The Active Healthy Kids Global Alliance organized the concurrent preparation of Report Cards on the physical activity of children and youth in 38 countries from 6 continents (representing 60% of the world’s population). Nine common indicators were used (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and the Built Environment, and Government Strategies and Investments), and all Report Cards were generated through a harmonized development process and a standardized grading framework (from A = excellent, to F = failing). The 38 Report Cards were presented at the International Congress on Physical Activity and Public Health in Bangkok, Thailand on November 16, 2016. The consolidated findings are summarized in the form of a Global Matrix demonstrating substantial variation in grades both within and across countries. Countries that lead in certain indicators often lag in others. Average grades for both Overall Physical Activity and Sedentary Behavior around the world are D (low/poor). In contrast, the average grade for indicators related to supports for physical activity was C. Lower-income countries generally had better grades on Overall Physical Activity, Active Transportation, and Sedentary Behaviors compared with higher-income countries, yet worse grades for supports from Family and Peers, Community and the Built Environment, and Government Strategies and Investments. Average grades for all indicators combined were highest (best) in Denmark, Slovenia, and the Netherlands. Many surveillance and research gaps were apparent, especially for the Active Play and Family and Peers indicators. International cooperation and cross-fertilization is encouraged to address existing challenges, understand underlying determinants, conceive innovative solutions, and mitigate the global childhood inactivity crisis. The paradox of higher physical activity and lower sedentary behavior in countries reporting poorer infrastructure, and lower physical activity and higher sedentary behavior in countries reporting better infrastructure, suggests that autonomy to play, travel, or chore requirements and/or fewer attractive sedentary pursuits, rather than infrastructure and structured activities, may facilitate higher levels of physical activity.
Mark S. Tremblay, Joel D. Barnes, Silvia A. González, Peter T. Katzmarzyk, Vincent O. Onywera, John J. Reilly, Grant R. Tomkinson, and the Global Matrix 2.0 Research Team
Diego Augusto Santos Silva, Mark Tremblay, Andreia Pelegrini, Roberto Jeronimo dos Santos Silva, Antonio Cesar Cabral de Oliveira, and Edio Luiz Petroski
Criterion-referenced cut-points for health-related fitness measures are lacking. This study aimed to determine the associations between aerobic fitness and high blood pressure levels (HBP) to determine the cut-points that best predict HBP among adolescents.
This cross-sectional school-based study with sample of 875 adolescents aged 14–19 years was conducted in southern Brazil. Aerobic fitness was assessed using the modified Canadian Aerobic Fitness Test (mCAFT). Systolic and diastolic blood pressure were measured by the oscillometric method with a digital sphygmomanometer. Analyses controlled for sociodemographic variables, physical activity, body mass and biological maturation.
Receiver Operating Characteristic (ROC) curves demonstrated that mCAFT measures could discriminate HBP in both sexes (female: AUC = 0.70; male: AUC = 0.63). The cut-points with the best discriminatory power for HBP were 32 mL·kg-1·min-1 for females and 40 mL·kg-1·min-1 for males. Females (OR = 8.4; 95% CI: 2.1, 33.7) and males (OR: 2.5; CI 95%: 1.2, 5.2) with low aerobic fitness levels were more likely to have HBP.
mCAFT measures are inversely associated with BP and cut-points from ROC analyses have good discriminatory power for HBP.
Taru Manyanga, Daga Makaza, Carol Mahachi, Tholumusa F. Mlalazi, Vincent Masocha, Paul Makoni, Eberhard Tapera, Bhekuzulu Khumalo, Sipho H. Rutsate, and Mark S. Tremblay
The report card was a synthesis of the best available evidence on the performance of Zimbabwean children and youth on key physical activity (PA) indicators. The aim of this article was to summarize the results from the 2016 Zimbabwe Report Card.
The Report Card Working Group gathered and synthesized the best available evidence, met, discussed and assigned grades to 10 indicators based on the Active Healthy Kids Global Alliance global matrix grading system.
The indicators were graded as follows: overall PA (C+), organized sport participation (B), active play (D+), active transportation (A-), sedentary behaviors (B), school (D), family and peers (Incomplete), community and the built environment (F), government (D) and nongovernmental organizations (Incomplete).
Although the majority of children used active transport, played organized sports and engaged in acceptable levels of PA, most of them did not meet the recommended hours of unstructured/unorganized play per day. At present, there are limited data to accurately inform the Zimbabwe Report Card therefore studies employing robust research designs with representative samples are needed. Zimbabwe also needs to prioritize policies and investments that promote greater and safe participation in PA among children and youth.
Joel D. Barnes, Christine Cameron, Valerie Carson, Jean-Philippe Chaput, Rachel C. Colley, Guy E.J. Faulkner, Ian Janssen, Roger Kramers, Travis J. Saunders, John C. Spence, Patricia Tucker, Leigh M. Vanderloo, and Mark S. Tremblay
Samantha Stephens, Tim Takken, Dale W. Esliger, Eleanor Pullenayegum, Joseph Beyene, Mark Tremblay, Jane Schneiderman, Doug Biggar, Pat Longmuir, Brian McCrindle, Audrey Abad, Dan Ignas, Janjaap Van Der Net, and Brian Feldman
The purpose of this study was to assess the criterion validity of existing accelerometer-based energy expenditure (EE) prediction equations among children with chronic conditions, and to develop new prediction equations. Children with congenital heart disease (CHD), cystic fibrosis (CF), dermatomyositis (JDM), juvenile arthritis (JA), inherited muscle disease (IMD), and hemophilia (HE) completed 7 tasks while EE was measured using indirect calorimetry with counts determined by accelerometer. Agreement between predicted EE and measured EE was assessed. Disease-specific equations and cut points were developed and cross-validated. In total, 196 subjects participated. One participant dropped out before testing due to time constraints, while 15 CHD, 32 CF, 31 JDM, 31 JA, 30 IMD, 28 HE, and 29 healthy controls completed the study. Agreement between predicted and measured EE varied across disease group and ranged from (ICC) .13–.46. Disease-specific prediction equations exhibited a range of results (ICC .62–.88) (SE 0.45–0.78). In conclusion, poor agreement was demonstrated using current prediction equations in children with chronic conditions. Disease-specific equations and cut points were developed.
Taru Manyanga, Joel D. Barnes, Chalchisa Abdeta, Ade F. Adeniyi, Jasmin Bhawra, Catherine E. Draper, Tarun R. Katapally, Asaduzzaman Khan, Estelle Lambert, Daga Makaza, Vida K. Nyawornota, Reginald Ocansey, Narayan Subedi, Riaz Uddin, Dawn Tladi, and Mark S. Tremblay
Background: This study compares results of physical activity report cards from 9 countries with low to medium human development indices, participating in the Global Matrix 3.0 initiative. Methods: Country-specific report cards were informed by relevant data and government policy documents, reporting on 10 core indicators of physical activity for children and youth. Data were synthesized by report card working groups following a harmonized process. Grade assignments for each indicator utilized a standard grading rubric. Indicators were grouped into one of 2 categories: daily behaviors and settings and sources of influence. Descriptive statistics (average grades) were computed after letter grades were converted into interval variables. Spearman’s rank correlation coefficients were calculated for all correlation analyses. Results: Mean grades for daily behaviors were higher (C) than those for settings and sources of influence (D+). Twenty-nine out of the possible 90 grades were assigned an incomplete. There were moderate to strong positive and negative relationships between different global indices and overall physical activity, organized sport and physical activity, active play, family, community and environment, and government. Conclusions: Findings demonstrate an urgent need for high-quality data at the country level in order to better characterize the physical activity levels of children and youth in countries with low to medium human development indices.
Salomé Aubert, Joel D. Barnes, Megan L. Forse, Evan Turner, Silvia A. González, Jakub Kalinowski, Peter T. Katzmarzyk, Eun-Young Lee, Reginald Ocansey, John J. Reilly, Natasha Schranz, Leigh M. Vanderloo, and Mark S. Tremblay
Background: In response to growing concerns over high levels of physical inactivity among young people, the Active Healthy Kids Global Alliance developed a series of national Report Cards on physical activity for children and youth to advocate for the promotion of physical activity. This article provides updated evidence of the impact of the Report Cards on powering the movement to get children and youth moving globally. Methods: This assessment was performed using quantitative and qualitative sources of information, including surveys, peer-reviewed publications, e-mails, gray literature, and other sources. Results: Although it is still too early to observe a positive change in physical activity levels among children and youth, an impact on raising awareness and capacity building in the national and international scientific community, disseminating information to the general population and stakeholders, and on powering the movement to get kids moving has been observed. Conclusions: It is hoped that the Report Card activities will initiate a measurable shift in the physical activity levels of children and contribute to achieving the 4 strategic objectives of the World Health Organization Global Action Plan as follows: creating an active society, creating active environments, creating active lives, and creating active systems.
Joel D. Barnes, Christine Cameron, Valerie Carson, Jean-Philippe Chaput, Guy E.J. Faulkner, Katherine Janson, Ian Janssen, Roger Kramers, Allana G. LeBlanc, John C. Spence, and Mark S. Tremblay
The ParticipACTION Report Card on Physical Activity for Children and Youth is the most comprehensive assessment of child and youth physical activity in Canada and provides an update or “state of the nation” that assesses how Canada is doing at promoting and facilitating physical activity opportunities for children and youth. The purpose of this paper is to summarize the results of the 2016 ParticipACTION Report Card.
Twelve physical activity indicators were graded by a committee of experts using a process that was informed by the best available evidence. Sources included national surveys, peer-reviewed literature, and gray literature such as government and nongovernment reports and online content.
Grades were assigned to Daily Behaviors (Overall Physical Activity: D-; Organized Sport and Physical Activity Participation: B; Active Play: D+; Active Transportation: D; Physical Literacy: D+; Sleep: B; Sedentary Behaviors: F), Settings and Sources of Influence (Family and Peers: C+; School: B; Community and Environment: A-), and Strategies and Investments (Government: B-; Nongovernment: A-).
Similar to previous years of the Report Card, Canada generally received good grades for indicators relating to investment, infrastructure, strategies, policies, and programming, and poor grades for behavioral indicators (eg, Overall Physical Activity, Sedentary Behaviors).
Leigh M. Vanderloo, Jonathan L. Maguire, David W. H. Dai, Patricia C. Parkin, Cornelia M. Borkhoff, Mark S. Tremblay, Laura N. Anderson, Catherine S. Birken, and on behalf of the TARGet Kids! Collaboration
Background: This study aimed to examine the association between physical activity (PA) and a total cardio metabolic risk (CMR) score in children aged 3–12 years. Secondary objectives were to examine the association between PA and individual CMR factors. Methods: A longitudinal study with repeated measures was conducted with participants from a large primary care practice-based research network in Toronto, Canada. Mixed effects models were used to examine the relationship between parent-reported physical activity and outcome variables (total CMR score, triglycerides, glucose, high-density lipoprotein cholesterol, systolic blood pressure, waist circumference, weight-to-height ratio, and non-high-density lipoprotein cholesterol). Results: Data from 1885 children (6.06 y, 54.4% male) with multiple visits (n = 2670) were included in the analyses. For every unit increase of 60 minutes of PA, there was no evidence of an association with total CMR score (adjusted: −0.02 [−0.014 to 0.004], P = .11]. For the individual CMR components, there was evidence of a weak association between PA and systolic blood pressure (−0.01 [−0.03 to −0.01], P < .001) and waist-to-height ratio (−0.81 [−1.62 to −0.003], P < .001). Conclusion: Parent-reported PA among children aged 3–12 years was not statistically associated with total CMR, but was weakly associated with systolic blood pressure and waist-to-height ratio.
Leigh M. Vanderloo, Jonathan L. Maguire, Charles D.G. Keown-Stoneman, Patricia C. Parkin, Cornelia M. Borkhoff, Mark S. Tremblay, Laura N. Anderson, Catherine S. Birken, and on behalf of the TARGet Kids! Collaboration
Introduction: The authors aimed to examine the association between meeting the integrative movement behavior guidelines (physical activity, screen viewing, and sleep) and cardiometabolic risk (CMR) factors in young children. Methods: In this cross-sectional study, physical activity, screen viewing, and sleep were assessed using parent-reported data. The 24-Hour Movement Guidelines for the Early Years (0–4 y) were defined as 180 minutes of physical activity/day (of which ≥60 min should be moderate-to-vigorous intensity), ≤1 hour of screen viewing/day, and 10 to 13 hours of sleep/night. Waist circumference, glucose, high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure were measured in a clinical setting by trained staff. A total CMR score and individual CMR factors served as primary and secondary outcomes, respectively. Results: Of the 767 participants (3–4 y), 26.4% met none of the guideline’s recommendations, whereas 41.3%, 33.1%, and 10.6% of the sample met 1, 2, or all 3 recommendations, respectively. The number of recommendations met was not associated with the total CMR score or individual CMR factors (P > .05), with the exceptions of high-density lipoprotein (odds ratio = 1.61; 95% confidence interval, 1.11 to 2.33; P = .01). Conclusion: Meeting the 24-Hour Movement Guidelines in early childhood was not associated with overall CMR, but was associated with favorable cholesterol outcomes.