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Victoria Penpraze, John J. Reilly, Christina M. MacLean, Colette Montgomery, Louise A. Kelly, James Y. Paton, Thomas Aitchison and Stan Grant

There is limited evidence on how much and on which days accelerometry monitoring should be performed to obtain a representative measurement of physical activity (PA) in young children. We measured 76 children (40 M and 36 F, mean age 5.6 years ([SD ± 0.4]) on 7 days using Actigraph accelerometers. Mean daily PA was expressed in counts per min (cpm). Reliability increased as the number of days and hours of monitoring increased, but only to 10 hr per day. At 7 days of monitoring for 10 hr per day, reliability was 80% (95% CI [70%, 86%]). The number of days was more important to reliability than the number of hours. The inclusion or exclusion of weekend days made relatively little difference. A monitoring period of 7 days for 10 hr per day produced the highest reliability. Surprisingly short monitoring periods may provide adequate reliability in young children.

Open access

Mark S. Tremblay, Silvia A. Gonzalez, Peter T. Katzmarzyk, Vincent O. Onywera, John J. Reilly and Grant Tomkinson

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Kieran P. Dowd, Helen Purtill, Deirdre. M. Harrington, Jane F. Hislop, John J. Reilly and Alan E. Donnelly

Objectives:

This study aims to determine the minimum number of days of monitoring required to reliably predict sitting/lying time, standing time, light intensity physical activity (LIPA), moderate-to-vigorous intensity physical activity (MVPA) and steps in adolescent females.

Method:

195 adolescent females (mean age = 15.7 years; SD = 0.9) participated in the study. Participants wore the activPAL activity monitor for a seven day protocol. The amount of time spent sitting/lying, standing, in LIPA and in MVPA and the number of steps per day were quantified. Spearman-Brown Prophecy formulae were used to predict the number of days of data required to achieve an intraclass correlation coefficient of both 0.7 and 0.8.

Results:

For the percentage of the waking day spent sitting/lying, standing, in LIPA and in MVPA, a minimum of 9 days of accelerometer recording is required to achieve a reliability of ≥ 0.7, while a minimum of 15 days is required to achieve a reliability of ≥ 0.8. For steps, a minimum of 12 days of recording is required to achieve a reliability of ≥ 0.7, with 21 days to achieve a reliability of ≥ 0.8.

Conclusion:

Future research in adolescent females should collect a minimum of 9 days of accelerometer data to reliably estimate sitting/lying time, standing time, LIPA and MVPA, while 12 days is required to reliably estimate steps.

Open access

Razinah Sharif, Kar Hau Chong, Nur Hadiyani Zakaria, Min Li Ong, John J. Reilly, Jyh Eiin Wong, Hazizi Abu Saad and Bee Koon Poh

Background:

The 2016 Malaysia Active Healthy Kids Report Card aims to collect, assess, and grade current and comprehensive data on physical activity (PA) and associated factors in Malaysian children and adolescents aged 5 to 17 years.

Methods:

This report card was developed following the Active Healthy Kids Canada Report Card protocol. The Research Working Group identified the core matrices, assessed the key data sources, and evaluated the evidence gathered for grade assignments. A grade was assigned to each indicator by comparing the best available evidence against relevant benchmark using a standardized grading scheme.

Results:

Overall Physical Activity, Active Transportation, and Sedentary Behavior were assigned the D grade. The lowest grade of F was assigned to Diet, while School and Government Strategies and Investments were graded higher with a B. Five indicators were assigned INC (incomplete) due to a lack of representative data.

Conclusions:

The report card demonstrates that Malaysian children and adolescents are engaging in low levels of PA and active commuting, high levels of screen time, and have extremely low compliance with dietary recommendations. More efforts are needed to address the root causes of physical inactivity while increasing the opportunities for children and adolescents to be more physically active.

Open access

Christine Delisle Nyström, Christel Larsson, Bettina Ehrenblad, Hanna Eneroth, Ulf Eriksson, Marita Friberg, Maria Hagströmer, Anna Karin Lindroos, John J. Reilly and Marie Löf

Background:

The 2016 Swedish Report Card on Physical Activity (PA) for Children and Youth is a unique compilation of the existing physical and health related data in Sweden. The aim of this article is to summarize the procedure and results from the report card.

Methods:

Nationally representative surveys and individual studies published between 2005–2015 were included. Eleven PA and health indicators were graded using the Active Healthy Kids Canada grading system. Grades were assigned based on the percentage of children/youth meeting a defined benchmark (A: 81% to 100%, B: 61% to 80%, C: 41% to 60%, D: 21% to 40%, F: 0% to 20%, or incomplete (INC).

Results:

The assigned grades were Overall Physical Activity, D; Organized Sport Participation, B+; Active Play, INC; Active Transportation, C+; Sedentary Behaviors, C; Family and Peers, INC; School, C+; Community and the Built Environment, B; Government Strategies and Investments, B; Diet, C-; and Obesity, D.

Conclusions:

The included data provides some support that overall PA is too low and sedentary behavior is too high for almost all age groups in Sweden, even with the many national policies as well as an environment that is favorable to the promotion of PA.

Open access

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

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.

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Xanne Janssen, Dylan P. Cliff, John J. Reilly, Trina Hinkley, Rachel A. Jones, Marijka Batterham, Ulf Ekelund, Soren Brage and Anthony D. Okely

This study examined the classification accuracy of the activPAL, including total time spent sedentary and total number of breaks in sedentary behavior (SB) in 4- to 6-year-old children. Forty children aged 4–6 years (5.3 ± 1.0 years) completed a ~150-min laboratory protocol involving sedentary, light, and moderate- to vigorous-intensity activities. Posture was coded as sit/lie, stand, walk, or other using direct observation. Posture was classified using the activPAL software. Classification accuracy was evaluated using sensitivity, specificity and area under the receiver operating characteristic curve (ROC-AUC). Time spent in each posture and total number of breaks in SB were compared using paired sample t-tests. The activPAL showed good classification accuracy for sitting (ROC-AUC = 0.84) and fair classification accuracy for standing and walking (0.76 and 0.73, respectively). Time spent in sit/lie and stand was overestimated by 5.9% (95% CI = 0.6−11.1%) and 14.8% (11.6−17.9%), respectively; walking was underestimated by 10.0% (−12.9−7.0%). Total number of breaks in SB were significantly overestimated (55 ± 27 over the course of the protocol; p < .01). The activPAL performed well when classifying postures in young children. However, the activPAL has difficulty classifying other postures, such as kneeling. In addition, when predicting time spent in different postures and total number of breaks in SB the activPAL appeared not to be accurate.

Open access

Christiana M.T. van Loo, Anthony D. Okely, Marijka Batterham, Tina Hinkley, Ulf Ekelund, Soren Brage, John J. Reilly, Gregory E. Peoples, Rachel Jones, Xanne Janssen and Dylan P. Cliff

Background:

To validate the activPAL3 algorithm for predicting metabolic equivalents (TAMETs) and classifying MVPA in 5- to 12-year-old children.

Methods:

Fifty-seven children (9.2 ± 2.3y, 49.1% boys) completed 14 activities including sedentary behaviors (SB), light (LPA) and moderate-to-vigorous physical activities (MVPA). Indirect calorimetry (IC) was used as the criterion measure. Analyses included equivalence testing, Bland-Altman procedures and area under the receiver operating curve (ROC-AUC).

Results:

At the group level, TAMETs were significantly equivalent to IC for handheld e-game, writing/coloring, and standing class activity (P < .05). Overall, TAMETs were overestimated for SB (7.9 ± 6.7%) and LPA (1.9 ± 20.2%) and underestimated for MVPA (27.7 ± 26.6%); however, classification accuracy of MVPA was good (ROC-AUC = 0.86). Limits of agreement were wide for all activities, indicating large individual error (SB: −27.6% to 44.7%; LPA: −47.1% to 51.0%; MVPA: −88.8% to 33.9%).

Conclusions:

TAMETs were accurate for some SB and standing, but were overestimated for overall SB and LPA, and underestimated for MVPA. Accuracy for classifying MVPA was, however, acceptable.

Open access

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.

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Mark S. Tremblay, Casey E. Gray, Kingsley Akinroye, Dierdre M. Harrington, Peter T. Katzmarzyk, Estelle V. Lambert, Jarmo Liukkonen, Ralph Maddison, Reginald T. Ocansey, Vincent O. Onywera, Antonio Prista, John J. Reilly, María del Pilar Rodríguez Martínez, Olga L. Sarmiento Duenas, Martyn Standage and Grant Tomkinson

The Active Healthy Kids Canada (AHKC) Report Card on Physical Activity for Children and Youth has been effective in powering the movement to get kids moving by influencing priorities, policies, and practice in Canada. The AHKC Report Card process was replicated in 14 additional countries from 5 continents using 9 common indicators (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and Built Environment, and Government Strategies and Investments), a harmonized process and a standardized grading framework. The 15 Report Cards were presented at the Global Summit on the Physical Activity of Children in Toronto on May 20, 2014. The consolidated findings are summarized here in the form of a global matrix of grades. There is a large spread in grades across countries for most indicators. Countries that lead in certain indicators lag in others. Overall, the grades for indicators of physical activity (PA) around the world are low/poor. Many countries have insufficient information to assign a grade, particularly for the Active Play and Family and Peers indicators. Grades for Sedentary Behaviors are, in general, better in low income countries. The Community and Built Environment indicator received high grades in high income countries and notably lower grades in low income countries. There was a pattern of higher PA and lower sedentary behavior in countries reporting poorer infrastructure, and lower PA and higher sedentary behavior in countries reporting better infrastructure, which presents an interesting paradox. Many surveillance and research gaps and weaknesses were apparent. International cooperation and cross-fertilization is encouraged to tackle existing challenges, understand underlying mechanisms, derive innovative solutions, and overcome the expanding childhood inactivity crisis.