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Levels and Patterns of Physical Activity in Children and Adolescents With Type 1 Diabetes and Associated Metabolic and Physiologic Health Outcomes

Sarah Edmunds, Denise Roche, and Gareth Stratton

Background:

The current study objectively assessed physical activity (PA) levels and patterns in children and adolescents with type 1 diabetes and compared the metabolic and physiologic health profiles of those achieving and those not achieving the current recommendation of 60 minutes a day (minutes·D−1) of at least moderate intensity PA.

Method:

37 children and adolescents (20 boys, 17 girls) aged 12.7 ± 2.1 years (mean ± SD), disease duration 5.9 ± 3.0 years participated. PA was assessed using heart rate monitoring. Peak VO2, BMI, sum of 5 skinfolds, HbA1c, and daily insulin dosage were also determined.

Results:

Mean accumulated time in moderate-to-vigorous intensity PA was 53.6 ± 31.4 minutes·D−1. Levels of vigorous-intensity PA were low, mean 8.3 ± 10.2 minutes·D−1. When controlling for age, no differences in metabolic or physiologic health outcomes were evident between those individuals achieving, and those not achieving, 60 minutes·D−1 of moderate-to-vigorous intensity PA. PA predominantly occurred in short bouts lasting 5 minutes or less.

Conclusion:

The efficacy of accumulating 60 minutes·D−1 of moderate-to-vigorous intensity PA, in the form of short duration, intermittent bouts of largely unplanned PA, to promote health gains in children and adolescents with type 1 diabetes is questionable.

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Learning From the Experts: Exploring Playground Experience and Activities Using a Write and Draw Technique

Zoe Rebecca Knowles, Daniel Parnell, Gareth Stratton, and Nicola Diane Ridgers

Background:

Qualitative research into the effect of school recess on children’s physical activity is currently limited. This study used a write and draw technique to explore children’s perceptions of physical activity opportunities during recess.

Methods:

299 children age 7−11 years from 3 primary schools were enlisted. Children were grouped into Years 3 & 4 and Years 5 & 6 and completed a write and draw task focusing on likes and dislikes. Pen profiles were used to analyze the data.

Results:

Results indicated ‘likes’ focused on play, positive social interaction, and games across both age groups but showed an increasing dominance of games with an appreciation for being outdoors with age. ‘Dislikes’ focused on dysfunctional interactions linked with bullying, membership, equipment, and conflict for playground space. Football was a dominant feature across both age groups and ‘likes/dislikes’ that caused conflict and dominated the physically active games undertaken.

Conclusion:

Recess was important for the development of conflict management and social skills and contributed to physical activity engagement. The findings contradict suggestions that time spent in recess should be reduced because of behavioral issues.

Open access

Energy Cost of Free-Play Activities in 10- to 11-Year-Old Children

Kelly A. Mackintosh, Kate Ridley, Gareth Stratton, and Nicola D. Ridgers

Objective:

This study sought to ascertain the energy expenditure (EE) associated with different sedentary and physically active free-play activities in primary school-aged children.

Methods:

Twenty-eight children (13 boys; 11.4 ± 0.3 years; 1.45 ± 0.09 m; 20.0 ± 4.7 kg·m-2) from 1 primary school in Northwest England engaged in 6 activities representative of children’s play for 10 minutes (drawing, watching a DVD, playground games and free-choice) and 5 minutes (self-paced walking and jogging), with 5 minutes rest between each activity. Gas exchange variables were measured throughout. Resting energy expenditure was measured during 15 minutes of supine rest.

Results:

Child (Schofield-predicted) MET values for watching a DVD, self-paced jogging and playing reaction ball were significantly higher for girls (P < .05).

Conclusions:

Utilizing a field-based protocol to examine children’s free-living behaviors, these data contribute to the scarcity of information concerning children’s EE during play to update the Compendium of Energy Expenditures for Youth.

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Reliability and Validity of the System for Observing Children’s Activity and Relationships During Play (SOCARP)

Nicola D. Ridgers, Gareth Stratton, and Thomas L. McKenzie

Background:

Children frequently engage in diverse activities that are broadly defined as play, but little research has documented children’s activity levels during play and how they are influenced by social contexts. Assessing potentially modifiable conditions that influence play behavior is needed to design optimal physical activity interventions.

Methods:

System for Observing Children’s Activity and Relationships during Play (SOCARP) was developed to simultaneously assess children’s physical activity, social group sizes, activity type, and social behavior during play. One hundred and fourteen children (48 boys, 66 girls; 42% overweight) from 8 elementary schools were observed during recess over 24 days, with 12 days videotaped for reliability purposes. Ninety-nine children wore a uni-axial accelerometer during their observation period.

Results:

Estimated energy expenditure rates from SOCARP observations and mean accelerometer counts were significantly correlated (r = .67; P < .01), and interobserver reliabilities (ie, percentage agreement) for activity level (89%), group size (88%), activity type (90%) and interactions (88%) met acceptable criteria. Both physical activity and social interactions were influenced by group size, activity type, and child gender and body weight status.

Conclusions:

SOCARP is a valid and reliable observation system for assessing physical activity and play behavior in a recess context.

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Twelve-Month Effects of a Playground Intervention on Children’s Morning and Lunchtime Recess Physical Activity Levels

Nicola D. Ridgers, Stuart J. Fairclough, and Gareth Stratton

Background:

Recess is an opportunity for children to engage in daily physical activity. The aim of this study was to investigate the 12-month effects of a playground intervention on children’s moderate-to-vigorous (MVPA) and vigorous physical activity (VPA) during morning and lunchtime recess.

Methods:

Four hundred and seventy children (232 boys, 238 girls) from 26 elementary schools participated in the study. Fifteen schools redesigned the playground environment using playground markings and physical structures. Eleven schools served as socioeconomic matched controls. Physical activity levels were quantified using heart rate and accelerometry at baseline, 6 months, and 12 months post-intervention. A 3-level (time, pupil, and school) multilevel analysis was used to determine the effects of the intervention across time on MVPA and VPA.

Results:

Positive yet nonsignificant intervention effects were found for MVPA and VPA during morning and lunchtime recess. Intervention children were more active during recess than control children. Interactions revealed that the intervention effect was stronger at 6 months than 12 months post-intervention.

Conclusions:

A playground markings and physical structures intervention had a positive effect on intervention children’s morning and lunchtime MVPA and VPA when assessed using heart rate and accelerometry, but this effect is strongest 6-months post-intervention and decreased between 6 months and 12 months.

Open access

Results From Wales’ 2016 Report Card on Physical Activity for Children and Youth: Is Wales Turning the Tide on Children’s Inactivity?

Richard Tyler, Marianne Mannello, Rebecca Mattingley, Chris Roberts, Robert Sage, Suzan R Taylor, Malcolm Ward, Simon Williams, and Gareth Stratton

Background:

This is the second Active Healthy Kids Wales Report Card. The 2016 version consolidates and translates research related to physical activity (PA) among children and youth in Wales, and aims to raise the awareness of children’s engagement in PA and sedentary behaviors.

Methods:

Ten PA indicators were graded using the Active Healthy Kids—Canada Report Card methodology involving a synthesis and expert consensus of the best available evidence.

Results:

Grades were assigned as follows: Overall PA, D+; Organized Sport Participation, C; Active and Outdoor Play, C; Active Transportation, C; Sedentary Behaviors, D-; Physical Literacy, INC; Family and Peer Influences, D+; School, B; Community and the Built Environment, C; and National Government Policy, Strategies, and Investments, B-.

Conclusions:

Despite the existence of sound policies, programs, and infrastructure, PA levels of children and youth in Wales are one of the lowest and sedentary behavior one of the highest globally. From the 2014 Report Card, the Family and Peer Influences grade improved from D to D+, whereas Community and the Built Environment dropped from B to C. These results indicate that a concerted effort is required to increase PA and decrease sedentary time in children and young people in Wales.

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Patterns of Objectively Measured Moderate-to-Vigorous Physical Activity in Preschool Children

Mareesa O’Dwyer, Stuart J. Fairclough, Nicola Diane Ridgers, Zoe Rebecca Knowles, Lawrence Foweather, and Gareth Stratton

Background:

Identifying periods of the day which are susceptible to varying levels of physical activity (PA) may help identify key times to intervene and potentially change preschool children’s PA behaviors. This study assessed variability of objectively measured moderate-to-vigorous physical activity (MVPA) during weekdays and weekend days among preschool children.

Methods:

One hundred and eighty-eight children (aged 3 to 5 years; 53.2% boys) from a northwest English city wore uni-axial accelerometers for 7 consecutive days.

Results:

Higher levels of MVPA were recorded in boys, particularly those who attended preschool for a half day. Children who attended preschool for a full day engaged in 11.1 minutes less MVPA than children who attended for a half day. After-school hours were characterized by a decrease in activity for all groups. Patterns of activity during the weekend were smoother with less variability.

Conclusion:

This study identified discrete segments of the week, specifically afterschool and during the weekend, when preschoolers engage in low levels of PA. Higher levels of MVPA among children who attended preschool for less time each day suggests that the structured preschool environment is related to decreased activity. Consequently, there is a need for interventions in young children to focus on school and home environments.

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The Physiological Cost and Enjoyment of Wii Fit in Adolescents, Young Adults, and Older Adults

Lee E.F. Graves, Nicola D. Ridgers, Karen Williams, Gareth Stratton, Greg Atkinson, and Nigel T. Cable

Background:

Active video games (exergames) increase energy expenditure (EE) and physical activity (PA) compared with sedentary video gaming. The physiological cost and enjoyment of exergaming in adolescents, and young and older adults has not been documented, nor compared with aerobic exercise. This study compared the physiological cost and enjoyment of exergaming on Wii Fit with aerobic exercise in 3 populations.

Methods:

Cardiorespiratory and enjoyment measurements were compared in 14 adolescents, 15 young adults, and 13 older adults during handheld inactive video gaming, Wii Fit activities (yoga, muscle conditioning, balance, aerobics), and brisk treadmill walking and jogging.

Results:

For all groups EE and heart rate (HR) of Wii Fit activities were greater than handheld gaming (P < .001) but lower than treadmill exercise (P ≤ .001). Wii aerobics elicited moderate intensity activity in adolescents, young adults, and older adults with respective mean (SD) metabolic equivalents of 3.2 (0.7), 3.6 (0.8), and 3.2 (0.8). HR during Wii aerobics fell below the recommended intensity for maintaining cardiorespiratory fitness. Group enjoyment rating was greater for Wii balance and aerobics compared with treadmill walking and jogging (P ≤ .05).

Conclusions:

Wii Fit appears an enjoyable exergame for adolescents and adults, stimulating light-to-moderate intensity activity through the modification of typically sedentary leisure behavior.

Open access

Global Matrix 4.0 Physical Activity Report Card Grades for Children and Adolescents: Results and Analyses From 57 Countries

Salomé Aubert, Joel D. Barnes, Iryna Demchenko, Myranda Hawthorne, Chalchisa Abdeta, Patrick Abi Nader, José Carmelo Adsuar Sala, Nicolas Aguilar-Farias, Susana Aznar, Peter Bakalár, Jasmin Bhawra, Javier Brazo-Sayavera, Mikel Bringas, Jonathan Y. Cagas, Angela Carlin, Chen-Kang Chang, Bozhi Chen, Lars Breum Christiansen, Candice Jo-Anne Christie, Gabriela Fernanda De Roia, Christine Delisle Nyström, Yolanda Demetriou, Visnja Djordjic, Arunas Emeljanovas, Liri Findling Endy, Aleš Gába, Karla I. Galaviz, Silvia A. González, Kylie D. Hesketh, Wendy Yajun Huang, Omphile Hubona, Justin Y. Jeon, Danijel Jurakić, Jaak Jürimäe, Tarun Reddy Katapally, Piyawat Katewongsa, Peter T. Katzmarzyk, Yeon-Soo Kim, Estelle Victoria Lambert, Eun-Young Lee, Sharon Levi, Pablo Lobo, Marie Löf, Tom Loney, José Francisco López-Gil, Juan López-Taylor, Evelin Mäestu, Agus Mahendra, Daga Makaza, Marla Frances T. Mallari, Taru Manyanga, Bojan Masanovic, Shawnda A. Morrison, Jorge Mota, Falk Müller-Riemenschneider, Laura Muñoz Bermejo, Marie H. Murphy, Rowena Naidoo, Phuong Nguyen, Susan Paudel, Željko Pedišić, Jorge Pérez-Gómez, John J. Reilly, Anne Kerstin Reimers, Amie B. Richards, Diego Augusto Santos Silva, Pairoj Saonuam, Olga L. Sarmiento, Vedrana Sember, Mohd Razif Shahril, Melody Smith, Martyn Standage, Gareth Stratton, Narayan Subedi, Tuija H. Tammelin, Chiaki Tanaka, Riki Tesler, David Thivel, Dawn Mahube Tladi, Lenka Tlučáková, Leigh M. Vanderloo, Alun Williams, Stephen Heung Sang Wong, Ching-Lin Wu, Paweł Zembura, and Mark S. Tremblay

Background: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children’s and adolescents’ (5–17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. Methods: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders’ top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. Results: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. Conclusions: The Global Matrix 4.0 represents the largest compilation of children’s and adolescents’ PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation.