Publications by authors named "Russell R Pate"

283 Publications

Operationalizing and Testing the Concept of a Physical Activity Desert.

J Phys Act Health 2021 Mar 30:1-8. Epub 2021 Mar 30.

Background: The prevalence of childhood obesity is higher in economically and socially deprived areas. Higher levels of physical activity reduce the risk of excessive weight gain in youth, and research has focused on environmental factors associated with children's physical activity, though the term "physical activity desert" has not come into wide use.

Methods: This exploratory study operationalized the term "physical activity desert" and tested the hypothesis that children living in physical activity deserts would be less physically active than children who do not. A cross-sectional study design was applied with 992 fifth-grade students who had provided objectively measured physical activity data. Five of 12 possible elements of the built environment were selected as descriptors of physical activity deserts, including no commercial facilities, no parks, low play spaces, no cohesion, and the presence of incivilities.

Results: Univariate and multivariate analyses showed that only the absence of parks was associated with less physical activity in children.

Conclusion: Children living in a "no park" zone were less active than their counterparts who lived near a park. This study contributes preliminary conceptual and operational definitions of "physical activity desert." Future studies of physical activity deserts should be undertaken in larger and more diverse samples.
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http://dx.doi.org/10.1123/jpah.2020-0382DOI Listing
March 2021

Impact of a year-round school calendar on children's BMI and fitness: Final outcomes from a natural experiment.

Pediatr Obes 2021 Mar 25:e12789. Epub 2021 Mar 25.

Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA.

Background: Structure may mitigate children's accelerated summer BMI gain and cardiorespiratory-fitness (CRF) loss.

Objectives: Examine BMI and CRF change during school and summer for year-round and traditional calendar school children.

Methods: Three schools (N = 2279, 1 year-round) participated in this natural experiment. Children's BMI z-score (zBMI) and CRF (PACER laps) were measured from 2017 to 2019 each May/August. Mixed effects regression estimated monthly zBMI and CRF change during school/summer. Secondary analyses examined differences by weight status and race. Spline regression models estimated zBMI and CRF growth from kindergarten-sixth grade.

Results: Compared to traditional school, children attending a year-round school gained more zBMI (difference = 0.015; 95CI = 0.002, 0.028) during school, and less zBMI (difference = -0.029; 95CI = -0.041, -0.018), and more CRF (difference = 0.834; 95CI = 0.575, 1.093) monthly during summer. Differences by weight status and race were observed during summer and school. Growth models demonstrated that the magnitude of overall zBMI and CRF change from kindergarten-sixth grade was similar for year-round or traditional school children.

Conclusions: Contrary to traditional school children zBMI increased during the traditional 9-month school calendar and zBMI decreased during the traditional summer vacation for year-round school children. Structured summer programming may mitigate accelerated summer BMI gain and CRF loss especially for overweight or obese, and/or Black children.
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http://dx.doi.org/10.1111/ijpo.12789DOI Listing
March 2021

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis.

Int J Behav Nutr Phys Act 2021 02 10;18(1):28. Epub 2021 Feb 10.

MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.

Purpose: The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.

Methods: Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.

Results/findings: Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.

Conclusions: Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.
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http://dx.doi.org/10.1186/s12966-021-01095-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877033PMC
February 2021

How Many US Children and Adolescents with Overweight and Obesity Could Improve Their Percent Body Fat by Exercising?: Meta-Analytic Based Estimates.

Child Obes 2021 Mar 5;17(2):144-150. Epub 2021 Feb 5.

Children's Physical Activity Research Group, Department of Exercise Science, University of South Carolina, Columbia, SC, USA.

Provide national estimates of the number of US children and adolescents with overweight and obesity who could improve their percent body fat by exercising. Data were derived from (1) a previous meta-analysis, (2) 2015-2016 prevalence data from the National Health and Nutrition Examination Survey (NHANES), and (3) 2017 US Census population data. Multiplicative calculations were based on (1) number-needed-to treat data from a previous meta-analysis of the number of children with overweight and obesity who could reduce their percent body fat by participating in either aerobic, strength, or combined aerobic and strength training, (2) 2015-2016 NHANES data on the prevalence of children and adolescents with overweight or obesity, and (3) 2017 US Census population data on children and adolescents 2-19 years of age. For both children and adolescents with overweight or obesity, the number who could improve their percent body fat was estimated at 4,388,273 [95% confidence interval (CI) 3,831,523-4,845,023] for either aerobic or strength exercise and 6,507,410 (95% CI 5,744,285-7,267,534) for combined aerobic and strength exercise. A large number of US children and adolescents with overweight and obesity could improve their percent body fat by exercising.
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http://dx.doi.org/10.1089/chi.2020.0245DOI Listing
March 2021

The impact of summer vacation on children's obesogenic behaviors and body mass index: a natural experiment.

Int J Behav Nutr Phys Act 2020 11 26;17(1):153. Epub 2020 Nov 26.

Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ, USA.

Background: Children's BMI gain accelerates during summer. The Structured Days Hypothesis posits that the lack of the school day during summer vacation negatively impacts children's obesogenic behaviors (i.e., physical activity, screen time, diet, sleep). This natural experiment examined the impact of summer vacation on children's obesogenic behaviors and body mass index (BMI).

Methods: Elementary-aged children (n = 285, 5-12 years, 48.7% male, 57.4% African American) attending a year-round (n = 97) and two match-paired traditional schools (n = 188) in the United States participated in this study. Rather than taking a long break from school during the summer like traditional schools, year-round schools take shorter and more frequent breaks from school. This difference in school calendars allowed for obesogenic behaviors to be collected during three conditions: Condition 1) all children attend school, Condition 2) year-round children attend school while traditional children were on summer vacation, and Condition 3) summer vacation for all children. Changes in BMI z-score were collected for the corresponding school years and summers. Multi-level mixed effects regressions estimated obesogenic behaviors and monthly zBMI changes. It was hypothesized that children would experience unhealthy changes in obesogenic behaviors when entering summer vacation because the absence of the school day (i.e., Condition 1 vs. 2 for traditional school children and 2 vs. 3 for year-round school children).

Results: From Condition 1 to 2 traditional school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 24.2, 95CI = 10.2, 38.2), screen time minutes (∆ = 33.7, 95CI = 17.2, 50.3), sleep midpoint time (∆ = 73:43, 95CI = 65:33, 81:53), and sleep efficiency percentage (-∆ = 0.7, 95CI = -1.1, - 0.3) when compared to year-round school children. Alternatively, from Condition 2 to 3 year-round school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 54.5, 95CI = 38.0, 70.9), light physical activity minutes (∆ = - 42.2, 95CI = -56.2, - 28.3) MVPA minutes (∆ = - 11.4, 95CI = -3.7, - 19.1), screen time minutes (∆ = 46.5, 95CI = 30.0, 63.0), and sleep midpoint time (∆ = 95:54, 95CI = 85:26, 106:22) when compared to traditional school children. Monthly zBMI gain accelerated during summer for traditional (∆ = 0.033 95CI = 0.019, 0.047) but not year-round school children (∆ = 0.004, 95CI = -0.014, 0.023).

Conclusions: This study suggests that the lack of the school day during summer vacation negatively impacts sedentary behaviors, sleep timing, and screen time. Changes in sedentary behaviors, screen time, and sleep midpoint may contribute to accelerated summer BMI gain. Providing structured programming during summer vacation may positively impact these behaviors, and in turn, mitigate accelerated summer BMI gain.

Trial Registration: ClinicalTrials.gov Identifier: NCT03397940 . Registered January 12th 2018.
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http://dx.doi.org/10.1186/s12966-020-01052-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690133PMC
November 2020

Implementation Monitoring of a Promotora-Led, Home-Based Obesity Prevention Pilot Study With Latino Preschool Children and Their Mothers.

Int Q Community Health Educ 2020 Nov 3:272684X20970375. Epub 2020 Nov 3.

Department of Exercise Science, Physical Activity Research Group, University of South Carolina, Columbia, South Carolina, United States.

Background: Latino preschool children have higher rates of obesity than children from other racial/ethnic backgrounds. Few effective, culturally-tailored obesity prevention interventions exist that have focused on Latino preschool children, and even fewer have published results of the process evaluation. The purpose of this paper was to monitor reach, fidelity, and completeness of implementation to determine whether ANDALE, a promising -led, home-based pilot study to prevent obesity in Latino preschool children, was implemented as planned.

Methods: Guided by a logic model, we assessed reach, implementation fidelity and completeness through descriptive analyses of multiple data sources. Reach was assessed through attendance records. Fidelity was assessed via observation checklist and completeness was assessed via survey with both parents and in a subsample of 12 families.

Results: recruited participants primarily through their own social networks and delivered the intervention to 50 families (mother-child dyads); the majority were of Mexican-origin, low-acculturation, dual-parent households. Nearly all (98%) families completed the whole 10-week intervention. Results demonstrated completeness and fidelity of implementation were acceptable in a subsample of 12 families. In sum, 75% of families in the subsample met the criteria (≥75%) for overall implementation of essential program elements (i.e., reach, completeness, and fidelity).

Conclusion: Evidence suggests that ANDALE was delivered with high levels of completeness and fidelity in this sample of Latino families with preschool-aged children. These results support implementation of ANDALE in a large, randomized trial.
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http://dx.doi.org/10.1177/0272684X20970375DOI Listing
November 2020

An observation system to assess physical activity of children with developmental disabilities and delays in preschool.

Disabil Health J 2021 Apr 29;14(2):101008. Epub 2020 Sep 29.

University of South Carolina, Department of Exercise Science, 921 Assembly Street, Suite 212, Columbia, SC, 29208, USA. Electronic address:

Background: Physical activity (PA) behaviors during preschool settings can influence the health and development of children with developmental disabilities (DD). There is a need for a direct observation system that simultaneously assesses PA and preschool environmental contexts.

Objective: The purpose of this study was to develop an observation instrument for measuring PA and related contextual factors of preschoolers with DD, and to establish content validity and reliability.

Methods: Content validity was established through consultation with experts, informal observations in inclusive and special education preschools, and literature reviews. Categories and codes were identified and modified from existing observational systems for young children. Reliability was assessed in a convenience sample of preschool children with DD using a cross-sectional design. Data were collected using a momentary time sampling system (5-sec observe, 25-sec record) following a focal child. Inter-rater reliability was assessed during 20% of the observation sessions.

Results: The instrument development process resulted in ten coding categories that accounted for PA levels, types, and social and physical environmental contexts relevant to preschoolers with disabilities. Observers completed 137.5 observation sessions, yielding 5498 30-s observation intervals. Interval-by-interval percent agreement was excellent (91%-100%) and kappa values were high (0.82-0.99).

Conclusions: The instrument was found to be a reliable measure of PA of preschoolers with DD and provided important contextual information about PA behaviors in early childhood special education settings. Additionally, it allowed for the simultaneous measurement of specific types and contexts of PA behaviors of preschoolers with DD and will be useful for describing PA and informing future interventions.
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http://dx.doi.org/10.1016/j.dhjo.2020.101008DOI Listing
April 2021

Preschool Healthy Food Policy Did Not Increase Percent of Food Wasted: Evidence from the Carolinas.

Nutrients 2020 Oct 2;12(10). Epub 2020 Oct 2.

Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.

This research evaluates the effects of a South Carolina (SC) policy, which changed the nutrition standards for foods served in early care and education (ECE) settings, on wasted food. A two-group pre-test/post-test evaluation was performed in ECE centers serving children age 3-5 from households with lower incomes in SC ( = 102 children from 34 centers, intervention) and North Carolina (NC; = 99 children from 30 centers, comparison). Direct observation was performed to assess the quantity and kcal of food served and quantity and percent of food discarded, by food group and nutrient, enabling assessment of waste in the absence of intervention. Mixed-effects linear models were fit to estimate, by state, differences in change from baseline to post-implementation at the center level. Covariates were selected a priori, including center enrollment, racial composition, director educational attainment, years in operation, for-profit status, and Child and Adult Care Food Program (CACFP) participation. Waste of food was high across states and time points. The policy was not associated with a change in percent of food discarded in SC compared to NC in adjusted analyses.
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http://dx.doi.org/10.3390/nu12103024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600022PMC
October 2020

Neighborhood Socioeconomic Deprivation Associated with Fat Mass and Weight Status in Youth.

Int J Environ Res Public Health 2020 09 3;17(17). Epub 2020 Sep 3.

Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA.

(1) Background: Few studies have examined the relationship between neighborhood socioeconomic deprivation (SED) and weight-related outcomes in youth, controlling for weight-related behaviors. Hence, the purpose of this study was to examine the association between neighborhood SED, weight status, and fat mass in a diverse sample of youth, before and after controlling for physical activity and diet. (2) Methods: The sample included 828 youth from the Transitions and Activity Changes in Kids study. Neighborhood SED was expressed as an index score at the census tract of residence. Height, weight, and body composition were measured and used to calculate fat mass index (FMI) and weight status. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior (min/h) were measured via accelerometry. Diet quality was assessed via the Block Food Screener for Kids. Multilevel regression models were employed to examine these relationships. (3) Results: Neighborhood SED was significantly associated with FMI and weight status before and after controlling for MVPA, sedentary behavior, and diet. Notably, youth residing in the most deprived neighborhoods had significantly higher FMI and were 30% more likely to be overweight/obese (OR = 1.30; 95% CI = 1.03-1.65). (4) Conclusions: Greater neighborhood SED was consistently and significantly associated with higher fat mass index and increased likelihood of overweight/obesity among youth.
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http://dx.doi.org/10.3390/ijerph17176421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503851PMC
September 2020

Dynamics of sleep, sedentary behavior, and moderate-to-vigorous physical activity on school versus nonschool days.

Sleep 2021 Feb;44(2)

Department of Exercise Science, University of South Carolina, Columbia, SC.

Study Objectives: Studies examining time-use activity behaviors (sleep, sedentary behavior, and physical activity) on school days compared with nonschool days have examined these behaviors independently, ignoring their interrelated nature, limiting our ability to optimize the health benefits of these behaviors. This study examines the associations of school-day (vs. nonschool day) with time-use activity behaviors.

Methods: Time series data (6,642 days) from Fitbits (Charge-2) were collected (n = 196, 53% female, 5-10 years). We used a variable-centered dynamic structural equation modeling approach to estimate day-to-day associations of time-use activity behaviors on school days for each child. We then used person-centered cluster analyses to group individuals based on these estimates.

Results: Within-participant analysis showed that on school days (vs. nonschool days), children (1) slept less (β = -0.17, 95% CI = -0.21, -0.13), (2) were less sedentary (β = -0.05, 95% CI = -0.09, -0.02), and (3) had comparable moderate-to-vigorous physical activity (MVPA; β = -0.05, 95% CI = -0.11, 0.00). Between-participant analysis showed that, on school days, children with higher sleep carryover experienced greater decreases in sleep (β = 0.44, 95% CI = 0.08, 0.71), children with higher body mass index z-score decreased sedentary behavior more (β = -0.41, 95% CI = -0.64, -0.13), and children with lower MVPA increased MVPA more (β = -0.41, 95% CI -0.64, -0.13). Cluster analysis demonstrated four distinct patterns of connections between time-use activity behaviors and school (High Activity, Sleep Resilient, High Sedentary, and Dysregulated Sleep).

Conclusions: Using a combination of person-centered and more traditional variable-centered approaches, we identified patterns of interrelated behaviors that differed on school, and nonschool days. Findings can inform targeted intervention strategies tailored to children's specific behavior patterns.
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http://dx.doi.org/10.1093/sleep/zsaa174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982135PMC
February 2021

Preschool Environmental Influences on Physical Activity in Children with Disabilities.

Med Sci Sports Exerc 2020 12;52(12):2682-2689

Department of Exercise Science, University of South Carolina, Columbia, SC.

Purpose: The purpose of this study was to describe associations between physical and social environmental features of preschools and physical activity behaviors of young children with developmental disabilities.

Methods: A sample of 34 preschool-age children (mean age, 4.28 ± 1.07; male, 64.7%) with developmental disabilities participated in this study. Physical activity and preschool environmental factors were measured through direct observation using the Observational System for Recording Physical Activity in Children-Developmental Disabilities version. Children were observed approximately eight times over the course of a week, yielding a total of 11, 310 observation intervals. The number of intervals and percentage of time spent in physical activity across environmental contexts were calculated. Logistic regression analyses were conducted to determine associations between time spent in physical activity and features of the physical and social environment.

Results: Children with disabilities were sedentary for most of the observed intervals (81.5%). Children were 4.8 times (confidence interval (CI), 4.25-5.50) more likely to be physically active while outdoors compared with indoors. Physical activity was more likely to occur in open spaces (odds ratio [OR], 3.3; CI, 2.59-4.19) and when using portable play equipment (OR, 2.7; CI, 1.31-5.64) compared with fixed playground equipment. While indoors, children in this study were 5.6 times (CI, 3.78-8.03) more likely to be active when in therapy compared with group time activities. Physical activity was more likely to occur when in solitary (OR, 3.4; CI, 2.87-4.10) or one-on-one group contexts (OR, 1.7-2.9) compared with in groups with an adult present.

Conclusions: Certain features of the preschool setting, such as location and social group composition, were more conducive to physical activity than others. Children with disabilities would benefit from more time outdoors and in smaller group settings during preschool.
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http://dx.doi.org/10.1249/MSS.0000000000002401DOI Listing
December 2020

Personal, Social, and Environmental Influences on Physical Activity in Groups of Children As Defined by Different Physical Activity Patterns.

J Phys Act Health 2020 Jul 30:1-7. Epub 2020 Jul 30.

Background: Interventions promoting physical activity (PA) in youth have had limited success, in part because studies with methodological challenges have yielded an incomplete understanding of personal, social, and environmental influences on PA. This study described changes in these factors for subgroups of youth with initially high PA that decreased (Active-Decline) compared with children with initially low PA that decreased (Inactive-Decline) from fifth to ninth grades.

Methods: Observational, prospective cohort design. Participants (n = 625) were fifth-grade children recruited in 2 school districts and followed from elementary to high school. Students and their parents responded to questionnaires to assess personal, social, and perceived physical environmental factors in the fifth (mean age = 10.5 [.5] y) and ninth (mean age = 14.7 [.6] y) grades. Analyses included a mixed-model 2-way repeated analysis of variances.

Results: Children in the Active-Decline compared with those in the Inactive-Decline group showed a more favorable profile in 6 of 8 personal variables (perceived barriers, self-efficacy, self-schema, enjoyment, competence, and fitness motives) and 4 of 6 social variables (friend support, parent encouragement, parent support, and parent-reported support).

Conclusions: The results suggest efforts to promote PA should target selected personal, social, and perceived environmental factors beginning before age 10 and continuing through adolescence.
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http://dx.doi.org/10.1123/jpah.2020-0159DOI Listing
July 2020

Inter-individual differences in body mass index were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity.

Pediatr Obes 2021 Jan 13;16(1):e12692. Epub 2020 Jul 13.

Children's Physical Activity Research Group, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA.

Background: Exercise has been recommended as an important intervention for reducing adiposity in children and adolescents with overweight and obesity.

Objective: Determine whether inter-individual differences exist in relation to exercise-induced changes in adiposity among children and adolescents with overweight and obesity.

Methods: Meta-analysis of randomized controlled aerobic exercise trials and body mass index (BMI) in kg · m . Change outcome standard deviations were pooled using the inverse-variance heterogeneity model.

Results: Twenty-eight studies (1185 participants) were included. Inter-individual differences in BMI were -0.1 (95% compatibility interval, -0.7 to 0.7). The 95% prediction interval for inter-individual responses in a future study was -2.9 to 2.9. The probability of a clinically meaningful difference in variability was 29% (possibly clinically important) in favour of controls vs exercisers.

Conclusions: Inter-individual differences for BMI in kg · m were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity.
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http://dx.doi.org/10.1111/ijpo.12692DOI Listing
January 2021

Association between change in maternal physical activity during pregnancy and infant size, in a sample overweight or obese women.

Women Health 2020 09 26;60(8):929-938. Epub 2020 Jun 26.

University of South Carolina , Columbia, SC, USA.

Physical activity (PA) naturally declines during pregnancy and its effects on infant size are unclear, especially in overweight or obese pregnancies, a low-active subpopulation that tends deliver heavier infants. The objective of this study was to evaluate changes in prenatal PA and infant birthweight in a group of overweight or obese pregnant women. We employed a prospective analysis using data from a randomized controlled exercise trial (2001 to 2006) in sedentary, overweight or obese pregnant women in Michigan. Women with complete data on peak oxygen consumption, daily PA (via pedometers) and birthweight were included in the analyses. Change in PA was estimated via repeated measures analyses, and then its influence on infant birthweight was assessed via linear regression. Eighty-nine pregnant women were included and considered low-active (6,579.91 ± 2379.17 steps/day). PA declined from months 4 to 8 (-399.73 ± 371.38 steps∙day∙month). Analyses showed that the decline in PA (β = -0.28 g, 95%CI: -0.70, 0.25 g, = .35) was not associated with birthweight. The findings of this study demonstrated that the decline in maternal PA during mid- to late-pregnancy, in overweight or obese women, was unrelated to infant birthweight. Future investigations should employ rigorous measurements of PA and infant anthropometry in this subpopulation.
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http://dx.doi.org/10.1080/03630242.2020.1779904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415545PMC
September 2020

Cross-Country Comparisons of Physical Activity and Sedentary Behavior among 5-Year-Old Children.

Int J Pediatr 2020 1;2020:7912894. Epub 2020 Jun 1.

University of South Florida, Health Informatics Institute, Tampa, FL 33620, USA.

Purpose: Previous studies have observed that physical activity (PA) levels tend to be lower in the U.S. population than in many other countries. Within the U.S., PA levels in children are lower in the South than in other regions. Cross-country and interregional differences in PA have not been studied in young children.

Methods: In an ongoing study of children at genetic risk for Type 1 diabetes, PA was measured by accelerometry in samples of 5-year-old children ( = 2008) from Finland ( = 370), Germany ( = 85), Sweden ( = 706), and the U.S. ( = 847). The U.S. sample was drawn from centers in Washington State, Colorado, and Georgia/Florida. Children wore accelerometers for 7 days, and the data were reduced to daily minutes of light-, moderate- (MPA), vigorous- (VPA), and moderate-to-vigorous- (MVPA) intensity PA and sedentary behavior. Multiple regression was used to compare children across countries and across regions in the U.S, adjusting for wear time, body mass index, and demographic characteristics.

Results: After adjusting for previously mentioned factors, MVPA and MPA were lower in U.S. children than those in Finland and Sweden. Estimates of physical activity were higher in Finland than in other countries, although not all comparisons were significantly different. U.S children spent significantly more time in sedentary behavior than children in Finland ( < 0.0001). Within the U.S., children's PA was consistently lowest in Georgia/Florida and highest in Washington.

Conclusions: Cross-country differences in PA, previously reported for adults and adolescents, are evident in 5-year-old children. In general, PA levels are lower in U.S. children than their European counterparts, and within the U.S., are lower in Georgia/Florida and Colorado than in Washington. Future studies should be designed to identify the factors that explain these differences.
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http://dx.doi.org/10.1155/2020/7912894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290875PMC
June 2020

Healthy Eating Policy Improves Children's Diet Quality in Early Care and Education in South Carolina.

Nutrients 2020 Jun 11;12(6). Epub 2020 Jun 11.

Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.

Policies to promote healthy foods in early care and education (ECE) in the United States exist, but few have been prospectively evaluated. In South Carolina, a statewide program serving low-income children in ECE enacted new policies promoting healthy foods. We conducted an evaluation to measure changes in dietary intake among children in ECE exposed and not exposed to the new policy. Using direct observation, we assessed dietary intake in 112 children from 34 ECE centers in South Carolina and 90 children from 30 ECE centers in North Carolina (a state with no policy). We calculated Healthy Eating Index-2015 (HEI) scores to measure diet quality consumed before and after the policy was enacted. We fit mixed-effects linear models to estimate differences in HEI scores by state from baseline to post-policy, adjusting for child race, number of children enrolled, director education, center years in operation, participation in the Child and Adult Care Food Program (CACFP), and center profit status. The policy increased HEI scores for whole fruits, total fruits, and lean proteins, but decreased scores for dairy. Thus, the policy was associated with some enhancements in dietary intake, but additional support may help improve other components of diet.
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http://dx.doi.org/10.3390/nu12061753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353374PMC
June 2020

Poverty Status Moderates the Relationship between Cardiorespiratory Fitness and Academic Achievement.

J Sch Health 2020 08 16;90(8):630-640. Epub 2020 Jun 16.

Biostatistician, Department of Exercise Science, University of South Carolina, Arnold School of Public Health, 921 Assembly St., Suite 212, Columbia, South Carolina 29208.

Background: The purpose of the study was to examine the associations among cardiorespiratory fitness (CRF), weight status and academic achievement in youth, and to determine if these relationships are moderated by poverty status.

Methods: The sample included 5th (N = 27,791) and 8th grade (N = 16,047) South Carolina students. Academic achievement was assessed using a state-wide assessment and classified into 2 categories (ie, does not meet/approaches standards vs meets/exceeds standards). CRF was assessed and expressed as Healthy Fitness Zone (HFZ) or Needs Improvement/Needs-Improvement-Health Risk. Students' demographics and poverty status were reported. Multilevel logistic regression analyses were used to examine the association between CRF, weight status and academic achievement. Interaction terms were introduced into the final models. Analyses were performed separately by grade level and academic subject.

Results: The CRF was significantly associated with the odds of meeting/exceeding academic standards after controlling for covariates and adjusting for weight status. The relationship between CRF and academic achievement varied significantly by poverty status. After adjustment for CRF, weight status was not significantly associated with academic achievement.

Conclusions: The odds of achieving academic standards were significantly higher among students achieving CRF HFZ regardless of poverty status. CRF may partially mitigate the adverse effect of poverty on academic achievement.
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http://dx.doi.org/10.1111/josh.12913DOI Listing
August 2020

Linking Activity, Nutrition, and Child Health (LAUNCH): protocol for a longitudinal cohort study of children as they develop from infancy to preschool age.

BMC Public Health 2020 Jun 15;20(1):931. Epub 2020 Jun 15.

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Suite 212, Columbia, SC, 29208, USA.

Background: Physical activity is known to provide important health benefits in children ages 3 years and above, but little is known about the effects of physical activity on health in very young children under age 3. LAUNCH (Linking Activity, Nutrition, and Child Health) is a study designed to expand the body of knowledge on development of physical activity behavior and associations between physical activity and other health characteristics as children transition from infancy to preschool age.

Methods: Physical activity and sedentary behavior will be measured objectively in young children over a period of 30 months. Each child will complete a measurement protocol at 6, 12, 18, 24, 30 and 36 months of age. The following factors will be measured at each time point: physical activity, sedentary behavior, anthropometric characteristics, and motor developmental status. Objectively-measured sleep behavior will be included as an optional component of the protocol. Parents will provide information on demographic factors, parenting behaviors, home and childcare characteristics, and the child's dietary and sleep behaviors.

Discussion: LAUNCH will employ a longitudinal study design and objective measures of physical activity, sedentary behavior and sleep in examining developmental trends for those characteristics in children between the ages of 6 and 36 months. Associations among physical activity, sedentary behavior, sleep, and weight status will be examined. Findings will inform public health guidance and intervention strategies for very young children.
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http://dx.doi.org/10.1186/s12889-020-09023-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296728PMC
June 2020

Participation in the Child and Adult Care Food Program is associated with fewer barriers to serving healthier foods in early care and education.

BMC Public Health 2020 Jun 5;20(1):856. Epub 2020 Jun 5.

Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.

Background: Early care and education (ECE) is an important setting for influencing young children's dietary intake. There are several factors associated with barriers to healthy eating in ECE, and recent evidence suggests that participation in the Child and Adult Care Food Program (CACFP), the primary national food assistance program in ECE, may be associated with fewer barriers to serving healthier foods. However, no prior studies have examined differences between CACFP participants and non-participants across a large, multi-state sample. This is the first study to examine the association between CACFP participation and barriers to serving healthier foods in ECE using a random sample of directors from two regions across the country.

Methods: We conducted a cross-sectional survey among a random sample of child care center directors from four states (Massachusetts, North Carolina, Rhode Island, and South Carolina). We conducted logistic and Poisson regression to calculate the odds and incidence rate ratios of reporting 1) no barriers, 2) specific barriers (e.g., cost), and 3) the total number of barriers, by CACFP status, adjusting for covariates of interest.

Results: We received 713 surveys (36% response rate). About half (55%) of centers participated in CACFP. The most prevalent reported barriers to serving healthier foods were cost (42%) and children's food preferences (19%). Directors from CACFP centers were twice as likely to report no barriers, compared to directors from non-CACFP centers (OR 2.03; 95% CI [1.36, 3.04]; p < 0.01). Directors from CACFP centers were less likely to report cost as a barrier (OR = 0.46; 95% [CI 0.31, 0.67]; p < 0.001), and reported fewer barriers overall (IRR = 0.77; 95% CI [0.64, 0.92]; p < 0.01), compared to directors from non-CACFP centers.

Conclusions: CACFP directors reported fewer barriers to serving healthier foods in child care centers. Still, cost and children's food preferences are persistent barriers to serving healthier foods in ECE. Future research should evaluate characteristics of CACFP participation that may alleviate these barriers, and whether barriers emerge or persist following 2017 rule changes to CACFP nutrition standards.
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http://dx.doi.org/10.1186/s12889-020-08712-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275407PMC
June 2020

Are There Inter-Individual Differences in Fat Mass and Percent Body Fat as a Result of Aerobic Exercise Training in Overweight and Obese Children and Adolescents? A Meta-Analytic Perspective.

Child Obes 2020 07 2;16(5):301-306. Epub 2020 Jun 2.

Department of Exercise Science, Children's Physical Activity Research Group, University of South Carolina, Columbia, SC, USA.

Determine whether inter-individual response differences exist with respect to changes in fat mass and percent body fat as a result of aerobic exercise training in overweight and obese children and adolescents. Using the meta-analytic approach, randomized controlled trials that examined the effects of aerobic exercise training on fat mass and percent body fat in overweight and obese children and adolescents were included. Change outcome standard deviations for fat mass and percent body fat were used to calculate true inter-individual differences from each study. The inverse variance heterogeneity model was used to pool results. Pooled changes for inter-individual response differences in fat mass (16 studies, 575 participants) were 0.9 kg (95% confidence interval [CI], -1.4 to 1.8 kg) while tau ([Formula: see text]) was 2.9. For percent body fat, inter-individual differences (27 studies, 1035 participants) were 0.6% (95% CI, -0.6% to 1.0%, [Formula: see text] = 0.7). The 95% prediction interval for true inter-individual responses in a future study was -4.9 to 5.5 kg for fat mass and -0.7% to 1.7% for percent body fat. The percent chance, that is, probability, of a clinically meaningful difference in variability was 47% for fat mass and 26% for percent body fat, both of which were considered as only possibly clinically important. There is a lack of convincing evidence to suggest that true inter-individual response differences exist with respect to aerobic exercise training and changes in fat mass and percent body fat in overweight and obese children and adolescents.
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http://dx.doi.org/10.1089/chi.2020.0056DOI Listing
July 2020

Changes in Diet Quality in Youth Living in South Carolina From Fifth to 11th Grade.

J Nutr Educ Behav 2020 10 23;52(10):928-934. Epub 2020 Apr 23.

Department of Exercise Science, University of South Carolina, Columbia, SC.

Objective: To examine diet quality levels and changes in a diverse sample of youth from fifth to 11th grade, and interactions by race/ethnicity and socioeconomic status.

Design: Transitions and Activity Changes in Kids prospective cohort study.

Setting: Elementary, middle, and high schools in South Carolina.

Participants: A sample of 260 fifth-graders (106 boys and 154 girls) with complete data at baseline and at least 1 time point each in middle school and in high school.

Main Outcome Measure: Dietary intake assessed with the Block Food Screener for Kids (last week). Diet quality was assessed using energy-adjusted intakes of 5 food groups.

Analysis: Descriptive statistics and growth curve models for the total group and by gender for diet quality from fifth to 11th grade (P < 0.05).

Results: Both boys and girls had low levels of diet quality, which continued to decline through 11th grade. Significant main effects by race and poverty as well as a race by poverty interaction were observed.

Conclusions And Implications: Programs and policies that support healthy dietary patterns in children transitioning from elementary to middle and high school are needed. Specific efforts that focus on nutrition disparities in children from low-income and minority backgrounds are warranted.
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http://dx.doi.org/10.1016/j.jneb.2020.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554150PMC
October 2020

Longitudinal Associations Between Psychosocial, Home, and Neighborhood Factors and Children's Physical Activity.

J Phys Act Health 2020 03 1;17(3):306-312. Epub 2020 Mar 1.

Background: Physical activity (PA) provides important health benefits to children, and a large percentage of children's PA occurs at home. The purpose of this study was to examine the associations between psychosocial, home, and neighborhood environmental factors and children's reported PA at home and in the neighborhood, during the transition from elementary to high school.

Methods: A total of 555 participants (44% boys) were recruited in grade 5 and followed through grades 6, 7, and 9. Children self-reported PA in 3 locations-at home, in the neighborhood, and on the street. Children reported parent support and neighborhood environment, parents reported PA equipment, and a windshield survey assessed incivilities and outside PA equipment. Longitudinal Poisson models evaluated the relationships between environmental variables and 3 self-reported PA variables, adjusting for gender, race/ethnicity, and parent education.

Results: Parent support and PA equipment were significant positive predictors of home PA. Child's perceived environment (positive) and incivilities (negative) were significant predictors of neighborhood PA. Parental support, perceived environment, and outside PA equipment were positive significant predictors of street PA.

Conclusions: This study supports the need for both family and community/neighborhood PA interventions that encourage parents to support child PA and for communities to reduce incivilities.
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http://dx.doi.org/10.1123/jpah.2019-0137DOI Listing
March 2020

Physical Activity and Adiposity in a Racially Diverse Cohort of US Infants.

Obesity (Silver Spring) 2020 03 16;28(3):631-637. Epub 2020 Jan 16.

Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Objective: Early life physical activity may help prevent obesity, but objective quantification in infants is challenging.

Methods: A total of 506 infants were examined from 2013 to 2016. Infants wore accelerometers for 4 days at ages 3, 6, 9, and 12 months. Daily log-transformed physical activity counts were computed, averaged, and standardized across assessments. A linear mixed model was used to examine trends in standardized physical activity counts as well as associations between physical activity and BMI z score, sum of subscapular and triceps skinfold thickness for overall adiposity (SS+TR), and their ratio for central adiposity (SS:TR).

Results: Among infants, 66% were black and 50% were female. For each additional visit, standardized physical activity counts increased by 0.23 (CI: 0.18 to 0.27; P < 0.0001). This translates to 126.3 unadjusted physical activity counts or a 4% increase for each visit beyond 3 months. In addition, a 1-SD increase in standardized physical activity counts (550 unadjusted physical activity counts) was associated with a 0.01-mm lower SS:TR (95% CI: -0.02 to -0.001; P = 0.03). However, standardized physical activity counts were not associated with BMI z score or SS+TR.

Conclusions: Physical activity increased over infancy and was associated with central adiposity. Despite limitations, researchers should consider objective measurement in infants.
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http://dx.doi.org/10.1002/oby.22738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042075PMC
March 2020

The potential of a year-round school calendar for maintaining children's weight status and fitness: Preliminary outcomes from a natural experiment.

J Sport Health Sci 2020 01 23;9(1):18-27. Epub 2019 May 23.

Department of Nursing and Health Innovation, Arizona State University, Tempe, AZ 85281, USA.

Purpose: To evaluate the potential of a year-round school calendar (180-day school year distributed across 12 months) as an intervention compared to a traditional school calendar (180-day school year distributed across 9 months) for mitigating children's weight gain and fitness loss via a natural experiment.

Methods: Height, weight, and cardiorespiratory fitness (CRF) (i.e., Fitnessgram Progressive Aerobic Cardiovascular Endurance Run) were measured in children (5-12 years old) in 3 schools (2 traditional, 1 year-round,  = 990 students, age = 8.6 ± 2.4 years, 53.1% male, 68.9% African American) from 1 school district. Structure (represented by the presence of a school day) was the independent variable. Changes in body mass index (BMI), age- and sex-specific BMI z-scores (zBMI), BMI percentile, percent of overweight or obese children, and CRF (Progressive Aerobic Cardiovascular Endurance Run laps completed) were assessed for summer 2017 (May-August 2017), school year 2017/2018 (August 2017-May 2018), and summer 2018 (May-August 2018). Primary analyses examined the overall change in weight and CRF from summer 2017 until summer 2018 via multilevel mixed effects regression, with group (traditional year-round calendar), time, and a group-by-time interaction as the independent variables. Secondary regression analyses estimated differences in change within and between groups during each time period, separately.

Results: Year-round students gained less BMI (difference in ∆ = -0.44, 95% confidence interval (CI): -0.67 to -0.03) and less CRF (difference in ∆ = -1.92, 95%CI: -3.56 to -0.28) than students attending a traditional school overall. Compared with traditional students, during both summers, year-round students gained less BMI (summer 2017 difference in ∆ = -0.15, 95%CI: -0.21 to -0.08; summer 2018 difference in ∆ = -0.16, 95%CI: -0.24 to -0.07) and zBMI (summer 2017 difference in ∆ = -0.032, 95%CI: -0.050 to -0.010; summer 2018 difference in ∆ = -0.033, 95%CI: -0.056 to -0.009), and increased CRF (summer 2017 difference in ∆ = 0.40, 95%CI: 0.02-0.85; summer 2018 difference in ∆ = 0.23, 95%CI: -0.25 to 0.74). However, the opposite was observed for the school year, with traditional students gaining less BMI and zBMI and increasing CRF compared with year-round students (difference in BMI ∆ = 0.05, 95%CI: 0.03-0.07; difference in zBMI ∆ = 0.012, 95%CI: 0.005-0.019; difference in Progressive Aerobic Cardiovascular Endurance Run laps ∆ = -0.43, 95%CI: -0.58 to -0.28).

Conclusion: The year-round school calendar had a small beneficial impact on children's weight status but not CRF. It is unclear if this benefit to children's weight would be maintained because gains made in the summer were largely erased during the school year. Trajectories of weight and CRF gain/loss were consistent with the structured days hypothesis.
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http://dx.doi.org/10.1016/j.jshs.2019.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6943754PMC
January 2020

Childcare Center Characteristics Moderate the Effects of a Physical Activity Intervention.

Int J Environ Res Public Health 2019 12 22;17(1). Epub 2019 Dec 22.

Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Suite 212, Columbia, SC 29201, USA.

Center-based early childhood education and care (ECEC) programs are well-positioned to create positive impacts on the health and development of large numbers of young children by promoting physical activity using evidence-based programs. Studies testing physical activity programs for young children should examine the circumstances under which programs are most effective by assessing the role of contextual factors on program outcomes. The purpose of this study was to examine the moderating effects of baseline ECEC center characteristics on the relationship between the Study of Health and Activity in Preschool Environments (SHAPES) intervention and moderate-to-vigorous physical activity (MVPA). MVPA was assessed via accelerometry; center characteristics, practices, and social and physical environments were assessed by director interview and observation; and center quality was assessed using the Early Childhood Environment Rating Scale-Revised Edition. Mixed-model analyses of covariance (ANCOVAs) examined intervention effects on MVPA during the school day; interactions between baseline center variables and group assignment (intervention vs. control) tested for moderation. Two center instructional practices, two social environment characteristics, and one physical environment characteristic at baseline moderated the effects of SHAPES on MVPA outcomes. Assessing baseline practices and center characteristics may aid efforts to match centers with interventions likely to increase physical activity as well as suggest additional intervention strategies to test.
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http://dx.doi.org/10.3390/ijerph17010101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982193PMC
December 2019

Surveillance of Physical Activity: Actions Needed to Support New Federal Guidelines.

Am J Public Health 2020 01;110(1):87-89

Russell R. Pate is with the Arnold School of Public Health, University of South Carolina, Columbia, SC. James F. Sallis is with the Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA. Keshia M. Pollack Porter is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

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http://dx.doi.org/10.2105/AJPH.2019.305443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893320PMC
January 2020

Area-level Socioeconomic Environment and Cardiorespiratory Fitness in Youth.

Med Sci Sports Exerc 2019 12;51(12):2474-2481

Department of Exercise Science, University of South Carolina, Columbia, SC.

Introduction: Cardiorespiratory fitness is one of the most important markers of cardiometabolic health and is a strong predictor of cardiovascular disease and all-cause mortality across the lifespan. However, little is known regarding the relationship of area-level socioeconomic environment on cardiorespiratory fitness during childhood and adolescence.

Purpose: To examine the relationship between area-level socioeconomic environment and cardiorespiratory fitness in a diverse sample of school-age youth; and to determine the extent to which grade level, sex, race/ethnicity, and student poverty status moderate this relationship.

Methods: South Carolina FitnessGram data for school year 2015 to 2016 were obtained for 44,078 youth. Cardiorespiratory fitness was determined using Progressive Aerobic Cardiovascular Endurance Run or 1-mile run/walk test. Area-level socioeconomic environment was expressed as a composite index score at the census tract level using data from the American Community Survey. Multilevel logistic regression analyses were conducted, controlling for individual-level characteristics and nesting within schools and districts. Interaction terms were then introduced to the model to examine their effect of multiple sociodemographic moderators.

Results: Approximately half of the sample had inadequate cardiorespiratory fitness for health. The odds of achieving the Healthy Fitness Zone for cardiorespiratory fitness decreased by approximately 25% to 34% with increasing deprivation of the area-level socioeconomic environment, after controlling for covariates. The association between area-level socioeconomic environment and cardiorespiratory fitness also varied significantly by sex, grade level, and race/ethnicity subgroups.

Conclusions: Cardiorespiratory fitness was positively associated with area-level socioeconomic environment; however, the relationship varied by demographic characteristics. These results highlight the importance of examining the influence of area-level socioeconomic environment on health across the life span. Additional research is needed to explore how area-level socioeconomic environment may impact evidence-based efforts to improve youth cardiorespiratory fitness levels.
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http://dx.doi.org/10.1249/MSS.0000000000002066DOI Listing
December 2019

Sport participation, physical activity and sedentary behavior in the transition from middle school to high school.

J Sci Med Sport 2020 Apr 1;23(4):385-389. Epub 2019 Nov 1.

Department of Exercise Science, Public Health Research Center, University of South Carolina, USA.

Objectives: To examine associations between sport participation, and objectively assessed physical activity and sedentary behavior in youth during the transition from middle school to high school.

Design: Longitudinal study with 2-year follow-up.

Methods: Sport participation and accelerometer-measured physical activity and sedentary behavior were assessed in 306 children (122 males, 184 females) when they were in 7th and 9th grades (mean age of 12.5 ± 0.5 years).

Results: Sport participation and physical activity declined from 7th to 9th grade, but total physical activity (d = 0.38, p < 0.0001) and moderate-to-vigorous physical activity (d = 0.26, p = 0.0004) remained higher in sport participants compared to non-participants. In 9th grade, the full sample of sport participants compared to non-participants had higher levels of total physical activity (20.7 min/h vs. 18.5 min/h) and moderate-to-vigorous physical activity (1.8 min/h vs. 1.6 min/h). Sex-specific analysis revealed similar patterns in both females and males. Sedentary behavior remained lower (d = -0.37, p = <0.0001) in the full sample of sport participants compared to non-participants (39.8 min/h vs. 41.7 min/h) in 9th grade. Similar patterns were observed in both females and males.

Conclusions: Children's participation in sport is associated with greater levels of physical activity and lower levels of sedentary behavior during the transition from middle school to high school. Promoting children's participation in sports could be an effective public health strategy to help children meet the current physical activity guideline.
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http://dx.doi.org/10.1016/j.jsams.2019.10.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054172PMC
April 2020

Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials.

BMJ Open 2019 11 11;9(11):e031220. Epub 2019 Nov 11.

Exercise Science, University of South Carolina, Columbia, South Carolina, USA.

Objectives: Determine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m, fat mass and per cent body fat) in overweight and obese children and adolescents.

Design: Network meta-analysis of randomised exercise intervention trials.

Setting: Any setting where a randomised trial could be conducted.

Participants: Overweight and obese male and/or female children and adolescents 2-18 years of age.

Interventions: Randomised exercise intervention trials4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training.

Primary Outcomes: Changes in BMI in kg/m, fat mass and per cent body fat.

Results: Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training ([Formula: see text] ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to -0.6; fat mass -2.1, -3.3 to -1.0 kg; per cent fat -1.5, -2.2 to -0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, -1.4 to -0.1; fat mass -2.5, -4.1 to -1.0 kg; per cent fat, -2.2, -3.2 to -1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,-2.5 to -0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI.

Conclusions: Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents.

Prospero Registration Number: CRD42017073103.
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http://dx.doi.org/10.1136/bmjopen-2019-031220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858189PMC
November 2019