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Purpose: To study the relationship between actual motor competence (AMC) and perceived motor competence (PMC) in a large sample of 6- to 12-year-old children. Method: The AMC and PMC were measured (N = 1,669, 55% boys) with the Athletic Skills Track and the Physical Self-Confidence Scale, respectively. A variable-centered approach was applied to examine the AMC–PMC association by means of correlation coefficients and Fisher’s z tests. Cluster analyses were used to identify profiles of children from a person-centered perspective. Results: The AMC–PMC correlation strengthened with increasing age (r = .084 in 6- to 7-year-olds to r = .416 in 10- to 11-year-olds). The person-centered approach revealed two profiles with corresponding levels of AMC and PMC, and two profiles with divergent levels. Discussion: In addition to clarifying the age-related increase in the association between AMC and PMC, the profiles from the person-centered approach result in new gateways for tailoring interventions to the needs of children with different AMC–PMC profiles.

ObjectiveThis study evaluated the effect of an after-school group-based medium-intensity multicomponent behavioural intervention programme for children aged 8-12 years with overweight or obesity on body mass index standard deviation score (BMI SDS). In accordance with standardized protocols body weight and height were measured in 195 participants (88 boys, 107 girls) at baseline and at the end of the programme. A total of 166 children derived from a school-based monitoring system served as control group. Multivariate regression analyses examined the effect of the intervention and the independent factors associated with better outcomes in the intervention group.ResultsAnalysis of covariance showed a significant intervention effect on BMI SDS in favour of the intervention group (b-coefficient -0.13 ± 0.03; p< 0.01) compared with the control group. Change in BMI SDS between baseline and follow-up in the intervention group was associated with baseline age (b-coefficient 0.03 ± 0.02; p= 0.04) but was independent from gender, ethnicity, baseline BMI SDS, time between baseline and follow-up, school year and attendance rate.

Objective This study evaluated the effect of an after-school group-based medium-intensity multicomponent behavioural intervention programme for children aged 8–12 years classified as overweight, obese or at risk for overweight on body mass index standard deviation score (BMI SDS). In accordance with standardized protocols body weight and height were measured in 195 participants (88 boys, 107 girls) at baseline and at the end of the programme. A total of 166 children derived from a school-based monitoring system served as control group. Multivariate regression analyses examined the effect of the intervention and the independent factors associated with better outcomes in the intervention group. Results Analysis of covariance showed a significant intervention effect on BMI SDS in favour of the intervention group (b-coefficient − 0.13 ± 0.03; p

Quality of life is an umbrella term for the quality of the various domains in life [...]

Unhealthy eating behaviors and low levels of physical activity are major problems in adolescents and young adults in vocational education. To develop effective intervention programs, more research is needed to understand how different types of motivation contribute to health behaviors. In the present study, Self-Determination Theory is used to examine how motivation contributes to dietary and physical activity behaviors in vocational students. This cross-sectional study included 809 students (mean age 17.8 ± 1.9 years) attending vocational education in the Netherlands. Linear multilevel regression analyses were used to investigate the association between types of motivation and dietary and physical activity behaviors. Amotivation was negatively associated with breakfast frequency and positively associated with diet soda consumption and high-calorie between-meal snacks. A positive association was found between autonomous motivation and water intake, breakfast frequency, fruit intake, and moderate-to-vigorous physical activity. Autonomous motivation was negatively associated with the consumption of unhealthy products. Controlled motivation was not associated with physical activity or dietary behaviors. Different types of motivation seem to explain either healthy or unhealthy dietary behaviors in vocational students. Autonomous motivation, in particular, was shown to be associated with healthy behaviors and could therefore be a valuable intervention target.

The purpose of this study was to examine the test-retest reliability, internal consistency and concurrent validity of the Athletic Skills Track (AST). During a regular PE lesson, 930 4- to 12-year old children (448 girls, 482 boys) completed two motor skill competence tests: (1) the Körperkoordination-Test für Kinder (KTK) and (2) an age-related version of the AST (age 4–6 years: AST-1, age 6–9 years: AST-2, and age 9–12 years: AST-3). The test-retest reliability of the AST was high (AST-1: ICC = 0.881 (95% CI: 0.780–0.934); AST-2: ICC = 0.802 (95% CI: 0.717–0.858); and AST-3: ICC = 0.800 (95% CI: 0.669–0.871). The internal consistency, concerning the three age-bands of the AST was above the acceptable level of Cronbach’s α > 0.70 (AST-1: α = 0.764; AST-2: α = 0.700; and AST-3: α = 0.763). There was a moderate to high correlation between the time to complete the AST, and the age- and gender-related motor quotients of the KTK (AST-1: r = −0.747, p = 0.01; AST-2: r = −0.646, p = 0.01; and AST-3: r = −0.602, p = 0.01). The Athletic Skills Track is a reliable and valid assessment tool to assess motor skill competence among 4- to 12-year old children in the PE setting.

Background: The aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on morning recess PA levels of sixth- and seventh-grade children in primary schools, using accelerometry and additional global positioning system data. Methods: A quasi-experimental study design was used with 20 paired intervention and control schools. Global positioning system confirmatory analyses were applied to validate attendance at schoolyards during recess. Accelerometer data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses. Results: Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on moderate to vigorous PA were found. In-depth analyses of intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and the school’s commitment to the project strengthened this effect. Conclusions: The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA.

It is very important to learn balancing skills during childhood. Balancing is an essential motor skill to adopt and maintain an active lifestyle. Currently, balancing skills are often practiced in a traditional way in Physical Education (PE). BalanSAR adds Spatial Augmented Reality (SAR) to traditional balancing exercises in PE, by projecting (interactive) animations on the floor and surrounding gym equipment such as a bench. The purpose of this study was to examine the feasibility and user-experience of several non- and semi-interactive versions of BalanSAR among youth. We conducted three studies. In study 1 50 6- to 9-year old children were observed while balancing on a bench with non-interactive floating bubbles and swimming fishes projected around the bench. Based on the results of study 1, in study 2 a semi-interactive version of BalanSAR was developed and tested among 31 6- to 10-year old children. In study 3, 27 students designed, developed and tested 12 Wizard of Oz prototypes of BalanSAR. Based on the outcomes of the three studies recommendations for future interactive versions of BalanSAR have been formulated.

BACKGROUND: Physical activity (PA) is decreasing among children, while sedentary behavior (SB) is increasing. Schoolyards seem suitable settings to influence children's PA behavior. This study investigated the associations between schoolyard characteristics and moderate-to-vigorous physical activity (MVPA) and SB of children aged 8-11 years at schoolyards.METHODS: Twenty primary schools in the Netherlands were involved. A total of 257 children wore an accelerometer and global positioning system (GPS) device for 5 consecutive days to objectively assess their PA levels and presence at the schoolyard, respectively. Accelerometer and GPS data were merged using the personal activity and location measurement system. Multilevel linear regression analyses were used to study correlates of MVPA and SB at schoolyards.RESULTS: On average, children spent 54 minutes a day at the schoolyard, 9 minutes of which were spent in MVPA and 20 minutes in SB. Boys engaged in MVPA longer than girls at the schoolyard. Fixed equipment, such as high bars and soccer goals, teacher-initiated activities, and the presence of a ball games policy were correlates of more MVPA and less SB.CONCLUSION: Well-designed schoolyards, including PA-enhancing fixed equipment, a supportive PA climate created by teachers, and supportive schoolyard policies may contribute to increased PA and decreased SB during school recess among school-aged children.

IntroductionTo determine differences between workers in lower and higher socioeconomic positions (SEP) in: i) incidence, trends and type of occupational disease (OD) and ii) incapacity for work due to ODs. It is hypothesized that workers in lower and higher SEP still differ in health disparities from an occupational perspective.MethodsFrom a Dutch cohort of occupational physicians (OPs), ODs assessed by OPs were retrieved over a seven year period (2010–2016) for lower and higher SEP groups. Incidence and type of OD and incapacity for work were determined for the total number of ODs and six frequently occurring ODs. Trends in incidence were estimated using a multilevel negative binominal regression model.ResultIn total, 54 per 100,000 workers in elementary occupations, machine operating and assembly jobs, as well as managerial and intellectual jobs during 2016 had an OD diagnosed and reported by an OP, from which 98 per 100,000 were for lower SEP, and 36 per 100,000 for higher SEP. Among the lower SEP, musculoskeletal disorders (37%) and noise-induced hearing loss (NIHL) (32%) comprised two-thirds of the OD diagnoses. Among the higher SEP, distress/burnout comprised 60% of the OD diagnoses, with an increasing trend (6%; 95% CI: 3%-8%). Incapacity for work due to work-related low back disorders (69% vs 9%) and shoulder-, arm- and wrist disorders (89% vs 47%) differed significantly between workers in lower compared to higher SEP.DiscussionOccupational diseases occur at a 2.7 higher incidence rate for workers in lower SEP compared with higher SEP. Incapacity for work due to work-related musculoskeletal disorders are higher for workers in lower SEP compared with higher SEP, suggesting fewer opportunities to modify work tasks and working circumstances for lower SEP. Psychosocial risk factors constitute the greatest problem for workers in higher SEP, resulting in distress/burnout, accompanied by incapacity for work.

OBJECTIVES:: Decreased physical activity levels in children may partly explain the rising prevalence of functional constipation in childhood. The aim of the present study, therefore, was to examine the association between physical activity and functional constipation during the preschool period. METHODS:: This study was embedded in the Generation R study, a large prospective birth-cohort study in Rotterdam, The Netherlands. Physical activity was measured by an Actigraph accelerometer in 347 children (182 boys, 165 girls; mean age 25.1 months) and data were expressed as counts per minute. Data were categorized into light activity (302-614 counts/15 seconds), moderate activity (615-1230 counts/15 seconds), and vigorous activity (≥1231 counts/15 seconds). Functional constipation in the third and fourth year of life was defined according to the Rome II criteria. RESULTS:: Children spending time in the highest tertile of light (adjusted odds ratio [OR] 0.34; 95% confidence interval [CI] 0.13-0.87), moderate (adjusted OR 0.37; 95% CI 0.14-0.97), and total activity (adjusted OR 0.37; 95% CI 0.15-0.92) at the age of 2 years had significantly less functional constipation in the fourth year of life. For functional constipation in the third year of life, the results were in similar direction but not statistically significant. Additionally, children with physical activity of more than the WHO recommendation of 60 min/day had significantly less functional constipation in the fourth year of life (adjusted OR 0.48; 95% CI 0.24-0.97). CONCLUSIONS:: Physical activity is associated with a decreased risk of functional constipation in the preschool period, but this may be time dependent. Copyright © 2013 by European Society for Pediatric Gastroenterology.

Background: To determine differences between workers in lower and higher socioeconomic positions (SEP) in incidences of occupational disease (OD) and incapacity for work due to ODs. Methods: From a Dutch dynamic prospective cohort of occupational physicians (OPs), ODs assessed by OPs were retrieved for lower and higher SEP groups. Results: Among the lower SEP, musculoskeletal disorders, and noise-induced hearing loss (NIHL) comprised two-thirds of the OD diagnoses. Among the higher SEP, stress/burnout comprised 60% of the OD diagnoses. Temporary and permanent incapacity for work due to work-related lower back disorders and repetitive strain injuries differed significantly between workers in lower compared to higher SEP. Conclusions: Occupational diseases occur at a 2.7 higher incidence rate for workers in lower SEP compared with higher SEP. Incapacity for work varies between the type of OD and the level of SEP.

Background The Steep Ramp Test (SRT), a feasible, reliable, and valid exercise test on a cycle ergometer, may be more appealing for use in children in daily clinical practice than the traditional cardiopulmonary exercise test because of its short duration, its resemblance to children's daily activity patterns, and the fact that it does not require respiratory gas analysis. Objective The aim of the present study was to provide sex- and age-related normative values for SRT performance in Dutch white children and adolescents who were healthy and 8 to 19 years old. Design This was a cross-sectional, observational study. Methods A total of 252 Dutch white children and adolescents, 118 boys (mean age=13.4 years, SD=3.0) and 134 girls (mean age=13.4 years, SD=2.9), performed the SRT (work rate increment of 10, 15, or 20 W·10 s−1, depending on body height) to voluntary exhaustion to assess peak work rate (WRpeak). Normative values are presented as reference centiles developed by use of generalized additive models for location, scale, and shape. Results Peak work rate correlated highly with age (r=.915 and r=.811), body mass (r=.870 and r=.850), body height (r=.922 and r=.896), body surface area (r=.906 and r=.885), and fat free mass (r=.930 and r=.902) in boys and girls, respectively. The reference curves demonstrated an almost linear increase in WRpeak with age in boys, even when WRpeak was normalized for body mass. In contrast, absolute WRpeak in girls increased constantly until the age of approximately 13 years, when it started to level off. Peak work rate normalized for body mass in girls showed only a slight increase with age until 14 years of age, when a slight decrease in relative WRpeak was observed. Limitations The sample may not have been entirely representative of the Dutch population. Conclusions The present study provides sex- and age-related normative values for SRT performance in terms of both absolute WRpeak and relative WRpeak, thereby facilitating the interpretation of SRT results by clinicians and researchers.

PURPOSE: This study aimed to examine the reliability and validity of the steep ramp test (SRT), a feasible, maximal exercise test on a cycle ergometer that does not require the use of respiratory gas analysis, in healthy children and adolescents.METHODS: Seventy-five children were randomly divided in a reliability group (n = 37, 17 boys and 20 girls; mean ± SD age = 13.86 ± 3.22 yr), which performed two SRTs within 2 wk, and a validity group (n = 38, 17 boys and 21 girls; mean ± SD age = 13.85 ± 3.20 yr), which performed both an SRT and a regular cardiopulmonary exercise test (CPET) with respiratory gas analysis within 2 wk. Peak work rate (WRpeak) was the main outcome of the SRT. Peak oxygen uptake (V˙O2peak) was the main outcome of the CPET. Reliability was examined with the intraclass correlation coefficient and a Bland and Altman plot, whereas validity was assessed using Pearson correlation coefficients and stepwise linear regression analysis.RESULTS: Reliability statistics for the WRpeak values attained at the two SRTs showed an intraclass correlation coefficient of 0.986 (P < 0.001). The average difference between the two SRTs was -6.4 W, with limits of agreement between +24.5 and -37.5 W. A high correlation between WRpeak attained at the SRT and the V˙O2peak achieved during the CPET was found (r = 0.958; P < 0.001). Stepwise linear regression analysis provided the following prediction equation: V˙O2peak (mL·min) = (8.262WRpeak SRT) + 177.096 (R = 0.917, SEE = 237.4).CONCLUSION: The results suggest that the SRT is a reliable and valid exercise test in healthy children and adolescents, which can be used to predict V˙O2peak.

This paper presents the primary results of a study that examined the difference between exertion vs. non-exertion in game experience and social presence. This study aims to gain more insight in the influence of body movement in a cooperative game on social presence and game experience, to be better able to design interactive technology that helps people to adopt a healthy lifestyle and to connect people socially. The study was performed among 336 adults (age range: 16–64 years) who played a two-player exertion (n = 167) or a non-exertion (n = 169) version of cooperative Tetris. Analysis of an extended version of the Gaming Experience Questionnaire showed that although participants who played the exertion version of the game found themselves less competent, there was no significant difference between the two groups (exertion players and non-exertion players) in game experience or social presence.

Background: Physical Activity (PA) occurs in several behavioral domains (e.g., sports, active transport), and is affected by distinct environmental factors. By filtering objective PA using children's school schedules, daily PA can be separated into more conceptually meaningful domains. We used an ecological design to investigate associations between "playability" of 21 school-environments and children's objectively measured after-school PA. We also examined to what extent distinct time-periods after-school and the distance from children's residence to their school influenced this association. Methods: PA was measured in 587 8-11 year-old children by accelerometers, and separated in four two-hour time-periods after-school. For each school-environment, standardized playability-scores were calculated based on standardized audits within 800 m network buffers around each school. Schools and children's residences were geocoded, and we classified each child to be residing in 400, 800, 1600, or > 1600 m crow-fly buffers from their school. The influence of network-distance buffers was also examined using the same approach. Results: Playability was associated with light PA and moderate-to-vigorous PA after-school, especially in the time-period directly after-school and among children who lived within 800 m from their school. Playability explained approximately 30 % of the after-school PA variance between schools. Greater distance from children's residence to their school weakened the association between playability of the school-environments and after-school PA. Conclusions: This study demonstrated that relationships between the conceptually matched physical environment and PA can be revealed and made plausible with increasing specificity in time and distance.

Background The purpose of this study is to increase our understanding of environmental correlates that are associated with route choice during active transportation to school (ATS) by comparing characteristics of actual walking and cycling routes between home and school with the shortest possible route to school. Methods Children (n = 184; 86 boys, 98 girls; age range: 8–12 years) from seven schools in suburban municipalities in the Netherlands participated in the study. Actual walking and cycling routes to school were measured with a GPS-device that children wore during an entire school week. Measurements were conducted in the period April–June 2014. Route characteristics for both actual and shortest routes between home and school were determined for a buffer of 25 m from the routes and divided into four categories: Land use (residential, commercial, recreational, traffic areas), Aesthetics (presence of greenery/natural water ways along route), Traffic (safety measures such as traffic lights, zebra crossings, speed bumps) and Type of street (pedestrian, cycling, residential streets, arterial roads). Comparison of characteristics of shortest and actual routes was performed with conditional logistic regression models. Results Median distance of the actual walking routes was 390.1 m, whereas median distance of actual cycling routes was 673.9 m. Actual walking and cycling routes were not significantly longer than the shortest possible routes. Children mainly traveled through residential areas on their way to school (>80 % of the route). Traffic lights were found to be positively associated with route choice during ATS. Zebra crossings were less often present along the actual routes (walking: OR = 0.17, 95 % CI = 0.05–0.58; cycling: OR = 0.31, 95 % CI = 0.14–0.67), and streets with a high occurrence of accidents were less often used during cycling to school (OR = 0.57, 95 % CI = 0.43–0.76). Moreover, percentage of visible surface water along the actual route was higher compared to the shortest routes (walking: OR = 1.04, 95 % CI = 1.01–1.07; cycling: OR = 1.03, 95 % CI = 1.01–1.05). Discussion This study showed a novel approach to examine built environmental exposure during active transport to school. Most of the results of the study suggest that children avoid to walk or cycle along busy roads on their way to school. Electronic supplementary material The online version of this article (doi:10.1186/s12966-016-0373-y) contains supplementary material, which is available to authorized users.

Objective: To examine whether the "Short QUestionnaire to ASsess Health-enhancing physical activity" (SQUASH) and the "Injuries and Physical Activity in the Netherlands" questionnaire ("Ongevallen en Bewegen in Nederland," OBiN) were valid in assessing adherence to physical activity (PA) guidelines. Study Design and Setting: Participants (N = 187) aged 20-69 years were categorized as "inactive," "semiactive," or "norm-active" according to the Dutch PA, the American College of Sports Medicine (ACSM), and the combined guideline (adhering to either or both of two other guidelines) by the questionnaires and a combined heart rate monitor and accelerometer (Actiheart). Percentage of exact agreement and maximum disagreement (difference of two categories) for the categorization between questionnaires and Actiheart was calculated. Results: The SQUASH had a significant higher agreement than the OBiN for the Dutch PA (SQUASH: 78%, OBiN: 46%; P < 0.01) and combined guideline (SQUASH: 84%, OBiN: 55%; P < 0.01). Both questionnaires had a low agreement regarding the ACSM guideline (SQUASH: 37%, OBiN: 34%; P = 0.45). The SQUASH had a significant higher maximum disagreement than the OBiN for this guideline (SQUASH: 19.8%, OBiN 8%; P < 0.01). Conclusion: The SQUASH was a more valid measure than the OBiN for categorizing adults according to the Dutch PA and the combined guideline. Both questionnaires failed to correctly categorize adults according to the ACSM guideline. © 2012 Elsevier Inc. All rights reserved.

Purpose: To develop and evaluate two artificial neural network (ANN) models based on single-sensor accelerometer data and an ANN model based on the data of two accelerometers for the identification of types of physical activity in adults. Methods: Forty-nine subjects (21 men and 28 women; age range = 22-62 yr) performed a controlled sequence of activities: sitting, standing, using the stairs, and walking and cycling at two self-paced speeds. All subjects wore an ActiGraph accelerometer on the hip and the ankle. In the ANN models, the following accelerometer signal characteristics were used: 10th, 25th, 75th, and 90th percentiles, absolute deviation, coefficient of variability, and lag-one autocorrelation. Results: The model based on the hip accelerometer data and the model based on the ankle accelerometer data correctly classified the five activities 80.4% and 77.7% of the time, respectively, whereas the model based on the data from both sensors achieved a percentage of 83.0%. The hip model produced a better classification of the activities cycling, using the stairs, and sitting, whereas the ankle model was better able to correctly classify the activities walking and standing still. All three models often misclassified using the stairs and standing still. The accuracy of the models significantly decreased when a distinction was made between regular versus brisk walking or cycling and between going up and going down the stairs. Conclusions: Relatively simple ANN models perform well in identifying the type but not the speed of the activity of adults from accelerometer data. © 2010 by the American College of Sports Medicine.

Walking is an important source of outdoor physical activity among elderly people. In order to devise measures aimed at encouraging walking among the elderly it is important to understand how the local environment influences the walking behaviour of elderly people. Here, a model describing the influence of environmental street characteristics on the walking route choice of elderly people is presented. Techniques adapted from the field of transportation research were employed within the model. Data concerning the walking route choice to specific destinations reported by 364 independently living elderly residents (55-80 years) from three Dutch urban districts were collected. Route choice was modelled within a 'Geographic Information System' (GIS) database by using 'resistance factors' to describe the resistance to walking of street sections (i.e. links) within the street network. These factors were optimized by minimizing the difference between the estimated and the reported number of trips along each link. This is, to the authors' knowledge the first time that this technique has been applied within this context. The influence of link characteristics on link resistance was investigated by multivariate linear regression. The first results of the route choice model and the influence of street characteristics on route choice are reported and discussed. © 2009 Elsevier Ltd. All rights reserved.

In het verlengde hiervan is ook de vraag toegenomen naar valide en betrouwbare methoden voor het meten van sport en bewegen op verschillende niveaus, voor verschillende doelen en doelgroepen. Voor het formuleren en evalueren van beleidsdoelen is het van belang dat informatie over de ontwikkelingen met betrekkng tot sport en bewegen zo eenduidig mogelijk is. In de huidige situatie komen echter verschillende, schijnbaar tegenstrijdige cijfers met betrekking tot sport en bewegen naar voren. In dit artikel wordt aan de hand van een aantal voorbeelden nader ingegaan op verklaringen voor verschillen in cijfers over bewegen, toegespitst op de NNGB. Tevens wordt een voorstel gedaan voor het adresseren van lacunes en knelpunten op dit gebied.

Continuity of mental health care is a key issue in the organization and evaluation of services for patients with disabling chronic conditions. Over many years, health services researchers have been exploring the conceptual boundaries between continuity of care and other service characteristics. On the basis of papers published over the past decade, we argue that while conceptual consensus is growing, there is room to improve continuity measures, and the development of practical interventions is still at an early stage.There is growing consensus that continuity of care is a multidimensional concept. We identified four core elements: continuous care; care of an individual patient; cross-boundary care; and care recorded objectively. These elements help clarify conceptual boundaries, and incorporate measurement guidelines. With reference to these core elements, we define types of continuity of care, including informational continuity, management continuity, relational continuity and contact continuity. In order to improve continuity of care, better understanding is needed of the complex inter-relationship of core elements and types of continuity. A multilevel perspective on continuity of care can guide research to develop and evaluate new interventions. Achieving continuity of care is hindered by the lack of standard measures and administrative data appropriate to assessing continuity. Account should be taken not only of the nature of the patient population, but also of local conditions. To address these topics and identify best practices, research should be multidisciplinary and take a comparative, naturalistic form.

Objective: To examine clustering of energy balance-related behaviors (EBRBs) in young children. This is crucial because lifestyle habits are formed at an early age and track in later life. This study is the first to examine EBRB clustering in children as young as 2 years. Study design: Cross-sectional data originated from the Child, Parent and Health: Lifestyle and Genetic Constitution (KOALA) Birth Cohort Study. Parents of 2578 2-year-old children completed a questionnaire. Correlation analyses, principal component analyses, and linear regression analyses were performed to examine clustering of EBRBs. Results: We found modest but consistent correlations in EBRBs. Two clusters emerged: a "sedentary-snacking cluster" and a "fiber cluster." Television viewing clustered with computer use and unhealthy dietary behaviors. Children who frequently consumed vegetables also consumed fruit and brown bread more often and white bread less often. Lower maternal education and maternal obesity were associated with high scores on the sedentary-snacking cluster, whereas higher educational level was associated with high fiber cluster scores. Conclusions: Obesity-prone behavioral clusters are already visible in 2-year-old children and are related to maternal characteristics. The findings suggest that obesity prevention should apply an integrated approach to physical activity and dietary intake in early childhood. © 2009 Mosby, Inc. All rights reserved.

Walking is important for the health of elderly people. Previous studies have found a relationship between neighbourhood characteristics, physical activity and related health aspects. The multivariate linear regression model presented here describes the relationships between the perceived attractiveness of streets for walking along and (physical) street characteristics. Two hundred and eighty-eight independently living elderly people (between 55 and 80 years old) participated in the study. Street characteristics were assessed along homogeneous street subsections defined as 'links'. Positively related to perceived attractiveness of links were the following street characteristics: slopes and/or stairs, zebra crossings, trees along the route, front gardens, bus and tram stops, shops, business buildings, catering establishments, passing through parks or the city centre, and traffic volume. Litter on the street, high-rise buildings, and neighbourhood density of dwellings were negatively related to perceived link attractiveness. Overall, the results suggest that three main aspects affect perceived attractiveness of streets for walking, namely tidiness of the street, its scenic value and the presence of activity or other people along the street. The results are discussed within the context of these three aspects. © 2008 Elsevier Ltd. All rights reserved.

This paper describes explorations into related technology and research regarding the application of interactive video projection within physical education and the gym of the future. We discuss the application of exergaming in physical education, spatial augmented reality as a technology and participatory design with teachers and children as a design method to develop new concepts. Based on our initial findings we propose directions for further research. Further work includes developing new applications based on the wishes, needs and ideas of physical education teachers and children, incorporating opportunities provided by recent technological developments.

BACKGROUND AND OBJECTIVES: To review the clinimetric quality of motion sensors used to assess physical activity in healthy children and adolescents (2-18 years).METHODS: A systematic literature search was performed in PubMed, Embase, and SpycINFO. The clinimetric quality of two pedometers (Digi-Walker, Pedoboy), four one-dimensional accelerometers (LSI, Caltrac, Actiwatch, CSA/ActiGraph), and three three-dimensional accelerometers (Tritrac-R3D, RT3, Tracmor2) was evaluated and compared using a 20-item checklist.RESULTS: Overall, the quality of the studies (n = 35), and therefore the level of evidence for the reproducibility, validity, and feasibility of the motion sensors was modest (mean = 6.4 +/- 1.6 out of 14 points). There was strong evidence for a good reproducibility of the Caltrac in adolescents (12-18 years), a poor reproducibility of the Digi-Walker in children (8-12 years), a good validity of the CSA/ActiGraph in children and adolescents (8-18 years), and a good validity of the Tritrac-R3D in children (8-12 years).CONCLUSIONS: The CSA/ActiGraph and the Caltrac are the only motion sensors in which the reproducibility, validity, and feasibility have been examined in different age groups. Further studies of the reproducibility of motion sensors in preschool children, improvement of the quality of clinimetric studies, and evaluation of the acceptability of motion sensors are warranted.

The (pre)school environment is an important setting to improve children’s health. Especially, the (pre)school playground provides a major opportunity to intervene. This review presents an overview of the existing evidence on the value of both school and preschool playgrounds on children’s health in terms of physical activity, cognitive and social outcomes. In addition, we aimed to identify which playground characteristics are the strongest correlates of beneficial effects and for which subgroups of children effects are most distinct. In total, 13 experimental and 17 observational studies have been summarized of which 10 (77%) and 16 (94%) demonstrated moderate to high methodological quality, respectively. Nearly all experimental studies (n = 11) evaluated intervention effects on time spent in different levels of physical activity during recess. Research on the effects of (pre)school playgrounds on cognitive and social outcomes is scarce (n = 2). The experimental studies generated moderate evidence for an effect of the provision of play equipment, inconclusive evidence for an effect of the use of playground markings, allocating play space and for multi-component interventions, and no evidence for an effect of decreasing playground density, the promotion of physical activity by staff and increasing recess duration on children’s health. In line with this, observational studies showed positive associations between play equipment and children’s physical activity level. In contrast to experimental studies, significant associations were also found between children’s physical activity and a decreased playground density and increased recess duration. To confirm the findings of this review, researchers are advised to conduct more experimental studies with a randomized controlled design and to incorporate the assessment of implementation strategies and process evaluations to reveal which intervention strategies and playground characteristics are most effective. https://doi.org/10.1186/1479-5868-11-59 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

Background Active transport to school is associated with higher levels of physical activity in children. Promotion of active transport has therefore gained attention as a potential target to increase children’s physical activity levels. Recent studies have recognized that the distance between home and school is an important predictor for active travel among children. These studies did not yet use the promising global positioning system (GPS) methods to objectively assess active transport. This study aims to explore active transport to school in relation to the distance between home and school among a sample of Dutch elementary school children, using GPS. Methods Seventy-nine children, aged 6-11 years, were recruited in six schools that were located in five cities in the Netherlands. All children were asked to wear a GPS receiver for one week. All measurements were conducted between December 2008 and April 2009. Based on GPS recordings, the distance of the trips between home and school were calculated. In addition, the mode of transport (i.e., walking, cycling, motorized transport) was determined using the average and maximum speed of the GPS tracks. Then, proportion of walking and cycling trips to school was determined in relation to the distance between home and school. Results Out of all school trips that were recorded (n = 812), 79.2% were classified as active transport. On average, active commuting trips were of a distance of 422 meters with an average speed of 5.2 km/hour. The proportion of walking trips declined significantly at increased school trip distance, whereas the proportion of cycling trips (β = 1.23, p Conclusions In the current research setting, active transport between home and school was the most frequently used mode of travel. Increasing distance seems to be associated with higher levels of passive transport. These results are relevant for those involved in decisions on where to site schools and residences, as it may affect healthy behavior among children.

PURPOSE: Studies estimating the contribution of physical activity (PA) to the development of body mass index (BMI) in critical periods of childhood are warranted. Therefore, we have prospectively investigated this relationship in boys and girls of the KOALA Birth Cohort study, the Netherlands, in the period around adiposity rebound (i.e., 4-9 yr old). METHODS: PA was assessed in 470 children (231 boys, 239 girls) using accelerometers at the ages of 5 and 7 yr, and height and weight were measured at 5, 7, and 9 yr. BMI z-scores were calculated to standardize for age and sex. Leaner and heavier children were classified according to the 25th and 75th percentile of our study sample. To examine longitudinal relationships between PA and BMI z-scores, generalized estimating equation analyses were performed and stratified for sex and baseline weight status (leaner, normal weight, and heavier children). RESULTS: In heavier children, an increment of 6.5 min of moderate to vigorous PA (MVPA) was related to a subsequent decrease of 0.03 BMI z-scores both in boys (95% confidence interval = -0.07 to -0.001) and girls (95% confidence interval = -0.05 to -0.002). Light PA was also associated with a decrease of BMI in heavier boys but not girls. In normal weight children, MVPA was associated with decrease of BMI in boys but not girls. CONCLUSION: Increments of MVPA were associated with decreases in BMI z-score in heavier children, both boys and girls. Promoting MVPA should remain a major prevention vehicle for improving body composition in 4- to 9-yr-old children. Copyright © 2013 by the American College of Sports Medicine.

There has been an increasing focus on examining the relationship between neigh-bourhood built environment and health and health behaviours. This is mainly due to the potential of environmental interventions for having a sustained impact on entire population groups rather than a short-term impact on individuals (Giles-Corti et al. 2005). Moreover, environmental interventions may influence population groups that are hard to reach with health education programmes, such as those with lower edu-cation levels, lower incomes and language barriers (Swinburn et al. 1999). The relationship between where you live and health has long been recognised (Kawachi and Berkman 2003; Burton et al. 2011). In the past decade, the focus has been on the relationship between neighbourhood environment and physical activity to shed light on the potential drivers of the current overweight epidemic. Interest in the relation between built environment and physical activity has increased, mainly because many prevention and intervention strategies have had limited effect at population level (American Journal of Preventive Medicine 1998; Dishman and Buckworth 1996; Marcus et al. 2000; Dollman et al. 2005; McDonald 2007; Ooijendijk et al. 2008). Moreover, interest in this relationship has been stimulated by social—ecological models of health, which posit that changes in the natural and built environment that encourage physically active lifestyles may be as important as interventions at the individual or social level (Sallis et al. 2006; Brownson et al. 2009; Saelens et al. 2003; Giles-Corti and King 2009).

Background Children’s current physical activity levels are disturbingly low when compared to recommended levels. This may be changed by intervening in the school environment. However, at present, it is unclear to what extent schoolyard physical activity contributes towards reaching the daily physical activity guideline. The aim of this study was to examine how long and at what intensity children are physically active at the schoolyard during different time segments of the day. Moreover, the contribution of schoolyard physical activity towards achieving the recommended guideline for daily physical activity was investigated. Methods Children (n=76) between the age of 6–11 years were recruited in six different schools in five cities (>70.000 residents) in the Netherlands. During the weekdays of a regular school week, childrens’ physical activity and location were measured with ActiGraph accelerometers and Travelrecorder GPS receivers. Data was collected from December 2008 to April 2009. From the data, the amount of moderate to vigorous physical activity (MVPA) on and outside the schoolyard was established. Moreover, the percentage of MVPA on the schoolyard was compared between the following segments of the day: pre-school, school, school recess, lunch break and post-school. Differences between boys and girls were compared using linear and logistic mixed-effects models. Results On average, children spent 40.1 minutes/day on the schoolyard. During this time, boys were more active on the schoolyard, with 27.3% of their time spent as MVPA compared to 16.7% among girls (OR=2.11 [95% CI 1.54 - 2.90]). The children were most active on the schoolyard during school recess, during which boys recorded 39.5% and girls recorded 23.4% of the time as MVPA (OR=2.55 [95% CI: 1.69 - 3.85]). Although children were only present at the schoolyard for 6.1% of the total reported time, this time contributed towards 17.5% and 16.8% of boys’ and girls’ minutes of MVPA. Conclusions On the schoolyard, children’s physical activity levels are higher than on average over the whole day. Physical activity levels are particularly high during school recess. The school environment seems to be an important setting for improving children’s physical activity levels. Further research on the facilitators of these high activity levels may provide targets for further promotion of physical activity among children.

ObjectiveTo describe and identify correlates of objectively measured physical activity and sedentary behavior in 2-year-old toddlers.Study designA total of 347 children participating in a birth cohort study wore a unaxial ActiGraph accelerometer during 1 weekday and 1 weekend day. Information on potential correlates was assessed by parent-reported questionnaires, delivery reports, and regular visits to child health centers. Univariate and multivariable linear regression analyses were conducted to examine the associations between potential correlates and the following physical activity outcomes: percentage of time spent in sedentary behavior, percentage of time spent in moderate-to-vigorous physical activity, and mean counts per minute.ResultsA high percentage of monitored time was spent in sedentary behavior; 85.6% on weekdays and 84.5% on weekend days. Four correlates were significantly associated with at least 1 physical activity outcome in the multivariable regression models: child's sex, child's age, number of siblings, and season of measurement. The associations of gross motor development with moderate-to-vigorous physical activity and mean counts per minute approached significance. Associations of socioeconomic variables and child's body mass index z-score with physical activity outcomes were not significant.ConclusionTwo-year-old toddlers spend most of their time in sedentary behavior. No modifiable correlates were identified. Further research on physical activity and associated health benefits among very young children is warranted.Keywords: BMI, Body mass index, CPMCounts per minute, MVPAModerate-to-vigorous physical activity, NASPENational Association for Sport and Physical Education, TV, Television

Background Although environmental characteristics as perceived by parents are known to be related to children’s outdoor play behavior, less is known about the relation between independently measured neighborhood characteristics and outdoor play among children. The purpose of this study was to identify quantitative as well as qualitative neighborhood characteristics related to outdoor play by means of neighborhood observations. Methods Questionnaires including questions on outdoor play behavior of the child were distributed among 3,651 parents of primary school children (aged 4–12 years). Furthermore, neighborhood observations were conducted in 33 Dutch neighborhoods to map neighborhood characteristics such as buildings, formal outdoor play facilities, public space, street pattern, traffic safety, social neighborhood characteristics, and general impression. Data of the questionnaires and the neighborhood observations were coupled via postal code of the respondents. Multilevel GEE analyses were performed to quantify the correlation between outdoor play and independently measured neighborhood characteristics. Results Parental education was negatively associated with outdoor play among children. Neither the presence nor the overall quality of formal outdoor play facilities were (positively) related to outdoor play among children in this study. Rather, informal play areas such as the presence of sidewalks were related to children’s outdoor play. Also, traffic safety was an important characteristic associated with outdoor play. Conclusions This study showed that, apart from individual factors such as parental education level, certain modifiable characteristics in the neighborhood environment (as measured by neighborhood observations) were associated with outdoor play among boys and girls of different age groups in The Netherlands. Local policy makers from different sectors can use these research findings in creating more activity-friendly neighborhoods for children.

Purpose: The study's purpose was to identify children's physical activity type using artificial neural network (ANN) models based on uniaxial or triaxial accelerometer data from the hip or the ankle. Methods: Fifty-eight children (31 boys and 27 girls, age range = 9-12 yr) performed the following activities in a field setting: sitting, standing, walking, running, rope skipping, playing soccer, and cycling. All children wore uniaxial and triaxial ActiGraph accelerometers on both the hip and the ankle. Four ANN models were developed using the following accelerometer signal characteristics: 10th, 25th, 75th, and 90th percentiles; absolute deviation; coefficient of variability; and lag-one autocorrelation. The accuracy of the models was evaluated by leave-one-subject-out cross-validation. Results: The models based on hip accelerometer data correctly classified the activities 72% and 77% of the time using uniaxial and triaxial accelerometer data, respectively, whereas the models based on ankle accelerometer data achieved a percentage of 57% and 68%. The hip models were better able to correctly classify the activities walking, rope skipping, and running, whereas the ankle models performed better when classifying sitting. The models based on triaxial accelerometer data produced a better classification of the activities standing, running, rope skipping, playing soccer, and cycling than its uniaxial counterparts. Conclusions: Applying ANN models to processing accelerometer data from children is promising for classifying common physical activities. The highest percentage of correctly classified activities was achieved when using triaxial accelerometer data from the hip. © 2011 by the American College of Sports Medicine.

Background Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development. Methods Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics. Results Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for normal eaters. By contrast, stimulation to eat healthy worked particularly well for children with a deviant eating style or a high BMI. Conclusion Although most energy balance-related parenting practices were associated with desirable behaviors, some practices showed associations with undesirable child behavior and weight outcomes. Only parental stimulation showed desirable associations with regard to both diet and activity behavior. The interaction between parenting and child characteristics in the association with behavior calls for parenting that is tailored to the individual child.

This study examined built environmental correlates of children's walking and cycling behavior. Four hundred and forty-eight children from 10 Dutch neighborhoods completed a seven-day physical activity diary in which the number of walking and cycling trips for transportation, to school, and for recreation were assessed. The associations between observed built environmental characteristics and children's walking and cycling behavior were examined with multivariate linear regression analyses. The results showed that built environmental correlates of children's walking and cycling behavior differ by purpose and by commuting mode implying a behavior-specific approach for interventions and for future, preferably prospective, studies. © 2010 by the authors.

Purpose: To review recently published studies on the reproducibility, validity, and feasibility of motion sensors used to assess physical activity in healthy children and adolescents (2-18 yr). Methods: On October 2004, a systematic literature search in PubMed, EMBASE, and PsycINFO was performed. This search has been updated on October 2007. In this update, the clinimetric quality of three pedometers (Digi-Walker, Walk4Life, and Sun TrekLINQ) and nine accelerometers (ActiGraph, BioTrainer, StepWatch Activity Monitor, Actiwatch, Actical, Tritrac-R3D, RT3, ActivTracer, and Mini-Motionlogger) has been evaluated and compared using a checklist. Results: Thirty-two recently published clinimetric studies have been reviewed. All 12 motion sensors have been validated in youth in one or more studies. There is strong evidence for moderate validity of the StepWatch in children and adolescents (4-18 yr) and moderate to good validity of the ActiGraph in preschool children and young children (2-8 yr). There is less evidence for the reproducibility and feasibility of the 12 motion sensors. Strong evidence exists for good reproducibility of the ActiGraph in preschool children (2-4 yr). Conclusion: Compared to the review performed in 2004, there is increased evidence for the clinimetric quality of pedometers and accelerometers in youth. Most motion sensors seem reproducible, valid, and feasible in assessing physical activity in youth. © 2009 The American College of Sports Medicine.

Purpose: To investigate the effect of guideline operationalization in terms of intensity threshold, bout duration, and days on the proportion of children meeting the health-related 60-min physical activity guideline using a subjective and an objective assessment method. Methods: Five hundred and twenty-one children (6-11 yr) completed a physical activity diary for at least 4 d. A subsample of 51 children simultaneously wore an ActiGraph (ActiGraph, Pensacola, FL) accelerometer. Time spent above moderate-intensity thresholds of 3 and 5 METs, respectively, for continuous bouts of at least 1, 5, and 10 min was calculated. For each intensity threshold and bout duration, the proportion of children meeting the 60-min guideline was calculated. A distinction was made between meeting the 60-min threshold on each assessment day and meeting this threshold on average across all assessment days. Results: The proportion of children meeting the 60-min guideline differed considerably by guideline operationalization and assessment method. It ranged from 3% to 86% using the diary and from 0% to 100% using the ActiGraph. Overall, a higher proportion of children met the guideline when the 3-MET intensity threshold was used compared with the 5-MET threshold and when a shorter bout duration was used compared with a longer bout duration. More children met the guideline on average across all assessment days compared with the guideline on each assessment day. In general, boys were found to be more active than girls, independent of guideline operationalization and assessment method. Conclusion: Meeting the 60-min guideline highly depends on guideline operationalization and assessment method. Consensus about how the guideline should be operationalized is needed to monitor the extent to which populations of children meet the guideline and to simplify comparison, between studies Copyright © 2008 by the American College of Sports Medicine.

Purpose. To examine the association between children's physical activity and factors of the built environment. Design. Cross-sectional study. Setting. Ten neighborhoods in six cities in the Netherlands. Subjects. Four hundred twenty-two children (age range, 6–11 years; 49% male). Measures. Physical activity diary, neighborhood observations, and anthropometric measures. Analysis. Univariate and multivariate linear regression analyses. Results. According to univariate analyses adjusted for age, sex, body mass index, and highest level of maternal education, physical activity (≥ 3 metabolic equivalents) was significantly (p < .05) associated with the proportion of green space, with the residential density, with the general impression of activity-friendliness of the neighborhood, and with the frequency of certain types of residences (e.g., terraced houses), sports fields, water, dog waste, heavy traffic, and safe walking and cycling conditions (e.g., cycle tracks and 30-km speed zones) in the neighborhood. According to adjusted multivariate analyses, physical activity was best predicted by the frequency of parallel parking spaces in the neighborhood and by the general impression of activity-friendliness of the neighborhood (R2 = 0.193). Conclusions. Children's physical activity is associated with certain modifiable factors of the built environment. Longitudinal studies should examine whether there is a causal relationship.