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Background: Evidence for longitudinal associations between childhood weight status and academic achievement remains unclear due to considerable heterogeneity in study design, measures of academic achievement and appropriate categorization of weight status. Objective: To examine longitudinal associations between childhood weight status (underweight, healthy weight, overweight/obese) and academic achievement in the transition from preschool to primary (elementary) school among Australian school children. Methods: Data were from the Healthy Active Preschool and Primary Years study. Height and weight, for calculating BMI were measured at baseline (preschool age 3–5 years; 2008/9) and follow-up (primary school age 6–8 years; 2011/12). Academic achievement was measured at age 9 years. Results: No associations between BMI z-score or weight category in the preschool years and later NAPLAN scores were found for boys. For girls, having a higher BMI z-score (B = −13.68, 95%CI: −26.61, −0.76) and being affected by overweight (B = −33.57, 95%CI: −61.50, −5.24) in preschool was associated with lower language scores. Remaining affected by overweight from preschool to primary school was associated with lower numeracy (B = −25.03, 95%CI: −49.74, −0.33), spelling (B = −33.5, 95%CI: −63.43, −3.58), language (B = −37.89, 95%CI: −72.75, −3.03) and total achievement scores (B = −24.24, 95%CI: −44.85, −3.63) among girls. For boys, becoming affected by overweight was associated with lower spelling (B = −38.76, 95%CI: −73.59, −3.93) and total achievement scores (B = −27.70, 95%CI: −54.81, −0.58). Conclusions: Associations between being affected by overweight/obesity and poorer academic achievement were more pronounced in girls than boys, indicating potentially inequitable impacts of excess weight and highlighting the greater need for intervention among girls. However, stronger study designs are needed to confirm our findings. Refereed/Peer-reviewed

BACKGROUND: To achieve sustainability, we must consider scalable improvements in student movement behavior in the classroom setting, educational priorities. Flexible learning spaces that employ student‐centered pedagogy and contain a range of furniture and layout options, implemented to improve educational outcomes, may enable unintended health benefits. In this review, we summarize the evidence on the effects of flexible learning spaces on adolescent student movement behaviors and educational outcomes. METHODS: We searched 5 databases, retrieving 5 quantitative and one qualitative article meeting the review criteria. RESULTS: Students in flexible learning spaces spent less time sitting, and more time standing and moving. Students were also more engaged, on‐task, and collaborated and interacted more. Academic results for English, Mathematics and Humanities for those in flexible learning spaces were higher than peers in traditional classrooms. CONCLUSION: Evidence from the reviewed studies suggests that there may be beneficial outcomes across some movement behaviors as well as learning outcomes in classrooms that employ student‐centered pedagogy and use a built environment that facilitates autonomy and choice around where and how to learn. These learning environments present an opportunity for an interdisciplinary approach to address sedentary behavior in classrooms.

Aim This study examined the prevalence and risk factors of fine motor delay in Australian pre-school children from low-income communities. Methods Children from the Early Start Baseline Study completed the Ages and Stages Questionnaire (3rd edn.). Age, sex, executive function and family characteristics were assessed and associations with fine motor skills analysed. Results Data were available for 700 children (Mage 54.0 ± 8.6 months, 53.1% boys) of which 77.4% were typically developing, 12.1% at risk and 10.4% delayed for fine motor skill. Children had higher odds of being delayed if they were male (odds ratio (OR) 3.30, 95% confidence interval (CI) 2.22-4.90) or indigenous (OR 3.31, 95% CI 2.12-5.16) and had lower self-regulatory (OR 2.17, 95% CI 1.31-3.58). Higher vocabulary (OR 0.92, 95% CI 0.89-0.94), higher family income (OR 0.22, 95% CI 0.05-0.90) and family education (OR 0.25, 95% CI 0.08-0.74) were associated with lower odds of delay. Conclusion Almost one in four children from vulnerable communities experience fine motor difficulties, highlighting the importance of early screening and targeting key child and environmental risk factors.

The purpose of this systematic review was to investigate professional learning models (length, mode, content) offered as part of objectively measured physical childcare-based interventions. A systematic review of eight electronic databases was conducted to June 2017. Only English, peer-reviewed studies that evaluated childcare-based physical activity interventions, incorporated professional learning and reported objectively measured physical activity were included. Study designs included randomized controlled trails, cluster randomized trials, experimental or pilot studies. The search identified 11 studies. Ten studies objectively measured physical activity using accelerometers; five studies used both accelerometer and direct observation tools and one study measured physical activity using direct observation only. Seven of these studies reported statistically significant intervention effects. Only six studies described all components of professional learning, but only two studies reported specific professional learning outcomes and physical activity outcomes. No patterns were identified between the length, mode and content of professional learning and children's physical activity outcomes in childcare settings. Educators play a critical role in modifying children's levels of physical activity in childcare settings. The findings of this review suggest that professional learning offered as part of a physical activity intervention that potentially impacts on children's physical activity outcomes remains under-reported.

Summary: This study investigated the effects of physical activities that were integrated into a science lesson on learning among preschool children. A total of 90 children from seven childcare centres (Mage = 4.90, SD = 0.52; 45 girls) were randomly assigned across an integrated physical activity condition including task-relevant physical activities, a nonintegrated physical activity condition involving task-irrelevant physical activities, or a control condition involving the predominantly conventional sedentary style of teaching. Children learned the names of the planets and their order, based on the distance from the sun. For both the immediate and delayed (6 weeks after the programme) assessments, results showed that learning outcomes were highest in the integrated condition and higher in the nonintegrated condition than in the control condition. Children in the integrated condition scored higher on perceived enjoyment of learning than children in the control condition. Implications of integrated physical activity programmes for preschool children's health, cognition, and learning are further discussed. Copyright © 2017 John Wiley & Sons, Ltd.

Background The associations between sleep characteristics and adiposity in children under three years are not fully understood yet. Objective The objective of the study is to examine the cross-sectional and prospective associations between sleep characteristics and adiposity in toddlers over a 12-month period. Methods Participants were 202 toddlers from the GET-UP! Study Sleep duration, sleep timing, and sleep variability were assessed using 24-hour accelerometry for seven consecutive days. Height and weight were measured, and BMI z scores were calculated. Linear mixed models were performed to examine the cross-sectional and prospective associations between sleep characteristics and adiposity, with adjustments for clustering effects and demographic factors. Results Total sleep duration was negatively associated with higher adiposity cross-sectionally (B = -0.12; 95% CI: -0.23, -0.01; .033) but not prospectively (B = 0.01; 95% CI: -0.13, 0.10; .843). Nap duration was prospectively associated with higher levels of adiposity (B = 0.41; 95% CI: 0.14, 0.68; .003). Sleep variability and sleep timing were not associated with concurrent or subsequent adiposity. Conclusion Although sleep duration is an important factor associated with obesity in toddlerhood, the potential effects of different types of sleep duration may vary. While longer total sleep duration may protect children from increasing adiposity, longer nap duration seems to be risk factor. As evidence in this age group is scarce, more research is needed to confirm this finding.

In this intervention study, we investigated the effects of physical activities that were integrated into a geography task on preschool children's learning performance and enjoyment. Eight childcare centers with 87 four-to-five-year-old children were randomly assigned across an integrated physical activity condition, an unintegrated physical activity condition, and a control condition without physical activity. Children learned the names and a typical animal from each of the six continents using a floor-mounted world map with soft toy animals. Both learning conditions with physical activities showed higher performance than the learning condition without physical activities on an immediate retention test, and on a delayed retention test administered five weeks later. In addition, children in the physical activity conditions (integrated and nonintegrated) enjoyed their learning method the most. Infusing task-relevant physical activities into the classroom and the learning task is discussed as a promising way to improve children's learning, enjoyment, and health.

Objective To examine associations of volumes and bouts of sedentary behavior (SED) and moderate-to-vigorous physical activity (MVPA) with individual and clustered cardio-metabolic outcomes in overweight/obese children. Methods Cross-sectional data from 120 overweight/obese children (8.3 ± 1.1 years, 62% girls, 74% obese) with SED and MVPA assessed using accelerometry. Children were categorized into quartiles of mean bouts per day of SED (10, 20, and 30 min) and MVPA (5, 10, and 15 min). Associations with triglycerides, HDL cholesterol, glucose, insulin, systolic/diastolic blood pressure, and clustered cardio-metabolic risk (cMet) were examined using linear regression, adjusted for confounders. Results Independent of MVPA, SED volume was inversely associated with HDL cholesterol (β [95% CI] = −0.29 [−0.52, −0.05]). MVPA volume was inversely associated with diastolic blood pressure, independent of SED (β = −0.22 [−0.44, −0.001]), and cMet (β = −0.19 [−0.36, −0.01]) although not after adjustment for SED (β = −0.14 [−0.33, 0.06]). Independent of MVPA and SED volumes, participants in the highest quartile of 30 min bouts per day of SED had 12% lower HDL cholesterol than those in the lowest quartile (d = 0.53, P = 0.046, Ptrend = 0.11). Conclusions In addition to increasing MVPA, targeting reduced SED and limiting bouts of SED to

The purpose of this observational study was to compare the mastery of 12 fundamental movement skills (FMS) and skill components between a treatment-seeking sample of overweight/obese children and a reference sample from the United States. Mastery of six locomotor and six object-control skills (24 components in each subdomain) were video-assessed by one assessor using the test of gross motor development-2 (TGMD-2). The 153 overweight/obese children (mean ± s.d. age = 8.3 ± 1.1 years, BMI z-score = 2.78 ± 0.69, 58% girls, 77% obese) were categorized into age groups (for the underhand roll and strike: 7–8 years and 9–10 years; all other FMS: 6–7 years and 8–10 years) and mastery prevalence rates were compared with representative US data (N = 876) using χ2 analysis. For all 12 skills in all age groups, the prevalence of mastery was lower among overweight/obese children compared with the reference sample (all P < 0.05). This was consistent for 18 locomotor and upto 21 object-control skill components (all P < 0.05). Differences were largest for the run, slide, hop, dribble, and kick. Specific movement patterns that could be targeted for improvement include positioning of the body and feet, the control or release of an object at an optimal position, and better use of the arms to maintain effective force production during the performance of FMS. Physical activity programs designed for overweight and obese children may need to address deficiencies in FMS proficiency to foster the movement capabilities required for participation in health-enhancing physical activity.

Aims: To assess the acceptability and potential efficacy of an online healthy lifestyles program for parents of overweight, or at risk of overweight, preschool-aged children. Methods: A pilot trial was conducted within a regional area of New South Wales, Australia. Two cohorts totalling 47 dyads were recruited. Primary outcomes were parental self-reported perceived knowledge and parental proxy-reported behaviour of their child. Data analysis was completed using the Statistical Package for Social Sciences (v 16). Results: At follow up (10 weeks) parents reported high acceptability of the program. Changes in the hypothesised direction were reported for all parental perceived knowledge and parental and child behavioural outcomes. Conclusion: This is the first study to describe the acceptability and potential efficacy of an online healthy lifestyles program for parents of preschool children. The Time2bHealthy Program offers a viable option for parental involvement in obesity prevention programs targeting young children. Given the online nature of the program it has the capacity to be utilised within metropolitan, regional and rural areas of Australia.

Aim: The purpose of the present study was to describe preliminary research preceding the development of an online educational program for parents of preschool-aged children who are overweight or at-risk of overweight. Methods: The study consisted of an evaluation of current health-related websites and four focus groups with typical-end point users. It was conducted in one metropolitan region in New South Wales. Twenty-seven participants were recruited for the focus groups. The focus groups aimed to investigate the thoughts and opinions of participants towards an online educational program. Focus group transcripts were analysed using logico-inductive analysis procedures. Results: The evaluation of the websites revealed that most were largely repositories of information and did not provide guidance on how to practically implement the information into everyday life. Several themes emerged from the focus groups, including: usability and readability; credibility; inclusiveness; personalisation and practical help in modifying current behaviours. Conclusions: The present study highlights many of the limitations in current online programs/websites and interventions targeting preschool children. We have attempted to address these in the design and development of the Time2bHealthy Program. The present study describes the first step in the development of a novel and innovative initiative that has the potential to make a contribution to long-term health of preschool children and their families.

Efforts to treat obesity in childhood and adolescence would benefit from a greater understanding of evidence-based strategies to modify physical activity behaviour. A systematic review was conducted to examine the impact of child and adolescent obesity treatment interventions on physical activity. Studies included were randomized controlled trials or controlled trials, with overweight and obese youth (aged or=6/10). Research evaluating the effect of child and adolescent obesity treatment trials on physical activity is limited in both quantity and quality. Studies testing innovative, theoretically driven treatment approaches that use robust methodologies are required to better understand generalizable approaches for promoting physical activity participation among obese youth.

Aim: To determine the health-care charges associated with monitoring and managing, over 1 year, the cases of elevated insulin concentration, elevated alanine aminotransferase concentration and dyslipidaemia due to overweight or obesity among 15-19-year-old Australian males and females. Methods: Fasting blood samples (n = 500) were collected in 2004 from a representative population sample of adolescents (n = 496; mean age 15.3 years) attending schools in Sydney, Australia. Full service charges and Medicare expenditures for specialist medical and dietary consultations, pathology tests and radiological investigations, over 1 year, under efficient and inefficient health-care delivery models, including and excluding participants in the healthy body mass index (BMI) category. Results: Under an inefficient delivery model and including all participants with elevated risk factors, the Medicare expenditure was $A305.1 million per annum (M pa). Exclusion of participants in the healthy BMI category resulted in an annual Medicare expenditure of $A170.0M pa. Under an efficient delivery model and including all participants with elevated risk factors, the Medicare expenditure was $A295.5M pa. Exclusion of participants in the healthy BMI category reduced annual Medicare expenditure to $A164.8M pa. Medicare expenditure for 15-19-year-olds would increase by 48% if only cases among overweight and obese adolescents were treated and by 85% if all cases were identified and treated. Conclusions: Short-term management of the health consequences of overweight and obesity among adolescents will increase Medicare expenditure on this group by at least 48%. Failure to treat will delay, but compound, health-care expenditure. © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

The aim of this study was to determine compliance with the National Association for Sport and Physical Education (NASPE) guideline for physical activity and American Academy of Pediatrics (AAP) recommendation for electronic media use among urban pre-school children in two large cities on the East Coast of Australia. Cross-sectional data were collected from 266 parents. Time spent using electronic media (watching television, DVDs or on the computer) and in physical activity were parent reported. The proportion who met each guideline was calculated. 56 per cent and 79% of children met the NASPE guideline on weekdays and weekends, respectively, while 73% and 70% met the AAP recommendation on weekdays and weekends, with no difference between boys and girls. A substantial minority do not meet physical activity and electronic media use recommendations, highlighting the need to better understand what factors contribute to physical activity and electronic media use among this group of pre-schoolers.

The aim of this study was to identify potential correlates of objectively measured physical activity in a sample of obese children. A cross-sectional design was used to assess 137 5-9-year-old obese children (mean +/- s.d. age = 8.3 +/- 1.1 years; mean BMI z-score = 2.76 +/- 0.70; 58% girls) from two regional cities in New South Wales, Australia, before commencement in a treatment trial. Correlates examined included age, BMI z, parental BMI, perceived competence, health-related quality of life, daily minutes spent in small screen recreation (SSR), and fundamental motor skill (FMS) proficiency. Physical activity was assessed using accelerometers and values were calculated for % of monitored time spent in moderate- (MPA) and vigorous (VPA)-intensity physical activity and mean counts per minute (CPM). Analyses were conducted separately for boys and girls. Motor skill proficiency was significantly correlated with a number of physical activity variables for boys and girls. For boys, regression analysis revealed object-control proficiency predicted CPM (R(2) = 0.25) and age was a predictor of %MPA (R(2) = 0.56). Age and object-control skill proficiency were salient predictors of %VPA (R(2) = 0.34). For girls, age and daily minutes of SSR were the only significant predictors for CPM (R(2) = 0.13). Age was the sole predictor of %MPA (R(2) = 0.38) and %VPA (R(2) = 0.15). The targeting of FMSs at an early age should be tested in experimental studies as potential strategies to increase physical activity among obese children, particularly for boys. Interventions aimed at reducing sedentary behaviors among obese girls should also be considered.

Aim: Relatively little is known about the results of liver tests among adolescents. The purpose of this study was to describe the distributions of liver tests, to identify the upper normal limits (UNLs) and to describe the correlations among liver tests. Methods: Overnight fasting blood samples were collected from a representative population sample of 500 Grade 10 students (15 years old) attending schools in Sydney, Australia. Weight, height and waist girth were measured. UNLs were calculated for each enzyme as the 95th percentiles of the healthy body mass index category, after excluding those with high blood pressure, elevated low-density lipoprotein cholesterol (≥3.4 mmol/L) or triglyceride concentration (≥2.25 mmol/L) (n = 246). The distributions of alanine aminotransferase (ALT), γ-glutamyltransferase (GGT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were described, UNLs were identified and the correlations between enzyme concentrations were described. Results: The UNLs for ALT were 32 and 20 U/L; for GGT, 24 and 19 U/L; for AST, 33 and 26 U/L; and for ALP, 385 and 183 U/L, for boys and girls, respectively. ALT concentration was strongly correlated with GGT and AST (r = 0.5–0.6). Neither ALT nor GGT concentrations were correlated with ALP concentration, but AST concentration was moderately correlated with ALP concentration. Conclusions: These data are valuable in defining the distributions of liver tests, normal liver test ranges and relationships between liver tests among adolescents.

AIM: Active transport to and from school is frequently identified as an opportunity to increase energy expenditure among young people. The epidemiology of travel behaviours among Grade 6, 8 and 10 students in NSW is reported. METHODS: A representative population survey of students in NSW, Australia was conducted during February to May 2004 (n = 2750) and the prevalence of travelling to and from school by walking, car and public transport was determined for Grade 6, 8 and 10 students. RESULTS: Among Grade 6 students, approximately 30% travelled by car, 30% walked and 20% used public transport to travel to school (the travel habits of 20% could not be accurately characterised). Among secondary school students, approximately 50% used public transport, 15-20% travelled by car and 15-20% walked. Among those who walked or used public transport, the median times spent walking were 10-15 min and 5 min per trip, respectively. CONCLUSIONS: While there is little scope to increase the prevalence of active transport among secondary school students, there is potential to do so among primary school students. Primary school students who replace travelling to and from school by car with walking will experience an increase in activity energy expenditure of up to 10% and those who change to public transport will experience an increase in activity energy expenditure of up to 3%. Language: en

Objective: To determine secular trends in overweight/obesity among 7- to 15-year-olds for the periods 1985, 1997, and 2004. Research Method and Procedures: Data from representative surveys conducted in New South Wales, Australia, in 1985, 1997, and 2004 were analyzed. Height and weight were measured, and BMI categories were created using International Obesity Task Force definitions. Students were grouped as Grades 2 + 4 + 6 and 8 + 10. Results: The prevalences of overweight/obesity for 1985, 1997, and 2004 were 10.9%, 20.6%, and 25.7% among the younger boys and 10.6%, 19.5%, and 26.1% among the older boys. The average annual rate of increase for 1985 to 1997 was 0.81% and for 1997 to 2004 was 0.73% among the younger boys and was 0.74% and 0.94% for the two periods among the older boys. The prevalences of overweight/obesity in 1985, 1997, and 2004 were 14.0%, 22.0%, and 24.8% among the younger girls and 8.3%, 17.9%, and 19.8% among the older girls, respectively. The average annual rates of increase for the two periods were 0.8% and 0.4% among the younger girls and 0.80% and 0.27% among the older girls. Change in the prevalence of overweight/obesity and socioeconomic status were not associated. Discussion: Over the period 1985 to 1997, the prevalence of overweight and obesity increased significantly among the younger and older boys and the younger girls. The prevalence of overweight, but not obesity, increased among the older girls over this period. Over the period 1997 to 2004, the prevalence of overweight/obesity combined increased significantly among boys of both age groups but not among girls.

Aim: To describe the epidemiology of small screen recreation (SSR) that is: television, computer, video, and DVD use among school students aged 11–15 years in New South Wales, Australia. Methods: Cross-sectional representative population survey (n = 2750) of 45 primary and 48 secondary schools in rural and urban areas. Self-reported time spent in SSR was categorised according to national guidelines into less than 2 h per day (low users) or 2 or more hours per day (high users). Results: Of primary and secondary school students, 53% and 72%, respectively, were high users of SSR. Boys spent significantly more time in SSR and were more likely to be high users of SSR compared with girls. For primary students, rural boys had a higher prevalence of high SSR use than urban boys (odds ratio (OR) 1.9, 95% confidence interval (CI) 1.0–3.5), while overweight girls had a higher prevalence than healthy-weight girls (OR 1.8, 95% CI 1.2–2.8). For secondary students, rural boys had a lower prevalence of high SSR use than urban boys (OR 0.5, 95% CI 0.3–0.6), and girls from high SES backgrounds had a lower prevalence than girls from low socio-economic status backgrounds (OR 0.6, 95% CI 0.3–1.0). Conclusion: The majority of school students in New South Wales exceed the national guidelines for SSR. Reducing the time spent in SSR among young people is one potential approach to increasing energy expenditure and reducing adiposity or maintaining a healthy weight. First steps for intervention strategies among school-age children to reduce SSR could include teaching awareness skills and self-monitoring techniques.

Just as children need to be taught their ABCs to read and write, they also need to be taught fundamental movement skills (FMS), such as running, jumping, throwing and kicking, to provide the strongest foundation for a physically active lifestyle. Children who are proficient at FMS are more likely to be physically active and have adequate cardiorespiratory fitness, and are less likely to be overweight or obese compared with children who are not proficient. In addition, FMS-proficient children are more likely to become adolescents who are more active and with higher cardiorespiratory fitness levels.

Child obesity was described by the World Health Organisation in 1998 as one of the most pressing public health issues of our time that requires an urgent and informed response. (1) Unfortunately, despite much attention and efforts, the juggernaut that is the child obesity epidemic shows no sign of slowing down. The most recent representative data from Australia report that around 25% of school-aged children and adolescents (2) and 20% of preschool children (3) are overweight or obese, and that this figure continues to increase, even accelerate, among boys. The immediate health consequences of child obesity are well known and affect most body systems. (4) From a psychosocial perspective, obese children have poorer quality of life (5) and commonly experience peer prejudice. (6) Because obese children are more likely than their lean counterparts to become obese adults and suffer the associated adverse health outcomes, obese children have an increased risk of mortality and chronic adult health conditions, such as heart disease, diabetes and some cancers. (7) Clearly, strategies are needed at all levels of society and by all stakeholders if there is to be any hope of turning this problem around. The National Health and Medical Research Council The National Health and Medical Research Council (NHMRC) is Australia's peak funding body for medical research, with a budget of nearly A$500M a year . The Council was established to develop and maintain health standards and is responsible for implementing the ..... Click the link for more information. of Australia recommends that simple, well-designed interventions incorporating conventional weight-management strategies and which can be translated into practice are urgently needed in Australia. (8) This seems like a natural and sensible response.