Design of a garment for data collection of toddler language and physical activity

Design process phases of development, evaluation and implementation were used to create a garment to simultaneously collect reliable data of speech production and intensity of movement of toddlers (18-36 months). A series of prototypes were developed and evaluated that housed accelerometer-based motion sensors and a digital transmitter with microphone. The approved test garment was a top constructed from loop-faced fabric with interior pockets to house devices. Extended side panels allowed for sizing. In total, 56 toddlers (28 male; 28 female; 16-36 months of age) participated in the study providing pilot and baseline data. The test garment was effective in collecting data as evaluated for accuracy and reliability using ANOVA for accelerometer data, transcription of video for type of movement, and number and length of utterances for speech production. The data collection garment has been implemented in various studies across disciplines.

The association between adolescent self-reported physical activity and wellness : the missing piece for youth wellness programs

Purpose Potential positive associations between youth physical activity and wellness scores could emphasize the value of youth physical activity engagement and promotion interventions, beyond the many established physiological and psychological benefits of increased physical activity. The purpose of this study was to explore the associations between adolescents' self-reported physical activity and wellness. Methods This investigation included 493 adolescents (165 males and 328 females) aged between 12 and 15 years. The participants were recruited from six secondary schools of varying socioeconomic status within a metropolitan area. Students were administered the Five-Factor Wellness Inventory and the International Physical Activity Questionnaire for Adolescents to assess both wellness and physical activity, respectively. Results Data indicated that significant associations between physical activity and wellness existed. Self-reported physical activity was shown to be positively associated with four dimensions including friendship, gender identity, spirituality, and exercise—the higher order factor physical self and total wellness, and negatively associated with self-care, self-worth, love, and cultural identity. Conclusion This study suggests that relationships exist between self-reported physical activity and various elements of wellness. Future research should use controlled trials of physical activity and wellness to establish causal links among youth populations. Understanding the nature of these relationships, including causality, has implications for the justification of youth physical activity promotion interventions and the development of youth physical activity engagement programs.

Effects of a pediatric weight management program with and without active video games

Importance Active video games may offer an effective strategy to increase physical activity in overweight and obese children. However, the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown. Objective To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence-based weight management program delivered in the community. Design, Setting, and Participants Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts, Rhode Island, and Texas. Seventy-five overweight or obese children (41 girls [55%], 34 whites [45%], 20 Hispanics [27%], and 17 blacks [23%]) enrolled in a community-based pediatric weight management program. Mean (SD) age of the participants was 10.0 (1.7) years; body mass index (BMI) z score, 2.15 (0.40); and percentage overweight from the median BMI for age and sex, 64.3% (19.9%). Interventions All participants received a comprehensive family-based pediatric weight management program (JOIN for ME). Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program. Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program. Main Outcomes and Measures Objectively measured daily moderate-to-vigorous and vigorous physical activity, percentage overweight, and BMI z score. Results Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous (mean [SD], 7.4 [2.7] min/d) and vigorous (2.8 [0.9] min/d) physical activity at week 16 (P < .05). In the program-only group, a decline or no change was observed in the moderate-to-vigorous (mean [SD] net difference, 8.0 [3.8] min/d; P = .04) and vigorous (3.1 [1.3] min/d; P = .02) physical activity. Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16. However, the program and active gaming group exhibited significantly greater reductions in percentage overweight (mean [SD], −10.9% [1.6%] vs −5.5% [1.5%]; P = .02) and BMI z score (−0.25 [0.03] vs −0.11 [0.03]; P < .001). Conclusions and Relevance Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight.

Life transitions and changing physical activity patterns in young women

Background Physical activity (PA) patterns are likely to change in young adulthood in line with changes in lifestyle that occur in the transition from adolescence to adulthood. The aim of this study was to ascertain whether key life events experienced by young women in their early twenties are associated with increasing levels of inactivity. Methods This was a 4-year follow-up of 7281 participants (aged 18 to 23 years at baseline) in the Australian Longitudinal Study of Women’s Health, with self-reported measures of PA, life events, body mass index (BMI), and sociodemographic variables. Results The cross-sectional data indicated no change in PA between baseline (57% “active”) and follow-up (56% “active”). However, for almost 40% of the sample, PA category changed between baseline and follow-up, with approximately 20% of the women changing from being “active” to “inactive,” and another 20% changing from being “inactive” to “active.” After adjustment for age, other sociodemographic variables, BMI, and PA at baseline, women who reported getting married, having a first or subsequent child, or beginning paid work were more likely to be inactive at follow-up than those who did not report these events. Conclusions The results suggest that life events such as getting married, having children, and starting work are associated with decreased levels of PA in young adult women. Strategies are needed to promote maintenance of activity at the time when most women experience these key life-stage transitions.

Mediators of physical activity behavior change among women with young children

Background Women with children are less likely to engage in adequate physical activity (PA) than women without children. This study aimed to evaluate the efficacy of two strategies for promoting increased PA among mothers of preschool-aged children, and to explore the mediators of any resulting change in PA behavior. Design Controlled intervention trial incorporating repeated data collection from 554 women, randomized to one of three experimental conditions. Intervention Group 1 served as a control, while women in Groups 2 and 3 were given print information about overcoming PA barriers. Women in Group 3 were also invited to discuss the development of local strategies for the promotion of PA among mothers of young children. The primary strategies included increasing partner support, social advocacy, and capacity building, and were implemented through collaboration among participants, researchers, and community organizations. Main Outcome Measures Adequate physical activity (PA), self-efficacy (SE) and partner support (PS). Results: Following the intervention, women in Group 3 were significantly more likely to meet guidelines for PA than controls (odds ratio [OR]=1.71, confidence interval [CI]=1.05–2.77)] after controlling for age and PA at baseline. After controlling for baseline PA, residualized change in SE (OR=1.86, CI=1.17–2.94) and PS (OR=2.29, CI=1.46–3.58) significantly predicted meeting guidelines. After controlling for residual change in PS and SE, the significant intervention effect was attenuated (Group 3 OR=1.40, CI=0.76–2.36), indicating that partner support and self-efficacy may be mediators of physical activity behavior change. Conclusions The findings indicate that community participation approaches that facilitate increased self-efficacy and partner support can be effective in increasing PA among mothers of young children.

Nutrition and physical activity policies and practices in family child care homes

Background Family child care homes (FCCHs) are the second-largest provider of nonrelative care in the U.S. However, despite providing care for nearly 1.9 million children aged <5 years, little is known about the nutrition and physical activity practices of FCCHs. Purpose To address this gap, this study aims to describe policies and practices related to nutrition and physical activity in a representative sample of FCCHs. Methods A stratified random sample of registered FCCHs operating in Kansas (N=297) completed the Nutrition and Physical Activity Self Assessment for Child Care (NAPSACC) instrument. Prevalence estimates and 95% CIs for meeting or exceeding accepted child care standards were calculated using SAS PROC SURVEYFREQ. Results Most providers either met or exceeded child care standards related to serving fruit and vegetables and provision of daily physical activity. Very few providers reported serving fried meats or vegetables or unhealthy snack foods on a regular basis. Areas of concern included infrequent servings of low-fat milk, frequent use of unhealthy foods for celebrations, widespread use of TV and video games throughout the day, restricting physical activity for children who misbehave, and lack of appropriate indoor spaces for physical activity. Only a small percentage of providers reported receiving regular training in nutrition or physical activity. Relatively few providers had written guidelines on nutrition or physical activity. Conclusions Some strengths were exhibited by FCCHs, but substantial weaknesses were shown with respect to meeting established child care standards for nutrition and physical activity. Interventions to promote healthy eating and regular physical activity in FCCHs are thus warranted.

A nutrition and physical activity intervention for family child care homes

Background Family child care homes (FCCHs) provide child care to 1.9 million children in the U.S., but many do not meet established child care standards for healthy eating and physical activity. Purpose To determine the effects of a community-based train-the-trainer intervention on FCCHs policies and practices related to healthy eating and physical activity. Design Quasi-experimental design with replication in three independent cohorts of FCCHs. Setting/participants Registered FCCHs from 15 counties across Kansas participated in the Healthy Kansas Kids (HKK) program. Resource and referral agencies (RRAs) in each county recruited and enrolled between five and 15 child care providers in their service delivery area to participate in the program. The number of registered FCCHs participating in HKK in Years 1 (2006-2007); 2 (2007-2008); and 3 (2008-2009) of the program were 85, 64, and 87, respectively. A stratified random sample of registered FCCHs operating in Kansas (n=297) served as a normative comparison group. Interventions Child care trainers from each RRA completed a series of train-the-trainer workshops related to promotion of healthy eating and physical activity. FCCHs were subsequently guided through a four-step iterative process consisting of (1) self-evaluation; (2) goal setting; (3) developing an action plan; and (4) evaluating progress toward meeting goals. FCCHs also received U. S. Department of Agriculture resources related to healthy eating and physical activity. Main outcome measures Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) self-assessment instrument (NAP SACC-SA). Analyses of outcome measures were conducted between 2008 and 2010. Results Healthy Kansas Kids FCCHs exhibited significant improvements in healthy eating (Delta=6.9%-7.1%) and physical activity (Delta=15.4%-19.2%) scores (p<0.05). Within each cohort, pre-intervention scores were not significantly different from the state average, whereas post-intervention scores were significantly higher than the state average. Conclusions Community-based train-the-trainer interventions to promote healthy eating and physical activity in FCCHs are feasible, sustainable, and effective.

School-based physical activity programs for adolescent wellness improvement : an investigation of the association between wellness and physical activity

This thesis by publication included seven manuscripts that advanced contemporary understanding of the association between physical activity and wellness among adolescents. The findings suggested that due to potential interrelatedness between various aspects of wellness, changes in physical activity may also influence co-existing wellness domains; highlighting the potential for physical activity interventions to have a broad range of benefits among youth. These findings also added to the body of literature supporting the potential inclusion of physical activity as a component within multifaceted youth wellness programs. Findings reported in this thesis have implications for those seeking to initiate youth wellness interventions.

Tracking of physical activity in young children

The purpose of this study was to determine whether physical activity behavior tracks during early childhood. Forty-seven children (22 males, 25 females) aged 3-4 yr at the beginning of the study were followed over a 3-yr period. Heart rates were measured at least 2 and up to 4 d . yr(-1) with a Quantum XL Telemetry heart rate monitor. Physical activity was quantified as the percentage of observed minutes between 3:00 and 6:00 p.m. during which heart rate was 50% or more above individual resting heart rate (PAHR-50 Index). Tracking of physical activity was analyzed using Pearson and Spearman correlations. Yearly PAHR-50 index tertiles were created and examined for percent agreement and Cohen's kappa. Repeated measures ANOVA was used to calculate the intraclass correlation coefficient across the 3 yr of the study. Spearman rank order correlations ranged from 0.57 to 0.66 (P < 0.0001). Percent agreement ranged from 49% to 62%. The intraclass R for the 3 yr was 0.81. It was concluded that physical activity behavior tends to track during early childhood.

Calibration of the biotrainer pro activity monitor in children

The unique physical and movement characteristics of children necessitate the development of accelerometer equations and cut points that are population specific. The purpose of this study is to develop an ecologically valid cut point for the Biotrainer Pro monitor that reflects a threshold for moderate-intensity physical activity in elementary school children. A sample of 30 children (ages 8-12) wore a Biotrainer monitor while completing a series of 7 movement tasks (calibration phase) and while participating in an organized group activity (cross-validation phase). Videotapes from each session were processed using a computerized direct-observation technique to provide a criterion measure of physical activity. Analyses involved the use of mixed-model regression and receiver operator characteristic (ROC) curves. The results indicated that a cut point of 4 counts/min provides the optimal balance between the related needs for sensitivity (accurately detecting activity) and specificity (limiting misclassification of activity as inactivity). Results with the cross-validation data demonstrated that this value yielded the best overall kappa (.58) and a high classification agreement (84%) for activity determination. The specificity of 93% demonstrates that the proposed cut point can accurately detect activity; however, the lower sensitivity value of 61% suggests that some minutes of activity might be incorrectly classified as inactivity. The cut point of 4 counts/min provides an ecologically valid cut point to capture physical activity in children using the Biotrainer Pro activity monitor.

Children's understanding of the concept of physical activity

This study evaluated 4th-grade students' understanding of the concept of physical activity and assessed the effects of two interventions to enhance the students' understanding of this concept. Students were randomly assigned to 1 of 3 conditions: the video group (n = 40) watched a 5-min video describing physical activity; the verbal group (n = 42) listened to a generic description of physical activity; the control group received no instruction (n = 45). Students completed a 17-item checklist testing their understanding of the concept of physical activity. Compared to controls, students in the verbal and video group demonstrated significantly higher checklist scores, with the video group scoring significantly higher than the verbal group. Only 35.6% of the controls, compared to 52.4% and 70.0% of the verbal and video groups respectively, could classify greater than or equal to 15 of the checklist items correctly, The results indicate that, without intervention, children have a limited understanding of the concept of physical activity.

Parental influences on physical activity behavior in preschool children

Objective To evaluate a conceptual model linking parent physical activity (PA) orientations, parental support for PA, and PA behavior in preschool children. Methods Participants were 156 parent-child dyads from 13 child care centers in Queensland, Australia. Parents completed a questionnaire measuring parental PA, parental enjoyment of PA, perceived importance of PA, parental support for PA, parents' perceptions of competence, and child PA at home. MVPA while attending child care was measured via accelerometry. Data were collected between May and August of 2003. The relationships between the study variables and child PA were tested using observed variable path analysis. Results Parental PA and parents' perceptions of competence were positively associated with parental support for PA (β= 0.23 and 0.18, respectively, p<0.05). Parental support, in turn, was positively associated with child PA at home (β= 0.16, p<0.05), but not at child care (β= 0.01, p= 0.94). Parents' perceptions of competence was positively associated with both home-based and child care PA (β= 0.20 and 0.28, respectively, p<0.05). Conclusions Family-based interventions targeting preschoolers should include strategies to increase parental support for PA. Parents who perceive their child to have low physical competence should be encouraged to provide adequate support for PA. © 2009 Elsevier Inc.

Factorial validity and invariance of questionnaires measuring social-cognitive determinants of physical activity among adolescent girls

Background There are few theoretically derived questionnaires of physical activity determinants among youth, and the existing questionnaires have not been subjected to tests of factorial validity and invariance, The present study employed confirmatory factor analysis (CFA) to test the factorial validity and invariance of questionnaires designed to be unidimensional measures of attitudes, subjective norms, perceived behavioral control, and self-efficacy about physical activity. Methods Adolescent girls in eighth grade from two cohorts (N = 955 and 1,797) completed the questionnaires at baseline; participants from cohort 1 (N = 845) also completed the questionnaires in ninth grade (i.e., 1-year follow-up). Factorial validity and invariance were tested using CFA with full-information maximum likelihood estimation in AMOS 4.0, Initially, baseline data from cohort 1 were employed to test the fit and, when necessary, to modify the unidimensional models. The models were cross-validated using a multigroup analysis of factorial invariance on baseline data from cohorts 1 and 2, The models then were subjected to a longitudinal analysis of factorial invariance using baseline and follow-up data from cohort i, Results The CFAs supported the fit of unidimensional models to the four questionnaires, and the models were cross-validated, as indicated by evidence of multigroup factorial invariance, The models also possessed evidence of longitudinal factorial invariance. Conclusions Evidence was provided for the factorial validity and the invariance of the questionnaires designed to be unidimensional measures of attitudes, subjective norms, perceived behavioral control, and self-efficacy about physical activity among adolescent girls, (C) 2000 American Health Foundation and academic Press.

Calibration and evaluation of an objective measure of physical activity in pre-school children

Background The purposes of this study were 1) to establish accelerometer count cutoffs to categorize activity intensity of 3 to 5-y old-children and 2) to evaluate the accelerometer as a measure of children’s physical activity in preschool settings. Methods While wearing an ActiGraph accelerometer, 16 preschool children performed five, 3-min structured activities. Receiver Operating Characteristic (ROC) curve analyses identified count cutoffs for four physical activity intensities. In 9 preschools, 281 children wore an ActiGraph during observations performed by three trained observers (interobserver reli-ability = 0.91 to 0.98). Results Separate count cutoffs for 3, 4, and 5-y olds were established. Sensitivity and specificity for the count cutoffs ranged from 86.7% to 100.0% and 66.7% to 100.0%, respectively. ActiGraph counts/15 s were different among all activities (P < 0.05) except the two sitting activities. Correlations between observed and ActiGraph intensity categorizations at the preschools ranged from 0.46 to 0.70 (P < 0.001). Conclusions The ActiGraph count cutoffs established and validated in this study can be used to objectively categorize the time that preschool-age children spend in different physical activity intensity levels.

Validity of accelerometry in ambulatory children and adolescents with cerebral palsy

To evaluate the validity of the ActiGraph accelerometer for the measurement of physical activity intensity in children and adolescents with cerebral palsy (CP) using oxygen uptake (VO 2) as the criterion measure. Thirty children and adolescents with CP (mean age 12.6 ± 2.0 years) wore an ActiGraph 7164 and a Cosmed K4b 2 portable indirect calorimeter during four activities; quiet sitting, comfortable paced walking, brisk paced walking and fast paced walking. VO 2 was converted to METs and activity energy expenditure and classiWed as sedentary, light or moderate-to-vigorous intensity according to the conventions for children. Mean ActiGraph counts min -1 were classiWed as sedentary, light or moderate-to-vigorous (MVPA) intensity using four diVerent sets of cut-points. VO 2 and counts min¡1 increased signiWcantly with increases in walking speed (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that, of the four sets of cut-points evaluated, the Evenson et al. (J Sports Sci 26(14):1557-1565, 2008) cut-points had the highest classiWcation accuracy for sedentary (92%) and MVPA (91%), as well as the second highest classiWcation accuracy for light intensity physical activity (67%). A ROC curve analysis of data from our participants yielded a CP-speciWc cut-point for MVPA that was lower than the Evenson cut-point (2,012 vs. 2,296 counts min¡1), however, the diVerence in classiWcation accuracy was not statistically signiWcant 94% (95% CI = 88.2-97.7%) vs. 91% (95% CI = 83.5-96.5%). In conclusion, among children and adolescents with CP, the ActiGraph is able to diVerentiate between diVerent intensities of walking. The use of the Evenson cut-points will permit the estimation of time spent in MVPA and allows comparisons to be made between activity measured in typically developing adolescents and adolescents with CP. © 2011 Springer-Verlag.