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Global guidelines regarding infant physical activity, screen time and sleep were released by the World Health Organisation in 2019. Clinician and Early Childhood Educator's knowledge and advice given to parents regarding this content is unknown. The aims of this study were to determine the advice given to parents regarding infant care. This will enable a baseline from which future interventions and multidisciplinary professional development can be compared and reviewed.80 Clinicians (Medical, Nursing, Allied Health) and Early Childhood Educators from a local health district in NSW Australia completed an online survey. Medical records (N = 272) were also reviewed to determine if the documentation included advice in accordance with guidelines.Staff were aware that infant guidelines contributes to positive health outcomes (all85%). Nursing entered the most information into the medical record with80% of files containing general advice about infant physical activity and sleep. Only 30% of entries contained evidence of guideline specific information. Minimal entries from all clinicians contained information about screen time (2%).The majority of clinicians and Early Childhood Educators were aware of the content of the guidelines and the advice they report to provide is consistent. Medical record documentation regarding the specificity of advice provided is lacking.This study provides a baseline from which professional development interventions aimed at increasing compliance to infant guidelines can be compared.

Non-communicable diseases (NCDs) constitute a significant public health challenge and pose a great burden on health and social systems throughout the world. The Asia-Pacific region is in a vulnerable position as the prevalence of NCDs will inevitably increase with rapid socioeconomic transitions; yet it is ill prepared for this public health challenge as Asian children are among the most physically inactive in the world. Aligned with the WHO’s global strategy to control NCDs via preventive measures and health promotion policies, representatives from the Asia-Pacific region came together to develop consensus statement on integrated 24-hour activity guidelines for children and adolescents. These guidelines apply to children and adolescents, aged 5–18 years, in the Asia-Pacific region, regardless of gender, cultural background or socioeconomic status. These guidelines aim to provide the latest evidence-based recommendations, taking a holistic approach to lifestyle activities and adopting a practical perspective by framing these activities within a 24-hour period. Eating and dietary elements were incorporated as they closely influence the energy balance of the movement behaviours and vice versa. By investing in the younger generations through advocacy for healthier lifestyles, we aim to reduce the burden of NCDs in the Asia-Pacific region.

Supplementation of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) may enhance self-regulation (SR) and executive functioning (EF) in children of preschool age. The aim of the Omega Kid Study was to investigate the effect of n-3 LCPUFA supplementation on SR and EF in typically developing preschool-aged children. A double-blind placebo-controlled pilot trial was undertaken, the intervention was 12 weeks and consisted of 1.6 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day compared to placebo. The HS-Omega-3 Index® was assessed by capillary blood samples at baseline and post-intervention. Seventy-eight children were enrolled and randomised to either the n-3 LCPUFA treatment (n = 39) or placebo (n = 39) group. Post intervention, there was a significant three-fold increase in the HS-Omega-3 Index® in the n-3 LCPUFA group (p &lt, 0.001). There were no improvements in SR or EF outcome variables for the n-3 LCPUFA group post intervention compared to the placebo group determined by linear mixed models. At baseline, there were significant modest positive Spearman correlations found between the HS-Omega-3 index® and both behavioural self-regulation and cognitive self-regulation (r = 0.287, p = 0.015 and r = 0.242, p = 0.015 respectively). Although no treatment effects were found in typically developing children, further research is required to target children with sub-optimal self-regulation who may benefit most from n-3 LCPUFA supplementation.

This chapter focuses on practical implications of embodiment to facilitate learning in educational contexts. Starting from a brief historical overview of the scientific debate of action-perception that forms the genesis of embodiment, the chapter progresses to later influential theories. Contemporary trends are discussed in light of theories of embodied cognition, emphasising the importance of body movements in shaping higher-order cognitive processing and how embodied cognitive neuroscience links the brain, the body, and the broader environment. In reviewing the literature, empirical studies with movements are explored in relation to their type of embodiment (e.g., gestures, simulation, whole-body movements, physical activity), educational setting (e.g., preschool, primary school, high school), and learning domain (e.g., language, science). Lastly, embodiment is linked with interoception (i.e., understanding of our body and its needs), to help explain individual and developmental differences. Opportunities and limits of applying embodiment in education are further discussed.

Background A new physical activity and sedentary behaviour accreditation standard criterion for childcare settings was introduced by the provincial government in Alberta, Canada. The primary objective of this study was to examine if changes for in-care physical activity and sedentary time (ST) differed between centres in and around Edmonton, Alberta after implementing the new accreditation standards and non-accredited control centres in and around Ottawa, Ontario. Secondary objectives were to examine whether baseline age group (toddler, preschooler) or the childcare environment moderated any group differences in change of the primary outcomes. Furthermore, accreditation and control group differences in change of children’s body mass index (BMI) Z-scores or cognitive development as well as educators’ perceptions of the primary outcomes were explored. Methods Participants were 252 toddlers (19–35 months) and preschoolers (36–60 months) in childcare centres from Alberta (n = 11) and Ontario (n = 8) in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care ST, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer–derived before and 6 months after the implementation of the new standards. At both time points, cognitive development (working memory, expressive vocabulary), heights, and weights were measured, and BMI Z-scores were calculated. Additionally, the childcare environment was observed using the Environment and Policy Assessment and Observation (EPAO) and Movement Environment Rating Scale (MOVERS) tools. Demographic characteristics were parent-reported and weather variables were derived from Environment Canada data. Mixed models were conducted. Results In adjusted models (n = 241), change in children’s in-care ST (B = -0.07, 95%CI: − 1.43,1.29), LPA (B = 0.08, 95%CI: − 0.89,1.05), and log–transformed MVPA (B = 0.01, 95%CI: − 0.09,0.11) were not significantly different between accreditation and control groups. Age group and the childcare environment were not moderators. Significant increases in BMI Z-score (B = 0.19, 95%CI: 0.03,0.35) and high working memory (OR = 3.24, 95%CI: 1.32,7.97) were observed in the accreditation group and significant increases in expressive vocabulary (B = 3.18, 95%CI: 0.05,6.30) were observed in the control group. Conclusions The new accreditation criterion may not significantly change physical activity or ST in childcare settings and therefore may not explain findings for BMI Z-scores and cognitive development. Additional training and resources may be needed.

Background Little is known about how activity patterns change throughout childhood. This study examined changes and tracking of total volume and bouts of physical activity (PA) and sedentary time (SED) from early to late childhood. Methods Volume and bouts of SED and light-, moderate- and vigorous-intensity PA (LPA, MPA and VPA) were assessed by accelerometry at 3-5y (n = 758), 6-8y (n = 473) and 9-11y (n = 478). Mixed models examined changes and generalized estimating equations assessed tracking (β 0.6=strong), stratified by sex and controlling for baseline age and time between measurements. Results Patterns of SED increased and LPA decreased for both sexes. Total volume of MPA decreased for girls, but time in ≥ 1-min bouts increased for both sexes. Total volume of VPA increased for both sexes, with time spent in ≥ 1-min bouts increasing for boys. All volume and bout variables tracked moderately for boys, except SED bouts ≥15-min, LPA bouts ≥5-min and MPA bouts ≥1-min which tracked weakly. For girls, total SED and bouts ≥1-min tracked strongly, while total volume of LPA, MPA and VPA, ≥5- and ≥10-min SED bouts, and ≥1-min LPA and MPA bouts tracked moderately. Conclusions Activity patterns changed from early to late childhood, with total volumes and short bouts of PA and SED tracking more strongly than longer bouts. Although MVPA increased slightly, total volume and bouts of SED increased considerably more and, of concern, replaced LPA. Key messages Interventions are needed to ensure that young children establish and maintain healthy PA and SED levels from a young age.

Introduction Out of school hours care (OSHC) is a fast-growing childcare setting in Australia, however the types of foods and beverages offered are relatively unknown. This study describes the food and beverages offered and investigates sector-level and setting-level factors which may impact OSHC in meeting the Australian Dietary Guidelines (ADG). Methods This cross-sectional, observational study was conducted in 89 OSHC services (between 2018 and 2019). Food and beverages offered, kitchen facilities and menus were captured via direct observation. Foods were categorised into five food groups or discretionary foods, based on the ADG, and frequencies determined. Short interviews with OSHC directors ascertained healthy eating policies, staff training, food quality assessment methods and food budgets. Fisher’s exact test explored the influence of sector-level and setting-level factors on food provision behaviours. Results Discretionary foods (1.5 ± 0.68) were offered more frequently than vegetables (0.82 ± 0.80) (p < .001), dairy (0.97 ± 0.81) (p = .013) and lean meats (0.22 ± 0.54) (p < .001). OSHC associated with long day care and reported using valid food quality assessment methods offered more lean meats (p= .002, and p= .004). Larger organisations offered more vegetables (p = .015) and discretionary foods (p= .007). Menus with clearly worded instructions to provide fruits and vegetables daily offered more fruit (p= .009), vegetables (p < .001) and whole grains (p= .003). No other sector or setting-level factors were associated with services aligning with the ADG. Conclusion Future interventions could benefit from trialling menu planning training and tools to assist OSHC services in NSW meet the ADG requirements.

The aim of this systematic review was to summarize the literature on the associations between breaks in sitting time and cardiovascular health, in children and adolescents. The search was conducted using five databases (MEDLINE, SCOPUS, WEB OF SCIENCE, PSYCINFO and CINAHL) through to 01 October 2019. Due to heterogeneity of the data, meta-analyses were not possible. We screened 2577 studies, and 15 studies were included, representing 9116 participants, from six different countries. Five observational studies and four experimental studies showed associations between breaks in sitting time and cardiovascular health, i.e. an increased number of breaks in sitting time was negatively associated with a cardiovascular health outcome. No associations between number of breaks in sitting time and cardiovascular health outcomes were found in the six remaining studies. Studies examining associations between breaks in sitting time and cardiovascular health in children have shown some favorable associations. More epidemiological evidence is required, to inform lifestyle interventions and public health policies, which could translate into long-term implications on population health.

OBJECTIVE: The objective of this study was to systematically review the evidence of motor skill intervention programs on typically developing children's fine motor development aged birth to 6 years.METHODS: Six electronic databases were searched with no date restrictions. Inclusion criteria were any school-, community-, or home-based intervention targeting the development of fine motor skills of children aged birth to 6 years; randomized controlled trials using quasiexperimental, experimental, or single group prepost designs with a minimum sample size of 15 participants per group; and statistical analyses of fine motor skill development at both preintervention and postintervention or addressing the intervention effects on fine motor skill development. Data were extracted on design, participants, intervention components, methodological quality, and efficacy.RESULTS: Twenty-five of the total 31 studies reported positive intervention effects on fine motor skills. The meta-analyses included 19 studies and revealed moderate effect sizes of motor skill programs on fine motor, visual motor, and manual dexterity outcomes. There were substantial differences between intervention settings, facilitators, length, and content with most studies implemented in school settings and facilitated by teachers.CONCLUSION: Fine motor skill development in the early years is an extensive upcoming field of interest for many international researchers. This review study presents evidence on the positive effects of intervention programs that aim to enhance fine motor skills for young children. The findings are promising but need to be interpreted with caution because of the high risk of bias in many of the studies.

Background: In 2018, South Africa developed 24-hour movement behavior guidelines for children from birth to 5 years. This study reports on the stakeholder consultation as part of this development process. Methods: An online survey was completed by 197 participants; 9 focus groups (with parents/caregivers, early childhood development practitioners, and community health workers, total n = 70) were conducted, and a meeting with stakeholders from government and nongovernment organizations (n = 15) was held. Results: In the online survey, stakeholders overwhelmingly agreed with the guidelines (97.0%) and recognized the benefit of putting the guidelines into practice (88.8%). Most online survey respondents (88.3%) reported that the guidelines would benefit all South African children equally. Responses to open-ended questions in the online survey and focus group discussions revealed issues including safety and nutrition of children, perceived parental barriers to using the guidelines, and education. Training and provision of educational materials were identified from all stakeholders as key in the dissemination and implementation of the guidelines. Conclusions: The findings informed the development of the South African 24-hour movement behavior guidelines and revealed several important factors to address in the dissemination and implementation of the guidelines to ensure that they are applicable and equitable in South Africa.

This article presents the perceptions and experiences of 12 school principals, 35 teachers and 85 students on the influences and processes used by eight Australian government primary and secondary schools to transform traditionally arranged classrooms into flexible learning spaces. Characterised by a variety of furniture and layout options, these spaces are designed to enable a range of learning styles and activities and facilitate student-centred pedagogy. These changes to school learning environments are discussed in light of some central constructs of complexity theory, including inertial momentum, emergence, agent interaction, information flow, feedback loops and lock-in. The findings highlight the role of consultation, participation and ownership as central elements of sustainable change processes. Further effective design and transformation of learning environments requires a reflexive school community, pedagogical shift, professional development, and ongoing support to teachers and students. The discussion emphasizes the sociomaterial interplay between the pedagogical and physical classroom environment.

Globally, about 175 million children have no access to universal education in 2017. Nearly, 16 million young children in East Asia and Pacific Region are not enrolled into school, accounting for 19% of children in pre- and primary school age. This paper analyses surveillance data, extracted from the integrated Health and Demographic Surveillance System (iHDSS) database, developed by Papua New Guinea Institute of Medical Research in the period 2011–2017 to assess the implementation of Millennium Development Goals associated with universal education in Papua New Guinea (PNG). Net enrolment rate in primary education was 58%. Only 28% of children aged 7 were enrolled in Grade 1, and only 7% of children aged 15 years reached Grade 8 in the school year 2015. Late enrolment into Grade 1 among children aged 7 years was identified as the main cause of low net enrolment rate, leading to low completion rate of primary education in the following years and affecting the overall quality of universal education. Despite the improvement in gender equality, males had better access to education services than females as reflected in high male-to-female student ratios among the schooling age population, 5–24 years, which increased from 108 at primary to 132 at secondary and 181 at tertiary education. Educational policy-makers and practitioners should take immediate actions to improve net enrolment in Grade 1 and completion rate at primary education, as well as gender equality in education in PNG.

Background: This study examined the associations between environmental characteristics of early childhood education and care (ECEC) centers and 1-year change in toddlers’ physical activity and sedentary behavior while at the centers. Methods: Data from 292 toddlers from the GET-UP! study were analyzed. Environmental characteristics of ECEC centers were rated using the Infant/Toddler Environment Rating Scale-revised edition at baseline. Children’s physical activity and sedentary behavior in the centers were assessed using activPAL devices, at baseline and at 1-year follow-up. Linear mixed models were performed to examine the associations between the environmental characteristics and change in the proportion of time spent in physical activity and sedentary behavior. Results: Compared with baseline, children spent a higher proportion of time in sedentary behavior (sitting) but a lower proportion of time in standing and physical activity (stepping) while at ECEC centers, at 1-year follow-up. The environmental characteristics “interaction” (B = −1.39; P = .01) and “program structure” (B = −1.15; P = .04) were negatively associated with change in the proportion of time spent in physical activity. Conclusion: Better “interaction” and “program structure” may preclude children’s physical activity from declining over time and may be considered important features to target in future interventions in ECEC centers aiming at promoting active lifestyles.

Background: Although there is increasing evidence regarding children’s screen time, little is known about children’s sitting. This study aimed to determine the correlates of screen time and sitting in 6- to 8-year-old children. Methods: In 2011–2012, parents in the Healthy Active Preschool and Primary Years (HAPPY) study (n = 498) reported their child’s week/weekend day recreational screen time and potential correlates. ActivPALs™ measured children’s nonschool sitting. In model 1, linear regression analyses were performed, stratified by sex and week/weekend day and controlling for age, clustered recruitment, and activPAL™ wear time (for sitting analyses). Correlates significantly associated with screen time or sitting (P Results: Children (age 7.6 y) spent 99.6 and 119.3 minutes per day on week and weekend days engaging in screen time and sat for 119.3 and 374.6 minutes per day on week and weekend days, respectively. There were no common correlates for the 2 behaviors. Correlates largely differed by sex and week/weekend day. Modifiable correlates of screen time included television in the child’s bedroom and parental logistic support for, encouragement of, and coparticipation in screen time. Modifiable correlates of sitting included encouragement of and coparticipation in physical activity and provision of toys/equipment for physical activity. Conclusions: Interventions may benefit from including a range of strategies to ensure that all identified correlates are targeted.

Objectives The aim of this study was to explore factors which mediated or moderated the effect of the Time2bHealthy online program for parents of preschool-aged children on body mass index (BMI) change. Study design Mediation and moderation analyses of data from a two-arm parallel randomised controlled trial. Methods Randomisation was conducted after baseline measures. The intervention group received an 11-week online program, and the comparison group received emailed links to information from an evidence-based parenting website. Data on the primary outcome (child BMI), potential mediators (energy intake, fruit and vegetable intake, discretionary food intake, physical activity, screen-time, sleep, child feeding, parent self-efficacy or parent role-modelling) and potential moderators (child age, parent age, parent income, parent education or parent living situation) were collected at baseline, 3 months and 6 months. PROCESS macro for SPSS was used to analyse possible mediators and moderators on BMI outcomes. Results Despite significant food-related outcomes in the main analysis of this trial, no significant mediating or moderating effects were found for any hypothesised mediators or moderators. Conclusions This study's null results could be explained by the high proportion of children in the healthy weight range, the study period not being long enough to detect change, the multicomponent nature of the intervention or the relatively small number of outcomes measured. Future childhood obesity interventions should continue to explore the effects of mediators and moderators on BMI and consider collecting data on a wide range of mediating and moderating factors to allow for comparison between studies to develop a better understanding of the factors contributing to successful interventions.

This study explored parental engagement, child BMI and secondary outcomes from the social media component of an online healthy lifestyle program for parents of preschool-aged children. Intervention group participants received access to an online program and Facebook group. Data were collected at baseline and 3- and 6-months follow-up. Facebook usage data on comments and posts were used to determine total active engagement. There was a high level of Facebook group membership and most parents actively engaged at least once. Although there were varying levels of engagement between modules and cohorts, it was modest overall. User acceptability of the Facebook group was lower than expected. Children of parents in the intervention who engaged more in the Facebook group (by posting and commenting) demonstrated greater sleep duration over time (estimate 1.79, 95% CI 0.42 to 3.17, p = .01) Children of parents who engaged more in the Facebook group also participated in less moderate- to vigorous-intensity physical activity (estimate -0.14, 95% CI -0.26 to -0.01, p = .03). This study is one of the first parent-focussed healthy lifestyle interventions to include a social media component. Further research is recommended with larger sample sizes and longer duration to further explore the potential of social media in childhood obesity interventions.

Healthy Dads Healthy Kids (HDHK) was the first program internationally to specifically target overweight and obese fathers to improve their children's health. In previous randomized controlled trials, HDHK generated meaningful short-term improvements in the adiposity, physical activity, and eating behaviors of both fathers and children. The aim of this dissemination trial was to evaluate the 12-month impact of HDHK when delivered by trained facilitators across four low socioeconomic and regional communities in the Hunter Region, Australia. The study was a nonrandomized, prospective trial with minimal eligibility criteria (i.e., father body mass index [BMI] ≥ 25 kg/m2 and children aged 4-12 years). HDHK included eight weekly practical and theoretical sessions. Assessments were baseline, 3 months (post-intervention), 6-months, and 12-months. The primary outcome was fathers' weight. Secondary outcomes included child BMI z-score and validated lifestyle behavior measures (e.g., physical activity, diet). Overall, 189 fathers (mean age: 40.2 years, BMI: 32.6 kg/m2) and 306 children (mean age: 8.1 years) participated in one of 10 HDHK programs in four areas. Intention-to-treat linear mixed models revealed a significant mean reduction in fathers' weight at post-intervention (-3.6 kg, 95% confidence interval: -4.3, -2.9), which was maintained at 12 months (71% retention). Corresponding improvements were also detected in children's BMI z-score and a range of lifestyle behaviors for both fathers and children. Attendance and satisfaction levels were high. Positive intervention effects observed in previous randomized controlled trials were largely replicated and sustained for 12 months when HDHK was delivered by trained local facilitators in underserved communities. Further investigation into the key systems, processes, and contextual factors required to deliver HDHK at scale appears warranted.

The aim of this meta-analysis was to evaluate the effects of movement strategies during academic time, on children's and adolescents' cognitive processing, memory, behavioral control, and academic skills. We used a 2 × 2 design to categorize studies, based on their level of integration with (low vs. high) and relevance to the learning content (low vs high). Meta-analyses were conducted per overarching outcome constructs. Age was explored as a potential moderator. A total of 83 studies involving 25,641 participants were included. The high integration-high relevance movement strategy applied in longer-term (i.e., chronic) physical activity interventions had positive effects with the largest effect (ES = 0.94) on memory. The low integration-low relevance movement strategy had large effects on behavioral control measures for longer-term physical activity (ES = 1.42) and single (i.e., acute) bouts of physical activity; ES = 1.15). A nuanced pattern of results emerged in the other categories (high-low and low-high). A theory-based mapping of studies was used to disentangle the effects of different types of movement strategies during academic time on selective outcomes. Consistencies were identified and explained referring to theories grounded in educational psychology and exercise and cognition research.

Background: Excessive screen time may impede cognitive development in early childhood. Purpose: To examine the cross-sectional associations between screen time and expressive language, as well as working memory, in preschoolers. Methods: Participants were 97 preschoolers (36-60 months) in Alberta and Ontario, Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. The time that children spent on watching television, videos or DVDs (television time) or playing video or computer games (video game time) on a television, computer, or potable device were assessed using a parental questionnaire. Total screen time and adherence to the screen time recommendation (���1h/d) of the Canadian 24-Hour Movement Guidelines were calculated. Expressive vocabulary and working memory were assessed using the Early Years Toolbox. Due to the distribution, working memory was categorized as a binary variable based on the median score. The associations between screen time and cognitive development were examined using mixed models (expressive vocabulary) or generalized mixed models (working memory). Results: Pre-schoolers who had higher total screen time were less likely to have better working memory (OR=0.53;95%CI:0.31,0.89). Adherence to the screen time recommendation tended to be associated with better working memory (OR=3.35;95%CI:1.05,11.36), compared to non-adherence. Screen time was not associated with expressive vocabulary. Conclusion: Limiting total screen time to no more than one hour per day may facilitate executive function development in preschoolers. Screen time may be unrelated to expressive language development in this age group. Funding: The Canadian Institutes of Health Research (CIHR)., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress

Objectives:Few studies have examined the healthy eating environments within the Australian out of school hours care (OSHC) setting. This study aims to describe healthy eating environments, consisting of: (a) the alignment of provided food and beverages to Australian Dietary Guidelines; (b) healthy eating promotion practices; (c) nutrition education through cooking experiences; (d) staff role modelling healthy eating and (e) regular water availability.Design:A cross-sectional study was conducted using direct observations and the validated System for Observing Staff Promotion of Activity and Nutrition (SOSPAN) tool.Setting:OSHC located in urban and semi-rural regions of NSW, Australia.Participants:Staff (151) and children (1549) attending twelve OSHC services operating in the hours after school.Results:Fifty per cent (50 %) of services offered fruits and 100 % offered water as a part of the afternoon snack on all four observation days. Discretionary foods were offered on more days compared to vegetables (+1·9/d, P = 0·009), lean meats (+2·7/d, P =·0 004) and wholegrains (+2·8/d, P = 0 002). Staff promoted healthy eating on 15 % of days, sat and ate with children 52 %, consumed high sugar drinks 15 % and ate discretionary foods in front of children 8 % of days, respectively. No opportunities for cooking or nutrition education were observed.Conclusion:Afternoon snacks regularly contained fruits and water. Opportunities exist to improve the frequency by which vegetables, wholegrains and lean meats are offered in addition to staff healthy eating promotion behaviours. Future research is warranted to further explore healthy eating behaviours, practices and policies within the after-school sector.

It remains unclear whether the time-use composition of 24-h movement behaviours (sleep, sedentary time (ST), physical activity (PA)) and recreational screen use are independently associated with psychosocial health. This study examined the cross-sectional and longitudinal associations between 24-h movement behaviour composition, recreational screen use and psychosocial health outcomes in children. Measures completed at baseline (n = 127, 11.7 years) and follow-up (n = 88, 12.8 years) included accelerometer-based 24-h movement behaviours, self-reported recreational screen use and psychosocial health (Strengths and Difficulties Questionnaire, Kessler’s Psychological Distress Scale). Linear mixed models were used to examine the cross-sectional and longitudinal associations between the 24-h movement behaviour composition and recreational screen use levels with psychosocial health outcomes. Overall, the movement behaviour composition (p &lt, 0.05) and recreational screen use levels (p &lt, 0.01) were both cross-sectionally but not longitudinally associated with psychosocial health outcomes. Relative to other behaviours, sleep was negatively associated, while light-intensity PA was positively associated with internalising problems and total difficulties scores. ST was positively associated with internalising problems. High levels of recreational screen use (&gt, 2 h/day) were associated with greater externalising problems, total difficulties scores and psychological distress. These findings reinforce the importance of achieving a balance between different types of movement behaviours over a 24-h period for psychosocial health.

Background: Pilot/feasibility studies play an important role in the development and refinement of behavioral interventions by providing information about feasibility, acceptability, and potential efficacy. Despite their importance and wide-spread use, the approaches taken by behavioral scientists to scale-up early-stage studies to larger-scale trials has received little attention. The aim of our study was to understand the role that pilot studies play in the development and execution of larger-scale trials.Methods: We conducted interviews with behavioral interventionists identified in a systematic review as the lead author of a published pilot study that had also published larger-scale trial on a topic related to childhood obesity. Questions were asked about the role of pilot studies in developing larger-scale trials and the challenges encountered when scaling-up an intervention based upon pilot findings. Data were coded and analyzed using an inductive analytic approach to identify themes.Results: 24 Interventionists (54% women, 37-70 yrs old, mean 20 years since terminal degree) completed a total of 148 pilot studies across their careers (mean 6.4, range 1-20), of which 59% were scaled-up. Scaling was described as resource intensive and pilot work was considered essential to successfully competing for funding by 63% of the sample (n=15). When asked to define a high-quality pilot study, interventionists described studies that allowed them to evaluate components of their intervention (e.g., acceptability, feasibility) and study parameters (e.g., sample size, measures). Interventionists expressed that more process implementation measures, different study designs, and additional iterations could improve decisions to scale-up. Most agreed that pilot studies were likely to produce inflated estimates of potential efficacy though only nine interventionists provided potential solutions for decreasing inflated measures of efficacy. Suggested major causes of inflated effects included high levels of oversight in pilot studies (e.g., researcher support), reliance on subjective measures, and utilizing convenience or highly motivated samples. Potential solutions included designing pilots for real-world implementation, only conducting randomized controlled pilot studies, and pre-registering pilot studies. Conclusions: Pilot studies purposes are multifaceted and deemed essential to obtaining funding for larger-scale trials. Clarifying the form and function of preliminary, early-stage research may enhance the productive utilization of early-stage studies and reduced “voltage drop”.

Background The aim of this study was to evaluate the impact of COVID-19 on the levels of physical activity (PA) and sleep and to examine specific COVID-19 factors that may be associated with changes in PA and sleep among adults in Russia. Methods Cross-sectional data were collected during the period of tightest restrictions between 26 April 2020 and 6 June 2020. Eligible participants included all Russian adults aged 18 years and over. Participants reported their sleep patterns and problems, frequency and duration of walking, moderate- and vigorous-intensity PA, and muscle strengthening activities before COVID-19 and during the past 7 days. Access to an outdoor green space and fitness centres, use of online resources, adherence to self-isolation recommendations and other preventive measures from Ministry of Health were self-reported. Results The sample included 2432 participants from 62 regions, 83% of who were female. There was a significant decline in the number of days per week participants reported not getting enough sleep (3.21 ± 2.44 to 2.86 ± 2.57; P P P P Conclusion Compared with before COVID-19, PA and sleep hygiene were adversely affected during COVID-19. Awareness of factors associated with these declines will assit policymakers in developing strategies to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Objective:To assess the quality and quantity of foods and beverages provided to children aged 0–5 years in family day care and identify structural and sociodemographic factors associated with the nutritional quality of food provided.Design:A cross-sectional study measured the food and beverages provided to children using weighed food records. The number of serves from different food groups was calculated according to the Australian Guide to Healthy Eating, and a healthy food provision index score was created. Associations between structural and sociodemographic factors and healthy food provision index scores were analysed using linear mixed models.Setting:Family day care services in two large geographic areas in New South Wales, Australia.Participants:One hundred and four children in thirty-three family day care services.Results:During attendance at childcare, most children met recommended servings of fruit but not dairy, vegetables, lean meat and meat alternatives and wholegrains. Discretionary foods exceeded recommendations. Children’s age, socio-economic status and the type of main meal provided were significantly associated with the healthy food provision index score.Conclusions:Foods provided to children in family day care are aligned with dietary recommendations for fruit but not vegetables, dairy, lean meat and meat alternatives, wholegrains or discretionary foods. Interventions to promote healthy eating are needed to support families and educators to improve the nutritional quality of food provided to children.

Background Physical activity (PA) decreases and sedentary time (SED) increases across childhood, with both behaviours tracking. However, no studies have examined how accumulation patterns of PA and SED (i.e., prolonged bouts, frequency of breaks in sedentary time) change and track over time. The aim of this study was to investigate longitudinal changes in and tracking of total volume and accumulation patterns of SED, light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) among boys and girls. Methods In 2008/09 (T1), children in HAPPY (3-5y; n = 758) in Melbourne, Australia wore ActiGraph GT1M accelerometers to objectively assess SED, LPA, MPA and VPA. This was repeated at age 6-8y (T2; n = 473) and 9-11y (T3; n = 478). Ten pattern variables were computed: bouts of ≥ 5-, ≥ 10-, ≥ 15- and ≥ 20-min for SED, ≥ 1- and ≥ 5-min for LPA, ≥ 1-min for MPA, ≥ 1- and ≥ 5-min for VPA, and breaks in SED (interruptions of > 25 counts 15 s− 1). Longitudinal mixed models examined changes from T1-3, controlling for T1 age. Generalized estimating equations assessed tracking over the three time points, controlling for T1 age and time between measurements. Analyses were stratified by sex. Results Total volume and bouts of SED and SED breaks increased, while total volume and bouts of LPA decreased for both sexes. There was a small decrease in total volume of MPA for girls, but time spent in ≥ 1-min bouts increased for both sexes. Total volume of VPA increased for both sexes, with time spent in ≥ 1-min bouts increasing for boys only. All volume and pattern variables tracked moderately for boys, except for all SED bouts ≥ 15-min, LPA bouts ≥ 5-min and MPA bouts ≥ 1-min (which tracked weakly). For girls, total SED and SED bouts ≥ 1-min tracked strongly, total volume of LPA, MPA and VPA, ≥ 5- and ≥ 10-min SED bouts, and ≥ 1-min LPA and MPA bouts tracked moderately, and SED breaks, all SED bouts ≥ 15 min, LPA bouts ≥ 5 min and all VPA bouts tracked weakly. Conclusions Patterns of SED and PA change from early to late childhood; with the exception of SED breaks and VPA, changes were detrimental. Total volumes and short bouts tended to track more strongly than longer bouts. Interventions to prevent declines in PA and increases in SED are important from early in life.

Background: Papua New Guinea (PNG) has undergone a significant health transition, with the prevalence of non-communicable diseases increasing. Many children under 5 years of age suffer from the burden of malnutrition. While wasting and stunting still remain high, children who are overweight and obese are reportedly increasing.Objective: This study reports the prevalence of wasting, stunting, underweight, and overweight children under five in PNG and explores potential household and maternal socioeconomic factors associated with malnutrition.Method: Data were drawn from the Comprehensive Health and Epidemiological Surveillance System (CHESS) in PNG. Height and weight were directly measured, and wasting, stunting, overweight, and underweight statistics were determined using the 2006 WHO Standard Growth Standards. Household and maternal factors were assessed with parent interviews conducted by trained data collectors. Multivariate logistic regression analyses were conducted to report associations between selected socioeconomic correlates and child malnutrition outcomes.Result: The prevalence of wasting, stunting, underweight, and overweight children was 13.8, 46.5, 18.2, and 18%, respectively. Children from households with food shortage were more likely to be wasted than those from households without such an experience [OR: 1.43 (95% CI: 0.93–2.21)]. Children from the poor quintile were more likely to be stunted than those from the richest quintile [OR: 1.2 (95% CI: 0.79–1.82)]. Other factors associated with wasting included living in an urban vs. rural area [OR: 1.36 (0.77–2.4)], middle household wealth quintile vs. richest quintile [OR: 0.77 (0.38–1.55)], mothers in union with a man vs. mother unmarried or live in union [OR: 0.76 (0.4–1.42)], and male children vs. female [OR: 0.77 (0.53–1.11)]. Factors associated with stunting included residing in urban vs. rural areas [OR: 1.13 (0.8–1.6)], mother in union vs. single mother [OR: 0.86 (0.59–1.24)], and mothers with preparatory/elementary vs. mothers with vocational/college education [OR: 0.15 (0.02–1.01)].Conclusion: An integrated approach is needed to comprehensively address the household socioeconomic factors at the household level, contributing to the improvement of child health and development in PNG.

Assess educators' feeding practices and mealtime environments in family daycare services and examine the factors associated with educators' feeding practices and mealtime environments.Cross-sectional observational study of family daycare services (n = 33) in Australia. Best practices for mealtime environments and educator feeding practices were assessed during each mealtime using the Environment Policy Assessment and Observation instrument. Correlates assessed via survey included: socioeconomic status, main language spoken at home, early childhood career experience, and nutrition professional development. Descriptive statistics and independent t tests were calculated.Educators typically had higher scores, indicating better practices, for (the absence of) negative practices compared with positive practices. The only positive practice meeting best-practice standards was educators sitting with children during the meal. There were no significant correlations for educators' feeding practices or mealtime environment.Educators may benefit from professional development targeting positive feeding practices and supportive mealtime environments.

Background: Insufficient physical activity is one of four primary risk factors for non‐communicable diseases such as stroke, heart disease, type 2 diabetes, cancer and chronic lung disease. As few as one in five children aged 5 to 17 years have the physical activity recommended for health benefits. The outside‐school hours period contributes around 30% of children's daily physical activity and presents a key opportunity for children to increase their physical activity. Testing the effects of interventions in outside‐school hours childcare settings is required to assess the potential to increase physical activity and reduce disease burden. Objectives: To assess the effectiveness, cost‐effectiveness and associated adverse events of interventions designed to increase physical activity in children aged 4 to 12 years in outside‐school hours childcare settings. Search methods: We searched CENTRAL, MEDLINE, Embase, ERIC and SportsDISCUS to identify eligible trials on 18 August 2020. We searched two databases, three trial registries, reference lists of included trials and handsearched two physical activity journals in August 2020. We contacted first and senior authors on articles identified for inclusion for ongoing or unpublished potentially relevant trials in August 2020. Selection criteria: We included randomised controlled trials, including cluster‐randomised controlled trials, of any intervention primarily aimed at increasing physical activity in children aged 4 to 12 years in outside‐school hours childcare settings compared to usual care. To be eligible, the interventions must have been delivered in the context of an existing outside‐school hours childcare setting (i.e. childcare that was available consistently throughout the school week/year), and not set up in the after‐school period for the purpose of research. Two review authors independently screened titles and abstracts of identified papers with discrepancies resolved via a consensus discussion. A third review author was not required to resolve disagreements. Data collection and analysis: Two review authors independently extracted data and assessed the risk of bias of included trials with discrepancies resolved via a consensus discussion; a third review author was not required to resolve disagreements. For continuous measures of physical activity, we reported the mean difference (MD) with 95% confidence intervals (CIs) in random‐effects models using the generic inverse variance method for each outcome. For continuous measures, when studies used different scales to measure the same outcome, we used standardised mean differences (SMDs). We conducted assessments of risk of bias of all outcomes and evaluated the certainty of evidence (GRADE approach) using standard Cochrane procedures. Main results:We included nine trials with 4458 participants. Five trials examined the effectiveness of staff‐based interventions to change practice in the outside‐school hours childcare setting (e.g. change in programming, activities offered by staff, staff facilitation/training). Two trials examined the effectiveness of staff‐ and parent‐based interventions (e.g. parent newsletters/telephone calls/messages or parent tool‐kits in addition to staff‐based interventions), one trial assessed staff‐ and child‐based intervention (e.g. children had home activities to emphasise physical activity education learnt during outside‐school hours childcare sessions in addition to staff‐based interventions) and one trial assessed child‐only based intervention (i.e. only children were targeted). We judged two trials as free from high risk of bias across all domains. Of those studies at high risk of bias, it was across domains of randomisation process, missing outcome data and measurement of the outcome.There was low‐certainty evidence that physical activity interventions may have little to no effect on total daily moderate‐to‐vigorous physical activity compared to no intervention (MD 1.7 minutes, 95% CI –0.42 to 3.82; P = 0.12; 6 trials; 3042 children). We were unable to pool data on proportion of the OSHC session spent in moderate‐to‐vigorous physical activity in a meta‐analysis. Both trials showed an increase in proportion of session spent in moderate‐to‐vigorous physical activity (moderate‐certainty evidence) from 4% to 7.3% of session time; however, only one trial was statistically significant. There was low‐certainty evidence that physical activity interventions may lead to little to no reduction in body mass index (BMI) as a measure of cardiovascular health, compared to no intervention (SMD –0.17, 95% CI –0.44 to 0.10; P = 0.22; 4 trials, 1684 children). Physical activity interventions that were delivered online were more cost‐effective than in person. Combined results suggest that staff‐and‐parent and staff‐and‐child‐based interventions may lead to a small increase in overall daily physical activity and a small reduction or no difference in BMI. Process evaluation was assessed differently by four of the included studies, with two studies reporting improvements in physical activity practices, one reporting high programme satisfaction and one high programme fidelity. The certainty of the evidence for these outcomes was low to moderate. Finally, there was very low‐certainty evidence that physical activity interventions in outside‐school hours childcare settings may increase cardiovascular fitness.No trials reported on quality of life or adverse outcomes. Trials reported funding from local government health grants or charitable funds; no trials reported industry funding. Authors' conclusions: Although the review included nine trials, the evidence for how to increase children's physical activity in outside‐school hours care settings remains limited, both in terms of certainty of evidence and magnitude of the effect. Of the types of interventions identified, when assessed using GRADE there was low‐certainty evidence that multi‐component interventions, with a specific physical activity goal may have a small increase in daily moderate‐to‐vigorous physical activity and a slight reduction in BMI. There was very low‐certainty evidence that interventions increase cardiovascular fitness. By contrast there was moderate‐certainty evidence that interventions were effective for increasing proportion of time spent in moderate‐to‐vigorous physical activity, and online training is cost‐effective. Refereed/Peer-reviewed

Background: Papua New Guinea (PNG) is undergoing an epidemiological transition with increased mortality from NCDs. This study examined NCDs-attributed mortality and associated sociodemographic factors in PNG. Method: Using WHO 2016 instrument, 926 verbal autopsy (VA) interviews were conducted in six major provinces from January 2018 to December 2020. InterVA-5 tool was used to assign causes of death (COD). Multivariable logistic regression analysis was performed to identify sociodemographic factors associated with mortalities from emerging and endemic NCDs. Finding: NCDs accounted for 47% of all deaths, including 20% of emerging and 27% of endemic NCDs. Leading CODs from emerging NCDs were identified including cardiac diseases, stroke, and diabetes. The risk of dying from emerging NCDs was significantly lower among populations under age 44y compared with population aged 75+y (OR: 0.14 [0.045-0.433]; p-value: 0.001). People living in urban areas were twice likely to die from emerging NCDs than those in rural areas (OR: 1.92 [1.116-3.31]; p-value: 0.018). People in Madang province were 70% less likely to die from emerging NCDs compared to those from East New Britain province (OR: 0.314 [0.135-0.73]; p-value: 0.007). Leading CODs from endemic NCDs included digestive neoplasms, respiratory neoplasms, and other neoplasms. Only children aged 0-4y had significant lower risk of dying from endemic NCDs compared to the population aged 75+y (OR: 0.114 [95% CI: 0.014-0.896; p-value: 0.039). Interpretation: Public health interventions are urgently needed, prioritizing urban population and those aged over 44y to reduce premature mortality from NCDs. Funding: This study was funded by the PNG Government. Declaration of Interest: None to declare. Ethical Approval: The CHESS was granted ethics approvals from Instructional Review Board of PNG Institute of Medical Research (IRB’s Approval no. 18.05) and the Medical Research Advisory Committee of Papua New Guinea (MRAC’s Approval no. 18.06).

Background: There is a paucity of data from low- and middle-income countries on sedentary behaviour (SB) levels and patterns during early childhood. The purpose of this study was to examine how device-measured SB in young children differed across geographically, economically, and socio-demographically diverse populations, in an international sample. Methods: This multinational, cross-sectional pilot study included data from 1071 3–5-year-old children from 19 countries, collected between 2018 and 2020 (pre-COIVID). SB was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation and seated transport duration were calculated using PAL Analysis Algorithms and a custom-made analysis program. Linear mixed models were used to examine the differences in SB variables between sex, country-level income groups, caregiver education levels, urban/rural settings, and population density. Findings: Children spent 56% (7.4 hrs) of their waking time sedentary, and 42% accrued at least one sedentary bout/day lasting ≥60 min. The longest average bout duration was 81.1±45.4 min, and an average of 61.1±50.1 min/day was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, than children from low- and lower-middle-income countries. Few differences were found in SB patterns between urban/rural settings and caregiver education levels within each country-level income group, while multiple significant differences were found when comparing between country-level income groups. Higher population density was correlated with several higher SB measures. Interpretation: These data advance our understanding of young children’s SB patterns globally and the influences of country income, urban/rural setting, caregiver education levels, and population density. Country income levels and population density appear to be stronger drivers of the observed differences, than sex, rural or urban residential setting or caregiver educational attainment. Funding: American Council on Exercise, USA Beijing Health System High Level Talents Training Project, China 13 Biomedical Research Foundation, Dhaka, Bangladesh Canadian Institutes of Health Research Planning and Dissemination Grant Conselho Nacional de Pesquisa e Desenvolvimento Cientifico e Tecnologico - CNPq Research Department of National Planning and Monitoring, PNG Government Early Start, University of Wollongong, Australia Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg, South Africa Global Challenges Program, University of Wollongong, Australia Harry Crossley Foundation, South Africa National Health and Medical Research Council, Australia NIH - International Research Training Grant Pham Ngoc Thach University of Medicine, Vietnam Research University Grant (GUP), Universiti Kebangsaan Malaysia Sasakawa Sports Research Grant, Sasakawa Sports Foundation, Japan Stella de Silva Research Grant, Sri Lanka College of Paediatricians, Sri Lanka The DST-NRF Centre for Excellence in Human Development at the University of Witwatersrand, Johannesburg, South Africa The International Society of Behavioral Nutrition and Physical Activity, Pioneers Program Declaration of Interest: The authors have no competing financial or personal interests to declare. Ethical Approval: Ethical approval was obtained from the University of Wollongong, Australia (ref: 2018/044) and the appropriate ethics committee(s) in each country.

Objective This study aimed to examine the associations between sleep duration, adiposity indicators, and cognitive development in young children. Methods Participants were 217 children aged 19–60 months in Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. Nap duration and nighttime sleep duration were assessed using a parent questionnaire and were summed up as total sleep duration. Body mass index (BMI) z-scores and weight status were determined using the World Health Organization growth standards. Expressive vocabulary and working memory were assessed using the Early Years Toolbox in preschoolers only (36–60 months; n = 101). Mixed models (BMI z-score, expressive vocabulary) and generalized mixed models (weight status, working memory) were conducted. Results A linear association between total sleep duration and BMI z-score (B = −0.12; 95% CI: −0.23, −0.01) were observed. Compared to children having nighttime sleep within ±1SD (9.13–11.13 h/d) of the mean, those having shorter nighttime sleep had higher BMI z-scores (B = 0.39; 95% CI: 0.06, 0.73) and an increased risk of being overweight (OR = 4.54; 95% CI: 1.39, 14.81). Nap duration was not associated with adiposity indicators. In preschoolers, sleep duration was not associated with expressive vocabulary. Total sleep duration and nap duration were not associated with working memory. However, non-nappers were more likely to have greater working memory (OR = 4.04; 95% CI: 1.09, 14.92) compared to those having nap duration within ±1SD (0.46–2.18 h/d) of the mean. Conclusion Promoting longer total sleep, including more than nine hours of nighttime sleep, appears important for maintaining healthy adiposity levels in young children. Cessation of napping may be associated with better working memory in preschoolers.

Located in the South West Pacific region, with a population of 7.5 million, Papua New Guinea (PNG) is among a group of Pacific countries with sub-optimal health status. The maternal mortality ratio is 171 per 100,000 live births. Unmet need for contraception and family planning services, although poorly understood in PNG, may be one of the underlying causes of poor maternal health. This study set out to measure the prevalence and trends in unmet need for contraception and the identified socioeconomic factors associated with contraceptive use among women of reproductive age (15–49 years) in PNG. Data available from the Integrated Health and Demographic Surveillance System (IHDSS) were used in this study. A sub-population data set was extracted of 1434 women who gave birth in the preceding two years and resided in four rural surveillance sites: Asaro, Hides, Hiri and Karkar. Analyses of unmet need for contraception were performed with respect to birth spacing and limiting the number of births. Unmet need for contraception was 34% for the previous birth, 37% for the current pregnancy, and 49% for future family planning. The total unmet need for contraception was 35%, of which 49% was for spacing births and 51% for limiting births. Women’s age, education and household wealth are the most significant determinants of unmet need for contraception. The high level of unmet need for contraception may contribute to women’s poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and utilisation of contraceptives are required.

Background Child care centers are important for children’s behaviors. Aims To examine the cross-sectional associations between child care environmental characteristics and physical activity and sedentary time in children. Methods Participants were 124 toddlers and 118 preschoolers from 19 centers in Alberta and Ontario, Canada, in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care physical activity and sedentary time were assessed using Actigraph accelerometers. Child care environments, including structure (e.g., resources) and process (e.g., activities) quality, were measured using three instruments: (1) the Environment and Policy Assessment and Observation and (2) the Children’s Physical Environments Rating Scale, and (iii) the Movement Environment Rating Scale. Mixed models were performed to examine the associations between environmental characteristics and children’s sedentary time, light physical activity, and moderate-to-vigorous physical activity. Results A few structure quality characteristics related to child care policy and indoor environment were associated with higher physical activity and lower sedentary time in toddlers. The overall structure quality ( B = 0.04; 95% CI [0.003, 0.08]) and process quality ( B = 0.08; 95% CI [0.02, 0.15]) of the child care environment were associated with log moderate-to-vigorous physical activity in preschoolers. Specifically, structure quality characteristics of the outdoor environment and physical activity time, and process quality characteristics relevant to curriculum and pedagogy, were associated with higher physical activity and lower sedentary time in preschoolers. Discussion and Conclusion The child care structure quality characteristics that are important for children’ physical activity and sedentary behavior may vary by age group. Improving the overall process quality, in particular curriculum and pedagogy, of the child care environment, may promote more physical activity in preschoolers.

The World Health Organization (WHO) released the 2020 global guidelines on physical activity and sedentary behaviour. The new guidelines contain a significant change from the 2010 guidelines on physical activity for adults and older adults that has important implications for next-generation physical activity messaging: The removal of the need for aerobic activity to occur in bouts of at least 10 min duration. This change in the guidelines provides an opportunity to communicate in new ways that align with behavioural science, permitting physical activity communicators and promoters to better support people’s psychological needs, motivation, and ability to fit healthy levels of physical activity into their lives. The frames and messages we use to communicate about the guidelines matter because they influence whether activity is perceived as relevant, meaningful, and feasible – or not. When developing new physical activity communications there are some overarching principles, based on behavioural science, to keep in mind. Using established theory, this commentary aims to support the creation of more strategic frames and messages for increasing the value and integration of physical activity into daily living. Country-specific physical activity campaigns using these ideas will be discussed.

The International Study of Movement Behaviors in the Early Years (SUNRISE) was initiated in response to the 2019 WHO guidelines for physical activity, sedentary behavior, and sleep in children aged 0-5 years. This Swedish pilot study aimed to: (i) assess the proportion of preschoolers meeting the guidelines, (ii) evaluate the feasibility of the methods for the SUNRISE study, and (iii) assess how movement behaviors have been affected in preschoolers during the COVID-19 pandemic. Physical activity and sleep (waist-worn ActiGraph); screen time and movement behaviors (parental questionnaire); motor skills (Ages and Stages Questionnaire); and executive functions (3 iPad games) were assessed in 100 Swedish preschoolers (n = 58 boys). There were 19.4% of preschoolers (n = 14) who met the WHO guidelines. The motor skill and executive function assessments were feasible; however, 20% refused to wear the ActiGraph overnight. Additionally, during the pandemic Swedish childrens physical activity, time spent outside on weekdays and weekend days, and screen time significantly increased (+53; +124; +68; +30min/day, respectively, all p-values Funding Agencies|Region Ostergotland [LIO-936921]; Swedish Research Council for Health, Working Life and Welfare (FORTE) [2018-01137]

Background: The aim of this study was to examine the efficacy of an embedded after-school intervention, on promoting physical activity and academic achievement in primary-school-aged children. Methods: This 6-month, 2-arm cluster randomized controlled trial involved 4 after-school centers. Two centers were randomly assigned to the intervention, which involved training the center staff on and implementing structured physical activity (team sports and physical activity sessions for 75 min) and academic enrichment activities (45 min). The activities were implemented 3 afternoons per week for 2.5 hours. The control centers continued their usual after-school care practice. After-school physical activity (accelerometry) and executive functions (working memory, inhibition, and cognitive flexibility) were assessed pre- and postintervention. Results: A total of 60 children were assessed (7.7 [1.8] y; 50% girls) preintervention and postintervention (77% retention rate). Children in the intervention centers spent significantly more time in moderate to vigorous physical activity (adjusted difference = 2.4%; 95% confidence interval, 0.6 to 4.2; P = .026) and scored higher on cognitive flexibility (adjusted difference = 1.9 units; 95% confidence interval, 0.9 to 3.0; P = .009). About 92% of the intervention sessions were implemented. The participation rates varied between 51% and 94%. Conclusion: This after-school intervention was successful at increasing moderate to vigorous physical activity and enhancing cognitive flexibility in children. As the intervention was implemented by the center staff and local university students, further testing for effectiveness and scalability in a larger trial is required.

The primary aim of this study was to longitudinally examine potential demographic and screen time correlates of nap duration, nighttime sleep duration, and total sleep duration in young children over two time points.Data from the supporting Healthy physical AcTive Childcare setting (HATCH) study were analyzed. Participants were 206 toddlers (19-35 months) and preschoolers (36-60 months) in Alberta and Ontario, Canada. Child age, screen time (television, video games), and sleep duration (nap, nighttime) were measured at baseline and six-month follow-up, while other demographic variables were assessed at baseline only using the HATCH parental questionnaire. Mixed models were performed to examine the associations between potential correlates and sleep duration over time.In the multiple regression models, significant correlates of total sleep duration (min/d) were child age (months; B = -3.03; 95%CI:-3.88,-2.19) and parental education (bachelor's degree vs. below bachelor level; B = 29.74, 95%CI:7.43,52.06). Significant correlates of nighttime sleep duration (min/d) included child age (B = -0.81; 95CI%:-1.53,-0.10), child race/ethnicity (Caucasian vs. non-Caucasian; B = 15.31; 95%CI:0.38,30.25), household income ($150,000 vs.$50,000; B = 32.93, 95%CI:9.80,56.06), television time (B = -0.19, 95%CI:-0.32,-0.05), video games time (B = -0.19, 95%CI: -0.38, -0.01) and total screen time (B = -0.19; 95%CI:-0.29,-0.08). Significant correlates of nap duration (min/d) were child age (B = -2.10; 95%CI:-2.68,-1.51) and race/ethnicity (Caucasian vs. non-Caucasian; B = -13.73; 95%CI:-25.78,-1.68).Young children who were non-Caucasian, from lower income families, who had less-educated parents, or who had more screen time tended to have shorter sleep duration. Targeting these demographic groups and screen time appears important for promoting adequate sleep duration in early childhood.

Background: Because the elevated blood pressure (BP) in childhood is strongly associated with overweight and is a risk factor for later cardiovascular disease, a need to comprehend the early development of BP and its association with overweight is needed. We assessed differences of BP by weight status in Australian toddlers.Methods: From the Get-Up! Study in Australia, this sample included 265 toddlers (136 boys), aged 19.6 ± 4.2 months. BP was measured with a digital vital signs monitor. Participants were categorized as nonoverweight and overweight according to the World Health Organization definition for body mass index (BMI). Physical activity was captured with activPAL accelerometers, during childcare hours. To test differences in BP between nonoverweight and overweight children, we performed an analysis of covariance adjusting for sex, age, physical activity, and socioeconomic status.Results: Children with overweight showed higher z systolic BP values (P = .042 for BMI and P = .023 for waist circumference) when compared to nonoverweight children. However, no differences were found for z diastolic BP levels, between overweight and nonoverweight children. After adjustments for potential confounders (socioeconomic status, physical activity, sex, and age), there were no significant differences in BP variables between BMI and waist circumference groups.Conclusions: No associations between adiposity and BP levels were found in this sample. The unadjusted results, however, showed that children with higher levels of adiposity (BMI and waist circumference) exhibited higher levels of BP. Additional research is needed to determine which environmental and genetic factors might contribute to pediatric hypertension, particularly among toddlers.

Purpose Daily time spent on one activity cannot change without compensatory changes in others, which themselves may impact on health outcomes. Optimal daily activity combinations may differ across outcomes. We estimated optimal daily activity durations for the highest fitness and lowest adiposity. Methods Cross-sectional Child Health CheckPoint data (1182 11-12-year-olds; 51% boys) from the population-based Longitudinal Study of Australian Children were used. Daily activity composition (sleep, sedentary time, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA]) was from 8-day, 24-hour accelerometry. We created composite outcomes for fitness (VO2max; standing long jump) and adiposity (waist-to-height ratio; body mass index; fat-to-fat-free log-ratio). Adjusted compositional models regressed activity log-ratios against each outcome. Best activity compositions (optimal time-use zones) were plotted in quaternary tetrahedrons; the overall optimal time-use composition was the center of the overlapping area. Results Time-use composition was associated with fitness and adiposity (all measures pfitness days had higher LPA (3.4 h) and shorter sleep (8.25 h), but optimal adiposity days had lower LPA (1.0 h) and longer sleep (10.9 h). Balancing both outcomes, the overall optimal time-use composition was (mean [range]): 10.2 [9.5; 10.5] h sleep, 9.9 [8.8; 11.2] h sedentary time, 2.4 [1.8; 3.2] h LPA and 1.5 [1.5; 1.5] h MVPA. Conclusion Optimal time use for children’s fitness and adiposity involves trade-offs. To best balance both outcomes, estimated activity durations for sleep and LPA align with, but for MVPA exceed, 24-h guidelines.

The impact of declining physical activity and increased sedentary behaviour in children and adolescents globally prompted the development of national and international physical activity guidelines. This research aims to systematically identify and compare national and international physical activity guidelines for children and adolescents and appraise the quality of the guidelines to promote best practice in guideline development.This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Only national, or international physical activity and/or sedentary behaviour guidelines were included in the review. Included guidelines targeted children and adolescents aged between 5 and 18 years. A grey literature search was undertaken incorporating electronic databases, custom Google search engines, targeted websites and international expert consultation. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II).The search resulted in 50 national or international guidelines being identified. Twenty-five countries had a national guideline and there were three international guidelines (European Union, Nordic countries (used by Iceland, Norway and Sweden), World Health Organization (WHO)). Nineteen countries and the European Union adopted the WHO guidelines. Guidelines varied in relation to date of release (2008 to 2019), targeted age group, and guideline wording regarding: type, amount, duration, intensity, frequency and total amount of physical activity. Twenty-two countries included sedentary behaviour within the guidelines and three included sleep. Total scores for all domains of the AGREE II assessment for each guideline indicated considerable variability in guideline quality ranging from 25.8 to 95.3%, with similar variability in the six individual domains. Rigorous guideline development is essential to ensure appropriate guidance for population level initiatives.This review revealed considerable variability between national/international physical activity guideline quality, development and recommendations, highlighting the need for rigorous and transparent guideline development methodologies to ensure appropriate guidance for population-based approaches. Where countries do not have the resources to ensure this level of quality, the adoption or adolopment (framework to review and update guidelines) of the WHO guidelines or guidelines of similar quality is recommended.Review registration: PROSPERO 2017 CRD42017072558.

Introduction. There is a dearth of high-quality evidence on effective, sustainable, and scalable interventions to increase physical activity (PA) and concomitant outcomes in preschoolers. Specifically, there is a need to better understand how the preschool context can be used to increase various types of physically active play to promote holistic child development. The implementation of such interventions require highly competent preschool staffs, however, the competence in promoting PA is often low. The main aim of the ACTNOW study is therefore to investigate the effects of professional development for preschool staffs on child PA and developmental outcomes. Methods. The study will be conducted in Norway 2019-2022 and is designed as a two-arm (intervention; control) cluster randomized controlled trail with 7- and 18-month follow-ups. We aim to recruit 60 preschools and 1200 3-5-year old children to provide sufficient power to detect effect sizes between 0.20 and 0.30. The intervention is nested within two levels: the preschool- and the child. Central to the ACTNOW intervention are opportunities for children to engage in a variety of “enriched”, meaningful and enjoyable physically active play that supports the development of the whole child. To this end, the main intervention is a 7-month professional development/education module for preschool staff, aimed to provide them with the necessary capacity to deliver four core PA components to the children (moderate-to-vigorous PA, motor-challenging PA, cognitively engaging play, and physically active learning). We will include a range of child level outcomes, including physical activity, physical fitness, adiposity, motor skills, socio-emotional health, self-regulation, executive function, and learning. At the preschool level, we will describe implementation and adaptation processes using quantitative and qualitative data. Discussion. Professional development of staff and a whole-child approach that integrates PA with cognitively engaging play and learning activities in the preschool setting may provide a feasible vehicle to enhance both physical and cognitive development in young children. ACTNOW is designed to test this hypothesis to provide a sustainable way to build human capital and provide an early solution to lifelong public health and developmental challenges. Trial registration. The study is registered in Clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04048967?term=actnow&rank=1) 07.08.2019 with identification number NCT04048967.

Purpose In this study, we tested the effectiveness of a multicomponent sports-based program aimed at promoting early intervention, help seeking, and resilience among a sample of adolescent male sport participants. Methods The Ahead of the Game program comprised four intervention components and a messaging campaign. Two components targeted mental health literacy, intentions to seek and provide help, and resilience among adolescent boys. A mental health literacy program for parents and a coach education program to assist in the support of athletes’ psychological needs were also included. We evaluated the program using a nonrandomized controlled trial matching two regional communities. In total, 350 sport participants (mean, 14.53 yr) were included in an intervention group, whereas 466 (mean, 14.66 yr) received usual practice in a matched control community. One hundred and eighty parents or caregivers and eight coaches also participated in the intervention components. Between-group mean differences on the primary and secondary outcomes were analyzed using linear mixed models, adjusted for clustering at club level, participant age, and socioeconomic status. Results Significant positive group–time interactions were found for the primary outcomes of depression and anxiety literacy, intentions to seek help from formal sources, confidence to seek mental health information, and resilience. We also found a significant positive group–time interaction for the secondary outcome of well-being. There were no group–time interactions for social distance (stigma), intentions to seek help from informal sources, implicit beliefs about adversity, perceived familial support, or psychological distress. Conclusions Given the high rates of sport participation worldwide and the increasing focus on mental health in this domain, translation and dissemination of the program may be warranted after replication.

OBJECTIVE: To identify and evaluate the effects of community-based interventions on the sedentary behavior (SB) of Latin American children and adolescents. METHODS: A systematic review on community-based trials to reduce and/or control SB in Latin American countries (Prospero: CRD42017072157). Five databases (PubMed, Web of Science, Scopus, SciELO and Lilacs) and a reference lists were searched. RESULTS: Ten intervention studies met the eligibility criteria and composed the descriptive synthesis. These studies were conducted in Brazil (n=5), Mexico (n=3), Ecuador (n=1) and Colombia (n=1). Most interventions were implemented in schools (n=8) by educational components, such as meetings, lessons, and seminars, on health-related subjects (n=6). Only two studies adopted specific strategies to reduce/control SB; others focused on increasing physical activity and/or improving diet. Only one study used an accelerometer to measure SB. Seven studies investigated recreational screen time. Eight studies showed statistically significant effects on SB reduction (80%). CONCLUSIONS: Latin America community-based interventions reduced children and adolescents’ SB. Further studies should: define SB as a primary outcome and implement strategies to reduce such behaviour; focus in different SBs and settings, other than recreational screen time or at-home sitting time; and use objective tools together with questionnaires to measure sedentary behaviour in.

Background: The early years of life are critical for motor and cognitive development. A better understanding is needed on the associations between the control and development of motor and cognitive tasks. Aim: This study aimed to examine the association between gross motor skills and cognitive development in toddlers. Study design: Cross-sectional study. Subjects: This study included 335 toddlers (aged 19.80 ± 4.08 months, 53.7% boys) from 30 childcare services in Australia. Outcome measures: Children were assessed on gross motor skills (Peabody Developmental Motor Scales 2nd Edition; PDMS-2) and cognitive development (Bayley Scales of Infant and Toddler development 3rd edition; Bayley-III). Data analysis: A one-way ANCOVA was conducted to assess associations between gross motor skills and cognitive development controlling for childcare center, sex, age, body mass index and socioeconomic status. Results: The average scores were 96.41 ± 9.84 for gross motor skills (range gross motor quotient 35–165) and 11.45 ± 3.03 for cognitive development (range standard score 1–19). There was a significant positive association between gross motor skills and cognition, F (2,260) = 12.245, p < 0.001. Both locomotion and object manipulation were significantly positively associated with cognition, F (2,266) = 14.607, p < 0.001 and F (2,265) = 9.039, p < 0.001 respectively. Conclusions: Levels of gross motor skills are positively associated with cognitive development in this sample of Australian toddlers. Results reinforce the need for early commencement of gross motor skill promotion as this might be important for cognitive development in the early years.

AIM: Gross motor skills are important for children's health and development. Delays in these skills are a concern for healthy developmental trajectories and therefore early identification of delay is important. This study screened for gross motor delay in children from low-income communities and investigated potential risk factors associated with gross motor delay.METHODS: This cross-sectional study involved 701 pre-schoolers (Mage = 54.1 ± 8.6 months, 52.8% boys) from childcare services in low-income and remote communities in Australia. Gross motor delay was assessed using the Ages and Stages Questionnaire - third edition. Potential risk factors included: sex, age, birthweight, prematurity status, weight status, childcare service, postcode, parent's education, parent's marital status, parent's employment and family income.RESULTS: Results showed 4.4% of the children were delayed in gross motor skills and 8.8% were at risk of delay. Logistic regression showed being a boy (odds ratio (OR) 1.78, 95% confidence interval (CI) 1.12-2.84), underweight (OR 2.72, 95% CI 1.18-6.30) or overweight (OR 1.83, 95% CI 1.00-3.33), and parental unemployment (OR 1.79, 95% CI 1.01-3.16) were factors associated with a higher odds of children being delayed or at risk of gross motor delay. A higher family income (OR 0.35, 95% CI 0.13-0.93) was associated with lower odds of delay.CONCLUSION: This unique study demonstrated children in low-income communities, especially boys, underweight and overweight children, have higher odds of being at risk of gross motor delay. Therefore, early screening is vital in this population in order to identify delays and potentially intervene with appropriate motor skill interventions.

CONTEXT: The World Health Organization recommends tummy time for infants because of the benefits of improved motor development and reduced likelihood of plagiocephaly. Because of poor uptake of these recommendations, the association of tummy time with other health outcomes requires further investigation. OBJECTIVE: To review existing evidence regarding the association of tummy time with a broad and specific range of infant health outcomes. DATA SOURCES: Electronic databases were searched between June 2018 and April 2019. STUDY SELECTION: Peer-reviewed English-language articles were included if they investigated a population of healthy infants (0 to 12 months), using an observational or experimental study design containing an objective or subjective measure of tummy time which examined the association with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health, or risks/harms). DATA EXTRACTION: Two reviewers independently extracted data and assessed their quality. RESULTS: Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting. No association was found for fine motor development and communication. LIMITATIONS: Most studies were observational in design and lacked the robustness of a randomized controlled trial. High selection and performance bias were also present. CONCLUSIONS: These findings guide the prioritization of interventions aimed at assisting parents meet the global and national physical activity guidelines.