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Exploring 24-Hour Movement Behaviors in Early Years: Findings From the SUNRISE Pilot Study in Tunisia

Mohamed Amine Ltifi, Olfa Turki, Ghaith Ben-Bouzaiene, Jeffrey Cayaban Pagaduan, Anthony Okely, and Mohamed Souhaiel Chelly

Purpose: The International Study of Movement Behaviors in the Early Years (SUNRISE) was conducted in Tunisia to assess the proportion of preschoolers who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep. The study also evaluated the feasibility of the methods for the SUNRISE study. Methods: Five kindergartens were recruited from urban and rural areas in Tunisia. Physical activity and sleep duration were assessed using a waist-worn ActiGraph. Screen time and sleep quality were assessed via an interview-administered parent questionnaire. The NIH Toolbox was used. Results: A total of 112 preschoolers were assessed (50 boys, age = 4.1 [0.58]). Only 18% of children met all recommendations of the World Health Organization guidelines, while 53% met the sedentary screen time (in minutes per day), and 41% met physical activity recommendation (in minutes per day). Eighty-one percent of children met the sleep duration recommendation (in minutes per day). There was good compliance with the ActiGraph protocol. Conclusions: This pilot study provided important insights into the feasibility of the study and the movement behaviors of Tunisian preschool children. The results suggest there is a need to promote healthy levels of physical activity and sedentary screen time in children, which should be a priority in public health initiatives, including preschool curricula, in Tunisia.

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A Matched-Pair Analysis of Gross Motor Skills of 3- to 5-Year-Old Children With and Without a Chronic Physical Illness

Chloe Bedard, Sara King-Dowling, Brian W. Timmons, and Mark A. Ferro

Purpose: The purpose of this study was to compare the gross motor skills of children with a chronic physical illness with those of their healthy peers. Methods: Data for children with a chronic physical illness come from the Multimorbidity in Children and Youth Across the Life Course study, and data from children without a physical illness come from the Health Outcomes and Physical Activity in Preschoolers study. Multimorbidity in Children and Youth Across the Life Course and Health Outcomes and Physical Activity in Preschoolers included children ages 3–5 years and administered the Peabody Development Motor Scales-second edition. Participants were sex and age matched (20 male and 15 female pairs; M age = 54.03 [9.5] mo). Results : Gross motor skills scores were “below average” for 47% of children with a physical illness compared with 9% of children without a physical illness (P = .003). Matched-paired t tests detected significant differences in total gross motor scores (d z  = −0.35), locomotor (d z  = −0.31), and object control (d z  = −0.39) scores, with healthy children exhibiting better motor skills, and no significant difference in stationary scores (d z  = −0.19). Conclusions : This skill gap may increase burden on children with physical illness and future research should assess gross motor skills longitudinally to establish whether the gap widens with age.

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Association of Physical Fitness and Anthropometric Parameters With Lung Function in 7-Year-Old Children

Iker García, Marta San-Millán, Jorge Cazorla-González, Blanca Román-Viñas, Juan Serrano-Ferrer, Anna Jòdar-Portas, Anna Prats-Puig, and Raquel Font-Lladó

Purpose: Associations between health-related parameters and lung function remain unclear in childhood. The study aims to evaluate the relationship between physical fitness and anthropometric parameters with the lung function of healthy scholar-aged children. Method : A total of 418 children aged 7 years old participated in this study. The associations of physical fitness (handgrip strength, standing broad jump, and 800-m run) and anthropometric (waist circumference and body mass index) parameters with lung function (forced vital capacity and forced expiratory volume in 1 s) were analyzed using a mixed-linear regression model. Results: Girls had significantly lower forced vital capacity values (P = .006) and physical fitness (P < .030) compared to boys. On mixed-linear regression analyses, waist circumference (P = .003) was independently associated with forced vital capacity, explaining 34.6% of its variance, while handgrip strength (P = .042) and waist circumference (P = .010) were independently associated with forced expiratory volume in 1 second, accounting together for 26.5% of its variance in 7-year-old healthy children. Conclusions : Handgrip strength and waist circumference were associated with lung function in healthy children highlighting the influence of upper body muscular strength and trunk dimension on lung function. Our results corroborate the need to promote physical fitness during childhood to protect against lung complications in later on in life.

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Clustering Patterns of 24-Hour Physical Activity in Children 6–36 Months Old

Peter Olejua, Alexander C. McLain, Nabila Inak, Marsha Dowda, and Russell R. Pate

Purpose: To determine 24-hour physical activity (PA) clusters in children 6–36 months of age, factors associated with the clusters, and their agreement across time. Method: A longitudinal study followed 150 infants from South Carolina up to 36 months of age. Measures included 24-hour PA and demographic data. Functional clustering was used to obtain the clusters. The association between cluster membership and infant/parent characteristics was examined by Kruskal–Wallis and chi-squared tests. Concordance was measured with the kappa coefficient and percent agreement. Results: At each follow-up, 3 clusters were optimal, identified as late activity (cluster 1), high activity (cluster 2), and medium activity (cluster 3). The defining feature of the late activity cluster was that their physical activity (PA) activity was shifted to later in the day versus children in clusters 2 and 3. At 6 months, the clusters were associated with race (<0.001), crawling (0.043), other children in the household (0.043), and mother’s education (0.004); at 12 months with race (0.029), childcare (<0.001), and education (<0.001); and at 36 months with other children in the household (0.019). Clusters showed moderate agreement (kappa = .41 [.25 to .57], agreement = 61% [49% to 72%]) between 6 and 12 months and, at 36 months, showed no agreement with either 6 or 12 months. Conclusion: Twenty-four-hour PA can be clustered into medium, high, and late PA. Further research is needed into the consequences of late sleeping in children at this age. Clusters are associated with household and childcare factors, and cluster membership is dynamic across time.

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Gamification to Promote Physical Activity in Youth and Mothers With Obesity

Elizabeth Prout Parks, Kelly C. Allison, Yasmeen Bruton, Timothy Khalil, and Jonathan A. Mitchell

Purpose: Physical inactivity and sugar-sweetened beverage (SSB) consumption are associated with obesity. Gamification and self-monitoring to promote physical activity in youth is unknown, but evidence of effectiveness is present in adults. This study examined the effects of a gamification intervention on increased steps per day among parent–adolescent dyads with obesity compared with digital self-monitoring and if self-monitored SSB intake differed between these arms. Methods: Youth ages 10–16 years and their mothers (N = 39 pairs), both with obesity, were randomized to a self-monitoring (N = 18) or a self-monitoring plus gamification arm (N = 21) for 9 weeks. The step goal was set and incrementally increased each week and was measured with Fitbit devices. Mixed effects linear regression examined changes in steps and SSB consumption per day, per week by study arm. Results: During run-in, mothers averaged 8317 and youth 7508 steps per day. Compared with self-monitoring alone, gamification did not increase daily steps in mothers or youth beyond baseline levels. On average, SSB intake decreased in mothers by approximately 0.5 servings per day; occurred in both arms and persisted throughout the intervention. Conclusion: Gamification did not promote physical activity levels in mother–youth dyads with obesity. SSB intake declined in mothers with obesity in both study arms.

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Volume 36 (2024): Issue 1 (Feb 2024)

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Reference Values in the 6-Minute Walk Test in Chilean Children Aged 3–10 Years and Relationship With Cardiometabolic Risk

Pedro A. Latorre Román, Cristian Martínez Salazar, Juan A. Párraga Montilla, José Carlos Cabrera-Linares, Karina E. Andrade-Lara, Alejandro Robles Fuentes, and José Miguel Espinoza Silva

Purpose: The aim of this study was to evaluate the performance of healthy Chilean children aged 3–10 years in the 6-minute walking test (6MWT) and cardiometabolic risk variables and to determine sex- and age-specific reference values. Methods: This study involved 1165 healthy children (age = 6.36 [1.70] y old). The 6MWT was used to evaluate exercise performance. Furthermore, anthropometric measures were collected, like weight, height, body mass index, waist circumference, and skin folds. Resting heart rate and blood pressure (BP) were also evaluated. Results: The prevalence of overweight and obesity was 35.0% and 25.4% in preschoolers and 29.0% and 36.2% in school-age children, respectively, showing significant differences (P < .05) between age groups. The distance walked (6-min walk distance) increased significantly year on year at ages from 3 to 10 years. According to the regression analysis, 6MWT performance was positively related to age, systolic BP, and height, whereas it was negatively related to ∑4 skinfold fat, resting heart rate, diastolic BP, and waist circumference. Conclusions: This study provides a reference equation and an age- and sex-adjusted percentile curve to assess the predicted 6MWT performance in a cohort of prepubertal Chilean children. The 6-minute walk distance depends mainly on age; however, other variables, such as resting heart rate, BP, skinfold fat, and waist circumference, add significant information and should be taken into account.

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Physical Activity, but Not Body Mass Index Is Associated With Blood Pressure in Young Children

Katrina D. DuBose, Kathryn Beaman, Christine Habeeb, and Deirdre Dlugonski

Purpose: This study examined associations between physical activity (PA) and obesity with blood pressure (BP) in young children. Furthermore, a possible moderating effect of obesity status was examined. Methods: A cross-sectional study was completed with 121 children (3.96 [1.14] y). BP, weight, and height were measured, and body mass index (BMI) was calculated. Z scores were calculated for BMI, systolic, and diastolic values. Accelerometry measured time spent in PA intensities. Correlations and regressions examined relationships among PA intensities, BMI z scores, and BP z scores and to determine if obesity status moderated these relationships. Results: On average, the children spent 52 minutes per day in moderate-to-vigorous physical activity, 31% were considered overweight/obese, and 15% were considered hypertensive. After adjusting for confounders, participation in moderate, vigorous, and moderate-to-vigorous physical activity was related with lower systolic and diastolic BP z scores (P < .05). BMI z score was not related to BP values. Obesity status did not moderate the relationships between time spent in PA and BP. Conclusions: Participation in PA, but not obesity, was related to lower BP levels in young children. The impact PA has on BP is the same regardless of obesity status. Thus, young children should be encouraged to be active in different intensities to benefit the cardiovascular system.

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Child Soccer Players’ Perceptions of Strength and Conditioning Training: A Multimethod Approach Using Write, Draw, Show and Tell

Ricardo Martins, Emma Eyre, Matteo Crotti, Rhys Morris, Will Pattison, and Michael Duncan

Purpose: The use of strength and conditioning training in childhood is a hot topic surrounded by myths and misconceptions. Despite scientific evidence supporting the safety and benefits of this training for children, the lack of representation of their voices poses a challenge in designing training programs that meet their specific needs and requirements. Methods: Children’s views, experiences, and perceptions of strength and conditioning training were explored by Write, Draw, Show and Tell techniques. Sixteen grassroots soccer players aged 11–12 years took part in one of 3 focus groups exploring the topic. Data were analyzed following an inductive approach enabling themes to be explored and later deductive analyses using the Youth Physical Activity Promotion model to create pen profile diagrams. Results: Strength and conditioning were frequently associated with muscle growth, coordination, endurance, and rest. Enabling factors included autonomy, resilience, physical development, and training opportunities. Reinforcing factors included social support, social interference, coaches’ communication, role models, and the ways of implementation. Conclusions: Participants favor integrating strength and conditioning into their soccer training rather than conducting it as a separate session, which is reflected in their enjoyment. Nonetheless, children remain apprehensive about the potential effects of this type of training on their growth.

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Postural Balance in Boys With Intellectual Disabilities Who Participate in Soccer Training

Ghada Jouira, Haithem Rebai, Dan Iulian Alexe, and Sonia Sahli

Purpose: The aim of this study is to investigate the postural balance in children with intellectual disabilities who participate in soccer training compared with their sedentary peers. Method: Two groups of boys with intellectual disabilities aged 8–10 years participated in this study: a soccer group (n = 12) and a sedentary group (n = 12). Postural balance was assessed using a force platform under 4 different conditions: open eyes, and closed eyes, on firm and foam surfaces. The Timed Up and Go Test, 10-m Walking Test, and Four-Square Step Test were also conducted. Results: The soccer group had significantly lower (P < .05) center of pressure values compared with the sedentary group, on both firm and foam surfaces, but only under the open eyes condition. They were significantly faster (P < .05) in the Timed Up and Go Test, 10-m Walking Test, and Four-Square Step Test compared with their sedentary peers. However, there were no significant differences between the 2 groups on the sit-to-stand and turn-to-sit phases of the Timed Up and Go Test. Conclusion: Soccer participation may have a positive effect on postural balance in boys with intellectual disabilities. These findings may have implications for the development of exercise programs to improve postural balance and reduce the risk of falls in this population.