122 results on '"Onywera, V"'
Search Results
2. Sources of variability in childhood obesity indicators and related behaviors
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Katzmarzyk, P T, Broyles, S T, Chaput, J-P, Fogelholm, M, Hu, G, Lambert, E V, Maher, C, Maia, J, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, and Tudor-Locke, C
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- 2018
- Full Text
- View/download PDF
3. Mid‐upper arm circumference as a screening tool for identifying children with obesity: a 12‐country study
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Chaput, J.‐P., Katzmarzyk, P. T., Barnes, J. D., Fogelholm, M., Hu, G., Kuriyan, R., Kurpad, A., Lambert, E. V., Maher, C., Maia, J., Matsudo, V., Olds, T., Onywera, V., Sarmiento, O. L., Standage, M., Tudor‐Locke, C., Zhao, P., and Tremblay, M. S.
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- 2017
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4. Performance and age of African and non-African runners in half- and full marathons held in Switzerland, 2000–2010
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Aschmann A, Knechtle B, Cribari M, Rüst CA, Onywera V, Rosemann T, and Lepers R
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Sports medicine ,RC1200-1245 - Abstract
André Aschmann,1 Beat Knechtle,2 Marco Cribari,1 Christoph Alexander Rüst,1 Vincent Onywera,3 Thomas Rosemann,1 Romuald Lepers4 1Institute of General Practice and for Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3Department of Recreation Management and Exercise Science, Kenyatta University, Kenya; 4Institut National de la Santé et de la Recherche Médicale, Faculty of Sport Sciences, University of Burgundy, Dijon, France Background: Endurance running performance of African (AF) and non-African (NAF) athletes is investigated, with better performances seen for Africans. To date, no study has compared the age of peak performance between AF and NAF runners. The present research is an analysis of the age and running performance of top AF and NAF athletes, using the hypothesis that AF athletes were younger and faster than NAF athletes. Methods: Age and performance of male and female AF and NAF athletes in half-marathons and marathons held in Switzerland in 2000–2010 were investigated using single and multilevel hierarchical regression analyses. Results: For half-marathons, male NAF runners were older than male AF runners (P = 0.02; NAF, 31.1 years ± 6.4 years versus AF, 26.2 years ± 4.9 years), and their running time was longer (P = 0.02; NAF, 65.3 minutes ± 1.7 minutes versus AF, 64.1 minutes ± 0.9 minutes). In marathons, differences between NAF and AF male runners in age (NAF, 33.0 years ± 4.8 years versus AF, 28.6 years ± 3.8 years; P < 0.01) and running time (NAF, 139.5 minutes ± 5.6 minutes versus AF, 133.3 minutes ± 2.7 minutes; P < 0.01) were more pronounced. There was no difference in age (NAF, 31.0 years ± 7.0 years versus AF, 26.7 years ± 6.0 years; P > 0.05) or running time (NAF, 75.0 minutes ± 3.7 minutes versus AF, 75.6 minutes ± 5.3 minutes; P > 0.05) between NAF and AF female half-marathoners. For marathoners, NAF women were older than AF female runners (P = 0.03; NAF, 31.6 years ± 4.8 years versus AF, 27.8 years ± 5.3 years), but their running times were similar (NAF, 162.4 minutes ± 7.2 minutes versus AF, 163.0 minutes ± 7.0 minutes; P > 0.05). Conclusion: In Switzerland, the best AF male half-marathoners and marathoners were younger and faster than the NAF counterpart runners. In contrast to the results seen in men, AF and NAF female runners had similar performances. Future studies need to investigate performance and age of AF and NAF marathoners in the World Marathon Majors Series. Keywords: endurance, running, ethnicity, road race, gender difference
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- 2013
5. Inequality in physical activity, sedentary behaviour, sleep duration and risk of obesity in children: a 12‐country study
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Chaput, J.‐P., Barnes, J. D., Tremblay, M. S., Fogelholm, M., Hu, G., Lambert, E. V., Maher, C., Maia, J., Olds, T., Onywera, V., Sarmiento, O. L., Standage, M., Tudor‐Locke, C., Katzmarzyk, P. T., Department of Food and Nutrition, and Nutrition Science
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movement behaviours ,Disparity ,paediatric population ,Original Articles ,HEALTH INDICATORS ,Gini coefficient ,YOUTH ,WORLDWIDE ,RELIABILITY ,ADOLESCENTS ,Original Article ,SCHOOL-AGED CHILDREN ,VALIDITY ,3143 Nutrition ,MATRIX - Abstract
Summary Objective Studies examining associations between movement behaviours (i.e. physical activity, sedentary behaviour and sleep duration) and obesity focus on average values of these movement behaviours, despite important within‐country and between‐country variability. A better understanding of movement behaviour inequalities is important for developing public health policies and behaviour‐change interventions. The objective of this ecologic analysis at the country level was to determine if inequality in movement behaviours is a better correlate of obesity than average movement behaviour volume in children from all inhabited continents of the world. Methods This multinational, cross‐sectional study included 6,128 children 9–11 years of age. Moderate‐to‐vigorous physical activity (MVPA), total sedentary time (SED) and sleep period time were monitored over 7 consecutive days using waist‐worn accelerometry. Screen time was self‐reported. Inequality in movement behaviours was determined using Gini coefficients (ranging from 0 [complete equality] to 1 [complete inequality]). Results The largest inequality in movement behaviours was observed for screen time (Gini of 0.32; medium inequality), followed by MVPA (Gini of 0.21; low inequality), SED (Gini of 0.07; low inequality) and sleep period time (Gini of 0.05; low inequality). Average MVPA (h d−1) was a better correlate of obesity than MVPA inequality (r = −0.77 vs. r = 0.00, p = 0.03). Average SED (h d−1) was also a better correlate of obesity than SED inequality (r = 0.52 vs. r = −0.32, p = 0.05). Differences in associations for screen time and sleep period time were not statistically significant. MVPA in girls was found to be disproportionally lower in countries with more MVPA inequality. Conclusions Findings from this study show that average MVPA and SED should continue to be used in population health studies of children as they are better correlates of obesity than inequality in these behaviours. Moreover, the findings suggest that MVPA inequality could be greatly reduced through increases in girls' MVPA alone.
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- 2018
6. THE INTERNATIONAL STUDY OF CHILDHOOD OBESITY, LIFESTYLE AND THE ENVIRONMENT: PRELIMINARY RESULTS FROM KENYA
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Onywera, V., Wachira, J., Muthuri, S., and Tremblay, M.
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- 2013
7. Relationships Between Outdoor Time, Physical Activity, Sedentary Time, and Body Mass Index in Children: A 12-Country Study
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Larouche, R, Mire, Ef, Belanger, K, Barreira, Tv, Chaput, Jp, Fogelholm, M, Hu, G, Lambert, Ev, Maher, C, Maia, J, Olds, T, Onywera, V, Sarmiento, Ol, Standage, M, Tudor-Locke, C, Katzmarzyk, Pt, Tremblay, Ms, Church, Ts, Lambert, Dg, Barreira, T, Broyles, S, Butitta, B, Champagne, C, Cocreham, S, Dentro, K, Drazba, K, Harrington, D, Johnson, W, Milauskas, D, Mire, E, Tohme, A, Rodarte, R, Amoroso, B, Luopa, J, Neiberg, R, Rushing, S, Lewis, L, Ferrar, K, Georgiadis, E, Stanley, R, Matsudo, Vkr, Matsudo, S, Araujo, T, de Oliveira LC, Rezende, L, Fabiano, L, Bezerra, D, Ferrari, G, Belanger, P, Borghese, M, Boyer, C, Leblanc, A, Francis, C, Leduc, G, Zhao, P, Diao, Cm, Li, W, Li WQ Liu, Liu, Eq, GS Liu HY, Ma, J, Qiao, Yj, Tian, Hg, Wang, Y, Zhang, T, Zhang, Fx, Sarmiento, O, Acosta, J, Alvira, Y, Diaz, Mp, Gamez, R, Garcia, Mp, Gomez, Lg, Gonzalez, L, Gonzalez, S, Grijalba, C, Gutierrez, L, Leal, D, Lemus, N, Mahecha, E, Mahecha, Mp, Mahecha, R, Ramirez, A, Rios, P, Suarez, A, Triana, C, Hovi, E, Kivela, J, Rasanen, S, Sanna, Roito, Taru, Saloheimo, Valta, L, Kurpad, A, Kuriyan, R, Lokesh, Dp, D'Almeida, Ms, Mattilda, Ra, Correa, L, Vijay, D, Wachira, Lj, Muthuri, S, Borges, Ad, Cachada, Sos, de Chaves RN, Gomes, Tnqf, Pereira, Sis, Santos, Dmde, dos Santos FK, da Silva PGR, de Souza MC, Lambert, V, April, M, Uys, M, Naidoo, N, Synyanya, N, Carstens, M, Cumming, S, Drenowatz, C, Emm, L, Gillison, F, Zakrzewski, J, Braud, A, Donatto, S, Lemon, C, Jackson, A, Pearson, A, Pennington, G, Ragus, D, Roubion, R, Schuna, J, Wiltz, D, Batterham, A, Kerr, J, Pratt, M, Pietrobelli, A, Larouche, Richard, Barreira, Tiago V., Hu, Gang, Maia, José, Sarmiento, Olga L., Katzmarzyk, Peter T., Mire, Emily F., Chaput, Jean Philippe, Lambert, Estelle V., Olds, Tim, Standage, Martyn, Belanger, Kevin, Fogelholm, Mikael, Maher, Carol, Onywera, Vincent, Tudor-Locke, Catrine, Tremblay, Mark S., and ISCOLE Research Group
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Male ,medicine.medical_specialty ,Pediatric Obesity ,Time Factors ,Sports medicine ,Cross-sectional study ,health promotion ,RJ101 ,Health Behavior ,Physical activity ,Physical Therapy, Sports Therapy and Rehabilitation ,Standard score ,RA773 ,Body Mass Index ,RC1200 ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Surveys and Questionnaires ,Accelerometry ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Child ,2. Zero hunger ,Sedentary time ,exercise ,030229 sport sciences ,medicine.disease ,motor behavior ,Obesity ,Country study ,Cross-Sectional Studies ,Social Class ,Pediatrics, Perinatology and Child Health ,epidemiology ,Female ,Sedentary Behavior ,Psychology ,Body mass index ,Demography - Abstract
Purpose: This study investigated the relationship between outdoor time and physical activity (PA), sedentary time (SED), and body mass index z scores among children from 12 lower-middle-income, upper-middle-income, and high-income countries. Methods: In total, 6478 children (54.4% girls) aged 9–11 years participated. Outdoor time was self-reported, PA and SED were assessed with ActiGraph GT3X+ accelerometers, and height and weight were measured. Data on parental education, neighborhood collective efficacy, and accessibility to neighborhood recreation facilities were collected from parent questionnaires. Country latitude and climate statistics were collected through national weather data sources. Gender-stratified multilevel models with parental education, climate, and neighborhood variables as covariates were used to examine the relationship between outdoor time, accelerometry measures, and body mass index z scores. Results: Each additional hour per day spent outdoors was associated with higher moderate- to vigorous-intensity PA (boys: +2.8 min/d; girls: +1.4 min/d), higher light-intensity PA (boys: +2.0 min/d; girls: +2.3 min/d), and lower SED (boys: −6.3 min/d; girls: −5.1 min/d). Effect sizes were generally weaker in lower-middle-income countries. Outdoor time was not associated with body mass index z scores. Conclusions: Outdoor time was associated with higher PA and lower SED independent of climate, parental education, and neighborhood variables, but effect sizes were small. However, more research is needed in low- and middle-income countries.
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- 2019
8. Thresholds of physical activity associated with obesity by level of sedentary behaviour in children
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Chaput, J-P, Barnes, J D, Tremblay, M S, Fogelholm, M, Hu, G, Lambert, E V, Maher, C, Maia, J, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tudor-Locke, C, and Katzmarzyk, P T
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SDG 3 - Good Health and Well-being ,education ,Journal Article ,human activities - Abstract
BACKGROUND: It is unknown whether moderate-to-vigorous physical activity (MVPA) thresholds for obesity should be adapted depending on level of sedentary behaviour in children.OBJECTIVE: The objective of the study is to determine the MVPA thresholds that best discriminate between obese and non-obese children, by level of screen time and total sedentary time in 12 countries.METHODS: This multinational, cross-sectional study included 6522 children 9-11 years of age. MVPA and sedentary time were assessed using waist-worn accelerometry, while screen time was self-reported. Obesity was defined according to the World Health Organization reference data.RESULTS: Receiver operating characteristic curve analyses showed that the best thresholds of MVPA to predict obesity ranged from 53.8 to 73.9 min d-1in boys and from 41.7 to 58.7 min d-1in girls, depending on the level of screen time. The MVPA cut-offs to predict obesity ranged from 37.9 to 75.9 min d-1in boys and from 32.5 to 62.7 min d-1in girls, depending on the level of sedentary behaviour. The areas under the curve ranged from 0.57 to 0.73 ('fail' to 'fair' accuracy), and most sensitivity and specificity values were below 85%, similar to MVPA alone. Country-specific analyses provided similar findings.CONCLUSIONS: The addition of sedentary behaviour levels to MVPA did not result in a better predictive ability to classify children as obese/non-obese compared with MVPA alone.
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- 2018
9. Thresholds of physical activity associated with obesity by level of sedentary behaviour in children
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Chaput, J.‐P., primary, Barnes, J. D., additional, Tremblay, M. S., additional, Fogelholm, M., additional, Hu, G., additional, Lambert, E. V., additional, Maher, C., additional, Maia, J., additional, Olds, T., additional, Onywera, V., additional, Sarmiento, O. L., additional, Standage, M., additional, Tudor‐Locke, C., additional, and Katzmarzyk, P. T., additional
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- 2018
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10. Food and Macronutrient Intake of Elite Kenyan Distance Runners.
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Onywera, V. O., Kiplamai, F. K., Tuitoek, P. J., Boit, M. K., and Pitsiladis, Y. P.
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RUNNERS (Sports) , *SPORTS nutrition , *INGESTION , *NUTRITION - Abstract
The food and macronutrient intake of elite Kenyan runners was compared to recommendations for endurance athletes. Estimated energy intake (EI: 2987 ± 293 kcal; mean ± standard deviation) was lower than energy expenditure (EE: 3605 ± 119 kcal; P < 0.001) and body mass (BM: 58.9 ± 2.7 kg vs. 58.3 ± 2.6 kg; P < 0.001) was reduced over the 7-d intense training period. Diet was high in carbohydrate (76.5%, 10.4 g/kg BM per day) and low in fat (13.4%). Protein intake (10.1%; 1.3 g/kg BM per day) matched recommendations for protein intake. Fluid intake was modest and mainly in the form of water (1113 ± 269 mL; 0.34 ± 0.16 mL/kcal) and tea (1243 ± 348 mL). Although the diet met most recommendations for endurance athletes for macronutrient intake, it remains to be determined if modifying energy balance and fluid intake will enhance the performance of elite Kenyan runners. [ABSTRACT FROM AUTHOR]
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- 2004
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11. Relationships between Parental Education and Overweight with Childhood Overweight and Physical Activity in 9-11 Year Old Children: Results from a 12-Country Study
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Muthuri, S. K., Onywera, V. O., Tremblay, M. S., Broyles, S. T., Chaput, J. P., Fogelholm, M., Hu, G., Kuriyan, R., Kurpad, A., Lambert, E. V., Maher, C., Maia, J., Matsudo, V., Olds, T., Sarmiento, O. L., Standage, M., Tudor Locke, C., Zhao, P., Church, T. S., Katzmarzyk, P. T., Lambert, D. G., Barreira, T., Broyles, S., Butitta, B., Champagne, C., Cocreham, S., Denstel, K. D., Drazba, K., Harrington, D., Johnson, W., Milauskas, D., Mire, E., Tohme, A., Rodarte, R., Amoroso, B., Luopa, J., Neiberg, R., Rushing, S., Lewis, L., Ferrar, K., Georgiadis, E., Stanley, R., Matsudo, V. K. R., Matsudo, S., Araujo, T., De Oliveira, L. C., Fabiano, L., Bezerra, D., Ferrari, G., Bélanger, P., Borghese, M., Boyer, C., Leblanc, A., Francis, C., Leduc, G., Diao, C., Li, W., Liu, E., Liu, G., Liu, H., Ma, J., Qiao, Y., Tian, H., Wang, Y., Zhang, T., Zhang, F., Sarmiento, O., Acosta, J., Alvira, Y., Diaz, M. P., Gamez, R., Garcia, M. P., Gómez, L. G., Gonzalez, L., Gonzalez, S., Grijalba, C., Gutierrez, L., Leal, D., Lemus, N., Mahecha, E., Mahecha, M. P., Mahecha, R., Ramirez, A., Rios, P., Suarez, A., Triana, C., Hovi, E., Kivelä, J., Räsänen, S., Roito, S., Saloheimo, T., Valta, L., Lokesh, D. P., D'Almeida, M. S., Mattilda R, A., Correa, L., Vijay, D., Wachira, L. J., Muthuri, S., Da Silva Borges, A., Sá Cachada, S. O., De Chaves, R. N., Gomes, T. N. Q. F., Pereira, S. I. S., De Vilhena E. Santos, D. M., Dos Santos, F. K., Da Silva, P. G. R., De Souza, M. C., Lambert, V., April, M., Uys, M., Naidoo, N., Synyanya, N., Carstens, M., Cumming, S., Drenowatz, C., Emm, L., Gillison, F., Zakrzewski, J., Braud, A., Donatto, S., Lemon, C., Jackson, A., Pearson, A., Pennington, G., Ragus, D., Roubion, R., Schuna, J., Wiltz, J. r., Batterham, A., Kerr, J., Pratt, M., Pietrobelli, Angelo, Muthuri, Stella K, Onywera, Vincent O, Tremblay, Mark S, Broyles, Stephanie T, Chaput, Jean-Philippe, Fogelholm, Mikael, Hu, Gang, Kuriyan, Rebecca, Kurpad, Anura, Lambert, Estelle V, Maher, Carol, Maia, José, Matsudo, Victor, Olds, Timothy, Sarmiento, Olga L, Standage, Martyn, Tudor-Locke, Catrine, Zhao, Pei, Church, Timothy S, Katzmarzyk, Peter T, MRC/UCT RU for Exercise and Sport Medicine, Faculty of Health Sciences, Department of Food and Nutrition, and Nutrition Science
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Gerontology ,Male ,Parents ,Pediatric Obesity ,Physiology ,Economics ,Physical fitness ,Economics of Training and Education ,SCHOOL-AGED CHILDREN, BODY-MASS INDEX, OBESITY ,Social Sciences ,lcsh:Medicine ,physical activity ,DETERMINANTS ,RA773 ,Overweight ,Pediatrics ,Families ,Fathers ,0302 clinical medicine ,Sociology ,Risk Factors ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Child ,lcsh:Science ,Children ,2. Zero hunger ,Human Capital ,Family Characteristics ,Multidisciplinary ,Child Health ,3142 Public health care science, environmental and occupational health ,FAMILY ,TIME ,3. Good health ,Multidisciplinary Sciences ,YOUTH ,Physiological Parameters ,Population Surveillance ,educational attainment ,OBESITY ,child health ,Educational Status ,ADIPOSITY ,Female ,SCHOOL-AGED CHILDREN ,medicine.symptom ,childhood obesity ,TRANSITION ,BEHAVIOR ,Research Article ,Childhood Obesity ,Mothers ,030209 endocrinology & metabolism ,fathers ,Childhood obesity ,Education ,03 medical and health sciences ,children ,medicine ,Humans ,Body Weights and Measures ,economics of training and education ,Socioeconomic status ,Exercise ,Life Style ,Educational Attainment ,business.industry ,Body Weight ,lcsh:R ,Biology and Life Sciences ,Odds ratio ,Physical Activity ,medicine.disease ,Obesity ,Educational attainment ,BODY-MASS INDEX ,mothers ,Age Groups ,People and Places ,Population Groupings ,lcsh:Q ,business ,Body mass index ,Demography - Abstract
Background: Globally, the high prevalence of overweight and low levels of physical activity among children has serious implications for morbidity and premature mortality in adulthood. Various parental factors are associated with childhood overweight and physical activity. The objective of this paper was to investigate relationships between parental education or overweight, and (i) child overweight, (ii) child physical activity, and (iii) explore household coexistence of overweight, in a large international sample. Methods: Data were collected from 4752 children (9–11 years) as part of the International Study of Childhood Obesity, Lifestyle and the Environment in 12 countries around the world. Physical activity of participating children was assessed by accelerometry, and body weight directly measured. Questionnaires were used to collect parents' education level, weight, and height. Results: Maternal and paternal overweight were positively associated with child overweight. Higher household coexistence of parent-child overweight was observed among overweight children compared to the total sample. There was a positive relationship between maternal education and child overweight in Colombia 1.90 (1.23–2.94) [odds ratio (confidence interval)] and Kenya 4.80 (2.21–10.43), and a negative relationship between paternal education and child overweight in Brazil 0.55 (0.33–0.92) and the USA 0.54 (0.33–0.88). Maternal education was negatively associated with children meeting physical activity guidelines in Colombia 0.53 (0.33–0.85), Kenya 0.35 (0.19–0.63), and Portugal 0.54 (0.31–0.96). Conclusions: Results are aligned with previous studies showing positive associations between parental and child overweight in all countries, and positive relationships between parental education and child overweight or negative associations between parental education and child physical activity in lower economic status countries. Relationships between maternal and paternal education and child weight status and physical activity appear to be related to the developmental stage of different countries. Given these varied relationships, it is crucial to further explore familial factors when investigating child overweight and physical activity. Refereed/Peer-reviewed
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- 2016
12. Assessment of Physical Fitness Status of Athletes with Intellectual Disabilities Participating in Special Olympics Programs in Nairobi County, Kenya
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Bukhala, P., primary, Onywera, V., additional, Toriola, A.L., additional, and Onagbiye, S.O., additional
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- 2017
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13. Sources of variability in childhood obesity indicators and related behaviors
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Katzmarzyk, P T, primary, Broyles, S T, additional, Chaput, J-P, additional, Fogelholm, M, additional, Hu, G, additional, Lambert, E V, additional, Maher, C, additional, Maia, J, additional, Olds, T, additional, Onywera, V, additional, Sarmiento, O L, additional, Standage, M, additional, Tremblay, M S, additional, and Tudor-Locke, C, additional
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- 2017
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14. Performance of Kenyan athletes in mountain versus flat marathon running - an example in Switzerland
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Harm, C, Knechtle, B, Rüst, C A, Rosemann, T, Lepers, R, Onywera, V, Harm, C, Knechtle, B, Rüst, C A, Rosemann, T, Lepers, R, and Onywera, V
- Abstract
The purpose of this study was to compare running performance of Kenyans in a flat city marathon and a mountain marathon in Switzerland. Running times of top three overall Kenyan runners were compared with running times of top three overall runners of other nations in a mountain and a flat marathon held in Switzerland between 2003 and 2011. In the mountain marathon top three male Kenyans achieved with 199±23min the 11th fastest running time behind athletes from Italy (177±1min), Switzerland (179±0min), France (186±5min), Great Britain (189±3min), Mexico (189±3min), Germany (192±5min), Czech Republic (195±13min), Morocco (195±7min), USA (196±6min) and Hungary (198±8min). Female Kenyan athletes did not even participate in the mountain marathon. In the city marathon top three male Kenyan athletes achieved the second fastest running time (130±1min) behind Swiss athletes (129±1min), Kenyan female runners had the fifth fastest running time (158±4min) behind athletes from Russia (153±2min), Ethiopia (154±2min), Switzerland (155±2min) and Poland (155±4min). To summarize, Switzerland, Kenyans achieved not the fastest running times in a mountain marathon while they attained the second fastest running times in flat marathon.
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- 2013
15. The aspect of nationality and performance in a mountain ultra-marathon-the ‘Swiss Alpine Marathon’
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Eichenberger, E, Knechtle, B, Rüst, C A, Lepers, R, Rosemann, T, Onywera, V O, Eichenberger, E, Knechtle, B, Rüst, C A, Lepers, R, Rosemann, T, and Onywera, V O
- Abstract
Runners from East Africa and especially from Kenya dominate middle- and long- distance running races worldwide. The aim of the present study was to investigate the participation and performance trends regarding the nationality of runners in a mountain ultra-marathon held in partially high alpine terrain. We hypothesized that Kenyan runners, living and training in the Great Rift Valley, a predominantly hilly, mountainous and altitudinous region like the Alps, would dominate also a mountain ultra-marathon because they are accustomed to high altitudes and mountainous terrains. We examined the participation and performance trends of ultra-marathoners regarding their nationalities in the 78-km ‘Swiss Alpine Marathon’ including 21 km in high alpine terrain where 12,194 men and 1,781 women finished between 1998 and 2011. A total of 1,682 women and 11,580 men, corresponding to 94.9 % of all finishers, originated from Switzerland, Germany, Denmark, Italy, Sweden, Great Britain, Austria, the Netherlands and Luxembourg where only one male Kenyan runner ever participated. Female runners from Denmark, Great Britain, Germany, Luxembourg, Switzerland and Sweden as well as male runners from Denmark, Great Britain, and Sweden increased their participation significantly. Women from the Netherlands became slower whereas women originating from Great Britain became faster. Men from the Netherlands, Denmark, Germany and Switzerland became slower. The fastest runners originated from Switzerland for both women and men. To summarize, runners from Switzerland dominated the ‘Swiss Alpine Marathon’. Paradoxically, and interestingly, the Kenyan runners were not dominating the ‘Swiss Alpine Marathon’. Further studies should investigate Kenyan participation and performance in ultra-marathons in Africa such as the ‘Comrades Marathon’. Key words: ALPINE ULTRA-RUNNING, ULTRA ENDURANCE, ENDURANCE RUNNING, ETHNICITY.
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- 2012
16. The Relation between Aerobic Fitness, Muscular Fitness, and Obesity in Children from Three Countries at Different Stages of the Physical Activity Transition
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Héroux, M., primary, Onywera, V., additional, Tremblay, M. S., additional, Adamo, K. B., additional, Lopez Taylor, J., additional, Jáuregui Ulloa, E., additional, and Janssen, I., additional
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- 2013
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17. The international study of childhood obesity, lifestyle and the environment
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Katzmarzyk, P., primary, Church, T., additional, Chaput, J., additional, Hu, G., additional, Kurpad, A., additional, Lambert, V., additional, Maia, J., additional, Matsudo, V., additional, Olds, T., additional, Onywera, V., additional, Sarmiento, O., additional, Standage, M., additional, Tremblay, M., additional, Tudor-Locke, C., additional, and Zhao, P., additional
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- 2012
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18. Cardiovascular fitness of a pediatric population in Central Kampala, Uganda.
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NSIBAMBI, C. A., WAMUKOYA, E. K., WANDERI, P. M., ONYWERA, V. O., and GOON, D. T.
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CARDIOVASCULAR fitness ,PHYSICAL fitness research ,COGNITIVE ability ,GENDER differences (Psychology) - Abstract
The purpose of this study was to determine the cardiovascular fitness of pediatric population in central Kampala, Uganda. A stratified random sampling was used to select 1929 pupils aged 6-9 years in Wakiso and Mukono districts. A pre-experimental design was used to collect data on the cardiovascular fitness endurance using a 9-minute distance run/walk test. Pupils in day schools had significantly higher mean score (1538.02±309.09) for the 9-minute distance run/walk than those in boarding schools (1486.27±305.22). There was significant gender difference in cardiovascular fitness endurance with boys recording higher mean score (1591±356.76) than girls (1440.64±236.72). Majority (71%) of pupils met acceptable cardiovascular fitness endurance according to percentile norms set by American Association of Health, Physical Education, Recreation and Dance (AAHPERD). About 18.8% and 10.1% had weak and critical cardiovascular endurance status, respectively, which necessitated intervention. Pupils in day schools had better cardiovascular fitness endurance than those in boarding schools; and boys had better cardiovascular endurance compared to girls. There is need for surveillance of physical activity patterns of Ugandan children which may affect their cardiovascular fitness endurance. [ABSTRACT FROM AUTHOR]
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- 2015
19. Determinants of overweight and obesity in Kenyan adolescents in public and private schools.
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OKOTH, M. A., OCHOLA, S., ONYWERA, V., and STEYN, N. P.
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OVERWEIGHT persons ,OBESITY & psychology ,BODY mass index ,DIETARY supplements ,KENYANS ,PSYCHOLOGY - Abstract
Overweight and obesity have been identified as increasing public health problems among adolescents in many developed and developing countries. This study aimed at measuring the determinants of overweight and obesity, namely body mass index (BMI), dietary intake and physical activity levels of students (15-19 years) at public (less affluent) versus private (more affluent) schools in Kisumu East District of Kenya (n=387). A 24-hour dietary recall and 7-day food frequency were conducted with each participant. Physical activity levels were measured using the physical activity questionnaire for adolescents (PAQ-A). A higher percent of overweight adolescents were found at private schools than public schools (17% vs. 14%). Overall, 15.5% of adolescents were overweight or obese (BMI>=25). Students at private schools had significantly higher intakes of all nutrients than those at public schools, except for cholesterol and fibre. Differences between private schools and public schools were particularly high for energy (2186 Kcal vs. 1845 Kcal), fat (66g vs. 50g), carbohydrate (302g vs. 345g), and polyunsaturated fats (16g vs. 10 g), respectively. Carbohydrates (p=0.003), fruit and vegetables (p=0.013), and fats (p=0.003) were negative predictors while meat and eggs (p=0.002) and protein (p=0.005) were positive predictors of BMI. Physical activity levels were lower at public schools than at private schools. The prevalence of overweight students was highest at private schools as were intake of calories, carbohydrate, and fat, suggestive of increased urbanisation of lifestyle and associated rise in NCDs. [ABSTRACT FROM AUTHOR]
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- 2015
20. An international comparison of dietary patterns in 9–11-year-old children
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Mikkilä, V, Vepsäläinen, H, Saloheimo, T, Gonzalez, S A, Meisel, J D, Hu, G, Champagne, C M, Chaput, J-P, Church, T S, Katzmarzyk, P T, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, and Fogelholm, M
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OBJECTIVES:Dietary pattern is defined as a combination of foods and drinks and the frequency of consumption within a population. Dietary patterns are changing on a global level, which may be linked to an increased incidence of chronic diseases. The aim of this study was to identify and compare the dietary patterns among 9–11-year-old children living in urban regions in different parts of the world.METHODS:Participants were 7199 children (54% girls), aged 9–11 years, from 12 countries situated in all major world regions. Food consumption was assessed using a 23-item Food Frequency Questionnaire (FFQ). To identify dietary patterns, principal components analyses (PCA) were carried out using weekly portions as input variables.RESULTS:Both site-specific and pooled PCA resulted in two strong components. Component 1 (‘unhealthy diet pattern’) included fast foods, ice cream, fried food, French fries, potato chips, cakes and sugar-sweetened sodas with >0.6 loadings. The loadings for component 2 (‘healthy diet pattern’) were slightly weaker with only dark-green vegetables, orange vegetables, vegetables in general, and fruits and berries reaching a >0.6 loading. The site-specific diet pattern scores had very strong correlations with the pattern scores from the pooled data: r=0.82 and 0.94 for components 1 and 2, respectively.CONCULSIONS:The results suggest that the same ‘healthier’ and ‘unhealthier’ foods tend to be consumed in similar combinations among 9–11-year-old children in different countries, despite variation in food culture, geographical location, ethnic background and economic development.
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- 2015
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21. Are participant characteristics from ISCOLE study sites comparable to the rest of their country?
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LeBlanc, A G, Katzmarzyk, P T, Barreira, T V, Broyles, S T, Chaput, J-P, Church, T S, Fogelholm, M, Harrington, D M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tudor-Locke, C, Zhao, P, and Tremblay, M S
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OBJECTIVES:The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) provides robust, multi-national information on physical activity, diet and weight status in 9–11-year-old children around the world. The purpose of this analysis was to examine the similarities and differences between participant characteristics from ISCOLE sites and data from nationally representative surveys from ISCOLE countries (Australia, Brazil, Canada, China, Colombia, Finland, Kenya, India, Portugal, South Africa, the United Kingdom and the United States).METHODS:Distributions of characteristics were assessed within each ISCOLE country-level database, and compared with published data from national or regional surveys, where available. Variables of comparison were identified a priori and included body mass index (BMI), physical activity (accelerometer-determined steps per day) and screen time (child-report).RESULTS:Of 12 countries, data on weight status (BMI) were available in 8 countries, data on measured physical activity (steps per day) were available in 5 countries and data on self-reported screen time were available in 9 countries. The five ISCOLE countries that were part of the Health Behaviour in School-aged Children Survey (that is, Canada, Finland, Portugal, the United Kingdom (England) and the United States) also provided comparable data on self-reported physical activity. Available country-specific data often used different measurement tools or cut-points, making direct comparisons difficult. Where possible, ISCOLE data were re-analyzed to match country-level data, but this step limited between-country comparisons.CONCLUSIONS:From the analyses performed, the ISCOLE data do not seem to be systematically biased; however, owing to limitations in data availability, data from ISCOLE should be used with appropriate caution when planning country-level population health interventions. This work highlights the need for harmonized measurement tools around the world while accounting for culturally specific characteristics, and the need for collaboration across study centers and research groups.
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- 2015
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22. Development and reliability of an audit tool to assess the school physical activity environment across 12 countries
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Broyles, S T, Drazba, K T, Church, T S, Chaput, J-P, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, and Katzmarzyk, P T
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Objectives:Schools are an important setting to enable and promote physical activity. Researchers have created a variety of tools to perform objective environmental assessments (or ‘audits’) of other settings, such as neighborhoods and parks; yet, methods to assess the school physical activity environment are less common. The purpose of this study is to describe the approach used to objectively measure the school physical activity environment across 12 countries representing all inhabited continents, and to report on the reliability and feasibility of this methodology across these diverse settings.Methods:The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) school audit tool (ISAT) data collection required an in-depth training (including field practice and certification) and was facilitated by various supporting materials. Certified data collectors used the ISAT to assess the environment of all schools enrolled in ISCOLE. Sites completed a reliability audit (simultaneous audits by two independent, certified data collectors) for a minimum of two schools or at least 5% of their school sample. Item-level agreement between data collectors was assessed with both the kappa statistic and percent agreement. Inter-rater reliability of school summary scores was measured using the intraclass correlation coefficient.Results:Across the 12 sites, 256 schools participated in ISCOLE. Reliability audits were conducted at 53 schools (20.7% of the sample). For the assessed environmental features, inter-rater reliability (kappa) ranged from 0.37 to 0.96; 18 items (42%) were assessed with almost perfect reliability (κ=0.80–0.96), and a further 24 items (56%) were assessed with substantial reliability (κ=0.61–0.79). Likewise, scores that summarized a school’s support for physical activity were highly reliable, with the exception of scores assessing aesthetics and perceived suitability of the school grounds for sport, informal games and general play.Conclusions:This study suggests that the ISAT can be used to conduct reliable objective audits of the school physical activity environment across diverse, international school settings.
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- 2015
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23. Are the correlates of active school transport context-specific?
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Larouche, R, Sarmiento, O L, Broyles, S T, Denstel, K D, Church, T S, Barreira, T V, Chaput, J-P, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, and Katzmarzyk, P T
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OBJECTIVES:Previous research consistently indicates that children who engage in active school transport (AST) are more active than their peers who use motorized modes (car or bus). However, studies of the correlates of AST have been conducted predominantly in high-income countries and have yielded mixed findings. Using data from a heterogeneous sample of 12 country sites across the world, we investigated the correlates of AST in 9–11-year olds.METHODS:The analytical sample comprised 6555 children (53.8% girls), who reported their main travel mode to school and the duration of their school trip. Potential individual and neighborhood correlates of AST were assessed with a parent questionnaire adapted from previously validated instruments. Multilevel generalized linear mixed models (GLMM) were used to examine the associations between individual and neighborhood variables and the odds of engaging in AST while controlling for the child’s school. Site moderated the relationship of seven of these variables with AST; therefore we present analyses stratified by site.RESULTS:The prevalence of AST varied from 5.2 to 79.4% across sites and the school-level intra-class correlation ranged from 0.00 to 0.56. For each site, the final GLMM included a different set of correlates of AST. Longer trip duration (that is, ⩾16 min versus ⩽15 min) was associated with lower odds of AST in eight sites. Other individual and neighborhood factors were associated with AST in three sites or less.CONCLUSIONS:Our results indicate wide variability in the prevalence and correlates of AST in a large sample of children from twelve geographically, economically and culturally diverse country sites. This suggests that AST interventions should not adopt a ‘one size fits all’ approach. Future research should also explore the association between psychosocial factors and AST in different countries.
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- 2015
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24. The epidemiological transition and the global childhood obesity epidemic
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Broyles, S T, Denstel, K D, Church, T S, Chaput, J-P, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, and Katzmarzyk, P T
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OBJECTIVES:Childhood obesity is now recognized as a global public health issue. Social patterning of obesity, consistent with the theory of epidemiologic transition, has not been well described in children, and the limited research has focused on developed settings. The aim of this study was to describe the relationship between childhood obesity and household income using objective measures of adiposity and to explore how this relationship differs across levels of country human development.METHODS:The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was a multi-national cross-sectional study conducted in 12 urban/suburban study sites that represented all inhabited continents and wide ranges of development. ISCOLE collected objectively measured height, body mass and percentage body fat in 7341 10-year-old children. Multi-level random-effects models were used to examine income gradients in several obesity measures.RESULTS:The mean age of the children was 10.4 years, and 12.6% were obese, ranging from 5.4% (Finland) to 23.8% (China). For both boys and girls, obesity prevalence, body fat percentage and body mass index (BMI) z-score increased linearly with higher income at lower levels of development (all P for trend ⩽0.0012), but decreased linearly with higher income at higher levels of development (all P for trend ⩽0.0003). Country human development explained 75% of the variation in the country-specific income–obesity relationships (r=−0.87, P=0.0003).CONCLUSIONS:Results are consistent with the theory of epidemiologic transition. Global efforts to control obesity must account for socioeconomic factors within a country’s context. Future research should seek to understand global socioeconomic patterns in obesity-related lifestyle behaviors.
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25. Reliability of accelerometer-determined physical activity and sedentary behavior in school-aged children: a 12-country study
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Barreira, T V, Schuna, J M, Tudor-Locke, C, Chaput, J-P, Church, T S, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Zhao, P, and Katzmarzyk, P T
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Objectives:Focused on the accelerometer-determined physical activity and sedentary time metrics in 9–11-year-old children, we sought to determine the following: (i) number of days that are necessary to achieve reliable estimates (G⩾0.8); (ii) proportion of variance attributed to different facets (participants and days) of reliability estimates; and (iii) actual reliability of data as collected in The International Study of Childhood Obesity, Lifestyle and Environment (ISCOLE).Methods:The analytical sample consisted of 6025 children (55% girls) from sites in 12 countries. Physical activity and sedentary time metrics measures were assessed for up to 7 consecutive days for 24 h per day with a waist-worn ActiGraph GT3X+. Generalizability theory using R software was used to investigate the objectives i and ii. Intra-class correlation coefficients (ICC) were computed using SAS PROC GLM to inform objective iii.Results:The estimated minimum number of days required to achieve a reliability estimate of G⩾0.8 ranged from 5 to 9 for boys and 3 to 11 for girls for light physical activity (LPA); 5 to 9 and 3 to 10, for moderate-to-vigorous physical activity (MVPA); 5 to 10 and 4 to 10 for total activity counts; and 7 to 11 and 6 to 11 for sedentary time, respectively. For all variables investigated, the ‘participant’ facet accounted for 30–50% of the variability, whereas the ‘days’ facet accounted for ⩽5%, and the interaction (P × D) accounted for 50–70% of the variability. The actual reliability for boys in ISCOLE ranged from ICCs of 0.78 to 0.86, 0.73 to 0.85 and 0.72 to 0.86 for LPA, MVPA and total activity counts, respectively, and 0.67 to 0.79 for sedentary time. The corresponding values for girls were 0.80–0.88, 0.70–0.89, 0.74–0.86 and 0.64–0.80.Conclusions:It was rare that only 4 days from all participants would be enough to achieve desirable reliability estimates. However, asking participants to wear the device for 7 days and requiring ⩾4 days of data to include the participant in the analysis might be an appropriate approach to achieve reliable estimates for most accelerometer-derived metrics.
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26. Nocturnal sleep-related variables from 24-h free-living waist-worn accelerometry: International Study of Childhood Obesity, Lifestyle and the Environment
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Tudor-Locke, C, Mire, E F, Barreira, T V, Schuna, J M, Chaput, J-P, Fogelholm, M, Hu, G, Kurpad, A, Kuriyan, R, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Zhao, P, Church, T S, and Katzmarzyk, P T
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Objectives:We describe the process of identifying and defining nocturnal sleep-related variables (for example, movement/non-movement indicators of sleep efficiency, waking episodes, midpoint and so on) using the unique 24-h waist-worn free-living accelerometer data collected in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).Methods:Seven consecutive days of 24-h waist-worn accelerometer (GT3X+, ActiGraph LLC) data were collected from over 500 children at each site. An expert subgroup of the research team with accelerometry expertize, frontline data collectors and data managers met on several occasions to categorize and operationally define nocturnal accelerometer signal data patterns. The iterative process was informed by the raw data drawn from a sub set of the US data, and culminated in a refined and replicable delineated definition for each identified nocturnal sleep-related variable. Ultimately based on 6318 participants from all 12 ISCOLE sites with valid total sleep episode time (TSET), we report average clock times for nocturnal sleep onset, offset and midpoint in addition to sleep period time, TSET and restful sleep efficiency (among other derived variables).Results:Nocturnal sleep onset occurred at 2218 hours and nocturnal sleep offset at 0707 hours. The mean midpoint was 0243 hours. The sleep period time of 529.6 min (8.8 h) was typically accumulated in a single episode, making the average TSET very similar in duration (529.0 min). The mean restful sleep efficiency ranged from 86.8% (based on absolute non-movement of 0 counts per minute) to 96.0% (based on relative non-movement of <100 counts per minute).Conclusions:These variables extend the potential of field-based 24-h waist-worn accelerometry to distinguish and categorize the underlying robust patterns of movement/non-movement signals conveying magnitude, duration, frequency and periodicity during the nocturnal sleep period.
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27. Relationships between active school transport and adiposity indicators in school-age children from low-, middle- and high-income countries
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Sarmiento, O L, Lemoine, P, Gonzalez, S A, Broyles, S T, Denstel, K D, Larouche, R, Onywera, V, Barreira, T V, Chaput, J-P, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, Church, T S, and Katzmarzyk, P T
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Objectives:Within the global context of the nutrition and physical activity transition it is important to determine the relationship between adiposity and active school transport (AST) across different environmental and socio-cultural settings. The present study assessed the association between adiposity (that is, body mass index z-score (BMIz), obesity, percentage body fat (PBF), waist circumference) and AST in 12 country sites, in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).Methods:The analytical sample included 6797 children aged 9–11 years. Adiposity indicators included, BMIz calculated using reference data from the World Health Organization, obesity (BMIz ⩾+2 s.d.), PBF measured using bioelectrical impedance and waist circumference. School travel mode was assessed by questionnaire and categorized as active travel versus motorized travel. Multilevel linear and non-linear models were used to estimate the magnitude of the associations between adiposity indicators and AST by country site and sex.Results:After adjusting for age, sex, parental education and motorized vehicle availability, children who reported AST were less likely to be obese (odds ratio=0.72, 95% confidence interval (0.60–0.87), P<0.001) and had a lower BMIz (−0.09, s.e.m.=0.04, P=0.013), PBF (least square means (LSM) 20.57 versus 21.23% difference −0.66, s.e.m.=0.22, P=0.002) and waist circumference (LSM 63.73 cm versus 64.63 cm difference −0.90, s.e.m.=0.26, P=0.001) compared with those who reported motorized travel. Overall, associations between obesity and AST did not differ by country (P=0.279) or by sex (P=0.571).Conclusions:AST was associated with lower measures of adiposity in this multinational sample of children. Such findings could inform global efforts to prevent obesity among school-age children.
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28. Associations between sleep patterns and lifestyle behaviors in children: an international comparison
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Chaput, J-P, Katzmarzyk, P T, LeBlanc, A G, Tremblay, M S, Barreira, T V, Broyles, S T, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Rae, D E, Maher, C, Maia, J, Matsudo, V, Onywera, V, Sarmiento, O L, Standage, M, Tudor-Locke, C, Zhao, P, and Olds, T
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OBJECTIVES:Although evidence is accumulating on the importance of a good night’s sleep for healthy eating and activity behaviors, existing research has mainly been conducted in high-income, developed countries with limited sociocultural variability. This study is the first to examine the associations between sleep patterns and lifestyle behaviors in children from 12 countries in five major geographic regions of the world.METHODS:This observational, multinational cross-sectional study included 5777 children aged 9–11 years from sites in Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom and the United States. Nocturnal sleep duration (hours per night), sleep efficiency (%) and bedtime (h:min) were monitored over 7 consecutive days using an accelerometer. Lifestyle behaviors included moderate-to-vigorous physical activity (MVPA), total sedentary time (SED), self-reported screen time (ST) and healthy/unhealthy diet patterns (HDP/UDP). Multilevel modeling analyses were used to account for the hierarchical nature of the data.RESULTS:Overall, participants averaged 8.8 (s.d. 0.9) hours of sleep with 96.2% (s.d. 1.4) sleep efficiency and a mean bedtime of 2218 hours. After adjustment for age, sex, highest parental education and BMI z-score, results showed that (i) sleep duration was negatively associated with MVPA, SED and UDP score; (ii) sleep efficiency was negatively associated with MVPA and UDP score, and positively associated with SED; and (iii) later bedtime was positively associated with SED, ST and UDP score, and negatively associated with MVPA and HDP score. Results using categories of sleep patterns were consistent with the linear associations. Results also revealed that associations between sleep patterns and MVPA, SED and ST were significantly different between study sites, with stronger associations in high-income countries compared with low/middle-income countries.CONCLUSIONS:Sleep characteristics are important correlates of lifestyle behaviors in children. Differences between countries suggest that interventions aimed at improving sleep and lifestyle behaviors should be culturally adapted.
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29. Association between body mass index and body fat in 9–11-year-old children from countries spanning a range of human development
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Katzmarzyk, P T, Barreira, T V, Broyles, S T, Chaput, J-P, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, and Church, T S
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The purpose was to assess associations between body mass index (BMI) and body fat in a multinational sample of 9–11-year-old children. The sample included 7265 children from countries ranging in human development. Total body fat (TBF) and percentage body fat (PBF) were measured with a Tanita SC-240 scale and BMI z-scores (BMIz) and percentiles were computed using reference data from the World Health Organization and the U.S. Centers for Disease Control and Prevention, respectively. Mean PBF at BMIz values of −1, 0 and +1 were estimated using multilevel models. Correlations between BMI and TBF were >0.90 in all countries, and correlations between BMI and PBF ranged from 0.76 to 0.96. Boys from India had higher PBF than boys from several other countries at all levels of BMIz. Kenyan girls had lower levels of PBF than girls from several other countries at all levels of BMIz. Boys and girls from Colombia had higher values of PBF at BMIz=−1, whereas Colombian boys at BMIz 0 and +1 also had higher values of PBF than boys in other countries. Our results show a consistently high correlation between BMI and adiposity in children from countries representing a wide range of human development.
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30. Association between home and school food environments and dietary patterns among 9–11-year-old children in 12 countries
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Vepsäläinen, H, Mikkilä, V, Erkkola, M, Broyles, S T, Chaput, J-P, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, Church, T S, Katzmarzyk, P T, and Fogelholm, M
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Objectives:We investigated the roles of home and school environments on dietary patterns among children from 12 countries differing widely in geographic region and levels of human and economic development.Methods:The sample included a total of 6685 (54% girls) 9–11-year-old children. Parents/guardians reported the availability of certain foods in the home, and trained researchers performed school audits recording the availability of foods for sale at schools. Foods were then divided into wholesome (nutrient-dense) and empty-calorie (nutrient-poor) foods and scored according to their availability. Children reported if their school provided school lunch and how many times during the last week they had eaten meals prepared away from home and school. Via principal components analysis, data-driven dietary pattern scores were calculated from food frequency questionnaires. Multilevel models were used to study the associations between home and school food environments (wholesome and empty-calorie foods) and dietary patterns (healthy and unhealthy diet pattern scores).Results:For low unhealthy diet pattern scores, low availability of empty-calorie foods at home was found to be more important than high availability of wholesome foods. More meals eaten outside home and school were associated with the higher unhealthy diet pattern scores. The availability of wholesome foods at home was positively associated with the healthy diet pattern scores. Food availability at school was not associated with the dietary patterns.Conclusions:In this sample, the home food environment was more significant than the school food environment in predicting the dietary patterns. The availability of empty-calorie foods was associated with the unhealthy dietary pattern even when the availability of wholesome foods at home was high. Meals prepared away from home contributed to the unhealthy dietary pattern. Therefore, parents should be encouraged to limit the availability of empty-calorie foods and eating outside the home.
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31. Active school transport and weekday physical activity in 9–11-year-old children from 12 countries
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Denstel, K D, Broyles, S T, Larouche, R, Sarmiento, O L, Barreira, T V, Chaput, J-P, Church, T S, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, and Katzmarzyk, P T
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OBJECTIVES:Active school transport (AST) may increase the time that children spend in physical activity (PA). This study examined relationships between AST and weekday moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time (SED) and total activity during naturally organized time periods (daily, before school, during school and after school) in a sample of children from 12 countries.METHODS:The sample included 6224 children aged 9–11 years. PA and sedentary time were objectively measured using Actigraph accelerometers. AST was self-reported by participants. Multilevel generalized linear and logistic regression statistical models were used to determine associations between PA, SED and AST across and within study sites.RESULTS:After adjustment for age, highest parental educational attainment, BMI z-score and accelerometer wear time, children who engaged in AST accumulated significantly more weekday MVPA during all studied time periods and significantly less time in LPA before school compared with children who used motorized transport to school. AST was unrelated to time spent in sedentary behaviors. Across all study sites, AST was associated with 6.0 min (95% confidence interval (CI): 4.7–7.3; P<0.0001) more of weekday MVPA; however, there was some evidence that this differed across study sites (P for interaction=0.06). Significant positive associations were identified within 7 of 12 study sites, with differences ranging from 4.6 min (95% CI: 0.3–8.9; P=0.04, in Canada) to 10.2 min (95% CI: 5.9–14.4; P<0.0001, in Brazil) more of daily MVPA among children who engaged in AST compared with motorized transport.CONCLUSIONS:The present study demonstrated that AST was associated with children spending more time engaged in MVPA throughout the day and less time in LPA before school. AST represents a good behavioral target to increase levels of PA in children.
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32. Birth weight and childhood obesity: a 12-country study
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Qiao, Y, Ma, J, Wang, Y, Li, W, Katzmarzyk, P T, Chaput, J-P, Fogelholm, M, Johnson, W D, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Tudor-Locke, C, Church, T S, Zhao, P, and Hu, G
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OBJECTIVES:Few studies have investigated the association between the full range of birth weight and the risk of childhood obesity in high-, middle- and low-income countries. The aim of the present study is to assess the association between different levels of birth weight and the risk of obesity among children aged 9–11 years in 12 countries.METHODS:A multinational, cross-sectional study of 5141 children aged 9–11 years was conducted in 12 countries. Height and weight were obtained using standardized methods. Time spent in moderate-to-vigorous physical activity (MVPA), sedentary and sleeping were objectively measured using 24-h, waist-worn accelerometer (Actigraph GT3X+) monitored for 7 days. Birth weight and other factors (regions, parental education, maternal history of gestational diabetes, children age, gender, breast feeding, gestational age, unhealthy diet scores and healthy diet scores) were collected by parental and children’s questionnaires. Multilevel modeling was used to account for the nested nature of the data.RESULTS:The overall prevalence of obesity (BMI z-score>+2 s.d.) was 15.4% for boys and 10.0% for girls. There was a positive association between birth weight and BMI z-scores. The multivariable-adjusted odds ratios (ORs) of childhood obesity were significantly higher among children whose birth weights were 3500–3999 g (OR 1.45; 95% confidence interval (CI): 1.10–1.92), and >4000 g (OR 2.08; 95% CI: 1.47–2.93), compared with the reference group (2500–2999 g). The positive association between birth weight and the odds of childhood obesity was seen in girls, whereas a U-shaped association appeared in boys.CONCLUSIONS:High levels of birth weight, defined as birth weight ⩾3500 g, were associated with increased odds of obesity among 9–11-year-old children in 12 countries. However, sex differences in the association between birth weight and the risk of obesity need to be considered when planning interventions to reduce childhood obesity.
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33. Associations between breakfast frequency and adiposity indicators in children from 12 countries
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Zakrzewski, J K, Gillison, F B, Cumming, S, Church, T S, Katzmarzyk, P T, Broyles, S T, Champagne, C M, Chaput, J-P, Denstel, K D, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, V, Mire, E F, Olds, T, Onywera, V, Sarmiento, O L, Tremblay, M S, Tudor-Locke, C, Zhao, P, and Standage, M
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OBJECTIVES:Reports of inverse associations between breakfast frequency and indices of obesity are predominantly based on samples of children from high-income countries with limited socioeconomic diversity. Using data from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), the present study examined associations between breakfast frequency and adiposity in a sample of 9–11-year-old children from 12 countries representing a wide range of geographic and socio-cultural variability.METHODS:Multilevel statistical models were used to examine associations between breakfast frequency (independent variable) and adiposity indicators (dependent variables: body mass index (BMI) z-score and body fat percentage (BF%)), adjusting for age, sex, and parental education in 6941 children from 12 ISCOLE study sites. Associations were also adjusted for moderate-to-vigorous physical activity, healthy and unhealthy dietary patterns and sleep time in a sub-sample (n=5710). Where interactions with site were significant, results were stratified by site.RESULTS:Adjusted mean BMI z-score and BF% for frequent breakfast consumers were 0.45 and 20.5%, respectively. Frequent breakfast consumption was associated with lower BMI z-scores compared with occasional (P<0.0001, 95% confidence intervals (CI): 0.10–0.29) and rare (P<0.0001, 95% CI: 0.18–0.46) consumption, as well as lower BF% compared with occasional (P<0.0001, 95% CI: 0.86–1.99) and rare (P<0.0001, 95% CI: 1.07–2.76). Associations with BMI z-score varied by site (breakfast by site interaction; P=0.033): associations were non-significant in three sites (Australia, Finland and Kenya), and occasional (not rare) consumption was associated with higher BMI z-scores compared with frequent consumption in three sites (Canada, Portugal and South Africa). Sub-sample analyses adjusting for additional covariates showed similar associations between breakfast and adiposity indicators, but lacked site interactions.CONCLUSIONS:In a multinational sample of children, more frequent breakfast consumption was associated with lower BMI z-scores and BF% compared with occasional and rare consumption. Associations were not consistent across all 12 countries. Further research is required to understand global differences in the observed associations.
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- 2015
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34. Adiposity and physical activity among children in countries at different stages of the physical activity transition: Canada, Mexico and Kenya.
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ONYWERA, V. O., HÉROUX, M., JÁUREGUI ULLOA, E., ADAMO, K. B., LÓPEZ TAYLOR, J., JANSSEN, I., and TREMBLAY, MARK S.
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SEDENTARY behavior ,PHYSICAL fitness ,OBESITY ,NUTRITION disorders ,CHILDREN'S health - Abstract
Physical inactivity is a risk factor for childhood overweight and obesity, and is associated with habitual lifestyle behaviours that are in rapid transition in many countries. Data comparing the weight status and physical activity among children in countries at different stages of the physical activity transition are lacking. The objective of this study was to compare the weight status and physical activity levels among children in Canada, Mexico and Kenya as a model to assess the physical activity transition. School children (aged 9-13 years) from Canada (n=736), Mexico (n=193) and Kenya (n=179) participated in this study. Body mass index (BMI) was used to determine weight status (underweight, normal weight, overweight and obesity). Activity monitors were used to measure daily step counts. Findings showed that 25.6% of Canadian children were overweight or obese, compared to 35.7% and 5.6% of Mexican and Kenyan children, respectively. Results indicated that 41.2% of the Kenyan children were underweight compared to 10.9% and 6.4% of Mexican and Canadian children, respectively. Mexican and Kenyan children were more physically active than Canadian children, accumulating an average of 15,757±5565, 15,605±5963 and 10,730±3969 steps per day, respectively. This inter-country comparison shows that childhood overweight and obesity levels are lowest and physical activity levels are high in Kenya, a country at an early stage of the physical activity transition. Further research using more representative samples is recommended. [ABSTRACT FROM AUTHOR]
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- 2013
35. Improving wear time compliance with a 24-hour waist-worn accelerometer protocol in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)
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Tudor Locke, C., Barreira, T. V., Schuna, J. M., Mire, E. F., Chaput, J. P., Fogelholm, M., Hu, G., Kuriyan, R., Kurpad, A., Lambert, E. V., Maher, C., Maia, J., Matsudo, V., Olds, T., Onywera, V., Sarmiento, O. L., Standage, M., Tremblay, M. S., Zhao, P., Church, T. S., Katzmarzyk, P. T., Lambert, D. G., Barreira, T., Broyles, S., Butitta, B., Champagne, C., Cocreham, S., Dentro, K., Drazba, K., Harrington, D., Johnson, W., Milauskas, D., Mire, E., Tohme, A., Rodarte, R., Amoroso, B., Luopa, J., Neiberg, R., Rushing, S., Lewis, L., Ferrar, K., Physio, B., Georgiadis, E., Stanley, R., Matsudo, V. K. R., Matsudo, S., Araujo, T., de Oliveira, L. C., Rezende, L., Fabiano, L., Bezerra, D., Ferrari, G., Bélanger, P., Borghese, M., Boyer, C., Leblanc, A., Francis, C., Leduc, G., Diao, C., Li, W., Liu, E., Liu, G., Liu, H., Ma, J., Qiao, Y., Tian, H., Wang, Y., Zhang, T., Zhang, F., Sarmiento, O., Acosta, J., Alvira, Y., Diaz, M. P., Gamez, R., Garcia, M. P., Gómez, L. G., Gonzalez, L., Gonzalez, S., Grijalba, C., Gutierrez, L., Leal, D., Lemus, N., Mahecha, E., Mahecha, M. P., Mahecha, R., Ramirez, A., Rios, P., Suarez, A., Triana, C., Hovi, E., Kivelä, J., Räsänen, S., Roito, S., Saloheimo, T., Valta, L., Lokesh, D. P., D'Almeida, M. S., Annie Mattilda, R., Correa, L., Vijay, D., Wachira, L. J., Muthuri, S., da Silva Borges, A., Oliveira Sá Cachada, S., de Chaves, R. N., Gomes, T. N. Q. F., Pereira, S. I. S., de Vilhena e. Santos, D. M., dos Santos, F. K., Rodrigues da Silva, P. G., de Souza, M. C., Lambert, V., April, M., Uys, M., Naidoo, N., Synyanya, N., Carstens, M., Donatto, S., Lemon, C., Jackson, A., Pearson, A., Pennington, G., Ragus, D., Roubion, R., Schuna, J., Wiltz, D., Batterham, A., Kerr, J., Pratt, M., Pietrobelli, Angelo, ISCOLE Research Group, Tudor-Locke, Catrine, Barreira, Tiago V, Schuna, John M, Mire, Emily F, Maher, Carol A, Olds, Timothy S, Katzmarzyk, Peter T, University of Helsinki, Department of Food and Nutrition, Nutrition Science, MRC/UCT RU for Exercise and Sport Medicine, and Faculty of Health Sciences
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Male ,Gerontology ,Pediatric Obesity ,Time Factors ,Accelerometry, Exercise, Measurement, Physical activity, Sedentary time, Pediatrics ,Medicine (miscellaneous) ,RA773 ,Accelerometer ,Pediatrics ,0302 clinical medicine ,Clinical Protocols ,Surveys and Questionnaires ,Accelerometry ,030212 general & internal medicine ,315 Sport and fitness sciences ,Child ,Measurement ,Nutrition and Dietetics ,ALGORITHMS ,Nutrition Surveys ,16. Peace & justice ,3. Good health ,Sedentary time ,Female ,medicine.medical_specialty ,Waist ,National Health and Nutrition Examination Survey ,Physical activity ,Physical Therapy, Sports Therapy and Rehabilitation ,Motor Activity ,Childhood obesity ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,medicine ,Humans ,WRIST ,Accelerometer data ,Wakefulness ,Life Style ,Exercise ,Protocol (science) ,HIP ,business.industry ,Methodology ,030229 sport sciences ,medicine.disease ,United States ,PHYSICAL-ACTIVITY ,Physical therapy ,Sleep ,business - Abstract
Background We compared 24-hour waist-worn accelerometer wear time characteristics of 9–11 year old children in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) to similarly aged U.S. children providing waking-hours waist-worn accelerometer data in the 2003–2006 National Health and Nutrition Examination Survey (NHANES). Methods Valid cases were defined as having ≥4 days with ≥10 hours of waking wear time in a 24-hour period, including one weekend day. Previously published algorithms for extracting total sleep episode time from 24-hour accelerometer data and for identifying wear time (in both the 24-hour and waking-hours protocols) were applied. The number of valid days obtained and a ratio (percent) of valid cases to the number of participants originally wearing an accelerometer were computed for both ISCOLE and NHANES. Given the two surveys’ discrepant sampling designs, wear time (minutes/day, hours/day) from U.S. ISCOLE was compared to NHANES using a meta-analytic approach. Wear time for the 11 additional countries participating in ISCOLE were graphically compared with NHANES. Results 491 U.S. ISCOLE children (9.92±0.03 years of age [M±SE]) and 586 NHANES children (10.43 ± 0.04 years of age) were deemed valid cases. The ratio of valid cases to the number of participants originally wearing an accelerometer was 76.7% in U.S. ISCOLE and 62.6% in NHANES. Wear time averaged 1357.0 ± 4.2 minutes per 24-hour day in ISCOLE. Waking wear time was 884.4 ± 2.2 minutes/day for U.S. ISCOLE children and 822.6 ± 4.3 minutes/day in NHANES children (difference = 61.8 minutes/day, p
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36. Child obesity and fitness levels among Kenyan and Canadian children from urban and rural environments: A KIDS-CAN Research Alliance Study.
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Adamo KB, Sheel AW, Onywera V, Waudo J, Boit M, and Tremblay MS
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- 2011
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37. Research priorities for child and adolescent physical activity and sedentary behaviours: An international perspective using a twin-panel Delphi procedure
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Gillis, L, Tomkinson, G, Olds, T, Moreira, C, Christie, C, Nigg, C, Cerin, E, Van Sluijs, E, Stratton, G, Janssen, I, Dorovolomo, J, Reilly, JJ, Mota, J, Zayed, K, Kawalski, K, Andersen, LB, Carrizosa, M, Tremblay, M, Chia, M, Hamlin, Michael, Thomas, NE, Maddison, R, Biddle, S, Gorely, T, Onywera, V, and Van Mechelen, W
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- 2014
38. Association between body mass index and body fat in 9–11-year-old children from countries spanning a range of human development
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Rebecca Kuriyan, E V Lambert, Timothy S. Church, Stephanie T. Broyles, Pei Zhao, Vincent Onywera, Anura V Kurpad, Peter T. Katzmarzyk, Olga L. Sarmiento, Martyn Standage, Tim Olds, Catrine Tudor-Locke, Gang Hu, José Maia, Jean-Philippe Chaput, Mikael Fogelholm, Mark S. Tremblay, Carol Maher, Victor Matsudo, Tiago V. Barreira, Katzmarzyk, PT, Barreira, TV, Broyles, ST, Chaput, JP, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, EV, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, OL, Standage, M, Tremblay, MS, Tudor-Locke, C, Zhao, P, Church, TS, and ISCOLE Research Group
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2. Zero hunger ,obesity ,Pediatrics ,medicine.medical_specialty ,Percentile ,business.industry ,Percentage body fat ,body mass index ,Total body ,General Medicine ,medicine.disease ,Obesity ,World health ,Human development (humanity) ,3. Good health ,children ,Methods ,medicine ,medicine.symptom ,business ,Body mass index ,Weight gain ,Demography - Abstract
The purpose was to assess associations between body mass index (BMI) and body fat in a multinational sample of 9–11-year-old children. The sample included 7265 children from countries ranging in human development. Total body fat (TBF) and percentage body fat (PBF) were measured with a Tanita SC-240 scale and BMI z-scores (BMIz) and percentiles were computed using reference data from the World Health Organization and the U.S. Centers for Disease Control and Prevention, respectively. Mean PBF at BMIz values of −1, 0 and +1 were estimated using multilevel models. Correlations between BMI and TBF were >0.90 in all countries, and correlations between BMI and PBF ranged from 0.76 to 0.96. Boys from India had higher PBF than boys from several other countries at all levels of BMIz. Kenyan girls had lower levels of PBF than girls from several other countries at all levels of BMIz. Boys and girls from Colombia had higher values of PBF at BMIz=−1, whereas Colombian boys at BMIz 0 and +1 also had higher values of PBF than boys in other countries. Our results show a consistently high correlation between BMI and adiposity in children from countries representing a wide range of human development. Refereed/Peer-reviewed
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- 2015
39. Inequality in physical activity, sedentary behaviour, sleep duration and risk of obesity in children: a 12-country study
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Chaput, J-P, Barnes, JD, Tremblay, MS, Fogelholm, M, Hu, G, Lambert, EV, Maher, C, Maia, J, Olds, T, Onywera, V, Sarmiento, OL, Standage, M, Tudor-Locke, C, and Katzmarzyk, PT
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movement behaviours ,disparity ,paediatric population ,Gini coefficient - Abstract
Objective: Studies examining associations between movement behaviours (i.e. physical activity, sedentary behaviour and sleep duration) and obesity focus on average values of these movement behaviours, despite important within-country and between-country variability. A better understanding of movement behaviour inequalities is important for developing public health policies and behaviour-change interventions. The objective of this ecologic analysis at the country level was to determine if inequality in movement behaviours is a better correlate of obesity than average movement behaviour volume in children from all inhabited continents of the world. Methods: This multinational, cross-sectional study included 6,128 children 9-11years of age. Moderate-to-vigorous physical activity (MVPA), total sedentary time (SED) and sleep period time were monitored over 7 consecutive days using waist-worn accelerometry. Screen time was self-reported. Inequality in movement behaviours was determined using Gini coefficients (ranging from 0 [complete equality] to 1 [complete inequality]). Results: The largest inequality in movement behaviours was observed for screen time (Gini of 0.32; medium inequality), followed by MVPA (Gini of 0.21; low inequality), SED (Gini of 0.07; low inequality) and sleep period time (Gini of 0.05; low inequality). Average MVPA (hd(-1)) was a better correlate of obesity than MVPA inequality (r=-0.77 vs. r=0.00, p=0.03). Average SED (hd(-1)) was also a better correlate of obesity than SED inequality (r=0.52 vs. r=-0.32, p=0.05). Differences in associations for screen time and sleep period time were not statistically significant. MVPA in girls was found to be disproportionally lower in countries with more MVPA inequality. Conclusions: Findings from this study show that average MVPA and SED should continue to be used in population health studies of children as they are better correlates of obesity than inequality in these behaviours. Moreover, the findings suggest that MVPA inequality could be greatly reduced through increases in girls' MVPA alone. Refereed/Peer-reviewed
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- 2018
40. Thresholds of physical activity associated with obesity by level of sedentary behaviour in children
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Chaput, J P, Barnes, J D, Tremblay, M S, Fogelholm, M, Hu, G, Lambert, E V, Maher, C, Maia, J, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tudor-Locke, C, and Katzmarzyk, P T
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adiposity ,education ,moderate-to-vigorous physical activity ,sedentary time ,guidelines ,screentime ,human activities - Abstract
Background: It is unknown whether moderate-to-vigorous physical activity (MVPA) thresholds for obesity should be adapted depending on level of sedentary behaviour in children. Objective: The objective of the study is to determine the MVPA thresholds that best discriminate between obese and non-obese children, by level of screen time and total sedentary time in 12 countries. Methods: This multinational, cross-sectional study included 6522 children 9-11 years of age. MVPA and sedentary time were assessed using waist-worn accelerometry, while screen time was self-reported. Obesity was defined according to the World Health Organization reference data. Results: Receiver operating characteristic curve analyses showed that the best thresholds of MVPA to predict obesity ranged from 53.8 to 73.9 min d -1 in boys and from 41.7 to 58.7 min d -1 in girls, depending on the level of screen time. The MVPA cut-offs to predict obesity ranged from 37.9 to 75.9 min d -1 in boys and from 32.5 to 62.7 min d -1 in girls, depending on the level of sedentary behaviour. The areas under the curve ranged from 0.57 to 0.73 ('fail' to 'fair' accuracy), and most sensitivity and specificity values were below 85%, similar to MVPA alone. Country-specific analyses provided similar findings. Conclusions: The addition of sedentary behaviour levels to MVPA did not result in a better predictive ability to classify children as obese/non-obese compared with MVPA alone. Refereed/Peer-reviewed
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- 2018
41. Sources of variability in childhood obesity indicators and related behaviors
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Olga L. Sarmiento, Martyn Standage, Jean-Philippe Chaput, Estelle V. Lambert, José Maia, Catrine Tudor-Locke, Mikael Fogelholm, Peter T. Katzmarzyk, Gang Hu, Vincent Onywera, Carol Maher, Mark S. Tremblay, Tim Olds, Stephanie T. Broyles, Katzmarzyk, PT, Broyles, ST, Chaput, J-P, Fogelholm, M, Hu, G, Lambert, EV, Maher, C, Maia, J, Olds, T, Onywera, V, Sarmiento, OL, Standage, M, Tremblay, MS, Tudor-Locke, C, University of Helsinki, Department of Food and Nutrition, and Nutrition Science
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Gerontology ,Pediatric Obesity ,lifestyle ,Waist ,Cross-sectional study ,Endocrinology, Diabetes and Metabolism ,education ,Child Behavior ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,variance ,Article ,Childhood obesity ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,3123 Gynaecology and paediatrics ,medicine ,Body Size ,Humans ,030212 general & internal medicine ,Exercise physiology ,Child ,Exercise ,2. Zero hunger ,adiposity ,OUTCOMES ,Nutrition and Dietetics ,business.industry ,multi-level models ,Anthropometry ,Explained variation ,medicine.disease ,Obesity ,PREVENTION ,Cross-Sectional Studies ,pediatric ,3121 General medicine, internal medicine and other clinical medicine ,Sedentary Behavior ,IDEFICS ,business ,Body mass index ,childhood obesity ,Demography - Abstract
The purpose of this study was to describe sources of variability in obesity-related variables in 6022 children aged 9-11 years from 12 countries. The study design involved recruitment of students, nested within schools, which were nested within study sites. Height, weight and waist circumference (WC) were measured and body mass index (BMI) was calculated; sleep duration and total and in-school moderate-to-vigorous physical activity (MVPA) and sedentary time were measured by accelerometry; and diet scores were obtained by questionnaire. Variance in most variables was largely explained at the student level: BMI (91.9%), WC (93.5%), sleep (75.3%), MVPA (72.5%), sedentary time (76.9%), healthy diet score (88.3%), unhealthy diet score (66.2%), with the exception of in-school MVPA (53.8%) and in-school sedentary time (25.1%). Variance explained at the school level ranged from 3.3% for BMI to 29.8% for in-school MVPA, and variance explained at the site level ranged from 3.2% for WC to 54.2% for in-school sedentary time. In general, more variance was explained at the school and site levels for behaviors than for anthropometric traits. Given the variance in obesity-related behaviors in primary school children explained at school and site levels, interventions that target policy and environmental changes may enhance obesity intervention efforts. Refereed/Peer-reviewed
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- 2018
42. Research priorities for child and adolescent physical activity and sedentary behaviours: an international perspective using a twin-panel Delphi procedure
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Gillis, L, Tomkinson, G, Olds, T, Moreira, C, Christie, C, Nigg, C, Cerin, E, Van Sluijs, E, Stratton, G, Janssen, I, Dorovolomo, J, Reilly, JJ, Mota, J, Zayed, K, Kawalski, K, Andersen, LB, Carrizosa, M, Tremblay, M, Chia, M, Hamlin, Michael, Thomas, NE, Maddison, R, Biddle, S, Gorely, T, Onywera, V, and Van Mechelen, W
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43. Mid-upper arm circumference as a screening tool for identifying children with obesity: a 12-country study
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ISCOLE Research Group, Chaput, JP, Katzmarzyk, PT, Barnes, JD, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, EV, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, OL, Standage, M, Tudor-Locke, C, Zhao, P, and Tremblay, MS
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children ,body mass index ,arm circumference ,Adiposity - Abstract
Background: No studies have examined if mid-upper arm circumference (MUAC) can be an alternative screening tool for obesity in an international sample of children differing widely in levels of human development. Objective: Our aim is to determine whether MUAC could be used to identify obesity in children from 12 countries in five major geographic regions of the world. Methods: This observational, multinational cross-sectional study included 7337 children aged 9–11 years. Anthropometric measurements were objectively assessed, and obesity was defined according to the World Health Organization reference data. Results: In the total sample, MUAC was strongly correlated with adiposity indicators in both boys and girls (r > 0.86, p < 0.001). The accuracy level of MUAC for identifying obesity was high in both sexes and across study sites (overall area under the curve of 0.97, sensitivity of 95% and specificity of 90%). The MUAC cut-off value to identify obesity was ~25 cm for both boys and girls. In country-specific analyses, the cut-off value to identify obesity ranged from 23.2 cm (boys in South Africa) to 26.2 cm (girls in the UK). Conclusions: Results from this 12-country study suggest that MUAC is a simple and accurate measurement that may be used to identify obesity in children aged 9–11 years. MUAC may be a promising screening tool for obesity in resource-limited settings. Refereed/Peer-reviewed
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- 2017
44. The epidemiological transition and the global childhood obesity epidemic
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Rebecca Kuriyan, Mark S. Tremblay, José Maia, Stephanie T. Broyles, Gang Hu, Carol Maher, Olga L. Sarmiento, Anura V Kurpad, Martyn Standage, Mikael Fogelholm, Victor Matsudo, Pei Zhao, Timothy S. Church, Catrine Tudor-Locke, Peter T. Katzmarzyk, Vincent Onywera, Kara D. Denstel, Tim Olds, E V Lambert, J-P Chaput, Broyles, S T, Denstel, K D, Church, T S, Chaput, J-P, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, E V, Maher, C, Maia, J, Matsudo, Victor, Olds, T, Onywera, V, Sarmiento, O L, Standage, M, Tremblay, M S, Tudor-Locke, C, Zhao, P, and Katzmarzyk, P T
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2. Zero hunger ,business.industry ,1. No poverty ,General Medicine ,medicine.disease ,Obesity ,Body fat percentage ,Human development (humanity) ,Childhood obesity ,3. Good health ,Epidemiological transition ,SDG 3 - Good Health and Well-being ,medicine ,Household income ,Global Childhood Obesity ,business ,Socioeconomics ,Socioeconomic status ,Body mass index ,Demography - Abstract
OBJECTIVES: Childhood obesity is now recognized as a global public health issue. Social patterning of obesity, consistent with the theory of epidemiologic transition, has not been well described in children, and the limited research has focused on developed settings. The aim of this study was to describe the relationship between childhood obesity and household income using objective measures of adiposity and to explore how this relationship differs across levels of country human development.METHODS: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was a multi-national cross-sectional study conducted in 12 urban/suburban study sites that represented all inhabited continents and wide ranges of development. ISCOLE collected objectively measured height, body mass and percentage body fat in 7341 10-year-old children. Multi-level random-effects models were used to examine income gradients in several obesity measures.RESULTS: The mean age of the children was 10.4 years, and 12.6% were obese, ranging from 5.4% (Finland) to 23.8% (China). For both boys and girls, obesity prevalence, body fat percentage and body mass index (BMI) z-score increased linearly with higher income at lower levels of development (all P for trend less than or equal to0.0012), but decreased linearly with higher income at higher levels of development (all P for trend less than or equal to0.0003). Country human development explained 75% of the variation in the country-specific income–obesity relationships (r=−0.87, P=0.0003).CONCLUSIONS: Results are consistent with the theory of epidemiologic transition. Global efforts to control obesity must account for socioeconomic factors within a country’s context. Future research should seek to understand global socioeconomic patterns in obesity-related lifestyle behaviors.
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- 2015
45. Reliability of accelerometer-determined physical activity and sedentary behavior in school aged children:a 12 country study
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Mark S. Tremblay, Pei Zhao, Rebecca Kuriyan, E V Lambert, Peter T. Katzmarzyk, Gang Hu, Mikael Fogelholm, John M. Schuna, Timothy S. Church, J-P Chaput, Tim Olds, Anura V Kurpad, Carol Maher, Vincent Onywera, Tiago V. Barreira, Victor Matsudo, José Maia, Olga L. Sarmiento, Martyn Standage, Catrine Tudor-Locke, Barreira, TV, Schuna, JM, Tudor-Locke, C, Chaput, JP, Church, TS, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, EV, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, OL, Standage, M, Tremblay, MS, Zhao, P, Katzmarzyk, PT, and ISCOLE Research Group
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obesity ,Physical activity ,General Medicine ,Sedentary behavior ,medicine.disease ,Accelerometer ,Childhood obesity ,Correlation ,Geography ,Country study ,children ,SDG 3 - Good Health and Well-being ,Statistics ,medicine ,Methods ,accelerometry ,Generalizability theory ,Reliability (statistics) ,Demography - Abstract
Objectives: Focused on the accelerometer-determined physical activity and sedentary time metrics in 9–11-year-old children, we sought to determine the following: (i) number of days that are necessary to achieve reliable estimates (Ggreater than or equal to0.8); (ii) proportion of variance attributed to different facets (participants and days) of reliability estimates; and (iii) actual reliability of data as collected in The International Study of Childhood Obesity, Lifestyle and Environment (ISCOLE).Methods: The analytical sample consisted of 6025 children (55% girls) from sites in 12 countries. Physical activity and sedentary time metrics measures were assessed for up to 7 consecutive days for 24 h per day with a waist-worn ActiGraph GT3X+. Generalizability theory using R software was used to investigate the objectives i and ii. Intra-class correlation coefficients (ICC) were computed using SAS PROC GLM to inform objective iii.Results: The estimated minimum number of days required to achieve a reliability estimate of Ggreater than or equal to0.8 ranged from 5 to 9 for boys and 3 to 11 for girls for light physical activity (LPA); 5 to 9 and 3 to 10, for moderate-to-vigorous physical activity (MVPA); 5 to 10 and 4 to 10 for total activity counts; and 7 to 11 and 6 to 11 for sedentary time, respectively. For all variables investigated, the ‘participant’ facet accounted for 30–50% of the variability, whereas the ‘days’ facet accounted for less than or equal to5%, and the interaction (P × D) accounted for 50–70% of the variability. The actual reliability for boys in ISCOLE ranged from ICCs of 0.78 to 0.86, 0.73 to 0.85 and 0.72 to 0.86 for LPA, MVPA and total activity counts, respectively, and 0.67 to 0.79 for sedentary time. The corresponding values for girls were 0.80–0.88, 0.70–0.89, 0.74–0.86 and 0.64–0.80.Conclusions: It was rare that only 4 days from all participants would be enough to achieve desirable reliability estimates. However, asking participants to wear the device for 7 days and requiring greater than or equal to4 days of data to include the participant in the analysis might be an appropriate approach to achieve reliable estimates for most accelerometer-derived metrics.
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- 2015
46. Development and reliability of an audit tool to assess the school physical activity environment across 12 countries
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Mark S. Tremblay, Jean-Philippe Chaput, Anura V Kurpad, Mikael Fogelholm, Vincent Onywera, Victor Matsudo, Rebecca Kuriyan, Timothy S. Church, Kathryn T. Drazba, Gang Hu, Pei Zhao, Olga L. Sarmiento, Carol Maher, Martyn Standage, Catrine Tudor-Locke, E V Lambert, Peter T. Katzmarzyk, Tim Olds, José Maia, Stephanie T. Broyles, Broyles, ST, Drazba, KT, Church, TS, Chaput, JP, Fogelholm, M, Hu, G, Kuriyan, R, Kurpad, A, Lambert, EV, Maher, C, Maia, J, Matsudo, V, Olds, T, Onywera, V, Sarmiento, OL, Standage, M, Tremblay, MS, Tudor-Locke, C, Zhao, P, Katzmarzyk, PT, and ISCOLE Research Group
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medicine.medical_specialty ,Medical education ,Engineering ,Data collection ,Intraclass correlation ,business.industry ,school ,4. Education ,education ,physical activity ,Sample (statistics) ,General Medicine ,Certification ,Audit ,medicine.disease ,Childhood obesity ,Cohen's kappa ,Physical therapy ,medicine ,Methods ,business ,Reliability (statistics) - Abstract
Objectives: Schools are an important setting to enable and promote physical activity. Researchers have created a variety of tools to perform objective environmental assessments (or ‘audits’) of other settings, such as neighborhoods and parks; yet, methods to assess the school physical activity environment are less common. The purpose of this study is to describe the approach used to objectively measure the school physical activity environment across 12 countries representing all inhabited continents, and to report on the reliability and feasibility of this methodology across these diverse settings.Methods: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) school audit tool (ISAT) data collection required an in-depth training (including field practice and certification) and was facilitated by various supporting materials. Certified data collectors used the ISAT to assess the environment of all schools enrolled in ISCOLE. Sites completed a reliability audit (simultaneous audits by two independent, certified data collectors) for a minimum of two schools or at least 5% of their school sample. Item-level agreement between data collectors was assessed with both the kappa statistic and percent agreement. Inter-rater reliability of school summary scores was measured using the intraclass correlation coefficient.Results: Across the 12 sites, 256 schools participated in ISCOLE. Reliability audits were conducted at 53 schools (20.7% of the sample). For the assessed environmental features, inter-rater reliability (kappa) ranged from 0.37 to 0.96; 18 items (42%) were assessed with almost perfect reliability (κ=0.80–0.96), and a further 24 items (56%) were assessed with substantial reliability (κ=0.61–0.79). Likewise, scores that summarized a school’s support for physical activity were highly reliable, with the exception of scores assessing aesthetics and perceived suitability of the school grounds for sport, informal games and general play.Conclusions: This study suggests that the ISAT can be used to conduct reliable objective audits of the school physical activity environment across diverse, international school settings. Refereed/Peer-reviewed
- Published
- 2015
47. Wealth and Sedentary Time Are Associated With Dietary Patterns Among Preadolescents in Nairobi City, Kenya.
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Kanerva N, Wachira LJ, Uusi-Ranta N, Anono EL, Walsh HM, Erkkola M, Ochola S, Swindell N, Salmela J, Vepsäläinen H, Stratton G, Onywera V, and Fogelholm M
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- Adolescent, Child, Female, Humans, Male, Body Mass Index, Cross-Sectional Studies, Economic Status statistics & numerical data, Exercise, Kenya, Principal Component Analysis, Time Factors, Urban Population, Diet Surveys, Accelerometry, Linear Models, Cities, Diet economics, Diet statistics & numerical data, Sedentary Behavior, Socioeconomic Factors
- Abstract
Objective: The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya., Design: Cross-sectional., Participants: Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi., Variables Measured: Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer., Analysis: Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression., Results: Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05)., Conclusions and Implications: Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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48. Wealth and obesity in pre-adolescents and their guardians: A first step in explaining non-communicable disease-related behaviour in two areas of Nairobi City County.
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Ochola S, Kanerva N, Wachira LJ, Owino GE, Anono EL, Walsh HM, Okoth V, Erkkola M, Swindell N, Stratton G, Onywera V, and Fogelholm M
- Abstract
The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (β = 0.01; SE 0.0; p = 0.003) and income (β = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ochola et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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49. Prevalence and correlates of compliance with 24-h movement guidelines among children from urban and rural Kenya-The Kenya-LINX project.
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Swindell N, Wachira LJ, Okoth V, Kagunda S, Owino G, Ochola S, Brophy S, Summers H, Richards A, Fairclough SJ, Onywera V, and Stratton G
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- Humans, Child, Female, Male, Kenya, Prevalence, Cross-Sectional Studies, Sleep, Sedentary Behavior, Swimming
- Abstract
Background: Like many countries in sub-Saharan Africa, Kenya has experienced rapid urbanization in recent years. Despite the distinct socioeconomic and environmental differences, few studies have examined the adherence to movement guidelines in urban and rural areas. This cross-sectional study aimed at examining compliance to the 24-hour movement guidelines and their correlates among children from urban and rural Kenya., Method: Children (n = 539) aged 11.1 ± 0.8 years (52% female) were recruited from 8 urban and 8 rural private and public schools in Kenya. Physical activity (PA) and sleep duration were estimated using 24-h raw data from wrist-worn accelerometers. Screen time (ST) and potential correlates were self- reported. Multi-level logistic regression was applied to identify correlates of adherence to combined and individual movement guidelines., Results: Compliance with the combined movement guidelines was low overall (7%), and higher among rural (10%) than urban (5%) children. Seventy-six percent of rural children met the individual PA guidelines compared to 60% urban children while more rural children also met sleep guidelines (27% vs 14%). The odds of meeting the combined movement guidelines reduced with age (OR = 0.55, 95% CI = 0.35-0.87, p = 0.01), was greater among those who could swim (OR = 3.27, 95% CI = 1.09-9.83, p = 0.04), and among those who did not engage in ST before school (OR = 4.40, 95% CI = 1.81-10.68, p<0.01). The odds of meeting PA guidelines increased with the number of weekly physical education sessions provided at school (OR = 2.1, 95% CI = 1.36-3.21, p<0.01) and was greater among children who spent their lunch break walking (OR = 2.52, 95% CI = 1.15-5.55, p = 0.02) or running relative to those who spent it sitting (OR = 2.33, 95% CI = 1.27-4.27, p = 0.01)., Conclusions: Prevalence of meeting movement guidelines among Kenyan children is low and of greatest concern in urban areas. Several correlates were identified, particularly influential were features of the school day, School is thus a significant setting to promote a healthy balance between sleep, sedentary time, and PA., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Swindell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2022
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50. Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys.
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Ramírez Varela A, Hallal PC, Mejía Grueso J, Pedišić Ž, Salvo D, Nguyen A, Klepac B, Bauman A, Siefken K, Hinckson E, Oyeyemi AL, Richards J, Salih Khidir ED, Inoue S, Amagasa S, Jauregui A, da Silva MC, Lee IM, Ding M, Kohl HW, Ekelund U, Heath GW, Powell KE, Foster C, Memon AR, Doumbia A, Rather AR, Razzaque A, Diouf A, Hino AA, Damasceno A, Abebe AD, Florindo AA, Mannocci A, Aringazina A, Juričan AB, Poffet A, Decelis A, Carlin A, Enescu A, Ochoa Avilés AM, Kontsevaya A, Somhegyi A, Vuillemin A, El Hamdouchi A, Théodore AA, Masanovic B, Lynch BM, Medina C, Del Campo C, Abdeta C, Moreways C, Ranasinghe C, Howitt C, Cameron C, Jurakić D, Martinez-Gomez D, Tladi D, Diro DT, Adlakha D, Mitić D, Bjelica D, Biernat E, Chisati EM, Lambert EV, Cerin E, Lee EY, Riso EM, Cañete Villalba F, Assah F, Lovrić F, Araya-Vargas GA, La Torre G, Cruz GIN, Baltaci G, Al Sabbah H, Nalecz H, Nashandi HL, Park H, Revuelta-Sánchez I, Nusurupia JJ, Zamora JL, Kopcakova J, Brazo-Sayavera J, Oppert JM, Nie J, Spence JC, Bradley JS, Mota J, Mitáš J, Chen J, Hylton KS, Fromel K, Milton K, Borodulin K, Moustapha KA, Martinez-Folgar K, Nasreddine L, Christiansen LB, Malisoux L, Malete L, Grepo-Jalao LC, Monteiro LZ, Al Subhi LK, Dakskobler M, Alnaji M, Garro MC, Hagströmer M, Murphy MH, Mclaughlin M, Rivera-Morales M, Scheinowitz M, Shkodra M, Piątkowska M, Chaudhury M, Alrashdi NZ, Mutrie N, Murphy N, Ahmad NH, Obeidat NA, Gómez NYR, Liangruenrom N, Arnesto OD, Flores-Flores O, Incarbone O, Chimeddamba O, Bovet P, Magalhães P, Jousilahti P, Katewongsa P, Gómez RAL, Shihab RA, Ocansey R, Veress R, Marine R, Carrizales-Ramos R, Saeed SY, El-Ashker S, Green S, Kasoma S, Beretervide S, Baldew SS, Nichols S, Khoo S, Hosseini SA, Goenka S, Gholamalishahi S, Kosen S, Compernolle S, Enescu SP, Popovic S, Paudel S, Andrade S, Titze S, Davidson T, Dusingizimana T, Dorner TE, Kolbe-Alexander TL, Huong TT, Sychareun V, Jarevska-Simovska V, Puloka VK, Onywera V, Wendel-Vos W, Dionyssiotis Y, and Pratt M
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- Humans, Legal Epidemiology, Surveys and Questionnaires, Global Health, Exercise, Policy
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Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries., Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years., Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved., Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.
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- 2022
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