Rachel C. Colley

Active video games and health indicators in children and youth: a systematic review

Background Active video games (AVGs) have gained interest as a way to increase physical activity in children and youth. The effect of AVGs on acute energy expenditure (EE) has previously been reported; however, the influence of AVGs on other health-related lifestyle indicators remains unclear. Objective This systematic review aimed to explain the relationship between AVGs and nine health and behavioural indicators in the pediatric population (aged 0–17 years). Data sources Online databases (MEDLINE, EMBASE, psycINFO, SPORTDiscus and Cochrane Central Database) and personal libraries were searched and content experts were consulted for additional material. Data selection Included articles were required to have a measure of AVG and at least one relevant health or behaviour indicator: EE (both habitual and acute), adherence and appeal (i.e., participation and enjoyment), opportunity cost (both time and financial considerations, and adverse events), adiposity, cardiometabolic health, energy intake, adaptation (effects of continued play), learning and rehabilitation, and video game evolution (i.e., sustainability of AVG technology). Results 51 unique studies, represented in 52 articles were included in the review. Data were available from 1992 participants, aged 3–17 years, from 8 countries, and published from 2006–2012. Overall, AVGs are associated with acute increases in EE, but effects on habitual physical activity are not clear. Further, AVGs show promise when used for learning and rehabilitation within special populations. Evidence related to other indicators was limited and inconclusive. Conclusions Controlled studies show that AVGs acutely increase light- to moderate-intensity physical activity; however, the findings about if or how AVG lead to increases in habitual physical activity or decreases in sedentary behaviour are less clear. Although AVGs may elicit some health benefits in special populations, there is not sufficient evidence to recommend AVGs as a means of increasing daily physical activity.

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 (nu2009=u2009459) 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.

The association between accelerometer-measured patterns of sedentary time and health risk in children and youth: results from the Canadian Health Measures Survey

BackgroundSelf-reported screen time is associated with elevated health risk in children and youth; however, research examining the relationship between accelerometer-measured sedentary time and health risk has reported mixed findings. The purpose of this study was to examine the association between accelerometer-measured patterns of sedentary time and health risk in children and youth.MethodsThe results are based on 1,608 children and youth aged 6 to 19u2009years from the Canadian Health Measures Survey (2007–2009). Sedentary time was measured using the Actical accelerometer. Breaks in sedentary time and prolonged bouts of sedentary time lasting 20 to 120u2009minutes were derived for all days, weekend days and during the after-school period (i.e., after 3u2009pm on weekdays). Regression analyses were used to examine the association between patterns of sedentary time and body mass index (BMI), waist circumference, blood pressure and non-HDL cholesterol.ResultsBoys accumulated more sedentary time on weekdays after 3u2009pm and had a higher number of breaks in sedentary time compared to girls. Overweight/obese boys (aged 6–19u2009years) accumulated more sedentary time after 3u2009pm on weekdays (282 vs. 259u2009min, pu2009<u2009.05) and as prolonged bouts lasting at least 80u2009minutes (171 vs. 133u2009min, pu2009<u2009.05) compared to boys who were neither overweight nor obese. Prolonged bouts of sedentary time lasting at least 80u2009minutes accumulated after 3u2009pm on weekdays were positively associated with BMI and waist circumference in boys aged 11–14u2009years (pu2009<u2009.006). Each additional 60u2009min of sedentary time after 3u2009pm on weekdays was associated with a 1.4u2009kg·m-2 higher BMI and a 3.4u2009cm higher waist circumference in 11–14u2009year old boys. No sedentary pattern variables differed between girls who were not overweight or obese and those who were overweight/obese and none of the sedentary pattern variables were associated with any health markers in girls.ConclusionsThe findings confirm results of other studies that reported accelerometer-measured sedentary time was not associated with health risk in children and youth. Even when the pattern and timing of sedentary time was examined relative to health markers, few associations emerged and were limited to boys aged 11–14u2009years.

Patterns of sedentary time and cardiometabolic risk among Canadian adults.

OBJECTIVEnThe aim of this study is to examine the associations of total sedentary time and patterns of sedentary time with cardiometabolic biomarkers in a large representative sample of Canadian adults.nnnMETHODSnThe study is based on 4935 adults aged 20-79years, from the 2007/09 and 2009/11 Canadian Health Measures Survey. Total sedentary time, patterns of sedentary time (≥20minute prolonged sedentary bouts, number of sedentary breaks), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer-derived. Waist circumference, systolic and diastolic blood pressure, high-density lipoprotein (HDL) cholesterol, and C-reactive protein were measured. Triglycerides, low-density lipoprotein (LDL) cholesterol, insulin, and glucose were also measured in a fasting sub-sample (n=2551).nnnRESULTSnTotal sedentary time and time in ≥20minute prolonged sedentary bouts were associated with higher insulin and lower diastolic blood pressure levels (P<0.05). On average, each additional 10 breaks/day was associated with 0.83 (95%CI: 1.35, 0.31) cm lower waist circumference, 0.32 (0.62, 0.02) mmHg lower systolic blood pressure, 0.01 (0.00, 0.02) mmol/l higher HDL-cholesterol, 3.72 (1.34, 6.13) % lower triglycerides, 0.57 (0.23, 0.92) % lower glucose, and 4.19 (1.80, 6.63) % lower insulin.nnnCONCLUSIONnThese findings in a large representative sample of Canadian adults indicate that breaking up sedentary time may be particularly important for cardiometabolic health.

Prolonged sitting and markers of cardiometabolic disease risk in children and youth: a randomized crossover study.

OBJECTIVEnRecent evidence suggests that short bouts of uninterrupted sedentary behavior reduce insulin sensitivity and glucose tolerance while increasing triglyceride levels in both healthy and overweight/obese adults. To date no study has examined the acute impact of uninterrupted sitting in children and youth. The objective of the present study was to determine whether 8 h of uninterrupted sitting increases markers of cardiometabolic disease risk in healthy children and youth, in comparison to 8 h of sitting interrupted by light intensity walk breaks or structured physical activity.nnnMATERIALS/METHODSn11 healthy males and 8 healthy females between the ages of 10 and 14 years experienced 3 conditions in random order: (1) 8 h of uninterrupted sitting (Sedentary); (2) 8 h of sitting interrupted with a 2-min light-intensity walk break every 20 min (Breaks); and (3) 8 h of sitting interrupted with a 2-min light-intensity walk break every 20 min as well as 2×20 min of moderate-intensity physical activity (Breaks+Physical Activity). Insulin, glucose, triglyceride, HDL and LDL cholesterol area under the curve were calculated for each condition.nnnRESULTSnWe observed no significant differences in the area under the curve for any marker of cardiometabolic disease risk across the 3 study conditions (all p>0.09).nnnCONCLUSIONSnThese results suggest that in comparison to interrupted sitting or structured physical activity, a single bout of 8 h of uninterrupted sitting does not result in measurable changes in circulating levels of insulin, glucose, or lipids in healthy children and youth.

Creation of a reference dataset of neck sizes in children: standardizing a potential new tool for prediction of obesity-associated diseases?

BackgroundNeck circumference (NC), is an emerging marker of obesity and associated disease risk, but is challenging to use as a screening tool in children, as age and sex standardized cutoffs have not been determined. A population-based sample of NC in Canadian children was collected, and age- and sex-specific reference curves for NC were developed.MethodsNC, waist circumference (WC), weight and height were measured on participants aged 6–17 years in cycle 2 of the Canadian Health Measures Survey. Quantile regression of NC versus age in males and females was used to obtain NC percentiles. Linear regression was used to examine association between NC, body mass index (BMI) and WC. NC was compared in healthy weight (BMIu2009<u200985th percentile) and overweight/obese (BMIu2009>u200985th percentile) subjects.ResultsThe sample included 936 females and 977 males. For all age and sex groups, NC was larger in overweight/obese children (pu2009<u20090.0001). For each additional unit of BMI, average NC in males was 0.49xa0cm higher and in females, 0.43xa0cm higher. For each additional cm of WC, average NC in males was 0.18xa0cm higher and in females, 0.17xa0cm higher.ConclusionThis study presents the first reference data on Canadian children’s NC. The reference curves may have future clinical applicability in identifying children at risk of central obesity-associated conditions and thresholds associated with disease risk.

Body composition measured by dual-energy X-ray absorptiometry half-body scans in obese children

Aim:u2002 To perform a methods comparison of a left or right half‐body scan versus whole‐body scan for measuring body composition in a sample of obese children.

Proportion of preschool-aged children meeting the Canadian 24-Hour Movement Guidelines and associations with adiposity: results from the Canadian Health Measures Survey

BackgroundNew Canadian 24-Hour Movement Guidelines for the Early Years have been released in 2017. According to the guidelines, within a 24-h period, preschoolers should accumulate at least 180xa0min of physical activity (of which at least 60xa0min is moderate-to-vigorous physical activity), engage in no more than 1xa0h of screen time, and obtain between 10 and 13xa0h of sleep. This study examined the proportions of preschool-aged (3 to 4xa0years) Canadian children who met these new guidelines and different recommendations within the guidelines, and the associations with adiposity indicators.MethodsParticipants were 803 children (mean age: 3.5xa0years) from cycles 2–4 of the Canadian Health Measures Survey (CHMS), a nationally representative cross-sectional sample of Canadians. Physical activity was accelerometer-derived, and screen time and sleep duration were parent-reported. Participants were classified as meeting the overall 24-Hour Movement Guidelines if they met all three specific time recommendations for physical activity, screen time, and sleep. The adiposity indicators in this study were body mass index (BMI) z-scores and BMI status (World Health Organization Growth Standards).ResultsA total of 12.7% of preschool-aged children met the overall 24-Hour Movement Guidelines, and 3.3% met none of the three recommendations. A high proportion of children met the sleep duration (83.9%) and physical activity (61.8%) recommendations, while 24.4% met the screen time recommendation. No associations were found between meeting individual or combined recommendations and adiposity.ConclusionsVery few preschool-aged children in Canada (~13%) met all three recommendations contained within the 24-Hour Movement Guidelines. None of the combinations of recommendations were associated with adiposity in this sample. Future work should focus on identifying innovative ways to reduce screen time in this population, and should examine the associations of guideline adherence with health indicators other than adiposity.

Measurement of sedentary behaviour in population health surveys: a review and recommendations

Background The purpose of this review was to determine the most valid and reliable questions for targeting key modes of sedentary behaviour (SB) in a broad range of national and international health surveillance surveys. This was done by reviewing the SB modules currently used in population health surveys, as well as examining SB questionnaires that have performed well in psychometric testing. Methods Health surveillance surveys were identified via scoping review and contact with experts in the field. Previous systematic reviews provided psychometric information on pediatric questionnaires. A comprehensive search of four bibliographic databases was used to identify studies reporting psychometric information for adult questionnaires. Only surveys/studies published/used in English or French were included. Results The review identified a total of 16 pediatric and 18 adult national/international surveys assessing SB, few of which have undergone psychometric testing. Fourteen pediatric and 35 adult questionnaires with psychometric information were included. While reliability was generally good to excellent for questions targeting key modes of SB, validity was poor to moderate, and reported much less frequently. The most valid and reliable questions targeting specific modes of SB were combined to create a single questionnaire targeting key modes of SB. Discussion Our results highlight the importance of including SB questions in survey modules that are adaptable, able to assess various modes of SB, and that exhibit adequate reliability and validity. Future research could investigate the psychometric properties of the module we have proposed in this paper, as well as other questionnaires currently used in national and international population health surveys.

Physical Activity and Sedentary Behavior in Obese Youth

OBJECTIVEnTo determine whether directly measured physical activity and sedentary behavior patterns of obese children presenting to a weight-management clinic differs from nationally representative samples of obese and normal-weight children.nnnSTUDY DESIGNnA cross-sectional comparison study of 3 groups of boys and girls between 8 and 18 years (mean, 13.4 years) was performed. A clinical group (n=56) seeking specialized care for obesity was compared with 2 nationally representative samples of children from the Canadian Health Measures Survey (CHMS): (1) body mass index>95th percentile (n=143); and (2) body mass index<85th percentile (n=958).nnnRESULTSnObese clinical and obese CHMS boys did not differ in daily moderate-to-vigorous physical activity (MVPA). Both obese groups engaged in less MVPA than normal-weight boys in the CHMS (P<.0006). Compared with normal-weight boys, obese boys had fewer days in which they accrued 60 or 30 minutes of MVPA (P=.006 and .01, respectively). Daily MVPA did not differ among the 3 groups of girls. Light activity in clinical boys was lower than in the normal weight CHMS boys, whereas clinical girls engaged in less light activity than both CHMS comparators. No differences were observed between groups for sedentary behavior.nnnCONCLUSIONSnObese youth, whether in clinic or the community, were not more sedentary than their normal-weight CHMS comparators. Although obese youth were less active, overall MVPA was low in all groups. This finding highlights the need for health professionals to target both physical activity and sedentary behavior in all children, rather than focusing on only children with obesity.