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International audience; OBJECTIVES: To delineate the clustering of energy balance-related behaviors in adolescents and investigate whether these behaviors are associated with the household socioeconomic status and parental education level. METHODS: Two cross-sectional studies assessed information on sedentary behavior, physical activity, sugar-sweetened beverages and fruit and vegetable consumption, and sleep duration by self-reported questionnaires in adolescents (12.5-17.5 years old) from Maringa/Brazil (BRACAH Study; n = 682) and ten European cities (HELENA Study; n = 1252) from nine different countries. Gender-specific cluster analyses were performed separately for each study, applying a combination of hierarchical and non-hierarchical methods. RESULTS: Girls showed equivalent behaviors: Sedentary; Active; Unhealthy Eating; Healthy Eating; while boys differed (Brazilian: Sedentary; Active; Healthy Eating; European: Sedentary; Healthy; Unhealthy Eating). In Brazil, we found no association between socioeconomic status and parental education. In European girls, the high socioeconomic status and both parents' university degree were associated with Healthy Eating. In European boys, the high socioeconomic status was associated with Unhealthy Eating, and the mothers' university degree was associated with the Healthy cluster. CONCLUSIONS: Adolescents show Sedentary behavior, regardless of their sex, country of origin, or socioeconomic condition.

On behalf of the UP&DOWN Study Group., [Objective]: To examine the association between cardiorespiratory fitness (CRF) at baseline and cardiovascular disease (CVD) risk in 6- to 10-year-olds (cross-sectional) and 2 years later (8- to 12-year-olds [longitudinal]) and whether changes with age in CRF are associated with CVD risk in children aged 8 to 12 years. [Patients and Methods]: Spanish primary schoolchildren (n=236) aged 6 to 10 years participated at baseline. Of the 23 participating primary schools, 22% (n=5) were private schools and 78% (n=18) were public schools. The dropout rate at 2-year follow-up was 9.7% (n=23). The 20-m shuttle run test was used to estimate CRF. The CVD risk score was computed as the mean of 5 CVD risk factor standardized scores: sum of 2 skinfolds, systolic blood pressure, insulin/glucose, triglycerides, and total cholesterol/high-density lipoprotein cholesterol. [Results]: At baseline, CRF was inversely associated with single CVD risk factors (all P0.85; P, This work was supported by grant DEP 2010-21662-C04-00 (DEP 2010-21662-C04-01: DEP 2010-21662-C04-02: DEP 2010-21662-C04-03: DEP 2010-21662-C04-04) from the National Plan for Research: Development and Innovation (R+D+i) MICINN and by grant FPU15/05337 from the Spanish Ministry of Education.

The present study investigated the association between cardiorespiratory fitness (CRF) and dietary intake in European adolescents. The study comprised 1492 adolescents (770 females) from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. CRF was assessed by the 20 m shuttle run test. Adolescents were grouped into low and high CRF levels according to the FITNESSGRAM Standards. Dietary intake was self-registered by the adolescents using a computer-based tool for 24 h dietary recalls (HELENA-Dietary Assessment Tool) on two non-consecutive days. Weight and height were measured, and BMI was calculated. Higher CRF was associated with higher total energy intake in boys (P = 0•003). No association was found between CRF and macronutrient intake (as percentage of energy), yet some positive associations were found with daily intake of bread/cereals in boys and dairy products in both boys and girls (all P < 0•003), regardless of centre, age and BMI. CRF was inversely related to sweetened beverage consumption in girls. These findings were overall consistent when CRF was analysed according to the FITNESSGRAM categories (high/low CRF). A high CRF was not related to compliance with dietary recommendations, except for sweetened beverages in girls (P = 0•002). In conclusion, a high CRF is associated with a higher intake of dairy products and bread/cereals, and a lower consumption of sweetened beverages, regardless of centre, age and BMI. The present findings contribute to the understanding of the relationships between dietary factors and physiological health indicators such as CRF. © 2011 The Authors.

[Objectives]: This study aimed to explore the associations of liver biomarkers with cardiometabolic risk factors and their clustering, and to provide reference values (percentiles) and cut-off points for liver biomarkers associated with high cardiometabolic risk in European adolescents., [Methods]: Alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), aspartate aminotransferase to ALT ratio (AST/ALT), waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol and insulin were measured in 1084 adolescents. We computed a continuous cardiometabolic risk score and defined the high cardiometabolic risk., [Results]: Higher ALT and GGT and lower AST/ALT were associated with adiposity and with the number of adverse cardiometabolic risk factors (Ps, [Conclusions]: Higher GGT and lower AST/ALT are associated with higher cardiometabolic risk factors and their clustering in male and female European adolescents, whereas the associations of ALT were gender dependent. Our results suggest the usefulness of AST/ALT as a screening test in the assessment of adolescents with high cardiometabolic risk and provide gender- and age-specific thresholds that might be of clinical interest., The HELENA study was carried out with the financial support of the European Community Sixth RTD Framework Programme (contract FOODCT-2005-007034). This work was also supported by grants from Spanish Ministry of Economy and Competitiveness (RYC-2010-05957; RYC-2011-09011) and the Spanish Ministry of Health: Maternal, Child Health and Development Network (no. RD08/0072).

We examined the association of cardiorespiratory fitness and fatness with health complaints and health risk behaviors in 691 (323 girls) Spanish children aged 6 to 17.9. Methods: Health complaints and health risk behaviors were self-reported using items of the Health Behavior in School-aged Children questionnaire. Weight and height were measured and body mass index was computed. Cardiorespiratory fitness was measured by the 20-m shuttle-run test, and youth categorized as fit/unfit. Results: Unfit youth were more likely to report health complaints sometime (OR: 2.556, 95% CI: 1.299–5.031; and OR: 1.997, 95% CI: 1.162–3.433, respectively) and health risk behaviors such as drinking alcohol sometime (OR: 5.142, 95% CI: 1.214–21.783; and OR: 2.413, 95% CI: 1.484–3.923) than their fit counterparts. Overweight-obese youth were more likely to report health complaints (OR: 1.732, 95% CI: 1.019–2.945; and OR: 1.983, 95% CI: 1.083–3.629, respectively). The analysis of the combined influence of fitness and fatness revealed that fit youth had lower health complaints index than the fat-unfit and unfat-unfit groups (all P < .05). Conclusions: Low fitness and overweight-obesity increased the risk of having health complaints in youth, yet high levels of cardiorespiratory fitness might overcome deleterious effects of overweight-obesity on health complaints.

En el presente estudio describe el trabajo desarrollado para la creación de la batería ALPHA-Fitness de test de campo para la evaluación de la condición física relacionada con la salud en niños y adolescentes. La batería ALPHA-Fitness basada en la evidencia incluye los siguientes test: 1) test de ida y vuelta de 20 metros para evaluar la capacidad aeróbica, 2) test de fuerza de prensión manual y 3) test de salto de longitud a pies juntos para evaluar la capacidad músculo-esquelética, y 4) el IMC, 5) el perímetro de la cintura, y 6) los pliegues cutáneos (tríceps y subscapular) para evaluar la composición corporal. Además, se incluyen 2 variantes: i) batería ALPHA-Fitness de alta prioridad. Esta variante incluye todos los tests excepto la medida de pliegues cutáneos, y ii) la batería ALPHA-Fitness extendida, que incluye todos los test y además del test de velocidad y agilidad de 4 x 10 m.

Background: Physical activity is necessary for bone mass development in adolescence. There are few studies quantifying the associations between physical activity and bone mass in adolescents. Purpose: To assess the relationship between moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) and bone mass in adolescents. Methods: Bone mass was measured by dual-energy X-ray absorptiometry and physical activity by accelerometers in 380 healthy Spanish adolescents (189 boys, aged 12.517.5 years) from the HELENACSS (20062007). Subjects were classified according to the recommended amount of MVPA (

The aim of this study was to provide percentiles values for four different aerobic performance tests in 2752 (1,261 girls) Spanish children aged 6 to 17.9 years. Aerobic performance was assessed by the shuttle run test (20mSRT), 1-mile, 1/2-mile and 1/4-mile run/walk tests. Height and weight were measured, and body mass index was calculated. Boys had significantly better score than girls in the studied tests in all age groups, except in 1/4-mile test in 6-7 year old children. Underweight children had similar performance than their normalweight counterparts, and underweight boys had better performance than their obese counterparts. Overweight and obese children had lower performance than their normalweight counterparts. Having percentile values of the most used field tests to measure aerobic performance in youth may help to identify children and adolescents at risk for the major chronic diseases, as well as to evaluate the effects of alternative interventions.

On behalf of the HELENA Study Group., The authors' aim in this cross-sectional study was to characterize levels of objectively measured physical activity and sedentary time in adolescents from 9 European countries. The study comprised 2,200 European adolescents (1,184 girls) participating in the HELENA cross-sectional study (2006-2008). Physical activity was measured by accelerometry and was expressed as average intensity (counts/minute) and amount of time (minutes/day) spent engaging in moderate- to vigorous-intensity physical activity (MVPA). Time spent in sedentary behaviors was also objectively measured. Cardiorespiratory fitness was measured by means of the 20-m shuttle run test. Level of maternal education was reported by the adolescents. A higher proportion of boys (56.8% of boys vs. 27.5% of girls) met the physical activity recommendations of at least 60 minutes/day of MVPA. Adolescents spent most of the registered time in sedentary behaviors (9 hours/day, or 71% of the registered time). Both average intensity and MVPA were higher in adolescents with high cardiorespiratory fitness, and sedentary time was lower in the high-fitness group. There were no physical activity or sedentary time differences between maternal education categories. These data provide an objective measure of physical activity and amount of time spent in sedentary behaviors in a relatively large number of European adolescents.

This study investigated differences in health-related fitness (20-m shuttle run, handgrip, bent arm hang, standing long jump, shuttle run 4 × 10 m and sit and reach tests) in 2474 Spanish adolescents (1196 boys and 1278 girls; age 13-18.5 years) classed as underweight, normal weight, overweight or obese according to body mass index. Body fat and fat-free mass were derived from skinfold thickness. The prevalence of underweight was higher than obesity in girls (4.8% vs 3.0%, respectively; P

On behalf of the HELENA study group.

Introduction: The influence of socioeconomic status on health-related fitness is not clear. Aim: To examine the influence of socioeconomic status on health-related fitness in adolescents. Methods: A total of 3,259 adolescents (15.0 ± 1.3 y) from the Healthy Lifestyle in Europe by Nutrition in Ado- lescence Cross-Sectional Study (HELENA-CSS) partici- pated in the study. Socioeconomic status was assessed by the family affluence scale (FAS). Speed-agility, muscular strength and cardiorespiratory fitness were assessed. Covariates included total body fat, physical activity and pubertal status. Results: Adolescents with high FAS had significantly higher fitness levels than their peers of lower FAS cate- gories except for speed-agility and handgrip in boys. Overall, the associations observed presented a medium to large effect size. Conclusion: These results suggest that socioeconomic status is positively associated with physical fitness in European adolescents independently of total body fat and habitual physical activity Introducción: La influencia del estatus socioeconómico sobre la condición física en relación con la salud no está clara. Objetivo: Examinar la influencia del estatus socioeconómico sobre la condición física en relación con la salud en adolescentes. Metodología: Un total de 3259 adolescentes (15,0 ± 1,3 años) del “Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study” (HELENA-CSS) participaron en el estudio. El estatus socioeconómico fue medido con una escala de riqueza familiar “family affluence scale (FAS)”. Se midieron velocidad-agilidad, fuerza muscular y capacidad aeróbica. Las covariables incluidas fueron grasa corporal total, actividad física y estadio madurativo. Resultados: Los adolescentes con alto FAS tuvieron significativamente mayores niveles de condición física que aquellos con bajo FAS exceptuando los tests de velocidad-agilidad y fuerza de prensión manual en chicos. En general, las asociaciones observadas presentaron un efecto del tamaño de la muestra (effect size) entre medio y largo. Conclusión: Estos resultados sugieren que el estatus socioeconómico esta positivamente asociado con la condición física en adolescentes Europeos independientemente de la grasa corporal total y el nivel de actividad física.

Objetivo: El consumo de tabaco entre los adolescentes así como la disminución de los niveles de práctica de actividad física constituyen un problema de salud pública. El objetivo es conocer la relación existente entre el consumo de tabaco y la práctica de actividad física. Ámbito: Adolescentes españoles escolarizados. Sujetos: 2.859 adolescentes españoles (1.357 hombres, 1.502 mujeres; rango de edad: 13-18,5 años). Intervenciones: Se aplica un cuestionario para conocer el consumo de tabaco y otros cuatro cuestionarios para conocer la práctica de actividad física en diferentes periodos de tiempo. Resultados: Un 40,8% de los adolescentes indicaron no practicar actividad física, mostrándose los varones más activos que las mujeres (p < 0,001). Un 29,9% de los adolescentes indicaron consumir tabaco habitualmente, no existiendo diferencias en función del sexo. Tanto en varones como en mujeres, los adolescentes activos manifiestan un menor consumo de tabaco (P ≤ 0,01). A mayor edad mayor consumo de tabaco y menor práctica de actividad física, tanto en varones como en mujeres (p < 0,001). Conclusiones: Los niveles de práctica de actividad física son bajos, siendo menores aún en el caso de las chicas. El consumo de tabaco muestra relación inversa con la práctica de actividad física, resultando los sujetos más activos físicamente los menos consumidores de tabaco.

Funder: Public Health Agency of Canada, Funder: Government of Norway, BACKGROUND: In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities. METHODS: The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG. RESULTS: Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities. CONCLUSIONS: Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.

Background Accelerometry has gained increasing popularity and yields numerous physical activity (PA) outcomes (Rowlands et al., 2019). These include traditional cut-point-based (i.e. light, moderate, and vigorous PA) and cut-point-free metrics (i.e. intensity gradient [IG] and average acceleration [AvAcc]). IG reflects the intensity distribution of PA across the day (Rowlands et al., 2018; Fairclough et al., 2019). AvAcc is a proxy for the daily volume of PA ( Rowlands et al., 2018; Fairclough et al., 2019). Cut-point-based metrics are commonly expressed in minutes per day, making their interpretation simple (Troiano et al., 2014). Yet, the measured acceleration needs to be categorised by setting population- and device-dependent cut-points to obtain these metrics (Troiano et al., 2014). Cut-point-free metrics, on the other hand, are comparable across studies, accelerometer brands (Migueles et al., 2022), and diverse populations (Rowlands et al., 2018). However, their interpretation is not easy. Besides, it is unknown how cut-point-free metrics are associated with cardiorespiratory fitness (CRF), an important health indicator in healthy individuals and patient populations with impaired CRF (Kodama et al., 2009). We thus aimed to 1) compare the association of CRF with cut-point-free metrics to that with cut-point-based metrics in a prospective cohort of healthy adults aged 20 to 89 years and patients with heart failure, and 2) provide age-, sex-, and CRF-related reference values for healthy adults. Methods The COmPLETE study was cross-sectional. Healthy individuals were recruited via unaddressed letters sent to randomly selected postal districts in the Basel area (Wagner et al., 2019). Patients with heart failure were approached as described elsewhere (Wagner et al., 2019). Subjects were asked to wear GENEActiv accelerometers on their non-dominant wrist for up to 14 days and undergo cardiopulmonary exercise testing on a cycle ergometer to determine CRF. Raw accelerometer data were processed using the R-package GGIR (Migueles et al., 2019; van Hees et al., 2013). Associations between CRF and accelerometer metrics were examined using multiple linear regression models adjusted for sex, age, and body mass index. Percentile curves were generated with Generalised Additive Models for Location, Scale, and Shape (Stasinopoulos & Rigby, 2008). Results Four hundred and sixty-three healthy adults and 67 patients with heart failure were included in the analyses. IG and AvAcc provide complementary information on PA. Both metrics were independently associated with CRF in healthy individuals. The best cut-point-free regression model (AvAcc+IG) performed similar to the best cut-point-based model (vigorous activity) and explained 73.9% and 74.2% of the variance in CRF, respectively. In patients with heart failure, IG was associated with CRF, independent of AvAcc. Cut-point-free models (IG+AvAcc, IG alone) had comparable predictive value for CRF as the best cut-point-based metric (moderate-to-vigorous activity). We produced age-, sex-, and CRF-related reference values for IG, AvAcc, moderate-to-vigorous, and vigorous activity for healthy adults. Moreover, we developed a web-based application (rawacceleration) facilitating the interpretation of cut-point-free metrics. Conclusions Cut-point-free metrics are not only more robust than cut-point-based metrics, but also have similar predictive value for CRF and, in turn, indirectly for the risk of mortality and longevity (Kodama et al., 2009; Mok et al., 2019). This may be the case in both healthy individuals and patients with heart failure. Our findings together with those of previous studies (Rowlands et al., 2018; Fairclough et al., 2019), therefore, provide a rationale that cut-point-free metrics facilitate the capture of the volume and intensity distribution of the PA profile across populations, and thus may be a viable alternative to cut-point-based metrics in describing PA. Our reference values will enhance the utility of IG and AvAcc and facilitate their interpretation. Finally, our web-based application will simplify this process and also support the translation of cut-point-free metrics into meaningful outcomes. References Fairclough, S. J., Taylor, S., Rowlands, A. V., Boddy, L. M., & Noonan, R. J. (2019) Average acceleration and intensity gradient of primary school children and associations with indicators of health and well-being. Journal of Sports Sciences, 37(18), 2159-2167. https://doi.org/10.1080/02640414.2019.1624313 Kodama, S., Saito, K., Tanaka, S., Maki, M., Yachi, Y., Asumi, M., Sugawara, A., Totsuka, K., Shimano, H., Ohashi, Y., Yamada, N., & Sone, H. (2009). Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis. JAMA, 301(19), 2024-35.https://doi.org/10.1001/jama.2009.681 Migueles, J. H., Molina-Garcia, P., Torres-Lopez, L. V., Cadenas-Sanchez, C., Rowlands, A. V., Ebner-Priemer, U. W., Koch, E. D., Reif, A., & Ortega, F. B. (2022). Equivalency of four research-grade movement sensors to assess movement behaviors and its implications for population surveillance. Science Reports, 12, Article 5525. https://doi.org/10.1038/s41598-022-09469-2 Migueles, J. H., Rowlands, A. V., Huber, F., Sabia, S., & van Hees, V. T. (2019). GGIR: A research community–driven open source R package for generating physical activity and sleep outcomes from multi-day raw accelerometer data. Journal for the Measurement of Physical Behaviour, 2(3),188-96. https://doi.org/10.1123/jmpb.2018-0063 Mok, A., Khaw, K.-T., Luben, R., Wareham, N., & Brage, S. (2019). Physical activity trajectories and mortality: Population based cohort study. BMJ, 365, l2323. https://doi.org/10.1136/bmj.l2323 Rowlands, A. V., Edwardson, C. L., Davies, M. J., Khunti, K., Harrington, D. M., & Yates, T. (2018). Beyond cut points: Accelerometer metrics that capture the physical activity profile. Medicine & Science in Sports & Exercise, 50(6), 1323-32. https://doi.org/10.1249/MSS.0000000000001561 Rowlands, A. V., Fairclough, S. J., Yates, T., Edwardson, C. L., Davies, M., Munir, F., Khunti, K., & Stiles, V. H. (2019). Activity intensity, volume, and norms: Utility and interpretation of accelerometer metrics. Medicine & Science in Sports & Exercise, 51(11), 2410-2422. https://doi.org/10.1249/MSS.0000000000002047 Stasinopoulos, D. M., & Rigby, R. A. (2008). Generalized additive models for location scale and shape (GAMLSS) in R. Journal of Statistical Software, 23(7), 1 - 46. https://doi.org/10.18637/jss.v023.i07 Troiano, R. P., McClain, J. J., Brychta, R. J., & Chen, K. Y. (2014). Evolution of accelerometer methods for physical activity research. British Journal of Sports Medicine, 48(13), 1019-1023. https://doi.org/10.1136/bjsports-2014-093546 van Hees, V. T., Gorzelniak, L., Dean León, E. C., Eder, M., Pias, M., Taherian, S., Ekelung, U., Renström, F., Franks, P. W., Horsch, A., & Brage, S. (2013). Separating movement and gravity components in an acceleration signal and implications for the assessment of human daily physical activity. PloS one, 8(4), Article e61691. https://doi.org/10.1371/journal.pone.0061691 Wagner, J., Knaier, R., Infanger, D., Arbeev, K., Briel, M., Dieterle, T., Hanssen, H., Faude, O., Roth, R., Hinrichs, T., & Schmidt-Trucksäss, A. (2019). Functional aging in health and heart failure: The COmPLETE Study. BMC Cardiovascular Disorders, 19, Article 180. https://doi.org/10.1186/s12872-019-1164-6

Introduction The development of appropriate motor skills early in life enhances the likelihood of lifelong physical activity (Hulteen et al., 2018). Furthermore, good fitness has direct health implications for child and youth development (Ortega et al., 2008). Physical fitness and the development of motor performance may be influenced by various factors like the Covid-19 pandemic as current example over the last two years. The pandemic affected children’s life, particularly regarding the reduced ability to attend structured leisure time sports activities. This study aims to describe the impact of the Covid-19 pandemic on secular trends in motor performance and body composition in first graders in the city of Basel. Methods In the city of Basel, Switzerland, all first graders were tested yearly since 2014 with four motor performance parameters and anthropometrics: 20-meter shuttle run, 20-meter sprint, jumping sidewards, balancing backward, body weight and height. Children are categorized as overweight when they are above 90. Percentile for their age and sex in BMI and as obese when above 97. Percentile. Linear regression for motor performance parameters and logistic regression for weight status was used to predict 2021 and 2022 performance parameters based on data from 2014 to 2020. These predictions were compared to the performance achieved in 2021 and 2022. Results Four thousand six-hundred sixty-two children were tested from 2014 to 2020, 728 in 2021, and 708 in 2022. The cohorts in 2021 and 2022 outperformed the predicted values by 6.1% [95 % CI: 1.8; 10.4] and 5.5% [1.0; 10.1] for shuttle run, 0.2% [-0.6; 1.0] and 3.5% [2.7; 4.4] for 20-meter sprint, 6.4% [3.7; 9.2] and 2.7% [-0.2; 5.5] for jumping sidewards and 4.0% [-0.5; 8.4] and 17.3% [12.1; 22.5] for balancing backward. The proportion of overweight children in 2021 (16.4%) and 2022 (15.5%) was 47.4% [31.4; 63.3] and 62.2% [26.4; 98.1] higher than predicted. The percentage of obese children deviated strongly by 55.9% [33.9; 77.9] and 61.8% [14.1; 113.0] from predicted values. Boys were more affected by the impact of Covid-19 showing a 70.4% [38.5; 102.3] and 79.4% [14.0; 145.9] higher proportion of obesity than expected from secular trends for both cohorts compared to girls (34.8% [-1.0; 70.6] and 34.5% [-42.8; 111.7]). Conclusion Although more children were classified as overweight and obese than expected, the children performed better in all motor performance parameters. Preserving the possibility for unstructured activities and outdoor play at all times during the Covid-19 restrictions is a potential reason that the pandemic situation did not limit motor development. Nevertheless, the increased number of overweight and obese children is alarming. Potential reasons like changes in eating behaviour or mental health due to the pandemic situation remain speculative. However, public health interventions for these cohorts focusing on healthy body composition are strongly recommended. References Hulteen, R. M., Morgan, P. J., Barnett, L. M., Stotten, D. F., & Lubans, D. E. (2018). Development of foundational movement skills: A conceptual model for physical activity across the lifespan. Sports Medicine, 48(7), 1533–1540. https://doi.org/10.1007/s40279-018-0892-6 Ortega, F. B., Ruiz, J. R., Castillo, M. J., & Sjöström, M. (2008). Physical fitness in childhood and adolescence: A powerful marker of health. International Journal of Obesity, 32(1), 1–11. https://doi.org/10.1038/sj.ijo.0803774

Background: The World Health Organization (WHO) released in 2020 updated global guidelines on physical activity and sedentary behaviour for children, adolescents, adults, older adults and sub-populations such as pregnant and postpartum women and those living with chronic conditions or disabilities. Objective: To summarize the evidence on the associations between physical activity, sedentary behaviour, and health-related outcomes used to inform the 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years. Methods: The update of the WHO guideline recommendations for children and adolescents utilized and systematically updated the evidence syntheses on physical activity and sedentary behaviour conducted for the 2016 Canadian 24-Hour Movement Guidelines for Children and Youth, the 2019 Australian 24-Hour Movement Guidelines for Children and Young People (5–17 years), and the 2018 Physical Activity Guidelines for Americans, Second Edition. Systematic reviews published from 2017 up to July 2019 that addressed the key questions were identified, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rate the certainty of the evidence for the entire body of evidence. Results: The updated literature search yielded 21 relevant systematic reviews. The evidence base reviewed (i.e., existing and new systematic reviews) provided evidence that greater amounts and higher intensities of physical activity as well as different types of physical activity (i.e., aerobic and muscle and bone strengthening activities) are associated with improved health outcomes (primarily intermediate outcomes). There was sufficient evidence to support recommendations on limiting sedentary behaviours, which was not addressed in the 2010 WHO guidelines. However, there is still insufficient evidence available to fully describe the dose-response relationships between physical activity or sedentary behaviour and health outcomes, and whether the associations vary by type or domain of physical activity or sedentary behaviour.Conclusions: Addressing the identified research gaps will better inform guideline recommendations in children and adolescents, and future work should aim to prioritize these areas of research. In the meantime, investment and leadership is needed to scale up known effective policies and programs aimed at increasing activity in children and adolescents., Public Health Agency of Canada, Government of Norway, Canadian Institutes of Health Research (CIHR), CHEO Research Institute, Research Council of Norway 249932/F20, University of Manchester P123958, UK Research and Innovation Future Leaders Fellowship MR/T021780/1, NICM-Blackmores Institute Fellowship, National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, University of Bristol, Spanish Ministry of Economy and Competitiveness DEP2016-79512-R DEP2017-91544-EXP, University of Granada, Research and Knowledge Transfer Fund (PPIT), Excellence Actions Programme: Units of Excellence; Scientific Unit of Excellence on Exercise and Health (UCEES), Andalusian Regional Government, Regional Ministry of Economy, Knowledge, Enterprises and University, European Union (EU) SOMM17/6107/UGR

OBJECTIVES: Research investigating the longitudinal effects of the most popular sports on bone development in adolescent males is scarce. The aim is to investigate the effect of 12-month participation in osteogenic and non-osteogenic sports on bone development.DESIGN: A 12-month study was conducted in adolescent males involved in football, swimming and cycling and compared with an active control group.METHODS: 116 adolescent males (13.1±0.1years at baseline): 37 footballers, 37 swimmers, 28 cyclists and 14 active controls were followed for 12 months. Bone mineral content (BMC) was measured by dual-energy X-ray absorptiometry, and bone stiffness was measured by quantitative ultrasound. Bone outcomes at 12 months were adjusted for baseline bone status, age, height, lean mass and moderate to vigorous physical activity.RESULTS: Footballers had higher improvement in adjusted BMC at the total body, total hip, shaft, Ward's triangle, legs and bone stiffness compared to cyclists (6.3-8.0%). Footballers had significantly higher adjusted BMC at total body, shaft and legs compared to swimmers (5.4-5.6%). There was no significant difference between swimmers and cyclists for any bone outcomes. Swimming and cycling participation resulted in non-significant lower bone development at most sites of the skeleton compared to controls (-4.3 to -0.6%).CONCLUSIONS: Football participation induces significantly greater improvements in BMC and bone stiffness over 12 months compared to cycling and swimming.CLINICAL TRIAL REGISTRATION: ISRCTN17982776.

On behalf of the HELENA Study Group., [Background and aims]: The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents., [Methods and results]: The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those who watched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P ≤ 0.01)., [Conclusion]: Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies may also investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status., The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034). The data for this study was gathered under the aegis of the HELENA project, and further analysis was additionally supported by the Spanish Ministry of Economy and Competitiveness (grants RYC-2010-05957 and RYC-2011-09011), the Spanish Ministry of Health: Maternal, Child Health and Development Network (grant RD16/0022), the Fondo Europeo de Desarrollo Regional (MICINN-FEDER) and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). Pontus Henriksson was supported by a grant from Henning and Johan Throne-Holst Foundation. Hanna Henriksson was supported by grants from the Swedish Society of Medicine and the County Council of Östergötland, Sweden. Dr. Gracia-Marco acknowledges “Programa de Captación de Talento - UGR Fellows” as part of “Plan Propio” of the University of Granada (Spain).

On behalf of the HELENA study group., [Background and aims] Inflammation may influence the cardio-metabolic profile which relates with the risk of chronic diseases. This study aimed to assess the inflammatory status by metabolic health (MH)/body mass index (BMI) category and to assess how inflammatory markers can predict the cardio-metabolic profile in European adolescents, considering BMI. [Methods and results] A total of 659 adolescents (295 boys) from a cross-sectional European study were included. Adolescents were classified by metabolic health based on age- and sex-specific cut-off points for glucose, blood pressure, triglycerides, high density cholesterol and BMI. C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin (IL-6), complement factors (C3, C4) and cell adhesion molecules were assessed. [Results] Metabolically abnormal (MA) adolescents had higher values of C3 (p < 0.001) and C4 (p = 0.032) compared to those metabolically healthy (MHy). C3 concentrations significantly increased with the deterioration of the metabolic health and BMI (p < 0.001). Adolescents with higher values of CRP had higher probability of being in the overweight/obese-MH group than those allocated in other categories. Finally, high C3 and C4 concentrations increased the probability of having an unfavorable metabolic/BMI status. [Conclusions] Metabolic/BMI status and inflammatory biomarkers are associated, being the CRP, C3 and C4 the most related inflammatory markers with this condition. C3 and C4 were associated with the cardio-metabolic health consistently., The HELENA Study was supported by the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034) and the Stockholm County Council. This analysis was also supported by the Spanish Ministry of Science and Innovation (JCI-2010-07055) and the gs4:European Regional Development Fund (FEDER). CCS is supported by the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). FBO is supported by a grant from the Spanish Ministry of Science and Innovation (RYC-2011-09011). AIR was funded by a Juan de la Cierva-Formación stipend from the Ministry of Economy and Competitiveness of the Spanish Government (FJCI-2014-19795).

We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P