Search

Background: Physical inactivity prevalence estimates for youth and adults have been published on a global scale and for various geographical and geopolitical permutations. Only one such study has presented estimates for adults in Muslim countries, and it is nearly 10 years old. I conducted an update of this study by incorporating newer data, refining methods, and including youth estimates., Methods: I identified 47 Muslim countries with physical inactivity data for youth, adults, or both. Data were extracted by country primarily from global estimates reported by Guthold et al in 2018 and 2020 and from World Health Organization surveillance data repositories. Weighted prevalence calculations for total prevalence and by sex, ethnicity (Arab vs non-Arab), and country income group accounted for country population, study sample size, and a country's proportion of Muslims. Z tests and chi-square tests, and follow-up odds ratios and percentage deviations, respectively, were used to determine differences by sex, ethnicity, and country income group., Results: Overall physical inactivity prevalence was 84.2% (youth) and 29.6% (adults). Gaps favoring males over females were observed for youth (5.6% lower prevalence) and adults (9.6% lower prevalence). Gaps favoring non-Arabs over Arabs were observed for youth (3.9% lower) and adults (3.8% lower). No pattern emerged for country income group for youth; however, prevalence for adults trended upward across income groups from low (22.7%) to high (62.0%)., Conclusions: Gaps by sex and ethnicity have narrowed since the original report and prevalence values are somewhat higher than current global estimates.

Objectives: The aim of the study was to quantify and compare potential energy expenditure associated with school recess in the U.S. based on four scenarios: professional recommendations and state policies for the conduct of recess, previous studies that measured physical activity intensity during recess (i.e., reality), and no daily recess., Methods: Estimated energy expenditure (kcal) was modeled using secondary data over six years of elementary school for boys and girls using a standard formula: Intensity × duration × frequency × mass ., Results: Boys and girls would expend similar energy under the professional recommendation (boys, 69,146 kcal; girls, 63,993 kcal) and state policy (boys, 69,532 kcal; girls, 64,351 kcal) scenarios. These values are significantly greater than a no recess scenario (boys, 26,974 kcal; girls, 24,821 kcal). The greatest energy expenditure was found for the reality scenario, based on actual studies that measured physical activity intensity (boys, 82,208 kcal; girls, 75,628 kcal)., Conclusions: Professional recommendations and state policies for recess duration may be overly conservative and recommendations for percentage of MVPA may be overly liberal compared to the reality of energy expended during recess. Both potential and real estimates dwarf a scenario of withholding recess (i.e., no recess), which is discouraged in only six state policies. Mandated reporting with "groundtruthing" is needed to determine true recess frequency/duration and state policy compliance., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Purpose : Health authorities recommend schools play a major role in providing and promoting physical activity (PA). School choice legislation has led to increases in both public charter schools and private schools, and these have greater flexibility in curriculum, staffing, and other practices than traditional public schools. Most schools have public websites for informing constituents about their goals, curricula, and programs. Little is known, however, about how they use websites to provide information about and advocate for PA programs. Thus, we compared how selected PA programs were represented on public charter and private elementary school websites. Methods : We conducted a systematic content analysis of the websites of 520 public charter and 990 private schools in California that included grades 1-5 and compared how they represented PE, interscholastic sport, and other PA opportunities. Results : Websites mentioned PA programs infrequently and provided little information about them. PE was the PA program mentioned most often on both charter (30.8%) and private (71.3%) school websites, but information about its frequency, duration, curricula, and who taught it was comparatively scarce (range: charter (4.8 - 22.5%); private (11.2 - 54.8%). More private than charter school websites mentioned interscholastic sport (45.6% vs. 16.5%, p <.001) and other extracurricular PA programs (26.8% vs. 20.4%, p =.006). Conclusion : Although available in nearly all schools, website content about PA/PE was limited. In this regard, however, private school websites were more fully developed than those in public charter schools.

Less than 25% of US children 6-17 years of age are sufficiently active. Faith-based settings are one of the nine societal sectors tasked with promoting physical activity (PA). Religious organizations frequently use diverse media, including websites, bulletins/newsletters, and calendars to inform current/potential members of events. These could be used to inform youth congregants about PA programs and/or various programs (e.g., worship, social group) with a PA component. We aimed to identify types of PA offerings available to youth and detect disparities by denomination. We performed a systematic line-by-line analysis of website content for a nationally representative, proportionate random sample of 1386 US synagogues representing five denominations: Humanistic (n = 24), Reconstructionist (n = 86), Reform (n = 462), Conservative (n = 368), and Orthodox (n = 446). We utilized crosstabulations and post hoc analyses (z scores) to identify denominational differences by a priori determined program type: education, worship, youth group, and preschool. Only 35% of the synagogues overall mentioned provision of at least one PA across program types. Proportions by denomination included: Humanistic (8%), Reconstructionist (48%), Reform (29%), Conservative (60%), and Orthodox (21%). There were denominational differences for education, worship, and preschool, with Conservative synagogue websites mentioning PA programs more frequently than expected. Future research should survey synagogue clergy and those overseeing media content toward understanding the decision-making process for mentioning/omitting PA when advertising youth programming., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background  There has been an increasing utilization of end-to-end (ETE) and reverse "supercharged" end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers (NTs) for treatment of high ulnar nerve injury. This study aimed to review the potential indications for, and outcomes of, ETE and SETS AIN-ulnar NT. Methods  A literature review was performed, and 10 articles with 156 patients who had sufficient follow-up to evaluate functional outcomes were included. English studies were included if they reported the outcome of patients with ulnar nerve injuries treated with AIN to ulnar motor NT. Outcomes were analyzed based on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip and key pinch strength, and interosseous Medical Research Council-graded motor strength. Comparisons were made using the independent t -test and the chi-square test. No nerve graft control group was required for eligibility. Ulnar nerve injury types varied. Results  NT resulted in 77% of patients achieving M3+ recovery, 53.7 ± 19.8 lb grip strength recovery, 61 ± 21% key pinch recovery, and a mean DASH score of 33.4 ± 16. In this diverse group, NT resulted in significantly greater M3+ recovery and grip strength recovery measured in pounds than in the nerve graft/conventional treatment group, and ETE repairs had significantly better outcomes compared with SETS repairs for grip strength, key pinch strength, and DASH scores, but heterogeneity limits interpretation. Conclusion  ETE and SETS AIN-ulnar NTs produce significant restoration of ulnar nerve motor function for high ulnar nerve injuries. For ulnar nerve transection injuries at or above the elbow, ETE NT results in superior motor recovery compared with nerve grafting/conventional repair. However, further research is needed to determine the best treatment for other types of ulnar nerve injury and the role of SETS NT., Competing Interests: Conflict of Interest None declared., (Society of Indian Hand Surgery & Microsurgeons. All rights reserved.)

Protein intake is an important factor for augmenting the response to resistance training in healthy individuals. Although food intake can help with anabolism during the day, the period of time during sleep is typically characterized by catabolism and other metabolic shifts. Research on the application of nighttime casein protein supplementation has introduced a new research paradigm related to protein timing. Pre-sleep casein supplementation has been attributed to improved adaptive response by skeletal muscle to resistance training through increases in muscle protein synthesis, muscle mass, and strength. However, it remains unclear what the effect of this nutritional strategy is on non-muscular parameters such as metabolism and appetite in both healthy and unhealthy populations. The purpose of this systematic review is to understand the effects of pre-sleep casein protein on energy expenditure, lipolysis, appetite, and food intake in both healthy and overweight or obese individuals. A systematic review following PRISMA guidelines was conducted in CINAHL, Cochrane, and SPORTDiscus during March 2021, and 11 studies met the inclusion criteria. A summary of the main findings shows limited to no effects on metabolism or appetite when ingesting 24-48 g of casein 30 min before sleep, but data are limited, and future research is needed to clarify the relationships observed.

Traumatic peripheral nerve injuries present a particular challenge to hand surgeons as mechanisms of nerve-healing pose serious limitations to achieving complete functional recovery. The loss of distal axonal segments through Wallerian degeneration results in the loss of neuromuscular junctions and irreversible muscle atrophy. Current methods of repair depend on the outgrowth of proximal nerve fibers following direct end-to-end repair or gap repair techniques. Investigational techniques in nerve repair using polyethylene glycol (PEG) nerve fusion have been shown to bypass Wallerian degeneration by immediately restoring nerve axonal continuity, thus resulting in a rapid and more complete functional recovery. The purpose of this article is to review the current literature surrounding this novel technique for traumatic nerve repair, paying particular attention to the underlying physiology of nerve healing and the current applications of PEG fusion in the laboratory and clinical setting. This article also serves to identify areas of future investigation to further establish validity and feasibility and encourage the translation of PEG fusion into clinical use., Competing Interests: Conflict of Interest None declared., (Society of Indian Hand & Microsurgeons. All rights reserved. Thieme Medical and Scientific Publishers Pvt. Ltd., A-12, 2nd Floor, Sector 2, Noida-201301 UP, India.)

Faith-based organizations are entities recommended to promote and provide health-related physical activity to youth. Meanwhile, religious institutions-including synagogues-typically use diverse media, including websites, bulletins/newsletters, and calendars to inform current and potential members about both general (e.g., theological) and specific practical messages (e.g., about the occurrence of services, meetings, and programs). Given the historical role synagogue centers played in the early- to mid-twentieth century in providing members recreational and sport programming, we were interested to know what physical activities synagogues currently advertise through the aforementioned media. From January through May 2019, we completed a line-by-line analysis of the public websites of a large nationally representative sample of synagogues ( n  = 1383 sites from 337 U.S. cities in 39 states) to assess content (including links to bulletins/newsletters and calendars) related to child and adolescent physical activity. Only 35.4% of the sampled websites used these media to mention that their synagogue provided even a single physical activity program/event. Thus, most synagogues either (a) did not provide physical activity programs for children and adolescents, or (b) neglected to use online platforms to promote engagement in them. We found 938 distinct programs/events and 1667 specific activities across synagogue websites that mentioned at least one physical activity. Programs by type and proportion (i.e., percentage of programs overall) included youth group (39.1%), preschool (26.9%), youth worship (18.0%), and youth education (16.0%). We situate our findings by explicating past and current functions of synagogues related to the provision of youth programming. Future research should examine the beliefs that synagogue rabbis and media gatekeepers hold toward physical activity in general and youth physical activity specifically. Youths should also be queried as to what role synagogue programming can/should play in promoting/providing and accommodating their physical activity needs and preferences., (© The Author(s), under exclusive licence to Springer Nature B.V. 2021.)

Vitamin D is widely known to regulate bone health, but there is increasing evidence that it may also ameliorate colitis through inflammation, cell proliferation and apoptosis, and the microbiota. The purpose of this review is to systematically examine the mechanisms by which vitamin D reduces colitis. PubMed and Web of Science were searched for articles published between 2008 and 2019 using key words such as "vitamin D," "colitis," "inflammatory bowel disease," "inflammation," "apoptosis," "cell proliferation," and "gut bacteria". Retrieved articles were further narrowed and it was determined whether their title and abstracts contained terminology pertaining to vitamin D in relation to colitis in human clinical trials, animal studies, and cell culture/biopsy studies, as well as selecting the best match sorting option in relation to the research question. In total, 30 studies met the established criteria. Studies consistently reported results showing that vitamin D supplementation can downregulate inflammatory pathways of COX-2, TNF-α, NF-κB, and MAPK, modify cell kinetics, and alter gut microbiome, all of which contribute to an improved state of colitis. Although vitamin D and vitamin D analogs have demonstrated positive effects against colitis, more randomized, controlled human clinical trials are needed to determine the value of vitamin D as a therapeutic agent in the treatment of colitis.

Background: Schools are important venues for providing and promoting physical activity, but little is known about how school websites are being used for these purposes. Completing a content analysis of existing school websites is essential to understanding their function and value relative to supporting physical education (PE) and physical activity., Methods: We conducted a quantitative, cross-sectional, systematic content analysis to analyze and identify correlates of the website features of 990 private elementary schools located in 325 California cities/localities., Results: Nearly all schools (98%) had a functioning website, but PE and physical activity content were displayed sparsely and inconspicuously. Regression models identified 10 predictors of website PE/physical activity content, including religious affiliation and having a separate webpage for PE., Conclusions: Websites can serve many functions, including providing information on the school vision/goals, curriculum content, class schedules, extracurricular activities, and core topics. This study is among the first to carry out a systematic analysis of school websites relative to PE and physical activity. Schools did not use the full potential of their websites to inform constituents about physical activity or to promote it. Schools should scrutinize their websites to ensure content and messaging are consistent with enabling students to engage in sufficient health-promoting physical activity., (© 2019, American School Health Association.)

Muslim women's perceptions of cultural, religious, and secular determinants of physical activity have been studied for many years, with information typically acquired through focus groups or interviews. Multiple reviews synthesizing the research have been published, however, individual studies have not been scrutinized for their quality/rigor. Therefore, I critically appraised the quality of the body of qualitative research studies that utilized focus groups to identify Muslim women's perceptions of physical activity barriers and facilitators. I utilized 26 items from the Consolidated Criteria for Reporting Qualitative Research (COREQ) to assess the quality of 56 papers published between 1987 and 2016. Using crosstabulations, I also examined associations between paper quality (low vs. high) and binary categorical variables for impact factor, maximum paper length allowed, publication year, and database the paper was indexed. Overall, papers averaged only 10.5 of 26 COREQ reporting criteria and only two out of 26 items were reported in more than 75% of the papers. Paper quality was not associated with impact factor and length. High quality papers were more likely published more recently (i.e., 2011 or later) and in journals indexed in the PubMed database compared to low quality papers. There is contention among qualitative researchers about standardizing reporting criteria, and while the trend in quality appears to be improving, journal reviewers and editors ought to hold authors to greater accountability in reporting.

Purpose : Quality physical education (PE) reaches many objectives (e.g., knowledge, physical fitness, and physical skills) and could provide at least half the dose of recommended daily physical activity for youths if their opportunity to learn is provided according to national professional recommendations (min/week) and related state mandates. A 2015 California class-action lawsuit required affected schools to post data indicating they scheduled PE time meeting the state mandate of 200 min per 10-day period. The extent to which schools posted PE schedules on their websites and demographic factors related to their compliance was investigated in this study. Method : We performed a quantitative, cross-sectional content analysis of the websites of 37 school districts plus a random sample of 860 elementary schools in them. Z tests were used to analyze frequencies/proportions and associations among demographic (e.g., Hispanic enrollment, PE specialist) and PE schedule variables (e.g., schools meeting state-mandated PE time). Results : Twenty-two districts (59.4%) had websites with ≥1 page/document related to PE opportunities. Only 11% of schools posted PE schedules, an event that was associated with employing a PE specialist ( p = .01). Of schools posting schedules, 68% specified a PE volume that met the state mandate. Meeting the mandate was independently associated with enrolling a minority of Hispanic students ( p = .02). Conclusion : Websites can provide information about the importance/occurrence of PE; however, schools in the lawsuit did not use the potential of their websites to inform constituents either about the lawsuit or their PE programs. Non-compliant schools should adjust PE schedules to meet statutory requirements.

Purpose : Given the unequal distribution of physical activity (PA) opportunities across middle schools, alternative options for promoting it should be explored. Faith-based schools are positioned to offer religious-themed PA interventions, yet few have been reported. We replicated previous research by investigating the effects of the Physical Activity for Lent (PAL) program on change in step count (ΔPA) and its associations with religiosity, enjoyment, and motivation (four subscales). Method : Over the 6-week Lenten season, three Catholic middle schools' students ( n = 128) participated in a randomly allocated controlled crossover trial of a pedometer-based virtual journey that followed Jesus's life path. We used the Reliable Change Index (RCI), general linear mixed models, and logistic regression to identify changes (pre- to post-Lent) in the independent variables, and their association with ΔPA overall and of being in the highest ΔPA tertile. Results : Between 11.6% (religiosity) and 34.7% (external regulation) of participants' scores changed. School (School 3 > Schools 1 and 2 by ~2,400 steps/day, p < .001) and grade (6th grade > 7th and 8th grades by ~2,500 steps/day, p < .001) - but not religiosity, enjoyment, or motivation - were significant predictors of ΔPA. As RCI for intrinsic motivation and identified regulation increased, students were more (OR = 2.49) and less (OR = 0.74) likely, respectively, to be in the high ΔPA tertile. Conclusion : Desirable ΔPA was situational (i.e., school, grade) and highest ΔPA tertile was associated with autonomous motivation. Faith-based PA interventions may need to include additional components to realize even greater gains.

Most youths fail to meet recommended public health recommendations for physical activity (PA) and schools have been assigned a key role in mitigating this problem. Charter school growth exploded recently, but little is known about these schools' support of PA. School websites offer public windows through which they can share information about their programs, policies, and values. Thus, during spring 2018, we completed a quantitative content analysis of specific information about PA on the websites of a representative sample of U.S. charter elementary schools ( n  = 759). Nearly all schools (97%) had a functioning website, but most (52%) did not mention even one of five PA programs frequently offered at schools: physical education (PE), recess, intramurals, interscholastics, and PA clubs. PE, a standard part of school curricula, was mentioned on only 34% of the sites. Although public health proponents identify schools as ideal locations for promoting PA, school websites are neglected both as a means for identifying the importance of PE and PA and as a vehicle for informing students about how and when to be active during the school day.

Background: Participation in regular physical activity (PA) has many health benefits for school-aged children. However, only about 20% of children worldwide meet recommendations for being sufficiently active. Children spend many hours per day at school and schools have a mandate for promoting PA. Private religious schools could serve as a novel source for religious-themed PA interventions., Methods: We randomly allocated 2 clusters of 2 Catholic middle (grades 6-8) schools/cluster to a 2-week no treatment/4-week intervention crossover trial to determine the effects of a 20-day Lenten-themed PA intervention on 187 students' pedometer steps taken at school. Specifically, students independently progressed through a workbook (Savior's Sandals) that depicted and informed about 11 locations in the Holy Land where Jesus lived, visited, and/or ministered, and included Scripturally-based questions about each place for students to answer. In all, students would accumulate 110,000 steps if they completed the workbook virtual journey. General linear mixed models with restricted maximum likelihood estimation to compensate for missing data were used to compute the intervention effects on mean daily steps., Results: There were significant main effects for the intervention overall and by school and grade level. Follow-up tests isolated that a single school (Mean diff  = + 2156 steps/day) and grade 6 students (Mean diff  = + 1678 steps/day) across all four schools experienced the greatest treatment effects., Conclusions: Religious-themed PA interventions can be effective; however, specific adjustments may be needed to optimize the intervention's effectiveness for a broader population of students., Trial Registration: Current Controlled Trials ISRCTN10273669 . Retrospectively registered 23 Oct 2018.

Previous research has found churches to be effective at delivering physical activity (PA) programs to their congregants. Mosques, however, have not been extensively studied. Therefore, we quantified U.S. Islamic centers' advertisement of PA programming and examined their programming characteristics. We conducted a content analysis of the websites of 773 eligible Islamic centers of which 206 centers in 32 states advertised PA programming. We categorized PA by program type: camping, fitness classes, sports, youth programs, and irregular offerings. We calculated descriptive statistics by program type for specific activity, frequency/duration/volume, participant/instructor sex, and instructor religion. Youth group (44%) and sports (23%) programs were most and least frequently advertised, respectively. Most centers (66%) that posted information on PA programming advertised only one program type. Men and Muslims taught most activities. Most activities-except for fitness classes-were advertised to a male audience. Islamic centers should offer and advertise additional PA programming-especially for women-and better utilize their websites for promoting such programming. Individual Islamic centers and Islamic- and non-religion based public health agencies can utilize our findings to fashion future PA offerings.

Background: Focal fibrocartilaginous dysplasia (FFCD) is a rare disorder of the upper and lower extremities. In the distal ulna, a ligamentous tether emerging from the metaphysis crosses the physis and restricts growth, leading to deformity. Lesion excision before radiocapitellar subluxation has been shown to restore growth and allow remodeling. We review the outcomes of 4 patients with FFCD of the distal ulna after the occurrence of radiocapitellar incongruity., Methods: This retrospective review examined 4 patients diagnosed with FFCD of the distal ulna from 2007 to 2015. Diagnosis was based on radiographic parameters and pathology when available. The radiographic and functional outcomes are reported., Results: Three males and 1 female patient presented at an average of 37.5 months (range, 22 to 48 mo) with ulnar FFCD and radiocapitellar joint incongruity. The first patient had progressive radiocapitellar dislocation, poor motion, pain, and deformity. The second patient presented for a third opinion after previous surgery secondary to deformity progression and radial head dislocation. These patients required salvage procedures with creation of a 1-bone forearm. Patient 3 had frank dislocation of the radiocapitellar joint, yet maintained functional motion. This family elected for continued observation. Patient 4 had a 50% subluxation of the radiocapitellar joint and underwent tether excision and ulnar lengthening with an external fixator. Both joint congruity and deformity improved with functional forearm and elbow motion., Conclusions: Delayed treatment of ulnar FFCD may require salvage procedures to maximize function and provide pain relief.

Background: Although there are over 26,000 private schools in the United States, little is known about the relationship of their characteristics to mandated and recommended time allocations for physical education (PE)., Methods: Private secondary schools (N = 450; grades 6-12) in California completed a 15-item questionnaire related to school characteristics and PE policies and practices. Using correlational analysis and predictive modeling, we assessed the associations and influences of various factors relative to the schools meeting state (California) and national professional time targets for PE., Results: Whereas most schools fell short of meeting PE weekly time recommendations, 5 of 10 tested variables were significantly associated with schools meeting PE minutes/week targets: school enrollment, school level, having a fitness testing policy, PE class size, and not permitting exemptions for PE. Large schools and those serving high school students provided more PE and were more likely to meet PE time allocation standards. Having policies for PE minutes/week and no exemptions for PE were significantly associated with a school having all its PE classes taught by a specialist., Conclusions: Private secondary schools should consider the adoption of professional guidelines related to PE time allocations, class size, conducting physical fitness testing, employing PE specialists, and not permitting exemptions for PE., (© 2018, American School Health Association.)

Background: After-school programs (ASPs) have the potential to contribute to student physical activity (PA), but there is limited empirical evidence to guide program development and implementation., Methods: We used pedometry to assess the overall effectiveness of an elementary school ASP running program relative to national and state PA recommendations and to compare 2 different formats (laps vs games) on PA and energy expenditure., Results: Both running laps and running games contributed substantially to PA accrual and energy expenditure (overall 24.2 minutes of PA and 52.6 kcal during sessions averaging 37 minutes), but the formats provided different outcomes relative to PA intensity and energy expenditure. Overall PA% was higher on lap days, but MVPA% (moderate-to-vigorous PA) was higher on game days. Only game days met the stipulation that ASPs provide activities at an intensity in which MVPA% of PA ≥ 50%., Conclusions: Both running laps and running games in an ASP can contribute to PA accrual. ASP providers should weigh the demands and outcomes of program activities, and especially consider the quality of activities, students' feelings about them, and the implementation demands on instructors., (© 2018, American School Health Association.)

Purpose: Interscholastic, intramural, and club physical activity (PA) programs can be important contributors to student PA accrual at schools. Few studies have assessed factors related to the provision of these extracurricular PA programs, especially in private schools., Methods: We used a 16-item questionnaire to assess the associations and influences of selected factors relative to extracurricular PA program policies and practices in 450 private California secondary schools. Associations were evaluated using contingency table analyses (i.e., chi-squared, effect size, and post-hoc analyses)., Results: Six factors were associated with schools providing extracurricular PA programs: school location, level, enrollment, and religious classification and whether the physical education (PE) program met state PE time standards and was taught by PE specialists., Conclusions: Both static factors (e.g., school location, level, enrollment, and religious affiliation) and modifiable factors (e.g., meeting PE standards and employing specialists) affect the provision of extracurricular PA programs. As education is state-mandated, additional study is recommended to assess the generalizability of these findings to other states and to public schools.

Background: We assessed the associations of 5 school and 7 neighborhood variables with fifth-grade students achieving Healthy Fitness Zone (HFZ) or Needs Improvement-Health Risk (NI-HR) on aerobic capacity (AC) and body composition (BC) physical fitness components of the state-mandated FITNESSGRAM ® physical fitness test., Methods: Data for outcome (physical fitness) and predictor (school and neighborhood) variables were extracted from various databases (eg, Data Quest, Walk Score ® ) for 160 schools located in San Diego, California. Predictor variables that were at least moderately correlated (|r| ≥ .30) with ≥1 outcome variables in univariate analyses were retained for ordinary least squares regression analyses., Results: The mean percentages of students achieving HFZ AC (65.7%) and BC (63.5%) were similar (t = 1.13, p = .26), while those for NI-HR zones were significantly different (AC = 6.0% vs BC = 18.6%; t = 12.60, p < .001). Correlations were greater in magnitude for school than neighborhood demographics and stronger for BC than AC. The school variables free/reduced-price lunch (negative) and math achievement (positive) predicted fitness scores. Among neighborhood variables, percent Hispanic predicted failure of meeting the HFZ BC criterion., Conclusions: Creating school and neighborhood environments conducive to promoting physical activity and improving fitness is warranted., (© 2017, American School Health Association.)

Schools are salient locations for addressing the high prevalence of overweight and obesity. Most US states require some physical education (PE) and the energy expended during PE has potential to positively affect energy balance. We previously used 2012 data to examine state policies for PE to calculate estimated student energy expenditure (EEE) under potential (i.e., recommendations followed) and existing conditions. Since then, data have been updated on both state policies and the conduct of PE. Based on updated data, we used PE frequency, duration, and intensity, student mass, and class size to calculate EEE for the delivery of PE under (a) national professional recommendations, (b) 2016 state policies, and (c) school-reported conditions. Although increased from four years ago, only 22 states currently have policies mandating specific PE minutes. EEE over 10years shows the enormous impact PE could have on energy balance. For the average recommended-size PE class, resultant annual EEE based on professional recommendations for min/week far exceeded those based on average state (n=22) policy for min/week by 44.5% for elementary, 62.7% for middle, and 59.5% for high schools. Since 2012 more states adopted policies for PE minutes than dropped them, however, EEE over 10years showed a net loss of 1200kcal/student. With no overall recent improvements in state PE policy and professional recommendations currently not being met, PE remains an underutilized public health resource for EEE. Strong policies, coupled with enhanced accountability of PE teachers and administrators, are needed to ensure PE exists in schools., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Physical education (PE) is mandated in most states, but few studies of PE in private schools exist., Methods: We assessed selected PE policies and practices in private secondary schools (grades 6 to 12) in California using a 15-item questionnaire related to school characteristics and their PE programs., Results: Responding schools (n = 450; response rate, 33.8%) were from 37 counties. Most were coeducational (91.3%) and had a religious affiliation (83%). Secular schools had more PE lessons, weekly PE min, and smaller class sizes. Most schools met guidelines for class size, but few met national recommendations for weekly PE minutes (13.7%), not permitting substitutions for PE (35.6%), and programs being taught entirely by PE specialists (29.3%)., Conclusions: Private schools, which serve about 5 million US children and adolescents, may be falling short in providing quality PE. School stakeholders should encourage adoption and implementation of policies and practices that abide by professional guidelines and state statutes.

Although preventing youth overweight and obesity is a public health priority, quality physical education (PE) is marginalized in practice. In May 2014, we estimated energy expenditure (EE; derived from PE frequency, duration, and intensity; mean student mass; and class size) from national recommendations and data from the 19 US states with PE duration guidelines, under 3 scenarios: potential (quality PE, defined as 50% moderate-to-vigorous physical activity [MVPA]), reality (MVPA = 35%), and classroom instruction only. Students in schools following nationally recommended PE standards from grades 1 through 10 could expend from 35 000 to 90 000 more kilocalories than students who received classroom instruction instead. PE's potential for increasing student EE will only be realized with stronger school policies and increased accountability.

Objective: Physical inactivity surveillance informs policy and treatment options toward meeting the World Health Organization's (WHO) goal of a 10% reduction in its prevalence by 2025. We currently do not know the aggregate prevalence for Muslim-majority countries, many of which have extremely high rates of comorbidities associated with physical inactivity., Method: Based on data for 163, 556 persons in 38 Muslim countries that were collected by the Global Physical Activity Questionnaire and the International Physical Activity Questionnaire, unweighted and weighted physical inactivity prevalence estimates were calculated. I used two-proportion Z tests to determine gender and ethnic differences within the sample and between the sample and 94 non-Muslim countries and odds ratios to determine the magnitude of significant differences., Results: Total physical inactivity prevalence was 32.3% (95% CI: 31.9, 32.7). Prevalence among males and females was 28.8% and 35.5%, respectively. Prevalence among non-Arabs and Arabs was 28.6% and 43.7%, respectively. Females and Arabs were more likely physically inactive than their respective counterparts [OR = 1.36 (1.33, 1.39) and OR = 1.94 (1.90, 1.98)]. Muslim countries were more likely physically inactive [OR = 1.23 (1.22, 1.25)] than non-Muslim ones, which was primarily due to the influence of Arabs [OR = 2.01 (1.97, 2.04)], and in particular female Arabs [OR = 2.22 (2.17, 2.27)]., Conclusion: Physical inactivity prevalence in the Muslim world is higher than non-Muslim countries and the difference is primarily due to higher rates among Arabs.

Purpose: Physical activity participation in physical education is compromised when students nonsuit. We investigated: (a) reasons for nonsuiting/support of policy change and whether they differed by gender, ethnicity, or grade; and (b) the likelihood of nonsuiting based on the same demographics., Method: Participants (N = 627) were 6th and 7th graders attending 1 urban middle school located in San Diego, CA. Students completed a questionnaire composed of 4 demographic items, level of agreement with 15 reasons for nonsuiting, and level of support of 6 proposed policy changes. Exploratory and confirmatory factor analyses were used to classify reasons for nonsuiting items and policy change items. Demographic differences among resultant factor scores and individual items were analyzed using t tests. Associations between factors/items and nonsuit frequency and demographics were analyzed using multinomial logistic regression., Results: Girls, Latinos, and 7th graders were more likely habitual nonsuits (> or = 4 nonsuits) compared with their respective counterparts. Statistically significant factor scores (reasons for nonsuiting; emotional excuses, utilitarian excuses) were higher among habitual nonsuits but were not different based on gender, grade, and ethnicity. Seventh graders and girls had statistically significantly higher policy change factor scores compared with their respective counterparts., Conclusion: Acting on student input toward reformulating suiting-out policy as well as addressing emotional excuse reasons, which are primarily under teacher control, may result in lower incidence of habitual nonsuiting.

Purpose: Some religions espouse doctrines that (in)directly impact physical activity (PA) behavior. Yet limited PA interventions have been tailored to religious minorities. Thus, a formative study was conducted to examine the effect of a faith-based pedometer program (Virtual Umra) on psychological correlates of PA behavior and their contribution to school-time changes in PA among Muslim adolescents., Method: Forty-three (27 girls, 16 boys; M(age) = 12.3 +/- 1.0 years) students at 1 Islamic middle school participated. Prebaseline and postprogram enjoyment and motivation were measured using the shortened PA Enjoyment Scale and the Situational Motivation Scale, respectively. Pedometer step counts were measured daily during a 2-week baseline and 8 weeks of Virtual Umra. The Reliable Change Index and Cohen's d were used to analyze individual- and group-level changes in enjoyment and motivation, respectively. Repeated-measures multivariate analysis of variance (RM-MANOVA) was used to analyze program and gender effects over time. Partial correlations examined the relationships between psychological correlates and PA change., Results: One third of the sample expressed greater enjoyment postprogram (p < .001, d = 0.99), while motivation was unaffected (p > .05; range, d = - 0.02 to 0.32). RM-MANOVA revealed that boys increased their steps, whereas girls reduced their step number through the program. Enjoyment increased and extrinsic motivation and amotivation decreased. Partial correlations revealed that enjoyment and more self-determined behavioral regulations were positively associated with non-physical education (PE)-day PA change; only intrinsic motivation was positively associated with PE-day PA change., Conclusion: Virtual Umra was associated with increased enjoyment of PA but needs further modification to more positively impact girls' PA.

Purpose: More than one fifth of American preschool-aged children are classified as overweight/obese. Increasing physical activity is one means of slowing/reversing progression to overweight or obesity. Measurement of physical activity in this age group relies heavily on motion sensors such as accelerometers. Output is typically interpreted through application of one of several cutpoints to quantify the amount of time spent at various physical activity levels. Cutpoint nonequivalence has resulted in widely varying estimates of physical activity. Thus, we sought to ascertain the convergent validity of four ActiGraph accelerometer cutpoints with the Observation System for Recording Activity in Children-Preschool (OSRAC-P)., Method: Two studies were conducted with sixty-nine 4- and 5-year-olds during unstructured outdoor free play at a single university campus preschool in Southern California. In Study 1 (N = 57), percentages of time spent in sedentary behavior (SED) and moderate-to-vigorous physical activity (MVPA) were compared at the aggregate level using the two-proportion z-test and Bland Altman plots. In Study 2 (N = 12), time-matched 5-s intervals between accelerometery and the OSRAC-P were compared using percent agreement, kappa, and classification functions., Results: In Study 1, cutpoints by Sirard, Trost, Pfeiffer, Dowda, and Pate (2005) best converged with the OSRAC-P estimates of SED and MVPA. In Study 2, Sirard et al. cutpoints and those by Pate, Almeida, McIver, Pfeiffer, and Dowda (2006) were more sensitive in detecting SED and MVPA, respectively., Conclusions: Choosing a cutpoint in this age group should be based on the exposure of interest, epoch/observation interval duration, and required degree of stringency for classifying physical activity level.

This study investigated the impact of renovation and redesign of a university preschool's outdoor space on children's sedentary behavior, light activity, and moderate-to-vigorous-physical-activity (MVPA) during unstructured recess. Physical activity was measured by accelerometry and direct observation in two independent samples of 50 (baseline) and 57 (postintervention) children (Mage = 4.4 yrs ± 0.5). Controlling for gender, age, BMI and recess length, observational data, but not accelerometry, revealed a significant decrease in intervals spent sedentary (-26.5%) and increases in light physical activity (+11.6%) and MVPA (+14.9%). Higher levels of MVPA were associated with specific environmental changes (new looping cycle path, OR = 2.18; increased playground open space, OR = 7.62; and new grass hill, OR = 3.27). Decreased sedentary behavior and increased light activity and MVPA may be realized with environmental changes that promote continuous and novel movement experiences in more expansive spaces.

Background: Despite frequent use of pedometers in interventions targeting youth PA, there is no literature that addresses the prevalence and reasons for protocol nonadherence., Methods: Adherence behaviors of early adolescents (n = 43; Meanage = 12.3 ± 1.0) in an 8-week, faith-based intervention were monitored/recorded. Students provided reasons for various aspects of protocol breach, which were used to develop a post intervention questionnaire. Analyses included calculations of frequency/percentage as well as cross tabulations/chi square to detect gender/age differences., Results: Over the intervention, recording PA in logs decreased by 85% and was attributed to forgetfulness and lack of time. For pedometers, highest-frequency events included error codes (n = 501), incorrect wear (37%, ≥ 1 day), and shaking (58%-69%, ≥ 1 time). Top reasons for shaking were to make up for lost step opportunities and get further along the route. Of permissible stepping strategies, males used ambulatory activity on the playground and stair usage more, while 6th graders used speed stepping in place more than their respective counterparts., Conclusions: Students admit to basal levels of nonadherence, which should be taken into consideration when designing/implementing interventions. Integrating intervention tasks into the regular curriculum and providing sufficient opportunities to perform them may alleviate some barriers to adherence. Future research should attempt to confirm results in other school types/levels as well as quantify these behaviors in free-living or unstructured settings.

Background: Curriculum interventions aimed at increasing physical activity in schools may prove useful in contexts where changes in policy/environment are not feasible. Design/evaluation of interventions targeting minority groups is important in light of well-publicized health disparities. Religious minorities represent a special subset that may positively respond to interventions tailored to their unique beliefs, which to date have been relatively underreported., Methods: Muslim American youth (n = 45) attending a parochial middle school participated in a religiously- and culturally-tailored 8-wk, interdisciplinary pedometer intervention. School-time ambulatory activity was quantified using a delayed multiple-baseline across subjects ABA design. Visual analysis of graphic data as well as repeated-measures ANOVA and ANCOVA and post hoc contrasts were used to analyze step counts including the moderating effects of day type (PE, no-PE), gender, BMI classification, grade, and time., Results: The intervention elicited modest increases in males' steps only with effect decay beginning midintervention. BMI classification and grade were not associated with changes in steps., Conclusions: Full curricular integration by affected classroom teachers, staff modeling of PA behavior, and alternative curriculum for girls' PE classes may further potentiate the intervention.

Objective: Quantify moderate-to-vigorous physical activity (MVPA) and its correlates in preschool children during outdoor unstructured play periods using direct observation., Methods: Cross-sectional data consisting of 204 observation periods collected from 51 four- and five-year-old children using the Observation System for Recording Physical Activity in Children - Preschool (OSRAC-P) at a preschool in southern California, autumn and spring 2009-2010. Gender and BMI classification and OSRAC-P environmental codes were related to observed MVPA in multiple logistic regression models., Results: Less than 21% of intervals were spent in MVPA overall. Boys and normal weight children engaged in higher intensity levels than their respective counterparts. More MVPA was associated with normal weight (OR=2.49-3.25, R(2)=3%), location (grass, playground, looping cycle path; OR=3.21-4.90, R(2)=4-12%), play context (ball/objects, wheel, open space; OR=2.78-8.51, R(2)=9%), and group composition (solitary, one-on-one; OR=1.34-2.08, R(2)=1%)., Conclusion: Open spaces located in playgrounds and grass fields, and activity-genic portable equipment, manipulative objects, and riding vehicles are some design and equipment features that appear to foster MVPA. Lowering play space density and engaging children through teacher prompts and teacher-arranged activities may further increase MVPA on playgrounds., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background and Methods: Accurate diagnosis and effective management of pelvic pain in women have become more challenging now that the number of women athletes and the number of diagnostic possibilities are increasing. We conducted a prospective study of women athletes with pelvic pain seen during a 2-yr period within a large well-defined clinical practice to clarify some of the current causes and treatment possibilities., Results: One hundred fourteen females, 14% of the total male/female cohort, were referred for treatment of suspected musculoskeletal injury. On the basis of history and physical and radiological examinations, 74 (64.9% of females) turned out to have injuries of the hip (group A) and/or soft tissues surrounding the hip (group B), and 40 (35.1%) had other sometimes more threatening diagnoses. In groups A and B, 40 (90.1%) of 44 patients who chose surgery achieved previous performance levels within 1 yr compared with only 4 (13.8%) of 29 who did not have surgery. Factors such as sport type, competitive status, and age did not affect the outcomes. Most diagnoses in group C, e.g., inflammatory bowel disease, reflex sympathetic dystrophy, and malignancy, usually eclipsed the potential musculoskeletal diagnoses in terms of long-term importance., Conclusions: In this series of patients, most pelvic pain in women athletes was identifiable and treatable. Most had benign musculoskeletal causes, and surgery played an important role in treatment of those causes. Still, we found a large number of other causes that required longer specialized care. Health care professionals seeing such patients need to be alert to the new concepts of pelvic injury and the various roles for surgery and the broad list of other considerations.

In this study, I conducted focus group interviews with 21 Arab American college students (9 men, 12 women; 9 Muslims, 12 non-Muslims), who were selected for extreme manifestation of religiosity or acculturation, to explore their beliefs and attitudes toward socioecological (SE) factors that facilitated and hindered their individual physical activity (PA) and body composition (I also considered body image and food and eating behavior). To analyze responses, I used a combination of deductive coding, which used levels of the SE model and demographic variable groupings, and inductive coding, to search for common themes among participants within and between research questions. Results revealed that (a) the context of physical activity participation differed by gender; (b) ideal body image was conflicted and varied by gender; and (c) consumption of cultural foods diminished along with Arab social customs related to eating. Interpersonal and cultural/community levels of the SE model were identified as primary influences, with parents regulating and instilling values backed by cultural norms to preserve Arab identity, especially in women. Finally, I identified an indeterminate adjustment period, during which immigrants transitioned between physical activity purpose/form in the Middle East and the United States.

Recruitment of minorities into health studies is a process that has been the subject of recent research effort. The prevalence of hypokinetic disease in the fast growing Middle Eastern-American community is higher than whites and some minority groups and descriptive research is needed to further quantify morbidity status and antecedent behavior. To date, we know of no study that reports recruitment methods of Middle Eastern-American young adults, a demographic group that is transitioning into an at-risk stratum for ethnically associated morbidity. We report and analyze a multi-method approach used in recruiting 240 young adults of this ethnic group into a 1-week study of physical activity utilizing activity logs and pedometers. Participants were primarily recruited through snowball sampling (48.3%), flyers (15.8%), presentations to university campus organizations (15.4%), and graduate research assistants (10.8%). Access was facilitated by assistants who were community insiders; active recruitment was more successful than passive recruitment; and different techniques appealed to different group segments based on gender and religion.

The prevalence of hypokinetic disease among persons of Middle Eastern heritage is higher than whites and research on American young adults of this population is limited. Therefore 214 tertiary students of Middle Eastern descent self-reported their physical activity (PA) over a 1-week monitoring period using pedometers and daily activity logs. Daily step count averaged 9,256 (SD = 3,084) steps, while daily energy expenditure averaged 6.26 kcal/kg (SD = 4.92). Most participants reported no weekly engagement in sport (69.2%) and walk/run (52.8%) activities, and at least once-weekly engagement in conditioning (68.7%) activities. Moderately religious and highly acculturated men, and Muslims, and moderately/highly acculturated persons were more likely to average > or = 10,000 steps/day and engage in at least one sport activity per week, respectively. These findings may be related to religious and cultural issues unique to Middle Eastern American college students whose collectivist social affiliations with family and community members may facilitate or inhibit various aspects of PA behavior.

Few studies of religiosity and physical activity (PA) correlates have been conducted; thus, a cross-sectional survey of 367 more and less religious Jewish adolescents' (M age = 12.8 years, SD = 0.9) perceptions of parental and environmental support of PA was conducted at religious day schools in two large American cities. Maternal Support, Environmental Support, and Paternal Non-Support factors were verified through confirmatory factor analysis. Factor scores were analyzed through a 2 x 2 (gender x religiosity level) multivariate analysis of variance. A significant main effect for religiosity was obtained (F = 6.93, p < .001); however, a main effect for gender and an interaction effect were not. Post hoc discriminant analysis revealed Paternal Non-Support and Environmental Support factors as differentiating more and less religious adolescents.