Showing papers by "John J. Reilly published in 2017"

Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep.

Abstract: The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period). The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the relationships within and among movement behaviours and several health indicators were completed and interpreted by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the guidelines, and the framework that was applied to develop the recommendations, followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546), 10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft guidelines and their dissemination. The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (<1 year), toddlers (1–2 years) and preschoolers (3–4 years) should achieve for a healthy day (24 h). Proactive dissemination, promotion, implementation, and evaluation plans were prepared to optimize uptake and activation of the new guidelines. These guidelines represent a sensible evolution of public health guidelines whereby optimal health is framed within the balance of movement behaviours across the whole day, while respecting preferences of end-users. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.

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

Abstract: The purpose of this systematic review was to examine the relationships between sedentary behaviour (SB) and health indicators in children aged 0 to 4 years, and to determine what doses of SB (i.e., duration, patterns [frequency, interruptions], and type) were associated with health indicators. Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, 1 month to 4.99 years), intervention/exposure and comparator (durations, patterns, and types of SB), and outcome/health indicator (critical: adiposity, motor development, psychosocial health, cognitive development; important: bone and skeletal health, cardiometabolic health, fitness, risks/harm). The quality of the evidence was assessed by study design and outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Due to heterogeneity, meta-analyses were not possible; instead, narrative syntheses were conducted, structured around the health indicator and type of SB. A total of 96 studies were included (195,430 participants from 33 countries). Study designs were: randomized controlled trial (n = 1), case-control (n = 3), longitudinal (n = 25), longitudinal with additional cross-sectional analyses (n = 5), and cross-sectional (n = 62). Evidence quality ranged from “very low” to “moderate”. Associations between objectively measured total sedentary time and indicators of adiposity and motor development were predominantly null. Associations between screen time and indicators of adiposity, motor or cognitive development, and psychosocial health were primarily unfavourable or null. Associations between reading/storytelling and indicators of cognitive development were favourable or null. Associations between time spent seated (e.g., in car seats or strollers) or in the supine position, and indicators of adiposity and motor development, were primarily unfavourable or null. Data were scarce for other outcomes. These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years, but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling. Additional high-quality research using valid and reliable measures is needed to more definitively establish the relationships between durations, patterns, and types of SB and health indicators, and to provide insight into the appropriate dose of SB for optimal health in the early years.

Health impact of catch‐up growth in low‐birth weight infants: systematic review, evidence appraisal, and meta‐analysis

Abstract: This study aimed to systematically review and appraise evidence on the short-term (e.g. morbidity, mortality) and long-term (obesity and non-communicable diseases, NCDs) health consequences of catch-up growth (versus no catch-up growth) in individuals with a history of low birth weight (LBW).We searched MEDLINE, EMBASE, Global Health, CINAHL plus, Cochrane Library, ProQuest Dissertations and Thesis, and reference lists. Study quality was assessed using the risk of bias assessment tool from the Agency for Health Care Research and Quality, and the evidence base was assessed using the GRADE tool. Eight studies in 7 cohorts (2 from high-income countries, 5 from low-middle income countries) met the inclusion criteria for short-term (mean age: 13.4 months) and/or longer-term (mean age: 11.1 years) health outcomes of catch-up growth which had occurred by 24 or 59 months. Of 5 studies on short-term health outcomes, 3 found positive associations between weight catch-up growth and body mass and/or glucose metabolism; 1 suggested reduced risk of hospitalisation and mortality with catch-up growth. Three studies on longer-term health outcomes found catch-up growth was associated with higher body mass, BMI, or cholesterol. GRADE assessment suggested that evidence quantity and quality were low. Catch-up growth following LBW may have benefits for the individual with LBW in the short term, and may have adverse population health impacts in the long-term, but the evidence is limited. Future cohort studies could address the question of the consequences of catch-up growth following LBW more convincingly, with a view to informing future prevention of obesity and NCDs.

Accelerometer measured levels of moderate-to-vigorous intensity physical activity and sedentary time in children and adolescents with chronic disease: a systematic review and meta-analysis

Abstract: Context Moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) are important for child and adolescent health. Objective To examine habitual levels of accelerometer measured MVPA and ST in children and adolescents with chronic disease, and how these levels compare with healthy peers. Methods Data sources: An extensive search was carried out in Medline, Cochrane library, EMBASE, SPORTDiscus and CINAHL from 2000–2017. Study selection: Studies with accelerometer-measured MVPA and/or ST (at least 3 days and 6 hours/day to provide estimates of habitual levels) in children 0–19 years of age with chronic diseases but without co-morbidities that would present major impediments to physical activity. In all cases patients were studied while well and clinically stable. Results Out of 1592 records, 25 studies were eligible, in four chronic disease categories: cardiovascular disease (7 studies), respiratory disease (7 studies), diabetes (8 studies), and malignancy (3 studies). Patient MVPA was generally below the recommended 60 min/day and ST generally high regardless of the disease condition. Comparison with healthy controls suggested no marked differences in MVPA between controls and patients with cardiovascular disease (1 study, n = 42) and type 1 diabetes (5 studies, n = 400; SMD -0.70, 95% CI -1.89 to 0.48, p = 0.25). In patients with respiratory disease, MVPA was lower in patients than controls (4 studies, n = 470; SMD -0.39, 95% CI -0.80, 0.02, p = 0.06). Meta-analysis indicated significantly lower MVPA in patients with malignancies than in the controls (2 studies, n = 90; SMD -2.2, 95% CI -4.08 to -0.26, p = 0.03). Time spent sedentary was significantly higher in patients in 4/10 studies compared with healthy control groups, significantly lower in 1 study, while 5 studies showed no significant group difference. Conclusions MVPA in children/adolescents with chronic disease appear to be well below guideline recommendations, although comparable with activity levels of their healthy peers except for children with malignancies. Tailored and disease appropriate intervention strategies may be needed to increase MVPA and reduce ST in children and adolescents with chronic disease.

Sedentary time, physical activity and compliance with IOM recommendations in young children at childcare

Abstract: The aim of this study was to report patterns of sitting, standing and physical activity (PA) and compliance with Institute of Medicine (IOM) recommendations for sedentary behavior (SB) and PA among children aged 1 to 5 years at childcare, and examine sociodemographic variations. Sitting, standing and PA time was assessed using an activPAL inclinometer over a period of 1 to 5 days in 301 children (49% boys; mean age = 3.7 ± 1.0 years) across 11 childcare services in Illawarra, NSW, Australia. Breaks and bouts of sitting and standing were calculated and categorized. Height and weight were assessed and parents completed a demographic survey. Differences by sex, age category (< 3 vs ≥ 3 years), weight status and SES were examined. Children spent 48.4% of their time at childcare sitting, 32.5% standing, and 19.1% in PA. Boys spent significantly more time in PA compared to girls (20.8% vs 17.7%; P = 0.003). Toddlers (< 3 years) spent significantly more time in PA compared to preschoolers (≥ 3 years) (22.2% vs 18.3%; P < 0.001). Children who were underweight spent significantly more time sitting compared with their overweight peers (52.4% vs 46.8%; P = 0.003). 56% and 16% of children met the IOM SB and PA recommendations, respectively. Girls (odds ratio [OR]; 95%CI = 0.26; 0.13 to 0.55) and preschoolers (0.16; 0.07 to 0.38) were less likely to meet the IOM PA recommendation compared to boys and toddlers. Young children spent ~ 50% of their time at childcare sitting. Girls and preschoolers sit more and are less likely to meet PA recommendations, making them important groups to target in future interventions.

Longitudinal Associations Between Childhood Obesity and Academic Achievement: Systematic Review with Focus Group Data.

Abstract: The purposes of this study were to review the evidence on longitudinal associations between child and adolescent obesity and academic achievement and to provide perceptions of adolescents with obesity and their parents on this topic. Synthesis of 31 studies (from 17 cohorts) suggested that relationships between obesity and academic achievement are not well established, except for adolescent girls’ maths attainment, potentially mediated by both weight-related bullying and executive cognitive functions. Focus groups with adolescent girls with obesity confirmed experiences of psychosocial distress at school particularly during Physical Education. Adolescents perceived that obesity was not related to academic achievement directly, but by their attitude to school. Interventions are warranted to promote psychosocial wellbeing and cognitive abilities linked to academic achievement in adolescent girls with obesity. Physical Education should be a positive experience for children and adolescents with obesity.

Longitudinal study of the associations between change in sedentary behavior and change in adiposity during childhood and adolescence: Gateshead Millennium Study.

Abstract: Longitudinal study of the associations between change in sedentary behavior and change in adiposity during childhood and adolescence: Gateshead Millennium Study

Pragmatic evaluation of the Go2Play Active Play intervention on physical activity and fundamental movement skills in children

Abstract: Active play is a novel approach to addressing low physical activity levels and fundamental movement skills (FMS) in children This study aimed to determine if a new school-based, ‘Go2Play Active Play’ intervention improved school day physical activity and FMS This was a pragmatic evaluation conducted in Scotland during 2015–16 Participants (n = 172; mean age = 7 years) were recruited from seven primary schools taking part in the 5-month intervention, plus 24 participants not receiving the intervention were recruited to act as a comparison group189 participants had physical activity measured using an Actigraph GT3X accelerometer at baseline and again at follow-up 5 months later A sub-sample of participants from the intervention (n = 102) and comparison (n = 21) groups had their FMS assessed using the Test of Gross Motor Development (TGMD-2) at baseline and follow-up Changes in school day physical activity and FMS variables were examined using repeated measures ANOVA The main effect was ‘group’ on ‘time’ from baseline to follow-up Results indicated there was a significant interaction for mean counts per minute and percent time in sedentary behavior, light intensity physical activity and moderate to vigorous physical activity (MVPA) (all p < 001) for school day physical activity There was a significant interaction for gross motor quotient (GMQ) score (p = 002) and percentile (p = 004), locomotor skills score and percentile (both p = 002), but no significant interaction for object control skills score (p = 01) and percentile (p = 03) The Go2Play Active Play intervention may be a promising way of improving physical activity and FMS but this needs to be confirmed in an RCT

Mothers' perceptions of child weight status and the subsequent weight gain of their children: a population-based longitudinal study.

Abstract: Mothers' perceptions of child weight status and the subsequent weight gain of their children: a population-based longitudinal study

Wrist Accelerometer Cut Points for Classifying Sedentary Behavior in Children

Abstract: Introduction: To examine the validity and accuracy of wrist accelerometers for classifying sedentary behavior (SB) in children. Methods: Fifty-seven children (5-8y and 9-12y) completed a ~170min protocol including 15 semi-structured activities and transitions. Nine ActiGraph (GT3X+) and two GENEActiv wrist cut-points were evaluated. Direct observation was the criterion measure. The accuracy of wrist cut-points was compared to that achieved by the ActiGraph hip cut-point (≤25 counts/15s) and the thigh-mounted activPAL3™. Analyses included equivalence testing, Bland-Altman procedures and area under the receiver operating curve (ROC-AUC). Results: The most accurate ActiGraph wrist cut-points (Kim, vector magnitude: ≤3958 counts/60s and vertical axis: ≤1756 counts/60s) demonstrated good classification accuracy (ROC-AUC = 0.85-0.86) and accurately estimated SB time in 5-8y (equivalence p=0.02; mean bias: 4.1%, limits of agreement [LoA]: -20.1-28.4%) and 9-12y (equivalence p 0.05) and classification accuracy (ROC-AUC = 0.79-0.80) was lower than for ActiGraph hip and activPAL3™. Conclusion: The most accurate SB ActiGraph (Kim) and GENEActiv (Schaefer) wrist cut-points can be applied in children with similar confidence as the ActiGraph hip cut-point (≤25 counts/15s), although activPAL3™ was generally more accurate.

Associations of Vigorous-intensity Physical Activity with Biomarkers in Youth

Abstract: IntroductionPhysical activity (PA) conveys known cardiometabolic benefits to youth, but the contribution of vigorous-intensity PA (VPA) to these benefits is unknown. Therefore, we sought to determine (a) the associations between VPA and cardiometabolic biomarkers independent of moderate-inte

Wrist Acceleration Cut Points for Moderate-to-Vigorous Physical Activity in Youth

Abstract: Purpose This study aimed to examine the validity of wrist acceleration cut points for classifying moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) physical activity. Methods Fifty-seven children (5-12 yr) completed 15 semistructured activities. Three sets of wrist cut points (>192 mg, >250 mg, and >314 mg), previously developed using Euclidian norm minus one (ENMO 192+), GENEActiv software (GENEA 250+), and band-pass filter followed by Euclidian norm (BFEN 314+), were evaluated against indirect calorimetry. Analyses included classification accuracy, equivalence testing, and Bland-Altman procedures. Results All cut points classified MPA, VPA, and MVPA with substantial accuracy (ENMO 192+: κ = 0.72 [95% confidence interval = 0.72-0.73], MVPA: area under the receiver operating characteristic curve (ROC-AUC) = 0.85 [0.85-0.86]; GENEA 250+: κ = 0.75 [0.74-0.76], MVPA: ROC-AUC = 0.85 [0.85-0.86]; BFEN 314+: κ = 0.73 [0.72-0.74], MVPA: ROC-AUC = 0.86 [0.86-0.87]). BFEN 314+ misclassified 19.7% non-MVPA epochs as MPA, whereas ENMO 192+ and GENEA 250+ misclassified 32.6% and 26.5% of MPA epochs as non-MVPA, respectively. Group estimates of MPA time were equivalent (P < 0.01) to indirect calorimetry for the BFEN 314+ MPA cut point (mean bias = -1.5%, limits of agreement [LoA] = -57.5% to 60.6%), whereas estimates of MVPA time were equivalent (P < 0.01) to indirect calorimetry for the ENMO 192+ (mean bias = -1.1%, LoA = -53.7% to 55.9%) and GENEA 250+ (mean bias = 2.2%, LoA = -56.5% to 52.2%) cut points. Individual variability (LoA) was large for MPA (min: BFEN 314+, -60.6% to 57.5%; max: GENEA 250+, -42.0% to 104.1%), VPA (min: BFEN 314+, -238.9% to 54.6%; max: ENMO 192+, -244.5% to 127.4%), and MVPA (min: ENMO 192+, -53.7% to 55.0%; max: BFEN 314+, -83.9% to 25.3%). Conclusion Wrist acceleration cut points misclassified a considerable proportion of non-MVPA and MVPA. Group-level estimates of MVPA were acceptable; however, error for individual-level prediction was larger.

Mid-upper arm circumference (MUAC) : new applications for an old measure

Abstract: Mid-upper arm circumference (MUAC) has a long history as a simple and valuable anthropometric marker of undernutrition, of particular value in resource-poor settings.1 Traditionally, low MUAC has been seen as a proxy for low fat-free mass,1 necessary because accurate measurement of fat-free mass in children is usually impractical in both clinical settings and resource-poor settings. An emerging body of evidence suggests that MUAC may have value beyond its traditional application in the assessment of undernutrition. The paper by Whitfield et al 2 notes that accurate measurement of body weight is often not possible in resource-poor settings, and this is important clinically because it substantially increases the risk of inaccurate drug dosage (where dosage is dependent on body weight). Whitfield et al 2 describe a study which suggests that MUAC, when combined with other anthropometric measures, could be a useful and accurate way of estimating body weight in children. In a sample of 775 predominantly HIV positive children and adolescents (from 18 months to 12 years of age) from Botswana, Whitfield et al made a range of anthropometric measures (height or length, ulnar and tibial lengths, MUAC and triceps skinfold, …

Early-Life Obesity Prevention: Critique of Intervention Trials During the First One Thousand Days.

Abstract: To critique the evidence from recent and ongoing obesity prevention interventions in the first 1000 days in order to identify evidence gaps and weaknesses, and to make suggestions for more informative future intervention trials. Completed and ongoing intervention trials have had fairly modest effects, have been limited largely to high-income countries, and have used relatively short-term interventions and outcomes. Comparison of the evidence from completed prevention trials with the evidence from systematic reviews of behavioral risk factors shows that some life-course stages have been neglected (pre-conception and toddlerhood), and that interventions have neglected to target some important behavioral risk factors (maternal smoking during pregnancy, infant and child sleep). Finally, while obesity prevention interventions aim to modify body composition, few intervention trials have used body composition measures as outcomes, and this has limited their sensitivity to detect intervention effects. The new WHO Healthy Lifestyles Trajectory (HeLTI) initiative should address some of these weaknesses. Future early obesity prevention trials should be much more ambitious. They should, ideally: extend their interventions over the first 1000 days; have longer-term (childhood) outcomes, and improved outcome measures (body composition measures in addition to proxies for body composition such as the BMI for age); have greater emphasis on maternal smoking and child sleep; be global.

Minimum Wear Duration for the activPAL Professional Activity Monitor in Adolescent Females

Abstract: Objectives: This study aims to determine the minimum number of days of monitoring required to reliably predict sitting/lying time, standing time, light intensity physical activity (LIPA), moderate-to-vigorous intensity physical activity (MVPA) and steps in adolescent females. Methods: 195 adolescent females (mean age=15.7 years; SD=0.9) participated in the study. Participants wore the activPAL activity monitor for a seven day protocol. The amount of time spent sitting/lying, standing, in LIPA and in MVPA and the number of steps per day were quantified. Spearman-Brown Prophecy formulae were used to predict the number of days of data required to achieve an intraclass correlation coefficient of both 0.7 and 0.8. Results: For the percentage of the waking day spent sitting/lying, standing, in LIPA and in MVPA, a minimum of 9 days of accelerometer recording is required to achieve a reliability of ≥0.7, while a minimum of 15 days is required to achieve a reliability of ≥0.8. For steps, a minimum of 12 days of recording is required to achieve a reliability of ≥0.7, with 21 days to achieve a reliability of ≥0.8. Conclusion: Future research in adolescent females should collect a minimum of 9 days of accelerometer data to reliably estimate sitting/lying time, standing time, LIPA and MVPA, while 12 days is required to reliably estimate steps.