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Bispectral index (BIS) monitoring of depth of anesthesia has pioneered the field for more recent monitoring devices like the A-line ARX Index (AAI) or the state (SE) and response entropy (RE) monitoring devices. Following an observational design the present study aimed to simultaneously compare in the same patient recorded BIS, AAI and entropy values.

Purpose: To determine how factors are related to change in cardiorespiratory fitness (CRF) across time in middle school girls followed through high school.Methods: Adolescent girls (N = 274, 59% African American, baseline age = 13.6 +/- 0.6 yr) performed a submaximal fitness test (PWC170) in 8th, 9th, and 12th grades. Height, weight, sports participation, and physical activity were also measured. Moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) were determined by the number of blocks reported on the 3-Day Physical Activity Recall (3DPAR). Individual differences and developmental change in CRF were assessed simultaneously by calculating individual growth curves for each participant, using growth curve modeling.Results: Both weight-relative and absolute CRF increased from 8th to 9th grade and decreased from 9th to 12th grade. On average, girls lost 0.16 kg[middle dot]m[middle dot]min-1[middle dot]kg-1[middle dot]yr-1 in weight-relative PWC170 scores (P < 0.01) and gained 10.3 kg[middle dot]m[middle dot]min-1[middle dot]yr-1 in absolute PWC170 scores. Girls reporting two or more blocks of MVPA or one or more blocks of VPA at baseline showed an average increase in PWC170 scores of 0.40-0.52 kg[middle dot]m[middle dot]min-1[middle dot]kg-1[middle dot]yr-1 (weight relative) and 22-28 kg[middle dot]m[middle dot]min-1[middle dot]yr-1 (absolute) in CRF. In weight-relative models, girls with higher BMI showed lower CRF ( approximately 0.37 g[middle dot]m[middle dot]min-1[middle dot]kg-1[middle dot]yr-1), but this was not shown in absolute models. In absolute models, white girls ( approximately 40 kg[middle dot]m[middle dot]min-1[middle dot]yr-1) and sport participants ( approximately 28 kg[middle dot]m[middle dot]min-1[middle dot]yr-1) showed an increase in CRF over time.Conclusion: Although there were fluctuations in PWC170 scores across time, average scores decreased during 4 yr. Physical activity was related to change in CRF over time; BMI, race, and sport participation were also important factors related to change over time in CRF (depending on expression of CRF-weight-relative vs absolute). Subsequent research should focus on explaining the complex longitudinal interactions between CRF, physical activity, race, BMI, and sports participation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the relationship between peer-related physical activity (PA) social networks and the PA of adolescent girls. METHODS: Cross-sectional, convenience sample of adolescent girls. Mixed-model linear regression analyses to identify significant correlates of self-reported PA while accounting for correlation of girls in the same school. RESULTS: Younger girls were more active than older girls. Most activity-related peer social network items were related to PA levels. More PA with friends was significantly related to self-reported PA in multivariate analyses. CONCLUSIONS: Frequency of PA with friends was an important correlate of PA among the peer network variables for adolescent girls. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Obesity rates are increasing among children of all ages, and reduced physical activity is a likely contributor to this trend. Little is known about the physical activity behavior of preschool-aged children or about the influence of preschool attendance on physical activity. The purpose of this study was to describe the physical activity levels of children while they attend preschools, to identify the demographic factors that might be associated with physical activity among those children, and to determine the extent to which children's physical activity varies among preschools. METHODS: A total of 281 children from 9 preschools wore an Actigraph (Fort Walton Beach, FL) accelerometer for an average of 4.4 hours per day for an average of 6.6 days. Each child's height and weight were measured, and parents of participating children provided demographic and education data. RESULTS: The preschool that a child attended was a significant predictor of vigorous physical activity (VPA) and moderate-to-vigorous physical activity (MVPA). Boys participated in significantly more MVPA and VPA than did girls, and black children participated in more VPA than did white children. Age was not a significant predictor of MVPA or VPA. CONCLUSIONS: Children's physical activity levels were highly variable among preschools, which suggests that preschool policies and practices have an important influence on the overall activity levels of the children the preschools serve. [ABSTRACT FROM AUTHOR]

This study was undertaken to investigate the influence of activated autologous blood therapy on immunological parameters and on the clinical outcome in patients with recurrent spontaneous abortion. In a prospective trial, 36 women with recurrent spontaneous abortion were treated with intramuscular reinjections of extracorporally haemolysed and ultraviolet irradiated autologous blood. A comprehensive immunological investigation revealed significant changes in lymphocyte subpopulations, plasma complement levels, mitogen stimulation and immunoglobulin levels during the treatment period. No side-effects were reported by the patients. From June 1994 to November 1995, 22 intrauterine and one extrauterine pregnancies occurred, resulting in 19 (86%) live births, two (9%) spontaneous abortions and one (4%) artificial abortion compared with a 64% live birth rate in the historical control group. We conclude that activated autologous blood therapy has detectable effects on the immune system, and seems to be promising for further investigation concerning the treatment of idiopathic recurrent spontaneous abortion. [ABSTRACT FROM PUBLISHER]

Abstract Background This paper describes Project FIT, a collaboration between the public school system, local health systems, physicians, neighborhood associations, businesses, faith-based leaders, community agencies and university researchers to develop a multi-faceted approach to promote physical activity and healthy eating toward the general goal of preventing and reducing childhood obesity among children in Grand Rapids, MI, USA. Methods/design There are four overall components to Project FIT: school, community, social marketing, and school staff wellness - all that focus on: 1) increasing access to safe and affordable physical activity and nutrition education opportunities in the schools and surrounding neighborhoods; 2) improving the affordability and availability of nutritious food in the neighborhoods surrounding the schools; 3) improving the knowledge, self-efficacy, attitudes and behaviors regarding nutrition and physical activity among school staff, parents and students; 4) impacting the 'culture' of the schools and neighborhoods to incorporate healthful values; and 5) encouraging dialogue among all community partners to leverage existing programs and introduce new ones. Discussion At baseline, there was generally low physical activity (70% do not meet recommendation of 60 minutes per day), excessive screen time (75% do not meet recommendation of < 2 hours per day), and low intake of vegetables and whole grains and high intake of sugar-sweetened beverages, French fries and chips and desserts as well as a high prevalence of overweight and obesity (48.5% including 6% with severe obesity) among low income, primarily Hispanic and African American 3rd-5th grade children (n = 403). Trial registration ClinicalTrials.gov NCT01385046

Abstract Background While socio-economic status has been shown to be an important determinant of health and physical activity in adults, results for children and adolescents are less consistent. The purpose of this study, therefore, is to examine whether physical activity and sedentary behavior differs in children by socio-economic status (SES) independent of body mass index. Methods Data were from two cohorts including 271 children (117 males; 154 females) in study 1 and 131 children in study 2 (63 males; 68 females). The average age was 9.6 and 8.8 years respectively. Height and body mass were assessed according to standard procedures and body mass index (BMI, kg/m2) was calculated. Parent-reported household income was used to determine SES. Habitual, free-living physical activity (PA) was assessed by a pedometer (steps/day) in study 1 and accelerometer (time spent in moderate-to-vigorous PA) in study 2. Self-reported time spent watching TV and on the computer was used as measure of sedentary behavior. Differences in PA and sedentary behavior by SES were initially tested using ANOVA. Further analyses used ANCOVA controlling for BMI, as well as leg length in the pedometer cohort. Results In study 1, mean daily steps differed significantly among SES groups with lower SES groups approximating 10,500 steps/day compared to about 12,000 steps/day in the higher SES groups. These differences remained significant (p < 0.05) when controlling for leg length. Lower SES children, however, had higher body mass and BMI compared to higher SES groups (p < 0.05) and PA no longer remained significant when further controlling for BMI. In study 2 results depended on the methodology used to determine time spent in moderate-to-vigorous physical activity (MVPA). Only one equation resulted in significant group differences (p = 0.015), and these differences remained after controlling for BMI. Significant differences between SES groups were shown for sedentary behavior in both cohorts (P < 0.05) with higher SES groups spending less time watching TV than low SES groups. Conclusions Children from a low SES show a trend of lower PA levels and spend more time in sedentary behavior than high SES children; however, differences in PA were influenced by BMI. The higher BMI in these children might be another factor contributing to increased health risks among low SES children compared to children from with a higher SES.

Abstract Background DRG-systems are used to allocate resources fairly to hospitals based on their performance. Statistically, this allocation is based on simple rules that can be modeled with regression trees. However, the resulting models often have to be adjusted manually to be medically reasonable and ethical. Methods Despite the possibility of manual, performance degenerating adaptations of the original model, alternative trees are systematically searched. The bootstrap-based method bumping is used to build diverse and accurate regression tree models for DRG-systems. A two-step model selection approach is proposed. First, a reasonable model complexity is chosen, based on statistical, medical and economical considerations. Second, a medically meaningful and accurate model is selected. An analysis of 8 data-sets from Austrian DRG-data is conducted and evaluated based on the possibility to produce diverse and accurate models for predefined tree complexities. Results The best bootstrap-based trees offer increased predictive accuracy compared to the trees built by the CART algorithm. The analysis demonstrates that even for very small tree sizes, diverse models can be constructed being equally or even more accurate than the single model built by the standard CART algorithm. Conclusions Bumping is a powerful tool to construct diverse and accurate regression trees, to be used as candidate models for DRG-systems. Furthermore, Bumping and the proposed model selection approach are also applicable to other medical decision and prognosis tasks.

Abstract Background The American Heart Association Position Statement on Cardiovascular Health Promotion in Public Schools encourages school-based interventions for the primary prevention of cardiovascular disease (CVD) through risk factor prevention or reduction in children with an emphasis on creating an environment that promotes healthy food choices and physical activity (PA). In an effort to address issues related to CVD risk factors including obesity in Michigan children, a multi-disciplinary team of Michigan State University (MSU) faculty, clinicians, and health profession students was formed to "(S)partner" with elementary school physical education (PE) teachers and MSU Extension staff to develop and implement a cost-effective, sustainable program aimed at CVD risk factor prevention and management for 5th grade students. This (S)partnership is intended to augment and improve the existing 5th grade PE, health and nutrition curriculum by achieving the following aims: 1) improve the students' knowledge, attitudes and confidence about nutrition, PA and heart health; 2) increase the number of students achieving national recommendations for PA and nutrition; and 3) increase the number of students with a desirable CVD risk factor status based on national pediatric guidelines. Secondary aims include promoting school staff and parental support for heart health to help children achieve their goals and to provide experiential learning and service for MSU health profession students for academic credit. Methods/Design This pilot effectiveness study was approved by the MSU IRB. At the beginning and the end of the school year students undergo a CVD risk factor assessment conducted by MSU medical students and graduate students. Key intervention components include eight lesson plans (conducted bi-monthly) designed to promote heart healthy nutrition and PA behaviors conducted by PE teachers with assistance from MSU undergraduate dietetic and kinesiology students (Spartners). The final 10 minutes of each lesson, MSU Spartners conduct small breakout/discussion groups with the 5th grade students. Additionally, each Spartner case manages/mentors two to three 5th grade students using a web-based goal setting and tracking protocol throughout the school year. Discussion This paper describes the rationale, development, and methods of the Spartners for Heart Health program. This is a multi-level intervention designed to promote heart healthy behaviors and prevent or manage CVD risk factors in children. We believe this will be a viable sustainable intervention that can be disseminated and adopted by other institutions with minimal cost by engaging college students as an integral part of the measurement and intervention teams.

Abstract Numerous studies have examined the association between the surrounding neighborhood environment and physical activity levels in adolescents. Many of these studies use a road network buffer or Euclidean distance buffer around an adolescent's home to represent the appropriate geographic area for study (i.e., neighborhood). However, little empirical research has examined the appropriate buffer size to use when defining this area and there is little consistency across published research as to the buffer size used. In this study, 909 12th grade adolescent girls of diverse racial and geographic backgrounds were asked to report their perceptions of an easy walking distance and a convenient driving distance. These two criterions are often used as the basis for defining one's neighborhood. The mean easy walking distance in minutes reported by adolescent girls was 14.8 minutes (SD = 8.7). The mean convenient driving distance in minutes reported was 17.9 minutes (SD = 10.8). Nested linear multivariate regression models found significant differences in reported 'easy walking distance' across race and BMI. White adolescents reported on average almost 2 minutes longer for an easy walking distance compared to African American adolescents. Adolescents who were not overweight or at risk for overweight reported almost 2 minutes fewer for an easy walking distance relative to those who were overweight or at risk for overweight. Significant differences by urban status were found in the reported 'convenient driving distance'. Those living in non-urban areas reported on average 3.2 minutes more driving time as convenient compared to those living in urban areas. Very little variability in reported walking and driving distances was explained by the predictors used in the models (i.e., age, race, BMI, physical activity levels, urban status and SES). This study suggests the use of a 0.75 mile buffer to represent an older female adolescent's neighborhood, which can be accessed through walking. However, determining the appropriate area inclusive of car travel should be tailored to the geographic location of the adolescent since non-urban adolescents are willing to spend more time driving to destinations. Further research is needed to understand the substantial variability across adolescent perceptions of an easy walking and convenient driving distance.

Abstract Background Rising obesity and declining physical activity levels are of great concern because of the associated health risks. Many children are left unsupervised after the school day ends, but little is known about the association between unsupervised time and physical activity levels. This paper seeks to determine whether adolescent girls who are without adult supervision after school are more or less active than their peers who have a caregiver at home. Methods A random sample of girls from 36 middle schools at 6 field sites across the U.S. was selected during the fall of the 2002–2003 school year to participate in the baseline measurement activities of the Trial of Activity for Adolescent Girls (TAAG). Information was collected using six-day objectively measured physical activity, self-reported physical activity using a three-day recall, and socioeconomic and psychosocial measures. Complete information was available for 1422 out of a total of 1596 respondents. Categorical variables were analyzed using chi square and continuous variables were analyzed by t-tests. The four categories of time alone were compared using a mixed linear model controlling for clustering effects by study center. Results Girls who spent more time after school (≥2 hours per day, ≥2 days per week) without adult supervision were more active than those with adult supervision (p = 0.01). Girls alone for ≥2 hours after school, ≥2 days a week, on average accrue 7.55 minutes more moderate to vigorous physical activity (MVPA) per day than do girls who are supervised (95% confidence interval ([C.I]). These results adjusted for ethnicity, parent's education, participation in the free/reduced lunch program, neighborhood resources, or available transportation. Unsupervised girls (n = 279) did less homework (53.1% vs. 63.3%), spent less time riding in a car or bus (48.0% vs. 56.6%), talked on the phone more (35.5% vs. 21.1%), and watched more television (59.9% vs. 52.6%) than supervised girls (n = 569). However, unsupervised girls also were more likely to be dancing (14.0% vs. 9.3%) and listening to music (20.8% vs. 12.0%) (p < .05). Conclusion Girls in an unsupervised environment engaged in fewer structured activities and did not immediately do their homework, but they were more likely to be physically active than supervised girls. These results may have implications for parents, school, and community agencies as to how to structure activities in order to encourage teenage girls to be more physically active.

Background: The American Heart Association Position Statement on Cardiovascular Health Promotion in Public Schools encourages school-based interventions for the primary prevention of cardiovascular disease (CVD) through risk factor prevention or reduction in children with an emphasis on creating an environment that promotes healthy food choices and physical activity (PA). In an effort to address issues related to CVD risk factors including obesity in Michigan children, a multi-disciplinary team of Michigan State University (MSU) faculty, clinicians, and health profession students was formed to "(S)partner" with elementary school physical education (PE) teachers and MSU Extension staff to develop and implement a cost-effective, sustainable program aimed at CVD risk factor prevention and management for 5th grade students. This (S)partnership is intended to augment and improve the existing 5th grade PE, health and nutrition curriculum by achieving the following aims: 1) improve the students' knowledge, attitudes and confidence about nutrition, PA and heart health; 2) increase the number of students achieving national recommendations for PA and nutrition; and 3) increase the number of students with a desirable CVD risk factor status based on national pediatric guidelines. Secondary aims include promoting school staff and parental support for heart health to help children achieve their goals and to provide experiential learning and service for MSU health profession students for academic credit.Methods/design: This pilot effectiveness study was approved by the MSU IRB. At the beginning and the end of the school year students undergo a CVD risk factor assessment conducted by MSU medical students and graduate students. Key intervention components include eight lesson plans (conducted bi-monthly) designed to promote heart healthy nutrition and PA behaviors conducted by PE teachers with assistance from MSU undergraduate dietetic and kinesiology students (Spartners). The final 10 minutes of each lesson, MSU Spartners conduct small breakout/discussion groups with the 5th grade students. Additionally, each Spartner case manages/mentors two to three 5th grade students using a web-based goal setting and tracking protocol throughout the school year.Discussion: This paper describes the rationale, development, and methods of the Spartners for Heart Health program. This is a multi-level intervention designed to promote heart healthy behaviors and prevent or manage CVD risk factors in children. We believe this will be a viable sustainable intervention that can be disseminated and adopted by other institutions with minimal cost by engaging college students as an integral part of the measurement and intervention teams. [ABSTRACT FROM AUTHOR]

Purpose: National surveillance of behaviors, including physical activity and sport can provide insight with respect to population-level trends. The purpose of this investigation was to characterize the existing sources of surveillance for organized youth sport participation in the United States and highlight knowledge gaps., Methods: We identified nationally representative and free publicly available surveillance data from 2012 to 2022 and report the prevalence of sport participation, the number of sports in which youth participated, and in which specific sports youth participated overall, and by demographic characteristics., Results: Eight surveillance systems met our inclusion criteria. Across systems, estimates ranged from 39.6% to 81.5% of youth participating in any organized sport, with 21.8% to 30.4% of youth participating in one sport. The most common sports were basketball and soccer. Limited information with respect to characteristics of sport participation was collected across systems., Conclusions: Multiple data sources regarding overall organized youth sport participation are available; there is little information further characterizing this participation (eg, setting, volume, specialization), limiting ability to examine important aspects related to public health. Comprehensive, on-going, national surveillance of multiple youth sport domains is needed in the United States to inform sport-promoting policy and ensure equitable provision of quality sport experiences.

Spending time outdoors may bolster mental health via relaxation and physical activity. Yet, most studies use self-report and involve majority White samples from higher income areas. Findings may not hold true using device-derived measurement, among minoritized participants, or in low-income neighborhoods. Our objectives were to test whether: i) time spent outdoors in physical activity is associated with mental health; ii) the effect is modified by the positive or negative outdoor conditions (amount of greenness or vacant houses/lots encountered while outdoors); iii) there is a correlation between our measures of outdoor conditions and perceived neighborhood conditions; and iv) there is a different relationship between time spent outdoors in parks (as an indicator of intentional nature exposure) and mental health. The sample of 112 participants (87% Black/African American persons) from 11 Detroit, MI neighborhoods wore a GPS and accelerometer for one week (May-Oct 2021) and completed a survey. We calculated exposure to greenness, vacant lots/houses while outdoors, and perceived neighborhood aesthetics. We fitted regression models for mental health measures separately and included time spent outdoors in PA, age, sex, and days with high precipitation. We then fitted models stratified by outdoor conditions. Last, we examined whether a similar relationship could be detected for time spent outdoors in parks. On average, ~30% of PA was conducted outdoors, and 56% of outdoor time involved PA. We observed an unexpected positive association between outdoor PA and anxiety (coef: 0.33, 95% CI: 0.14-0.51), depression (coef: 0.31, 95% CI: 0.15-0.47), and perceived stress score (coef: 0.18, 95% CI: 0.07-0.29). When stratified, we found consistent and/or larger associations for those exposed to high levels of vacant homes, high greenness (both aerial and street-level), low levels of vacant lots, and low perceived neighborhood aesthetics. Importantly and in contrast, we observed the opposite trend when examining time spent in parks (coef: -0.05, 95% CI: -0.10--0.01). These results contrast many studies showing positive relationships between time outdoors and mental health and highlight the need for research with diverse populations and better measures of outdoor conditions and intentionality of greenspace contact., Competing Interests: Declaration of interest The authors have no competing interests to disclose.

The pervasiveness of anxiety and stress among college students necessitates the investigation of potential alternative and accessible interventions which can be implemented into existing curricular and student-support programming to improve students' mental health. Mindfulness based cognitive therapy (MBCT) smartphone applications have shown promising outcomes in alleviating anxiety and stress. However, it is essential to gain insight into the feasibility and efficacy of such an interventional approach in a collegiate population, as well as explore potential underlying mechanisms, which could be better targeted to enhance the efficacy of future interventions for promoting mental health and well-being. The aims for this study were (1) to assess the efficacy of a 4-week MBCT intervention using the Sanvello smartphone application in reducing trait-level anxiety and chronic stress in college-aged young adults ( n = 150) compared to a positive control group ( n = 139), and (2) to examine potential mediators of this effect. Participants completed assessments of trait anxiety, chronic stress, cognitive reappraisal, cognitive refocusing, distractive refocusing, and negative automatic thoughts at pretest and following 4 weeks of the interventions. Analysis of primary outcomes revealed greater reductions in trait anxiety and chronic stress for the MBCT group, relative to the positive control group with small to moderate effect sizes. The anxiolytic and stress-reducing effects of the MBCT intervention were observed to be mediated by changes in negative automatic thoughts but not by changes in cognitive reappraisal, constructive refocusing, or distractive refocusing. Given the efficacy of the Sanvello smartphone application and the overwhelmingly strong assessments of the appropriateness and feasibility of it use; student support initiatives may be well served by adopting such a platform within the context of first-line treatment and prevention of high anxiety and chronic stress within first year college students. Registered at ClinicalTrials.gov [number NCT06019299]., Competing Interests: The authors declare that they have no conflict of interest., (© 2024 The Authors. Published by Elsevier B.V.)

Background: Considering the previous research that suggested that screen time (ST), sleep duration, physical activity (PA), obesity and cardiometabolic risk factors are related, it is essential to identify how these variables are associated over time, to provide knowledge for the development of intervention strategies to promote health in pediatric populations. Also, there is a lack of studies examining these associations longitudinally. The aims of the present study were: (1) to investigate the longitudinal relationships between ST, sleep duration, leisure PA, body mass index (BMI), and cardiometabolic risk score (cMetS) in children and adolescents; and (2) to verify scores and prevalence of cMetS risk zones at baseline and follow-up., Methods: This observational longitudinal study included 331 children and adolescents (aged six to 17 years; girls = 57.7%) from schools in a southern city in Brazil. ST, sleep duration, and leisure PA were evaluated by a self-reported questionnaire. BMI was evaluated using the BMI z-scores (Z&#95;BMI). The cMetS was determined by summing sex- and age-specific z-scores of total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides, glucose, and systolic blood pressure and dividing it by four. A two-wave cross-lagged model was implemented., Results: ST, sleep duration, and leisure PA were not associated with cMetS after 2-years. However, it was observed that higher ST at baseline was associated with shorter sleep duration at follow-up (B=-0.074; 95%IC=-0.130; -0.012), while higher Z&#95;BMI from baseline associated with higher cMetS of follow-up (B = 0.154; 95%CI = 0.083;0.226). The reciprocal model of relationships indicated that the variance of ST, sleep time, leisure PA, Z&#95;BMI, and cMetS explained approximately 9%, 14%, 10%, 67% and 22%, respectively, of the model. Individual change scores and prevalence indicated that cMetS had individual changes from 2014 to 2016., Conclusion: Sleep duration, ST and leisure PA were not associated with cMetS after 2 years. ST showed an inverse association with sleep duration, and Z&#95;BMI was positively associated with cMetS after a 2-year follow-up. Finally, the prevalence of no clustering of risk factors increased after two years. These findings suggest the need to promote healthy lifestyle habits from childhood and considering individual factors that can influence cardiometabolic health in children and adolescents., (© 2024. The Author(s).)

Background: Physical activity and sedentary behavior may differentially impact health-related quality of life in adults with cerebral palsy. Objective: The present investigation assessed the independent relationships between aspects of physical activity and sedentary behavior related to health related quality of life in adults with cerebral palsy. Methods: Through a cross-sectional online survey of 118 adults with cerebral palsy, participants self-reported the extent of their functional impairments using the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System; while mental and physical health-related quality of life were assessed using the RAND-36. Physical activity and sedentary behavior were quantified using the Physical Activity and Disability Survey-Revised and Sedentary Behavior Questionnaire, respectively. Results: Accounting for potential confounding influences of impairments, neither exercise-related physical activity, leisure time- related physical activity, occupational physical activity, nor sedentary behavior was associated with any characterization of health-related quality of life. However, greater engagement in general lifestyle physical activity was related to superior mental health-related quality of life. Conclusion: These findings provide initial evidence to suggest that focusing public health and therapeutic recommendations for individuals with cerebral palsy on general physical activity engagement throughout the day might incur potential benefits for enhancing mental health- related quality of life in this population.

Spending time outdoors is associated with increased time spent in physical activity, lower chronic disease risk, and wellbeing. Many studies rely on self-reported measures, which are prone to recall bias. Other methods rely on features and functions only available in some GPS devices. Thus, a reliable and versatile method to objectively quantify time spent outdoors is needed. This study sought to develop a versatile method to classify indoor and outdoor (I/O) GPS data that can be widely applied using most types of GPS and accelerometer devices. To develop and test the method, five university students wore an accelerometer (ActiGraph wGT3X-BT) and a GPS device (Canmore GT-730FL-S) on an elastic belt at the right hip for two hours in June 2022 and logged their activity mode, setting, and start time via activity diaries. GPS trackers were set to collect data every 5 seconds. A rule-based point cluster-based method was developed to identify indoor, outdoor, and in-vehicle time. Point clusters were detected using an application called GPSAS&#95;Destinations and classification were done in R using accelerometer lux, building footprint, and park location data. Classification results were compared with the submitted activity diaries for validation. A total of 7,006 points for all participants were used for I/O classification analyses. The overall I/O GPS classification accuracy rate was 89.58% (Kappa = 0.78), indicating good classification accuracy. This method provides reliable I/O clarification results and can be widely applied using most types of GPS and accelerometer devices., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Liu 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.)

Introduction: Healthy People 2030, a U.S. government health initiative, has indicated that increasing youth sports participation to 63.3% is a priority in the U.S. This study quantified the health and economic value of achieving this target., Methods: An agent-based model developed in 2023 represents each person aged 6-17 years in the U.S. On each simulated day, agents can participate in sports that affect their metabolic and mental health in the model. Each agent can develop different physical and mental health outcomes, associated with direct and indirect costs., Results: Increasing the proportion of youth participating in sports from the most recent participation levels (50.7%) to the Healthy People 2030 target (63.3%) could reduce overweight/obesity prevalence by 3.37% (95% CI=3.35%, 3.39%), resulting in 1.71 million fewer cases of overweight/obesity (95% CI=1.64, 1.77 million). This could avert 352,000 (95% CI=336,200, 367,500) cases of weight-related diseases and gain 1.86 million (95% CI=1.86, 1.87 million) quality-adjusted life years, saving $22.55 billion (95% CI=$22.46, $22.63 billion) in direct medical costs and $25.43 billion (95% CI= $25.25, $25.61 billion) in productivity losses. This would also reduce depression/anxiety symptoms, saving $3.61 billion (95% CI=$3.58, $3.63 billion) in direct medical costs and $28.38 billion (95% CI=$28.20, $28.56 billion) in productivity losses., Conclusions: This study shows that achieving the Healthy People 2030 objective could save third-party payers, businesses, and society billions of dollars for each cohort of persons aged 6-17 years, savings that would continue to repeat with each new cohort. This suggests that even if a substantial amount is invested toward this objective, such investments could pay for themselves., (Copyright © 2023 American Journal of Preventive Medicine. All rights reserved.)

Background: Poor dietary quality is associated with adiposity and other risks of cardiovascular disease (CVD) in children. In Kuwait, although children's food choices are a concern, no studies have evaluated dietary quality relative to the risk of CVD in Kuwaiti schoolchildren. This study hypothesized that dietary quality using the Healthy Eating Index (HEI) is associated with CVD risk factors in children and that there are associated sex differences., Objective: Our main objective was to evaluate the dietary quality of schoolchildren and investigate whether poor HEI scores are associated with CVD risk and if there are sex differences., Methods: This was a cross-sectional study of Kuwaiti fifth graders ( n = 313; 53% girls; mean age = 10.4 ± 0.4 years) who completed an adapted Block Kids 2004 food frequency questionnaire. Anthropometric, blood pressure, and biochemical data were also measured. HEI-2010 and HEI-2015 scores were calculated., Statistics: A general linear model and logistic regression were applied, controlling for moderate-vigorous physical activity (MVPA) and screen time (ST)., Results: The total HEI-2010 and HEI-2015 scores were 58 and 52 points, respectively; a trend analysis indicated that more girls than boys had poor (≤50 points) HEI-2015 scores ( p < 0.063). The maximum scores for total vegetables ( p < 0.001), dairy ( p < 0.034), and fatty acids ( p < 0.01) were significantly higher in girls, while the maximum scores for whole grains ( p < 0.046) and protein ( p < 0.006), but not sodium ( p < 0.009), were higher in boys. Obesity was inversely associated with poor total HEI 2010 and HEI 2015 scores (OR: 0.347, 95% CI: 0.234 - 0.516, p < 0.001 and OR: 0.561, 95% CI: 0.391-0.805, p < 0.002, respectively). However, the correlation was lost after adjustment for possible confounding factors., Conclusions: Dietary quality for children overall in this study was low, and there was only a weak association between poor scores and elevated blood pressure and none between scores and obesity. These findings have public health implications and warrant further investigation and attention.

Introduction: Studies have reported sex and race/ethnicity disparities in sedentary time (ST), but none have evaluated ST by well-defined periods of the weekday (before school, during school, afterschool, and evening) and weekend day (morning, afternoon, and evening). Comparing sex and race/ethnicity disparities in ST at different periods of a weekday and weekend day can deepen our understanding of disparities and inform intervention efforts. This study tests sex and race/ethnicity disparities in ST by period of day in a representative sample of US youth., Methods: Youth (N = 2,972) from the 2003-2006 NHANES waves reported demographic variables and wore an accelerometer for 7 consecutive days to assess ST. Linear regressions were conducted to test relationships between sex and race/ethnicity and ST (min/hour) during each period of a weekday and weekend day. ST differences by sex and race/ethnicity were calculated to identify the periods of the day presenting the largest opportunity to reduce disparities., Results: Females were more sedentary than males during school (p < 0∙0001), afterschool (p < 0∙0001), and weekday evenings (p < 0∙0001) after controlling for covariates. After controlling for covariates, race/ethnicity only was a significant predictor of ST during weekend mornings (p < 0∙0001). During school and afterschool emerged as the periods with the largest opportunities to reduce sex disparities in ST. Weekend mornings were identified as the largest opportunity to reduce race/ethnic disparities in ST., Conclusions: Sex disparities in ST appear to be driven mostly by the during school period of the day, while race/ethnic disparities in ST seem to be driven by the weekend morning period. Future intervention work should consider these periods when aiming to reduce ST disparities in youth., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Santiago-Rodríguez 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.)

Introduction: To reduce obesity-related disparities, reaching economically disadvantaged and/or minority status adolescents to assist them in meeting physical activity (PA) and nutrition recommendations is important. To address the problem, a 16-week intervention called Guys/Girls Opt for Activities for Life (GOAL) was designed. The purpose of this randomised controlled trial is to evaluate any effect of the intervention, compared with a control condition, on improving: (1) adolescents' % body fat (primary outcome), moderate-to-vigorous PA (MVPA), diet quality and cardiorespiratory fitness from 0 to 4 months; (2) body mass index (BMI), overweight/obesity percentage and quality of life from 0 to 4 months and to 13 months; and (3) perceived social support, self-efficacy and motivation from 0 to 4 months with evaluation of any mediating effect on adolescent PA and diet quality. An exploratory aim is to evaluate any effect of the intervention, compared with the control, on improving parents'/guardians' home environment, MVPA and diet quality from 0 to 4 months; and BMI from 0 to 4 months and to 13 months., Methods and Analysis: Adolescents (fifth to eighth grade) in 14 schools located in underserved urban communities are randomly assigned to the intervention or usual school offerings. One parent per adolescent is enrolled (882 dyads total). Cohort 1 includes four schools (2022-2023). Cohorts 2 and 3 include 5 schools in 2023-2024 and 2024-2025, respectively. The 16-week intervention has three components: (1) after-school GOAL club for adolescents to engage in PA and healthy eating/cooking activities; (2) three parent-adolescent meetings to empower parents to assist adolescents; and (3) GOAL social networking website for parents to share how they helped their adolescent., Ethics and Dissemination: The Michigan State University Biomedical Institutional Review Board provided ethical approval for the study. Findings will be shared via the trial registration database, peer-reviewed publications, conferences and community-oriented strategies., Trial Registration Number: NCT04213014., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Previous school-based high-intensity interval training (HIIT) interventions have focused on the quantity of physical activity (PA) achieved during physical education (PE) rather than students' PE experiences, including enjoyment. Purpose : To evaluate the feasibility of a fitness- and skill based HIIT intervention guided by the Self Determination Theory. Method : For this pretest-posttest randomized controlled 6-week pilot study, 4-5 th grade students (15 boys, 30 girls; age = 10.5 ± 0.9 years) completed a 16-19-minute HIIT circuit (INT); whereas, 22 students (10 boys, 12 girls; age = 10.5 ± 0.9 years) engaged in regular PE (CON). Two-way mixed ANCOVA tests were performed to assess preliminary efficacy. Results : Participants reported favorable program satisfaction (mean 3.6 ± 1.5 out of 5). The physical educator reported a high feasibility survey score (31/35), and themes emerging from a program acceptability interview included positive perceptions of the HIIT program and strategies for future implementation. A large effect size was evident for cardiorespiratory fitness (ηp 2  = 0.26), as VO 2peak increased in INT from 53.6 ± 6.1 to 56.9 ± 7.3 ml/kg/min and decreased in CON (53.9 ± 7.0 to 52.4 ± 10.4 ml/kg/min). Students in INT exhibited greater amounts of moderate-to-vigorous PA and vigorous PA during PE versus CON, based on accelerometer data (23.4 ± 5.0 vs. 15.7 ± 4.7 min/hr, ηp 2  = 0.45; 4.5 ± 2.6 vs. 2.3 ± 1.3 min/hr; ηp 2  = 0.27, respectively). Conclusions : Findings support the feasibility of this fitness- and skill-based HIIT program and may be a valuable addition to elementary school PE programs.

Background: National adherence to the recess recommendations of the Centers for Disease Control and Prevention (CDC) has not been comprehensively studied in the United States., Methods: Data from 6 nationally representative data sets over the last decade (Classification of Laws Associated with School Students, Early Childhood Longitudinal Study, National Health and Nutrition Examination Survey, National Youth Fitness Survey, School Health Policies and Practices Survey, and the School Nutrition and Meal Cost Study) provided estimates for adherence to CDC recess guidelines., Results: While approximately 65-80% of elementary school-children receive the recommended 20+ minutes of daily recess according to parent-, principal-, and school-report, adherence declines by sixth grade, and little information is available for middle/high school students. Adherence to playground safety was high (90%), but adherence to recommendations about recess before lunch (<50%), withholding recess as punishment (∼50%), and training recess staff (<50%) were lower., Conclusions: School policy and practice should align with CDC recommendations, with the aim of providing sufficient quality recess to all youth, K-12th grade. Comprehensive, on-going national surveillance of multiple recess domains is needed to inform policy and ensure equitable provision of recess., (© 2023 American School Health Association. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Natural experiments are often used to study interventions in which randomization to control versus intervention conditions are impossible. Nature-based interventions (i.e., programs designed to increase human interaction with nature and improve human health) are commonly studied as natural experiments. We used a natural experiment design to explore the benefits of ecological rehabilitation of parks on biodiversity and resident health in low-income, minoritized neighborhoods in Detroit, MI. Given the complexities and interconnectedness of lived experiences, community needs, and ecological health, this research design has presented challenges. Based on our experiences, we pose four key recommendations for researchers and practitioners conducting natural experiments, nature-based interventions, and those working in low-income, minoritized neighborhoods. We use the explicit examples of challenges faced as rationale for these recommendations. The key recommendations are (1) Engage with community leaders; (2) Build a transdisciplinary team and work closely; (3) Examine privilege; and (4) Create a unified vision., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Pearson, Pfeiffer, Buxton, Horton, Gardiner and Asana.)

Purpose: Previous literature has demonstrated the mediating role of adiposity in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk as well as the potential role of CRF in attenuating the adverse consequences associated with excess weight. This study aimed to evaluate the mediating role of CRF and adiposity in the possible association with cardiometabolic risk., Method: Observational 3-year longitudinal study that included 420 children and adolescents (10.50 [2.05] y of age at baseline; 56.2% girls). Body mass index (BMI) was calculated, and CRF was evaluated using field assessments. A clustered cardiometabolic risk score (cMetS) was calculated from glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, and triglycerides z scores. Analyses evaluated the mediating role of BMI in the association between CRF and cMetS as well as whether CRF mediated the association between BMI and cMetS., Results: BMI at baseline was directly associated with the cMetS at follow-up (0.102; 95% confidence interval, 0.020 to 0.181), independently of CRF, whereas CRF was only indirectly associated with cMetS at follow-up through BMI (-0.036; 95% confidence interval, -0.070 to -0.009), meaning that the association between CRF and cMetS was explained via the mediation role of BMI., Conclusions: BMI presented direct association with cMetS, whereas CRF exhibited indirect association with cMetS mediated via BMI.

Use of information and communication technology to improve health, known as eHealth, is an emerging concept in healthcare that may present opportunities to promote physical activity in adults with obesity. The purpose of this research was to systematically review eHealth intervention studies to promote physical activity in adults with obesity. Five electronic databases were used. Two authors screened articles, assessed risk of bias, and extracted data independently. A qualitative data synthesis for summarizing the findings was performed using harvest plots. In the search, 2276 articles were identified, and 18 studies met all inclusion criteria. Study quality ranged from poor to good. The included studies varied in intervention technology (e.g., web-based), physical activity assessment (e.g., device-based), and control group (e.g., wait-list). Behavioral change techniques used in the included studies were consistent with some techniques (e.g., self-monitoring) known as effective in face-to-face interventions, but more efficiently employed in eHealth using information and communication technology. Overall, this systematic review showed that a web-based or physical activity monitor-based eHealth intervention had the potential to effectively promote physical activity in adults with obesity. Some recommendations for future eHealth interventions to promote physical activity in adults with obesity were provided (e.g., use of theory, accelerometers).

Understanding how structural racism, including institutionalized practices such as redlining, influence persistent inequities in health and neighborhood conditions is still emerging in urban health research. Such research often focuses on historical practices, giving the impression that such practices are a thing of the past. However, mortgage lending bias can be readily detected in contemporary datasets and is an active form of structural racism with implications for health and wellbeing. The objective of the current study was to test for associations among multiple measures of mental health and a measure of contemporary redlining. We linked a redlining index constructed using Home Mortgage Disclosure Act data (2007-2013) to 2021 health data for Black/African American participants in the Study of Active Neighborhoods in Detroit (n = 220 with address data). We used multilevel regression models to examine the relationship between redlining and a suite of mental health outcomes (perceived stress, anxiety, depressive symptoms, and satisfaction with life), accounting for covariates including racial composition of the neighborhood. We considered three mediating factors: perceived neighborhood cohesion, aesthetics, and discrimination. Although all participants lived in redlined neighborhoods compared to the complete Detroit Metropolitan area, participants with very low income, low levels of experienced discrimination, and lower perceptions of neighborhood aesthetics resided in highly redlined neighborhoods (score ≥5). We observed that higher resident-reported neighborhood aesthetics were found in neighborhoods with lower redlining scores and were associated with higher levels of satisfaction with life. We found that lower levels of redlining were significantly associated with higher levels of perceived discrimination, which was significantly, positively associated with anxiety, depressive symptoms, and perceived stress scores. Our findings highlight that contemporary redlining practices may influence the aesthetics of the built environment because these neighborhoods experience less investment, with implications for residents' satisfaction with life. However, areas with lower redlining may be areas where Black/African American people experience increased perceived discrimination., (© 2023 The Authors.)

Exposure to nature views has been associated with diverse mental health and cognitive capacity benefits. Yet, much of this evidence was derived in adult samples and typically only involves residential views of nature. Findings from studies with children suggest that when more greenness is available at home or school, children have higher academic performance and have expedited attention restoration, although most studies utilize coarse or subjective assessments of exposure to nature and largely neglect investigation among young children. Here, we investigated associations between objectively measured visible nature at school and children's behavior problems (attention and externalizing behaviors using the Brief Problem Monitor Parent Form) in a sample of 86 children aged seven to nine years old from 15 classrooms across three schools. Images of classroom windows were used to quantify overall nature views and views of specific nature types (sky, grass, tree, shrub). We fitted separate Tobit regression models to test associations between classroom nature views and attention and externalizing behaviors, accounting for age, sex, race/ethnicity, residential deprivation score, and residential nature views (using Google Street View imagery). We found that higher levels of visible nature from classroom windows were associated with lower externalizing behavior problem scores, after confounder adjustment. This relationship was consistent for visible trees, but not other nature types. No significant associations were detected for attention problems. This initial study suggests that classroom-based exposure to visible nature, particularly trees, could benefit children's mental health, with implications for landscape and school design.

Abstract: Burghardt, WP, Pfeiffer, KA, and Kuenze, C. Assessing the relationship between external workloads and noncontact injuries during summer conditioning and preseason practice in National Collegiate Athletic Association Division 1 football players. J Strength Cond Res 37(4): 816-822, 2023-The purpose of this study was to prospectively investigate the relationship between noncontact injuries and workload in collegiate football during summer conditioning and preseason training. Workload and noncontact injury data were collected over the summer conditioning and preseason practice periods for a Division 1 National Collegiate Athletic Association football team ( n = 34). Seven- and 21-day exponentially weighted moving averages (EWMA) were calculated daily for each athlete. The acute:chronic ratio (A:C ratio) of these 2 measures was also calculated daily. Injury rates for noncontact injuries were calculated for both periods. Continuous variable modeling (panel logistic regression and restricted cubic spline) was used to assess the relationship of EWMA A:C ratio and noncontact injury using a 3-day lag period. Athletic exposures (AEs) were defined as individual sport training, practice, or competition sessions. Nine injuries were observed (6.97/1,000 AEs), with 4 injuries resulting in lost time (3.09/1,000 AEs). The mean EWMA A:C ratio was 0.92 ± 0.41 (95% confidence interval: 0.03-2.09). Both the panel logistic regression and the restricted cubic spline models showed a significant relationship between EWMA A:C ratio and noncontact injuries. However, the odds ratio (14.16) in the logistic regression had a very large standard error (14.51) and a wide 95% confidence interval (1.90-105.49). The restricted cubic spline model had a pseudo R2 of 0.136. Injury occurrence at given EWMA ratio values was lower than reported in previous research. Although both continuous models demonstrated a significant relationship between the EWMA A:C ratio and subsequent noncontact injuries over the next 3 days, neither model had sufficient goodness of fit to warrant adoption at this time., (Copyright © 2022 National Strength and Conditioning Association.)

Fun For Wellness (FFW) is a self-efficacy theory-based online behavioral intervention that aims to promote growth in physical activity and well-being. The FFW conceptual model for the promotion of subjective well-being posits that FFW exerts both a positive direct effect, and a positive indirect effect through well-being self-efficacy, on subjective well-being. Subjective well-being is defined in FFW as an individual's satisfaction with their status in seven key domains of their life. Well-being self-efficacy is defined in FFW as the degree to which an individual perceives that they have the capability to attain a positive status in seven key domains of their life. The objective of this study was to use baseline target moderation to assess variation in the impact of FFW on subjective well-being dimensions in adults with obesity. Data (N = 667) from the Well-Being and Physical Activity Study (ClinicalTrials.gov, identifier: NCT03194854) were reanalyzed. There was evidence that well-being self-efficacy at baseline moderated the direct effect of FFW on well-being self-efficacy at 30 days post-baseline for the occupational and psychological dimensions. Both of these findings suggest a "compensatory" effect. Similarly, there was evidence that well-being self-efficacy at baseline moderated the indirect effect of FFW on subjective well-being at 60 days post-baseline through well-being self-efficacy at 30 days post-baseline for the occupational and psychological dimensions. Both of these findings suggest a "compensatory" effect. Finally, there was evidence that well-being self-efficacy at baseline moderated the direct effect of FFW on subjective well-being at 60 days post-baseline for the community, occupational, and physical dimensions. Each of these three findings suggests some version of a "rich-get-richer" effect. In summary, results provide both supportive and unsupportive (i.e., interpersonal, economic, and overall dimensions) evidence regarding variation in the impact of the FFW intervention and should impact the design of future FFW trials., (© 2021. Society for Prevention Research.)

Background: The increase of hypertension in children and adolescents has attracted the attention of the scientific community largely due to its association with the obesity epidemic., Objectives: To describe the incidence of hypertension and its relationship with the cardiometabolic and genetic profile in children and adolescents from a city in southern Brazil in a three-year period., Methods: This longitudinal study followed 469 children and adolescents, aged 7-17 years old (43.1% boys), assessed at two-time points. We evaluated systolic and diastolic blood pressures (SBP and DBP), waist circumference (WC), body mass index (BMI), body fat percentage (%BF), lipid profile, glucose, cardiorespiratory fitness (CRF), and rs9939609 Polymorphism ( FTO ). Cumulative incidence of hypertension was calculated, and multinomial logistic regression was conducted. The statistical significance was established as p < 0.05., Results: After three years, the incidence of hypertension was 11.5%. Overweight or obese individuals were more likely to become borderline hypertensive (overweight OR: 3.22, 95% CI: 1.08-9.55; obesity OR: 4.05, 95% CI: 1.68-9.75), and obese individuals were more likely to become hypertensive (obesity OR: 4.84, 95% CI: 1.57-14.95). High-risk WC and %BF values were associated with hypertension development (OR: 3.41, 95% CI: 1.26-9.19; OR: 2.49, 95% CI: 1.08-5.75, respectively)., Conclusions: We found a higher incidence of hypertension in children and adolescents as compared with previous studies. Individuals with higher values of BMI, WC and %BF at baseline were more likely to develop hypertension, suggesting the importance of adiposity in the development of hypertension even in such a young population.

Background & Aims: Childhood obesity is linked to adulthood cardiovascular disease (CVD) risk and mortality. Approximately 32% of Kuwaiti children are obese, particularly boys. Data on other CVD risk factors are limited. This study aimed to determine the prevalence and sex differences of CVD risks in Kuwaiti schoolchildren., Methods: Kuwaiti fifth-grade schoolchildren (n = 367, 53% girls, age 10.4 ± 0.4 years) were evaluated. Informed parent/guardian consent and child assent were obtained for all participants. Outcome variables included (i) anthropometric: body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), percentage body fat (%BF); (ii) blood lipids: total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), non-HDL, TC:HDL ratio, triglycerides; and (iii) blood pressure (BP): systolic BP (SBP) and diastolic BP (DBP) measurements. ANOVA was conducted, while controlling for moderate-to-vigorous physical activity and screen time (ST); significance level was set at p ≤ 0.05., Results: Overall prevalence of CVD risks included: overweight (21.6%), obesity (39%), WC (10.2%), WHtR (43.3%), %BF (10.1%), TC (26.4%), LDL (13.2%), HDL (36.9%), non-HDL (22.5%), TC:HDL ratio (25.9%), triglycerides (45.5%), and BP (23.3%). More girls (27.1%) than boys (15.5%) were overweight (p = 0.007). More girls than boys were at greater risk of elevated triglycerides (52.3% vs. 37.7%, p = 0.032), low HDL (20.7% vs. 12.2%, p = 0.032) and elevated SBP (21% vs. 10.7%, p = 0.008) and DBP (21% vs. 8.8%, p = 0.001), respectively., Conclusions: CVD risks are a concern overall in children, especially in girls relative to overweight, dyslipidemia, and prehypertension. Intervention programs for Kuwaiti schoolchildren are recommended to prevent CVD risks., Competing Interests: Declaration of competing interest None., (Copyright © 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: Definitive evidence shows sedentary time (ST) is an independent risk factor for chronic disease, irrespective of physical activity. Despite calls to limit youth ST, studies demonstrate a spike in ST at the transition from childhood to adolescence. Identifying periods of the day (e.g., before school, during school, afterschool, and evenings) during which ST is higher in adolescents vs. children-that is, specifying when within daily routines ST disparities emerge-may be important to inform intervention strategies, as periods of the day correspond with variations in setting and supervision. The purpose of this study was to examine device-assessed ST engagement by period of day and developmental stage in a nationally representative sample of United States youth., Methods: Youth (N = 2,972 between 6-18 years) from the 2003-2004 and 2005-2006 waves of NHANES reported demographic variables and wore an accelerometer for seven consecutive days to determine ST. Linear regression analyses were applied to study associations between ST and developmental stage (childhood or adolescence) by period of the week and weekend days, while controlling for sex, race/ethnicity, annual family income, and body mass index., Results: Adjusted linear regressions (p-values &lt; 0.0001) showed that adolescents were more sedentary than children during school, afterschool, and weekday evening periods as well as all the weekend periods. However, during school (36.3 ± 7.3 vs. 28.2 ± 7.2 min/hour; b = -7.4 [-8.1, -6.6]) and afterschool periods (31.1 ± 7.7 vs. 22.7 ± 7.0 min/hour; b = -7.8 [-8.6, -7.0]) showed the largest weekly ST disparities by developmental stage. Overall, the during school and after school hours constitute most (during school = 35% and afterschool = 16%) of the weekly ST disparity between children and adolescents., Conclusions: Our data provide interventionists with estimates of the potential for ST reduction in each setting and period of the day among US adolescents. Future research should gather information about the barriers and facilitators of ST in adolescents by period of the day to help understand factors driving disparities., (© 2022. The Author(s).)

Identifying the best analytical approach for capturing moderate-to-vigorous physical activity (MVPA) using accelerometry is complex but inconsistent approaches employed in research and surveillance limits comparability. We illustrate the use of a consensus method that pools estimates from multiple approaches for characterising MVPA using accelerometry. Participants (n = 30) wore an accelerometer on their right hip during two laboratory visits. Ten individual classification methods estimated minutes of MVPA, including cut-point, two-regression, and machine learning approaches, using open-source count and raw inputs and several epoch lengths. Results were averaged to derive the consensus estimate. Mean MVPA ranged from 33.9-50.4 min across individual methods, but only one (38.9 min) was statistically equivalent to the criterion of direct observation (38.2 min). The consensus estimate (39.2 min) was equivalent to the criterion (even after removal of the one individual method that was equivalent to the criterion), had a smaller mean absolute error (4.2 min) compared to individual methods (4.9-12.3 min), and enabled the estimation of participant-level variance (mean standard deviation: 7.7 min). The consensus method allows for addition/removal of methods depending on data availability or field progression and may improve accuracy and comparability of device-based MVPA estimates while limiting variability due to convergence between estimates.

Physical activity levels are low in individuals with chronic disease (e.g., obesity) and have worsened during the COVID-19 pandemic., Purpose: Our pilot study tested a virtual exercise intervention for rural-dwelling adults with chronic disease from January-April 2021 for changes in mental health, physical fitness, and physical activity and for intervention fidelity., Methods: Participants ( n = 8 [7 female]; age = 57.5 ± 13.8 years, body mass index = 38.2 ± 8.0 kg/m 2 ) completed an exercise intervention led virtually by collegiate health science majors. Participants attended two 60-minute sessions/week for 12 weeks, completing individually-tailored and progressed aerobic and muscle-strengthening training. A non-randomized control group matched on gender and age continued normal activity during the 12 weeks. Changes in mental health, physical fitness, and physical activity measures were evaluated using a 2×2 (group × time) analysis of covariance., Results: Both groups improved mental health, but only intervention participants lost weight (3.1 ± 1.0 kg; no change in controls). Step test, arm curls, and chair stands improved by 16.1-20.6% in the intervention and 7.8-12.1% in the control groups. Intervention participants did not increase overall physical activity during or after the intervention. Intervention fidelity was high; participants attended ~73% of sessions and rated the sessions 4.7 ± 0.6 (out of 5). Researcher observations rated exercise sessions as meeting 12.7 ± 0.6 of 16 goals., Conclusions: Our virtual exercise program was associated with positive mental health and physical fitness changes. Such programs may provide a method, even beyond the pandemic, to improve fitness in adults with chronic disease.

Hot spot analysis of linked accelerometer and Global Positioning System data is often used to identify areas of high/low activity in the schoolyard. We illustrate the potential impact of a suite of methodological decisions (i) accelerometer metric; (ii) monitor epoch; (iii) number of recess periods/days and level of aggregation; (iv) sample size; (v) distance band; (vi) spatial versus spatiotemporal weighting scheme; and (vii) time band. Accelerometer metrics resulted in different clustering patterns. Longer epochs resulted in a less detailed picture of schoolyard behavior. Level of data aggregation impacted cluster patterns due to inter-period and inter-day differences, but clusters were consistent with increasing sample size. Use of spatiotemporal weight matrices resulted in better separation of hot and cold spots and revealed potentially important temporal clustering patterns. Increasing distance or time band resulted in reallocation of small clusters to larger clusters. Hot spot analysis decisions should be clearly reported in future studies., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier Ltd.)

Schools are well-positioned to provide physical activity opportunities to help youth achieve the recommended 60 or more daily minutes of moderate-to-vigorous physical activity. The Children's Physical Activity Research Group (CPARG) at the University of South Carolina has focused on understanding physical activity in school-aged youth for 30+ years. The purpose of this article was to critically review (CPARG) contributions to the field in school settings and school-age youth. We reviewed 127 published CPARG articles from six research projects conducted between 1993-2019. The review was guided by questions in five categories: measurement of physical activity and its determinants, characteristics of physical activity behavior, correlates/determinants of physical activity, physical activity interventions, and race/ethnicity and physical activity. Results were summarized by question and synthesized across categories. CPARG contributions included assessing physical activity levels, patterns, forms, and contexts; identifying and measuring physical activity correlates/determinants; and conducting school-based physical activity interventions. Identifying multiple domains of physical activity determinants enables researchers and practitioners to select/design age-appropriate, valid, and reliable instruments to assess determinants. Focusing on determinants enables them to create effective physical activity interventions, environments, programs, and policies in schools. These efforts must address race/ethnicity differences, ensuring that measurement instruments and intervention strategies are culturally appropriate.

ActiGraph sampling frequencies of more than 30 Hz may result in overestimation of activity counts in both children and adults, but research on free-living individuals has not included the range of sampling frequencies used by researchers. Objective. We compared count- and raw-acceleration-based metrics from free-living children and adolescents across a range of sampling frequencies. Approach. Participants ( n  = 445; 10-15 years of age) wore an ActiGraph accelerometer for at least one 10 h day. Vector magnitude counts, mean amplitude deviation, monitor-independent movement summary units, and activity intensity classified using six methods (four cut-points, two-regression model, and artificial neural network) were compared between 30 Hz and 60, 80, 90, and 100 Hz sampling frequencies using mean absolute differences, correlations, and equivalence testing. Main results. All outcomes were statistically equivalent, and correlation coefficients were ≥0.970. Absolute differences were largest for the 30 versus 80 and 30 versus 100 Hz count comparisons. For comparisons of 30 with 60, 80, 90, or 100 Hz, mean (and maximum) absolute differences in minutes of moderate-to-vigorous physical activity per day ranged from 0.1 to 0.3 (0.4 to 1.5), 0.3 to 1.3 (1.6 to 8.6), 0.1 to 0.3 (1.1 to 2.5), and 0.3 to 2.5 (1.6 to 14.3) across the six classification methods. Significance. Acceleration-based outcomes are comparable across the full range of sampling rates and therefore recommended for future research. If using counts, we recommend a multiple of 30 Hz because using a 100 Hz sampling rate resulted in large maximum individual differences and epoch-level differences, and increasing differences with activity level., (© 2022 Institute of Physics and Engineering in Medicine.)

The proliferation of approaches for analyzing accelerometer data using raw acceleration or novel analytic approaches like machine learning ('novel methods') outpaces their implementation in practice. This may be due to lack of accessibility, either because authors do not provide their developed models or because these models are difficult to find when included as supplementary material. Additionally, when access to a model is provided, authors may not include example data or instructions on how to use the model. This further hinders use by other researchers, particularly those who are not experts in statistics or writing computer code. Objective : We created a repository of novel methods of analyzing accelerometer data for the estimation of energy expenditure and/or physical activity intensity and a framework and reporting guidelines to guide future work. Approach : Methods were identified from a recent scoping review. Available code, models, sample data, and instructions were compiled or created. Main Results : Sixty-three methods are hosted in the repository, in preschoolers (n = 6), children/adolescents (n = 20), and adults (n = 42), using hip (n = 45), wrist (n = 25), thigh (n = 4), chest (n = 4), ankle (n = 6), other (n = 4), or a combination of monitor wear locations (n = 9). Fifteen models are implemented in R, while 48 are provided as cut-points, equations, or decision trees. Significance : The developed tools should facilitate the use and development of novel methods for analyzing accelerometer data, thus improving data harmonization and consistency across studies. Future advances may involve including models that authors did not link to the original published article or those which identify activity type., (© 2022 Institute of Physics and Engineering in Medicine.)

Use of raw acceleration data and/or 'novel' analytic approaches like machine learning for physical activity measurement will not be widely implemented if methods are not accessible to researchers. Objective : This scoping review characterizes the validation approach, accessibility and use of novel analytic techniques for classifying energy expenditure and/or physical activity intensity using raw or count-based accelerometer data. Approach : Three databases were searched for articles published between January 2000 and February 2021. Use of each method was coded from a list of citing articles compiled from Google Scholar. Authors' provision of access to the model (e.g., by request, sample code) was recorded. Main Results : Studies (N = 168) included adults (n = 143), and/or children (n = 38). Model use ranged from 0 to 27 uses/year (average 0.83) with 101 models that have never been used. Approximately half of uses occurred in a free-living setting (52%) and/or by other authors (56%). Over half of included articles (n = 107) did not provide complete access to their model. Sixty-one articles provided access to their method by including equations, coefficients, cut-points, or decision trees in the paper (n = 48) and/or by providing access to code (n = 13). Significance : The proliferation of approaches for analyzing accelerometer data outpaces the use of these models in practice. As less than half of the developed models are made accessible, it is unsurprising that so many models are not used by other researchers. We encourage researchers to make their models available and accessible for better harmonization of methods and improved capabilities for device-based physical activity measurement., (© 2022 Institute of Physics and Engineering in Medicine.)