Tiago V. Barreira

Effect of Pedometer-Based Physical Activity Interventions: A Meta-Analysis.

CRD summary The review concluded that pedometers had a moderate positive effect on physical activity of approximately 2,000 steps per day compared with comparator. There were greater effects in females and the intervention strategy of 10,000 steps/day as a goal. Given uncertain quality of the included studies and a lack of study detail, caution is required when interpreting the authors’ conclusions.

The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): design and methods

BackgroundThe primary aim of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was to determine the relationships between lifestyle behaviours and obesity in a multi-national study of children, and to investigate the influence of higher-order characteristics such as behavioural settings, and the physical, social and policy environments, on the observed relationships within and between countries.Methods/designThe targeted sample included 6000 10-year old children from 12 countries in five major geographic regions of the world (Europe, Africa, the Americas, South-East Asia, and the Western Pacific). The protocol included procedures to collect data at the individual level (lifestyle, diet and physical activity questionnaires, accelerometry), family and neighborhood level (parental questionnaires), and the school environment (school administrator questionnaire and school audit tool). A standard study protocol was developed for implementation in all regions of the world. A rigorous system of training and certification of study personnel was developed and implemented, including web-based training modules and regional in-person training meetings.DiscussionThe results of this study will provide a robust examination of the correlates of adiposity and obesity in children, focusing on both sides of the energy balance equation. The results will also provide important new information that will inform the development of lifestyle, environmental, and policy interventions to address and prevent childhood obesity that may be culturally adapted for implementation around the world. ISCOLE represents a multi-national collaboration among all world regions, and represents a global effort to increase research understanding, capacity and infrastructure in childhood obesity.

Validity and reliability of omron pedometers for prescribed and self-paced walking

PURPOSE The purpose of this study was to examine the validity and reliability evidence for the Omron Healthcare HJ-151 and HJ-720ITC pedometers for prescribed and self-paced walking. METHODS A total of 47 adults (24 males, 23 females; age = 24 +/- 4.4 yr.; body mass index = 25.7 +/- 4.2 kg x m(-2)) participated in this study. Under prescribed walking conditions, 34 participants completed three randomized 100-m walking trials through a range of scripted walking speeds (slow, moderate, and very brisk) for each pedometer model. Under self-paced walking conditions, 31 participants completed one 1-mile walk on a standardized course for each model. HJ-151 pedometers were chosen at random from a pool of 54 devices and were worn along the waistband at the right hip, the left hip, and the midback, whereas HJ-720ITC pedometers were chosen from a pool of 24 devices and incorporated right pocket, left pocket, and backpack positions in addition to the three waist-mounted sites. Absolute percent error (APE) scores were calculated to examine pedometer accuracy between actual steps (a criterion measure) and pedometer-determined steps. Coefficient of variation (CoV) was computed to describe interdevice reliability. RESULTS With the exception of the HJ-720ITC at the backpack position in the prescribed walking setting (mean APE = 3.4%), the HJ-151 and the HJ-720ITC accurately reported step counts under prescribed and self-paced conditions (all APE values <3.0%). Moreover, interdevice reliability evidence was established for the HJ-151 and the HJ-720ITC under prescribed and self-paced conditions (all CoV values <2.1%). CONCLUSIONS The Omron HJ-151 and HJ-720ITC pedometers demonstrated validity and reliability at various mounting positions under prescribed and self-paced walking conditions with both healthy and overweight adults.

Fully automated waist-worn accelerometer algorithm for detecting children’s sleep-period time separate from 24-h physical activity or sedentary behaviors

Analysis of 24-h waist-worn accelerometer data for physical activity and sedentary behavior requires that sleep-period time (from sleep onset to the end of sleep, including all sleep epochs and wakefulness after onset) is first identified. To identify sleep-period time in children in this study, we evaluated the validity of a published automated algorithm that requires nonaccelerometer bed- and wake-time inputs, relative to a criterion expert visual analysis of minute-by-minute waist-worn accelerometer data, and validated a refined fully automated algorithm. Thirty grade 4 schoolchildren (50% girls) provided 24-h waist-worn accelerometry data. Expert visual inspection (criterion), a published algorithm (Algorithm 1), and 2 additional automated refinements (Algorithm 2, which draws on the instruments inclinometer function, and Algorithm 3, which focuses on bedtime and wake time points) were applied to a standardized 24-h time block. Paired t tests were used to evaluate differences in mean sleep time (expert criterion minus algorithm estimate). Compared with the criterion, Algorithm 1 and Algorithm 2 significantly overestimated sleep time by 43 min and 90 min, respectively. Algorithm 3 produced the smallest mean difference (2 min), and was not significantly different from the criterion. Relative to expert visual inspection, our automated Algorithm 3 produced an estimate that was precise and within expected values for similarly aged children. This fully automated algorithm for 24-h waist-worn accelerometer data will facilitate the separation of sleep time from sedentary behavior and physical activity of all intensities during the remainder of the day.

Identifying children's nocturnal sleep using 24-h waist accelerometry.

PURPOSE The purposes of this study were 1) to add layers and features to a previously published fully automated algorithm designed to identify childrens nocturnal sleep and to exclude episodes of nighttime nonwear/wakefulness and potentially misclassified daytime sleep episodes and 2) to validate this refined sleep algorithm (RSA) against sleep logs. METHODS Forty-five fourth-grade school children (51% female) participants were asked to log evening bedtime and morning wake time and wear an ActiGraph GT3X+ (ActiGraph LLC, Pensacola, FL) accelerometer at their waist for seven consecutive days. Accelerometers were distributed through a single school participating in the Baton Rouge, USA, site of the International Study of Childhood Obesity, Lifestyle, and the Environment. We compared log-based variables of sleep period time (SPT), bedtime, and wake time to corresponding accelerometer-determined variables of total sleep episode time, sleep onset, and sleep offset estimated with the RSA. In addition, SPT and sleep onset estimated using standard procedures combining sleep logs and accelerometry (Log + Accel) were compared to the RSA-derived values. RESULTS RSA total sleep episode time (540 ± 36 min) was significantly different from Log SPT (560 ± 24 min), P = 0.003, but not different from Log + Accel SPT (549 ± 24 min), P = 0.15. Significant and moderately high correlations were apparent between RSA-determined variables and those using the other methods (r = 0.61 to 0.74). There were no differences between RSA and Log + Accel estimates of sleep onset (P = 0.15) or RSA sleep offset and log wake time (P = 0.16). CONCLUSIONS The RSA is a refinement of our previous algorithm, allowing researchers who use a 24-h waist-worn accelerometry protocol to distinguish childrens nocturnal sleep (including night time wake episodes) from daytime activities.

Anthropometric Correlates of Total Body Fat, Abdominal Adiposity, and Cardiovascular Disease Risk Factors in a Biracial Sample of Men and Women

OBJECTIVE To investigate associations between anthropometric measurements and total body fat, abdominal adipose tissue, and cardiovascular disease risk factors in a large biracial sample. PATIENTS AND METHODS This study is limited to cross-sectional analyses of data from participants attending a baseline visit between January 26, 1996, and February 1, 2011. The sample included 2037 individuals aged 18 to 69 years: 488 African American women (24%), 686 white women (34%), 196 African American men (9%), and 667 white men (33%). Anthropometry included weight; hip circumference; waist circumference; waist-hip, waist-height, and weight-height ratios; body adiposity index; and body mass index. Body fat and percentage of fat were measured by dual-energy x-ray absorptiometry, and abdominal visceral and subcutaneous adipose tissue were measured by computed tomography. Bivariate correlations, logistic regression models, and receiver operator characteristic curves were used, and analyses were stratified by sex and race. RESULTS In each sex-by-race group, all anthropometric measures were highly correlated with percentage of fat, fat mass, and subcutaneous adipose tissue and moderately correlated with visceral adipose tissue, with the exception of the waist-hip ratio. The odds of having an elevated cardiometabolic risk were increased more than 2-fold per SD increase for most anthropometric variables, and the areas under the curve for each anthropometric measure were significantly greater than 0.5. CONCLUSION Several common anthropometric measures were moderately to highly correlated with total body fat, abdominal fat, and cardiovascular disease risk factors in a biracial sample of women and men. This comprehensive analysis provides evidence of the linkage between simple anthropometric measurements and the purported pathways between adiposity and health.

How Many Days Are Enough? A Study of 365 Days of Pedometer Monitoring

This study was designed to determine the number of days of pedometer monitoring necessary to achieve reliable and valid estimates of a 1-year average of step counts in adults based on either consecutive days (CD) or random days (RD) of data collection. Twenty-three participants (16 women; M age = 38 years, SD = 9.9) wore a Yamax SW 200 pedometer and recorded their step counts for 365 consecutive days. Nine measurement periods of various lengths were selected (2, 3, 4, 5, 6, 7, 14, 21, and 30 days). Each measurement period was randomly selected 10 times each for CD and RD from the larger database. For reliability and validity, two-way intraclass correlation coefficients and mean absolute percentage error (MAPE) were calculated, respectively. The year-round average was considered the criterion measure of the “true” habitual physical activity. Data were analyzed separately by CD and RD. At least 5 CD or 6 RD were necessary to achieve an ICC of .80. A minimum of 30 CD or 14 RD were necessary to achieve an MAPE lower than 10%. These findings provide researchers and practitioners with useful information to determine appropriate measurement length and the method of data selection based on a desired level of reliability and validity.

Physical Activity, Sedentary Time, and Obesity in an International Sample of Children

PURPOSE To determine the relationships between moderate-to-vigorous physical activity (MVPA), vigorous physical activity (VPA), sedentary time, and obesity in children from 12 countries representing a wide range of human development. METHODS The sample included 6539 children age 9-11 yr. Times in MVPA, VPA, and sedentary behaviors were assessed by accelerometry. The body mass index (BMI; kg·m) was used to classify children as obese based on z-scores (> +2 SD) from World Health Organization reference data. RESULTS The mean (SD) times spent in MVPA, VPA, and sedentary behavior were 60 (25) min·d, 18 (11) min·d, and 513 (69) min·d, respectively. The overall proportion of the sample that was obese ranged from 5.2% to 24.6% across sites. The odds ratios for obesity were significant for MVPA (0.49; 95% CI, 0.44-0.55), VPA (0.41; 0.37-0.46), and sedentary time (1.19; 1.08-1.30) in the overall sample. The associations of MVPA and VPA with obesity were significant in all 12 sites, whereas the association between sedentary time and obesity was significant in five of the 12 sites. There was a significant difference in BMI z-scores across tertiles of MVPA (P < 0.001) but not across tertiles of sedentary time in a mutually adjusted model. The results of receiver operating characteristic curve analyses for obesity indicated that the optimal thresholds for MVPA (area under the curve [AUC], 0.64), VPA (AUC, 0.67) and sedentary behavior (AUC, 0.57) were 55 (95% CI, 50-64) min·d, 14 (11-16) min·d, and 482 (455-535) min·d, respectively. CONCLUSIONS Greater MVPA and VPA were both associated with lower odds of obesity independent of sedentary behavior. Sedentary time was positively associated with obesity, but not independent of MVPA. Attaining at least 55 min·d of MVPA is associated with lower obesity in this multinational sample of children, which supports current guidelines.

Correlates of Total Sedentary Time and Screen Time in 9–11 Year-Old Children around the World: The International Study of Childhood Obesity, Lifestyle and the Environment

Purpose Previously, studies examining correlates of sedentary behavior have been limited by small sample size, restricted geographic area, and little socio-cultural variability. Further, few studies have examined correlates of total sedentary time (SED) and screen time (ST) in the same population. This study aimed to investigate correlates of SED and ST in children around the world. Methods The sample included 5,844 children (45.6% boys, mean age = 10.4 years) from study sites in Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Child- and parent-reported behavioral, household, and neighborhood characteristics and directly measured anthropometric and accelerometer data were obtained. Twenty-one potential correlates of SED and ST were examined using multilevel models, adjusting for sex, age, and highest parental education, with school and study site as random effects. Variables that were moderately associated with SED and/or ST in univariate analyses (p<0.10) were included in the final models. Variables that remained significant in the final models (p<0.05) were considered correlates of SED and/or ST. Results Children averaged 8.6 hours of daily SED, and 54.2% of children failed to meet ST guidelines. In all study sites, boys reported higher ST, were less likely to meet ST guidelines, and had higher BMI z-scores than girls. In 9 of 12 sites, girls engaged in significantly more SED than boys. Common correlates of higher SED and ST included poor weight status, not meeting physical activity guidelines, and having a TV or a computer in the bedroom. Conclusions In this global sample many common correlates of SED and ST were identified, some of which are easily modifiable (e.g., removing TV from the bedroom), and others that may require more intense behavioral interventions (e.g., increasing physical activity). Future work should incorporate these findings into the development of culturally meaningful public health messages.

Body adiposity index, body mass index, and body fat in white and black adults.

To the Editor: Body mass index (BMI) is widely used as a proxy for body fat and has been shown to correlate with other measures of adiposity.1 However, its use is limited by differences in body fatness for a given BMI across age, sex, and race.2–3 To address this limitation, Bergman et al. developed the body adiposity index (BAI) in samples of Mexican-Americans and blacks.4 However, no sex-specific information was provided, and it is unknown how well BAI performs in whites. We investigated the sex-specific relationship between both BMI and BAI and body fat in white and black adults.