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Background: Physiotherapy and occupational therapy are currently described using the duration of treatment (days or weeks), the frequency of therapy sessions (on a daily or 3-5 days per week basis) and considering the duration of a session (e.g., 30 or 45 min). The content is often poorly defined and the intensity is rarely reported. Using digital technology some of these shortcomings can be overcome. The cumulative parameters of walking and activity sessions, the duration of walking, the time spent in an upright or lying/sitting position and the number of steps can now be analyzed. In this study, we examined the parameters during non-treatment periods and therapy time in patients recovering from fragility fractures., Methods: The study is a secondary data analysis of a trial that examined the improvement of physical activity (PA) and self-efficacy of fragility fracture patients. Changes in mobility parameters were measured using the ActivPal3 sensor during the 1st and 3rd weeks of rehabilitation and 104 patients were analyzed (mean age 82.5 years). Parameters included the time during supervised treatment, the mean number of steps, cumulative time in an upright position and walking duration, the number of walking intervals of > 10 s and sit to stand transfers., Results: Patients received 3-4 therapy sessions adding up to 90-120 min per day. More than 50% of the daily walking activities were achieved in these sessions until discharge. With this amount of therapeutic input most parameters meaningfully improved from baseline to the second measurement. The number of steps increased by 30%, the mean time in an upright position increased by 26% and the mean time spent walking increased by 49%., Conclusion: The sensor-derived measurements describe the amount of walking activity administered during the supervised therapy sessions. This could be used as a starting point for future trials to improve the outcomes or as a standard of process evaluation for clinical services., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Children who are overweight and obese display lower physical activity levels than normal weight peers. Measures of weight status, perceived motor competence, and motor skill performance have been identified as potential correlates explaining this discrepancy. 1881 children (955 males; 926 females; 9.9 years) were assessed as part of the Physical Health Activity Study Team project. The age, habitual physical activity participation (PAP), body mass index (BMI), socioeconomic status (SES), motor performance (MP), and perceived athletic competence (PAC) of each child included were assessed. Gender-specific linear regression analyses (main effects model) were conducted to identify the percent variance in PAP explained by the following variables: BMI, MP, and PAC. For males, 18.3% of the variance in PAP was explained by BMI, MP, and PAC. PAC explained 17% of the variance, while MP, BMI, and SES only accounted for 0.6%, 0.7%, and 0.5%, respectively. PAC explained 17.5% of PAP variance in females; MP explained 0.8%. BMI, SES, and chronological age were not significant correlates of PAP in girls. An established repertoire of motor skill performance has been seen as a vehicle to PAP in children; however, this study indicates that PAC should not be overlooked in intervention strategies to promote increased PAP.

This study investigated the utility of the Study of Health and Activity in Preschool Environments (SHAPES) conceptual model, which targeted physical activity (PA) behavior in preschool children, by examining the relationship between implementation monitoring data and child PA during the school day. We monitored implementation completeness and fidelity based on multiple elements identified in the conceptual model. Comparing high-implementing, low-implementing, and control groups revealed no association between implementation and outcomes. We performed post hoc analyses, using process data, to refine our conceptual model's depiction of an effective preschool PA-promoting environment. Results suggest that a single component of the original four-component conceptual model, providing opportunities for moderate-to-vigorous physical activity through recess for 4-year-old children in preschool settings, may be a good starting place for increasing moderate-to-vigorous physical activity. Interventions that are implemented with optimal levels of completeness and fidelity are more likely to achieve behavior change if they are based on accurate conceptual models. Examining the mechanisms through which an intervention produces its effects, as articulated in the conceptual model that guides it, is particularly important for environmentally focused interventions because they are guided by emerging frameworks. The results of this study underscore the utility of using implementation monitoring data to examine the conceptual model on which the intervention is based.

We investigated the longitudinal associations among physical activity (PA), motor competence (MC), cardiorespiratory fitness (VO 2peak ), and body fatness across 7 years, and also analyzed the possible mediation effects of PA, MC, and VO 2peak on the relationships with body fatness. This was a seven-year longitudinal study with three measuring points (mean ages [in years] and respective sample size: 6.75±0.37, n=696; 9.59±1.07, n=617; 13.35±0.34, n=513). PA (moderate-to-vigorous PA-MVPA and vigorous PA-VPA) was monitored using accelerometers. MC was assessed by the "Körperkoordinationstest für Kinder-KTK" test battery. VO 2peak was evaluated using a continuous running protocol until exhaustion. Body fatness was determined by the sum of four skinfolds. Structural equation modeling was performed to evaluate the longitudinal associations among PA, MC, VO 2peak, and body fatness and the potential mediation effects of PA, MC, and VO 2peak . All coefficients presented were standardized (z-scores). MC and VO 2peak directly influenced the development of body fatness, and VO 2peak mediated the associations between MVPA, VPA, MC, and body fatness. MC also mediated the associations between MVPA, VPA, and body fatness. In addition, VO 2peak had the largest total association with body fatness (β=-0.431; P<.05), followed by MC (β=-0.369; P<.05) and VPA (β=-0.112; P<.05). As PA, MC, and VO 2peak exhibited longitudinal association with body fatness, it seems logical that interventions should strive to promote the development of fitness and MC through developmentally appropriate physical activities, as the synergistic interactions of all three variables impacted body fatness., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The current study evaluated the reciprocal longitudinal relationship between physical activity (PA) and motor competence (MC) and the potential mediation of cardiorespiratory endurance across 7 years., Methods: This was a 7-year longitudinal study, the Copenhagen School Child Intervention Study (CoSCIS), with 3 measuring points [mean ages (in years) and respective sample size: 6.75 ± 0.37, n = 696; 9.59 ± 1.07, n = 617; 13.35 ± 0.34, n = 513]. PA was assessed using accelerometers. MC was evaluated by the Körperkoordinationstest für Kinder (KTK) test battery. Cardiorespiratory fitness (VO 2 peak) was evaluated using a continuous running protocol until exhaustion. Structural equation modeling was performed to evaluate the longitudinal associations., Results: Vigorous PA (VPA) and MC presented reciprocal longitudinal association during the 7-year follow-up (VPA → MC; β = 0.18; 95% CI: 0.10, 0.26; MC → VPA; β = 0.14; 95% CI: 0.08, 0.21). In addition, VO 2 peak mediated the relationship in both directions (VPA → MC; β = 0.09; 95% CI: 0.06, 0.12; MC → VPA; β = 0.06; 95% CI: 0.03, 0.09)., Conclusions: PA and MC presented a positive reciprocal relationship across childhood through early adolescence and VO 2 peak mediated the association in both directions. Interventions targeting to increase PA in children and adolescents should also address the development of MC skills because of the clear positive feedback loop between PA and MC.

Background: The role of psychosocial stress in the development of obesity and metabolic syndrome is receiving increased attention and has led to examination of whether physical activity may moderate the stress-metabolic syndrome relationship. The current study examined relationships among physical activity, stress, and metabolic syndrome in adolescents., Methods: Participants (N = 126; 57 girls, 69 boys) were assessed for anthropometry, psychosocial stress, physical activity, and metabolic syndrome variables; t tests were used to examine sex differences, and regression analysis was used to assess relationships among variables controlling for sex and maturity status., Results: Mean body mass index approached the 75th percentile for both sexes. Typical sex differences were observed for systolic blood pressure, time spent in moderate and vigorous physical activity, and perceived stress. Although stress was not associated with MetS (β = -.001, P = .82), a modest, positive relationship was observed with BMI (β = .20, P = .04)., Conclusions: Strong relationships between physical activity and stress with MetS or BMI were not found in this sample. Results may be partially explained by overall good physical health status of the participants. Additional research in groups exhibiting varying degrees of health is needed.

Background: Replacing sedentary time with physical activity through new generation exergames (eg, XBOX Kinect) is a potential intervention strategy. The study's purpose was to compare youth energy expenditure while playing different exergames in single- vs. multiplayer mode., Methods: Participants (26 male, 14 female) were 10 to 13 years old. They wore a portable metabolic analyzer while playing 4 XBOX Kinect games for 15 minutes each (2 single-, 2 multiplayer). Repeated-measures ANOVA (with Bonferroni correction) was used to examine player mode differences, controlling for age group, sex, weight status, and game., Results: There was a significant difference in energy expenditure between single player (mean = 15.4 ml/kg/min, SD = 4.5) and multiplayer mode (mean = 16.8 ml/kg/min, SD = 4.7). Overweight and obese participants (mean = 13.7 ml/kg/min, SD = 4.2) expended less energy than normal weight (mean = 17.8 ml/kg/min, SD = 4.5) during multiplayer mode (d = 0.93)., Conclusion: Player mode, along with personal factors such as weight status, may be important to consider in energy expenditure during exergames.

Background: The purpose of this study was to determine the independent and joint association of weight status and physical activity on resting blood pressure and C-reactive protein in children., Methods: Participants were 174 (71 males, 103 females) children (mean age = 10.5 ± 0.4 yrs). Physical activity was self-reported, body mass index was calculated from measured height and body mass, and blood pressure was measured according to standard procedures. A subset of 91 children had C-reactive protein measured by fingerstick blood sample. Four weight/physical activity groups were created by cross tabulation of weight status classification and physical activity level., Results: The prevalence of low physical activity (< 5 days/wk moderate-vigorous activity) did not differ between overweight and normal weight children (50%). Physical activity was not correlated with C-reactive protein (r = 0.01; P = 0.91) and C-reactive protein was not significantly different between physical activity groups (P = 0.87). Physical activity did not modify the difference in blood pressure or C-reactive protein within weight categories., Conclusions: Fatness (specifically overweight and obesity), but not physical activity, was shown to be associated with blood pressure and C-reactive protein levels in children. Physical activity did not attenuate blood pressure or C-reactive protein in overweight and obese children.

Background: Leisure-time physical activity (LTPA) is recommended during pregnancy and has been associated with lower risk of delivering a large infant. We sought to characterize the effect of LTPA across the entire birth weight distribution., Methods: Women enrolled in the Pregnancy Outcomes and Community Health (POUCH) Study (1998-2004) were followed-up in 2007. Follow-up efforts were extensive for a subcohort and minimal for the remainder (nonsubcohort). Thus, 596 subcohort and 418 nonsubcohort women who delivered at term participated. Offspring were categorized as small-, appropriate-, or large-for-gestational-age (SGA, AGA, and LGA, respectively) based on gender and gestational age-specific birth weight z-scores (BWz). At follow-up, women recalled pregnancy LTPA and were classified as inactive, insufficiently active or meeting LTPA recommendations. Linear, logistic, and quantile regression analyses were conducted separately by subcohort status., Results: Meeting LTPA recommendations decreased odds of LGA significantly among the nonsubcohort (aOR = 0.30, 95% CI: 0.14-0.64) and nonsignificantly among the subcohort (aOR = 0.68, 95% CI: 0.34-1.34). In quantile regression, meeting LTPA recommendations reduced BWz among the upper quantiles in the nonsubcohort., Conclusions: LTPA during pregnancy lowered odds of LGA and reduced BWz among the upper quantiles, without shifting the entire distribution. LTPA during pregnancy may be useful for reducing risks of large fetal size.

It is unknown how the estimation of aerobic fitness in children and adolescents compares among physical working capacity (PWC) protocols with different stage lengths. The purpose of this study was twofold: (1) compare PWC tests with 2-, 3-, and 6-min stage lengths in youth, and (2) examine the relationship between PWC at a heart rate (HR) of 170 beats min(-1) (PWC170) and peak oxygen consumption (VO(2)peak). Fifty youth (31 m, 19 f), aged 11-16 years participated. Each participant visited the laboratory twice and performed three PWC tests (2-, 3-, 6-min stages) on a cycle ergometer. Tests usually consisted of three stages of increasing loads with the goal of reaching HR ≥ 165 beats min(-1). Individual regression lines were created to predict workload at HR = 170 beats ∙ min(-1) for each test. Participants completed two VO(2peak) tests, both running and cycling. Repeated measures ANOVA was used to compare PWC170 values. Pearson correlation was used to assess the relationships between VO(2peak) and power output for different PWC170 stage lengths. The three PWC170 protocols differ significantly; therefore, it is not advisable to directly compare results from different protocols. Furthermore, PWC170 showed moderate associations with VO(2peak), with the 2-min protocol showing the best correlation.

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.

Background: In adults, associations between church attendance and positive health behaviors exist; however, similar evidence among children and youth is lacking. The purposes of this investigation were to examine the associations between physical activity (PA) and church attendance, PA and use of church as a PA facility, and PA and proximity to churches among those who use church as a PA facility (while addressing racial and geographical differences)., Methods: High school girls (N=915, age=17.7±0.6 years, 56% African American) completed the 3-Day Physical Activity Recall and surveys including demographics and use of PA facilities. Geographic Information Systems data were used to spatially examine the number of churches within a 0.75-mile street network buffer around girls' homes. Associations were examined using mixed model analyses controlling for demographic factors., Results: For the overall sample, total METs (56 versus 52) and proportion of girls meeting PA guidelines (62% vs. 52%) were significantly higher in church attendees versus nonattendees. Among participants who used facilities, having more churches close to home was associated with more PA., Conclusions: Church attendance and use are correlates of physical activity that should be further explored and addressed in future intervention research with adolescent girls.

Objective: To examine how "travel by walking" before and after school contributes to total physical activity of adolescent girls., Design: Cross-sectional sample., Setting: Thirty-six middle schools from Arizona, Maryland, Minnesota, Louisiana, California, and South Carolina participating in the Trial of Activity for Adolescent Girls (TAAG)., Participants: Seventeen hundred twenty-one sixth-grade girls consented to participate; adequate information was available for 1596 participants (93%)., Main Exposure: Travel by walking before school, after school, and before and after school combined assessed from the 3-Day Physical Activity Recall., Main Outcome Measure: Mean minutes of physical activity measured by accelerometry were estimated for total physical activity (light, moderate, vigorous), moderate to vigorous activity (MVPA), and MVPA of 3 metabolic equivalents., Results: Travel by walking was reported by 14% of participants before school and 18% after school. Girls who reported travel by walking before and after school (combined) had 13.7 more minutes (95% confidence interval, 1.2-26.3) of total physical activity and 4.7 more minutes (95% confidence interval, 2.2-7.2) of MVPA than girls who did not report this activity. Before-school and after-school walkers (but not both) accumulated 2.5 more minutes (95% confidence interval, 0.10-4.9) and 2.2 more minutes (95% confidence interval, 0.24-4.2) of MVPA on an average weekday, respectively, than nonwalkers., Conclusion: Our results provide evidence that walking to and from school increases weekday minutes of total physical activity and MVPA for middle-school girls.

Objective: To compare the physical activity levels of overweight and non overweight 3- to 5-y-old children while attending preschool. A secondary aim was to evaluate weight-related differences in hypothesized parental determinants of child physical activity behavior., Design: Cross-sectional study., Subjects: A total of 245, 3- to 5-y-olds (127 girls, 118 boys) and their parent(s) (242 mothers, 173 fathers) recruited from nine preschools. Overweight status determined using the age- and sex-specific 85th percentile for body mass index (BMI) from CDC Growth Charts., Measurements: Physical activity during the preschool day was assessed on multiple days via two independent objective measures-direct observation using the observation system for recording activity in preschools (OSRAP) and real-time accelerometry using the MTI/CSA 7164 accelerometer. Parents completed a take-home survey assessing sociodemographic information, parental height and weight, modeling of physical activity, support for physical activity, active toys and sporting equipment at home, child's television watching, frequency of park visitation, and perceptions of child competence., Results: Overweight boys were significantly less active than their nonoverweight peers during the preschool day. No significant differences were observed in girls. Despite a strong association between childhood overweight status and parental obesity, no significant differences were observed for the hypothesized parental influences on physical activity behavior., Conclusions: Our results suggest that a significant proportion of overweight children may be at increased risk for further gains in adiposity because of low levels of physical activity during the preschool day.