.02, 0.04) lower child ‘Snacks’ score. There was no significant relationship between ‘Fruit and Vegetables’ score and parental diet quality. Higher parental diet quality was associated with a lower dietary pattern score in children that was characterised by a lower consumption frequency of confectionery, chocolate, cakes, biscuits and savoury snacks. These results highlight the importance of parental modelling, in terms of their dietary choices, on the diet of children.

Agreement between parental perception of child weight status and actual weight status is similar across different ethnic groups in New Zealand

INTRODUCTION Accurate parental perception of their childs weight is poor. Accuracy may be influenced by differences in ethnicity but this is currently unknown. AIM To determine whether agreement between parental perception of child weight status and actual child weight status differs according to ethnic group (NZ European, Māori, Pacific, Asian), and to investigate whether it is influenced by various demographic and behavioural factors. METHODS A total of 1093 children (4-8 years old) attended a weight screening initiative. Parents completed questionnaires on demographics, beliefs about child weight, parenting style, parental feeding practices and social desirability. Actual measured weight status was compared with parental perception of weight status (underweight, normal weight, overweight). RESULTS Agreement about child weight status was apparent in 85% of NZ European, 84% of Māori, 82% of Pacific and 88% of Asian children. However, adjusting for chance led to kappas of 0.34, 0.38, 0.41 and 0.53, respectively, indicating only fair-to-moderate agreement. Overall, agreement between measured body mass index and parental perception was not related to ethnic group, child sex and age, maternal age and education, and household deprivation (k ranged from 0.16 to 0.47). However, agreement about weight status was higher in parents who reported higher levels of restrictive feeding than in parents who reported less restriction (P < 0.01) but agreement was only fair. CONCLUSION Agreement between parental perception and actual weight status was fair and did not differ between the ethnic groups examined.