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Take TIME (Tobacco-free, Injury-free, Moving daily, Eating healthy) was an early intervention strategy targeting community readiness to support healthy lifestyles for young children in Uxbridge, Canada. This study aimed to assess the effectiveness of Take TIME using the Community Readiness Model adapted for childhood obesity prevention. Six interviews were completed in Uxbridge, before and after the intervention, with purposively selected community leaders in education, political, business, religious, not-for-profit, and healthcare fields. Each interview was rated independently by two scorers. Interview content was scored (scale from 1 to 9, with 1 being no awareness and 9 being a high level of community ownership) according to the Community Readiness Model criteria on six dimensions, with overall readiness calculated as the mean score of all dimensions. T-tests compared readiness by time-point and between communities. Overall community readiness significantly improved (p = 0.03) in Uxbridge from pre-intervention (3.63 ± 1.14 vague awareness) to post-intervention (5.21 ± 0.97 preparation). Seven interviews were also completed with leaders in the matched town of Rockwood, Canada which served as the control community. Rockwood readiness was close to the Uxbridge post-intervention score (5.35 ± 1.11). Results indicated increased awareness and leadership support post-intervention in Uxbridge, but further improvements in community knowledge, formalized efforts, and additional leadership support are desired. Take TIME increased community readiness to support healthy lifestyles for young children and may be useful to other communities at similar stages, given its theoretical alignment with the community readiness model. Future research should investigate the impact of Take TIME in demographically diverse communities and appropriate interventions to move communities from the preparation to the action stage. [ABSTRACT FROM AUTHOR]

Background: Children with congenital heart disease (CHD) often have inactive lifestyles and motor skill deficits beginning in infancy. The least active infants continue to be the least active children at school age. Enhancing physical activity and motor development in infancy, at the time of CHD treatment, may prevent inactive lifestyle habits. Methods: All children being treated, through surgery or catheterization, for congenital heart disease are eligible if they are 3 to 72 months of age at enrollment. The Peabody Motor Development Scales (Version 2) and 7-day accelerometry (Actigraph GT9X Link) assess motor skills and physical activity prior to treatment and 7 weeks, 6 months and 12 months post-treatment. Participants are randomized 3:1 to intervention:control. Until 7 weeks post-treatment, intervention activities focus on regaining pre-treatment mobility and midline crossing. From 7 weeks to 6 months post-treatment, the intervention is individualized to each child's assessment results and is parent-led, delivered at home and play-based. Conclusion: This feasibility study will provide essential data for a randomized controlled trial to evaluate play-based, parent-delivered interventions optimized to support age-appropriate physical activity and motor skills among young children with CHD. Preliminary intervention efficacy data will inform an evidence-based sample size calculation, optimize intervention timing, and identify hypotheses on the motor skill—physical activity connection and the impact of play-based, parent-led interventions during recovery from CHD treatment. Long-term, the goal is to optimize motor skill and active lifestyles among young children with CHD, enabling their healthy growth and development and enhancing childhood quality of life. Trial registration: Clinical trials registration:NCT04619745. [ABSTRACT FROM AUTHOR]

Physical activity counselling can target cognitive-affective participation barriers, but counselling benefits for children with medical conditions/disabilities were unknown. This study investigated successes, challenges, and the impact of physical activity counselling on children and their families. One-on-one semi-structured interviews were completed with 7 patients (2 male/5 female, aged 13–17) and 4 parents who participated in 2–8 weekly counselling sessions (2015–2020). Interviews were recorded and transcribed verbatim for inductive thematic analyses. Counselling encouraged positive mindset changes (viewing physical activity more holistically, making it "more fun and manageable", helping them to "learn how to love moving and doing sports"). Participants felt strong support (feeling heard, validated, and provided with "hope... that we can still achieve things... even though it may seem like there's limitations"). Counselling was viewed positively. The intent to improve active lifestyle attitudes and confidence was reflected in positive, primarily cognitive-affective (motivation for activity, "more general skills of having a positive attitude towards physical activity and the willingness to try new things") outcomes. More sessions, additional resources to keep, and follow-up after counselling completion were recommended to support behaviour change. Future research should evaluate enhanced counselling services and comparing children who have and have not received such counselling. [ABSTRACT FROM AUTHOR]

Purpose: Summer camps for children living with heart disease can have a profound impact on well‐being. However, specialized camps often require extensive resources (i.e., 24‐h medical staff supervision) and may be located in far remote settings. Integrating children with heart disease into mainstream day camps may address these barriers. The purpose of this study is to describe the experience of attending an integrated day camp from the perspectives of children with heart disease and their parents. Design and Methods: This study used a qualitative descriptive design. Among 25 eligible families, 9 participated in interviews which were held 3 months to 2 years after attending an integrated camp (mean age of children at camp was 7.3 ± 2.25 years). Interviews were audio‐recorded and transcribed verbatim for an inductive thematic analysis. Results: Many parents chose the integrated camp as their child's first summer camp experience, citing trust in the local division of Cardiology's approval of the camp activities as an important reason for enrolling. All participants agreed the integrated camp was a valued opportunity which should continue, although not all described positive camp experiences. Participants' descriptions of the integrated camp were organized into two main themes: 1) overall expectations of the camp and 2) important opportunities afforded by the camp experience. Partaking in a typical camp experience, connecting to local children with heart disease, adequate safety precautions and activity adaptations were specific expectations held by participants. Important opportunities included greater independence and confidence, navigating disclosure of their diagnosis to peers on their own terms, and more diverse social connections. Improving communication with parents to ensure expectations match camp objectives would have enhanced the experience. Practice Implications: Practitioners looking for an alternative to specialized camps for their patients with heart disease may use these results to guide the design and promotion of an integrated camp. [ABSTRACT FROM AUTHOR]

This pilot study examined proposed accessibility guidelines for running slope and cross slope and the perceived difficulty ratings of individuals with mobility limitations. Participants were 23 men and women, 23 to 67 years, with vision or mobility limitations who walked at their preferred pace before rating the path difficulty (1 to 10 scale). Paths meeting the proposed accessibility guidelines were rated as either easy or moderate for difficulty of use. Slopes exceeding the guidelines may also be acceptable for very short distances or on hard/paved surfaces. Future research should include a large representative population, evaluate surface firmness, and examine different perceptions between ambulatory individuals and wheelchair users. Keywords: trails; disability; running slope; cross slope; level of difficulty

Background: The Canadian Assessment of Physical Literacy (CAPL) was conceptualized as a tool to monitor children's physical literacy. The original model (fitness, activity behavior, knowledge, motor skill) required revision and relative weights for calculating/interpreting scores were required. Methods: Nineteen childhood physical activity/fitness experts completed a 3-round Delphi process. Round 1 was open-ended questions. Subsequent rounds rated statements using a 5-point Likert scale. Recommendations were sought regarding protocol inclusion, relative importance within composite scores and score interpretation. Results: Delphi participant consensus was achieved for 64% (47/73) of statement topics, including a revised conceptual model, specific assessment protocols, the importance of longitudinal tracking, and the relative importance of individual protocols and composite scores. Divergent opinions remained regarding the inclusion of sleep time, assessment/ scoring of the obstacle course assessment of motor skill, and the need for an overall physical literacy classification. Conclusions: The revised CAPL model (overlapping domains of physical competence, motivation, and knowledge, encompassed by daily behavior) is appropriate for monitoring the physical literacy of children aged 8 to 12 years. Objectively measured domains (daily behavior, physical competence) have higher relative importance. The interpretation of CAPL results should be reevaluated as more data become available. [ABSTRACT FROM AUTHOR]

Background: Healthy active lifestyles are critically important for children with complex heart problems (CHP) that affect heart structure, rhythm or function. They are at increased risk for morbidities such as atherosclerosis, obesity, anxiety and depression. Educating children with CHP and their families about the relevance of healthy lifestyles is an important part of clinical care. Design This study used a collaborative approach among six patients/family members and 22 health professionals to develop a series of knowledge‐to‐action tools suitable for counselling children with CHP and their families about their healthy lifestyle needs. Methods: After development of the knowledge‐to‐action tools had been completed, one cardiologist and one research assistant implemented one or more of these new resources during each clinic visit as appropriate for each patient. Thirty‐nine parents and eight children completed post‐clinic interviews to explore their perceptions of the new resources. The nine resources developed included brochures and websites addressing physical activity with a heart condition, body contact restrictions, exercise test results, emotional health, finding community resources, encouragement for asking healthy lifestyle questions and a brief, in‐clinic healthy lifestyle assessment. Results: Families found the resources useful and helpful for clarifying their specific concerns. They also provided suggestions to improve the content and delivery of the resources so that they would be suitable for a variety of settings—schools, community and sports. Conclusion: Future research is required to evaluate the effectiveness of these resources for raising awareness and knowledge about healthy active lifestyles among children with CHP and the impact of these resources for changing healthy lifestyle behaviours. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment. Method: Seventeen adolescents 12–18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5‐day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi‐structured interviews that were audio‐recorded and transcribed. Results were analyzed deductively using qualitative techniques. Results: Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group‐based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology. Discussion Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment. [ABSTRACT FROM AUTHOR]

Background: Participation in physical activity is essential to the long‐term health and development of all children. However, children living with cardiac conditions are typically not active enough to sustain positive health outcomes. Understanding the experiences of children living with congenital heart disease in community‐based settings could help inform the physical activity counselling practices of clinicians. The current study explored the perceptions of 7‐ to 10‐year‐old children with moderate or complex congenital heart disease as they participated in a 10‐week multisport programme. Methods: Detailed field notes recorded the discussions and behaviours of 11 participants (45% female participants) each week during the programme sessions. Among those, four participants (50% female participants) were purposively selected to participate in preprogramme and postprogramme focus groups to gather more detailed accounts of their experiences. Results: Four main themes surrounding physical activity were identified: (a) motivation, (b) self‐efficacy, (c) peer influences, and (d) family influences. Although feelings of excitement and enjoyment towards physical activity were prevalent throughout the data ("I'm really excited ... because I really like those sports"), participants also often felt frustrated, nervous, and fatigued ("I'm not very good at the skills"). Social inclusion with peers and family influences were meaningful reasons to engage in physical activity ("I really like playing games together"). Following the completion of the programme, participants emphasized their enjoyment of physical activity as a primary source of motivation, demonstrating an important shift from recognizing positive health outcomes ("... it's good for you") towards more intrinsic sources of motivation ("... because it's fun"). Conclusion: Opportunities for physical activity that enhance positive experiences and build intrinsic motivation should be identified and promoted to children with congenital heart disease. Community‐based programmes may also be an appropriate context for children with cardiac conditions to engage and maintain participation in physical activity through adolescence. [ABSTRACT FROM AUTHOR]

Background: The Canadian Assessment of Physical Literacy (CAPL) accurately and reliably assesses the physical literacy level of young children. However, in preliminary analyses ceiling effects were noted among 183 older children. The purposes of this study were to assess the validity of a modified CAPL designed for older children (CAPL 789) and to offer descriptive results. Methods: CAPL 789 assessed the physical literacy of Canadian children in grades 7–9. Data were collected from schools and recreation facilities in the provinces of Alberta and Ontario (Canada), yielding a new sample of 245 participants (129 girls, 13.7 ± 0.9 years). Descriptive statistics were calculated for all CAPL domains. Age and gender effects were examined to support the validity. Results: Physical competence score (/32) increased with age (F = 4.90, p < 0.05), the means in grades 7–9 being 18.9 ± 3.2, 20.9 ± 4.4 and 21.2 ± 3.4, respectively. Girls scored significantly higher (t = −2.29, p < 0.05) than boys (6.6 ± 1.2 vs 6.3 ± 1.3) in the knowledge assessment (/10). Conclusion: The CAPL 789 was feasible among children from grades 7–9. Additional research is required to establish the psychometric properties in children 12 to 16 years. [ABSTRACT FROM AUTHOR]

This study examined gender, disability type, age, and specific diagnostic category in relation to habitual physical activity levels (HPA), perceived fitness (PF), and perceived participation limitations (PPL) of youths, ages 6 to 20 years, in Ontario, Canada. Data collected through a mailed survey (Longmuir & Bar-Or, 1994) were reanalyzed using ANOVA and chi square statistics to provide new information. The 458 girls and 499 boys were classified by disability type: physical, chronic medical, visual, and hearing. Significant differences (p < .01) were between (a) HPA and disability type, specific diagnostic category, and age: (b) PF and disability type; and (c) PPL and disability type. Gender did not influence the results. Youths with cerebral palsy, muscular dystrophy, and visual impairment had the most sedentary lifestyles. [ABSTRACT FROM AUTHOR]

Physical activity is promoted for optimal health but may carry risks for children who require medically necessary activity restrictions. The sensitivity, specificity, and reliability of the Get Active Questionnaire (GAQ) for identifying children needing special considerations during physical activity was evaluated among parents of 207 children aged 3 to 14 years (97 (47%) female, mean age of 8.4 ± 3.7 years). GAQ responses were compared with reports obtained directly from the treating physician (n = 192/207) and information in the medical chart (clinic notes/physician letter, n = 111/207). Parent GAQ responses (either "No to all questions" or "Yes to 1 or more questions") agreed with physician (κ = 0.16, p = 0.003) and medical record (κ = 0.15, p = 0.003) reports regarding the need for special consideration during physical activity (Yes/No). Sensitivity was 71% (20/28) and specificity was 59% (96/164), with few false-negative responses. The GAQ was most effective for rheumatology and cardiology patients. False positives were 29% to 46%, except among chronic pain (80%) and rehabilitation (75%) patients. Test–retest reliability was moderate (Cronbach's α = 0.70) among 57 parents who repeated the GAQ 1 week later. The GAQ effectively identified children not requiring physical activity restrictions and those with medical conditions similar to those of concern among adults. Additional questions from a qualified exercise professional, as recommended for a "Yes" response on the GAQ, should reduce the false-positive burden. Indicating the timeframe of reference for each question and including an option to describe other special considerations (e.g., medication, supervision) are recommended. [ABSTRACT FROM AUTHOR]

Objective We sought to determine the prevalence of, and identify factors associated with, parent questions about physical activity for their child with a chronic cardiac, respiratory, or rheumatologic condition. Methods This cross-sectional study of 56 children (32 [57%] female), 3 to 18 years of age, with chronic cardiac (n=21), respiratory (n=18), or rheumatologic (n=17) conditions involved a parent questionnaire about their child's physical activity participation and measurement of the child's activity with an omni-directional accelerometer for 1 week. Results Parents of 20 (36%) children had at least one question about their child's physical activity participation, and the prevalence of questions did not vary by age (Wald chi square = 0.77, P=0.38), gender (Wald chi square = 0.11, P=0.74), or clinic (Wald chi square = 1.77, P=0.41). Parent questions were associated (P = 0.04) with lower levels of activity for boys (95% confidence interval [CI] for estimated marginal means: With questions: 197, 395; Without questions: 346, 500) and higher levels of activity for girls (95% CI for estimated marginal means: With questions: 268, 448; Without questions: 239, 369). A multivariable logistic regression model found that parents with questions had higher odds of having a child who was less well (odds ratio [OR]=19.9 for unwell, OR=5.6 for generally well with some symptoms versus well and asymptomatic) and had a history of cardiac arrhythmia (OR=7.6). Conclusions Over one-third of parents reported having questions about physical activity for their child with a chronic medical condition, suggesting substantial uncertainty even among children reported as active. Presence of parent uncertainty is associated with parent reports of the child being unwell or a history of cardiac arrhythmia. By asking parents if they have questions about their child's activity, health care professionals may be better able to identify inactive boys and overprotective attitudes toward active girls. [ABSTRACT FROM AUTHOR]

An arm ergometer analog of the Canadian Aerobic Fitness Test (CAFT) has been proposed for subjects with impairments of mobility (Longmuir & Shephard, 1995). Because of muscle weakness or spasm, only 63% of the adults concerned could maintain the required cadence in the original test version. Thus, in the present study it was hypothesized that a reduced crank loading would yield a higher success rate. In a sample of 35 adults with mobility impairment, 82% were able to complete at least one stage of the modified lest. Difficulty was encountered mainly by persons with cerebral palsy or multiple sclerosis. The revised protocol had a high (r = .97) 1-week test/retest reliability, with no test/retest bias except that subjects with brain lesions scored somewhat higher at their second assessment. A scaled prediction of peak oxygen intake using the standard CAFT equation agreed closely with direct arm ergometer determinations of it. The modified test showed a mean discrepancy ±SD of 0.1 ± 4.8 ml/[kg · min). Further validation is needed, but the current analog of the standard CAFT appears to be useful for many with mobility impairments. [ABSTRACT FROM AUTHOR]

The Arm CAFT is a simple submaximal arm ergometer lest for subjects with mobility disabilities, designed to match the Canadian Aerobic Fitness Test (CAFT) in both administration and interpretation. It is here evaluated relative to direct arm ergometer measurements of peak oxygen intake in 41 men and women with mobility disabilities, aged 20-60, who were attending an "integrated" sports facility. Peak oxygen intake was predicted using the original CAFT equation, but the oxygen cost of arm ergometer test stages was substituted and predictions were scaled downward by 70/100 to allow for the lower peak aerobic power of the upper limbs. In 16 subjects who maintained cranking cadence, predictions were reliable over 1 week, with a small increase of score at the second test. Although the Arm CAFT protocol is reliable and free of bias, it has only a limited validity, and only a minority of the stronger individuals with mobility disabilities can sustain the required cranking rhythm. [ABSTRACT FROM AUTHOR]

To date, very little published information has been available on the physical activity participation of disabled youth. A questionnaire, which was modified from the Canada Fitness Survey, was distributed by mail to physically disabled, sensory impaired, and chronically ill children and adolescents in Ontario, Canada. Nine hundred eighty-seven responses were collected from subjects 6 to 20 years of age, with a response rate of 58%. Twenty-nine percent of physically challenged youth were found to be sedentary, and 39% were active. Activity levels were significantly related to age (p < .01), with a marked decline in the second decade of life. Activity levels were not significantly influenced by gender, but the data suggest that girls have lower activity levels and a faster and earlier decline in activity than boys. Overall, the data collected provide baseline information on the role of physical activity in the lives of Ontario youth with physical disabilities, sensory impairments, and chronic illnesses. [ABSTRACT FROM AUTHOR]