Impaired physical function associated with childhood obesity: How should we intervene?

- Background This study examined relationships between adiposity, physical functioning and physical activity. - Methods Obese (N=107) and healthy-weight (N=132) children aged 10-13 years underwent assessments of percent body fat (%BF, dual energy X-ray absorptiometry), knee extensor strength (KE, isokinetic dynamometry), cardiorespiratory fitness (CRF, peak oxygen uptake by cycle ergometry), physical health-related quality of life (HRQOL), worst pain intensity and walking capacity [six-minute walk (6MWT)]. Structural equation modelling was used to assess relationships between variables. - Results Moderate relationships were observed between %BF and 6MWT, KE strength corrected for mass and CRF relative to mass (r -.36 to -.69, P≤.007). Weak relationships were found between: %BF and physical HRQOL (r -.27, P=.008); CRF relative to mass and physical HRQOL (r -.24, P=.003); physical activity and 6MWT (r .17, P=.004). Squared multiple correlations showed that 29.6% variance in physical HRQOL was explained by %BF, pain and CRF relative to mass, while 28% variance in 6MWT was explained by %BF and physical activity. - Conclusions It appears that children with a higher body fat percentage have poorer KE strength, CRF and overall physical functioning. Reducing percent fat appears to be the best target to improve functioning. However, a combined approach to intervention, targeting reductions in body fat percentage, pain and improvements in physical activity and CRF may assist physical functioning.

Feasibility of an in-patient exercise intervention for children undergoing haematopoietic stem cell transplant

With improving survival rates following HSCT in children, QOL and management of short- and long-term effects need to be considered. Exercise may help mitigate fatigue and declines in fitness and strength. The aims of this study were to assess the feasibility of an inpatient exercise intervention for children undergoing HSCT and observe the changes in physical and psychological health. Fourteen patients were recruited, mean age 10 yr. A 6MWT, isometric upper and lower body strength, balance, fatigue, and QOL were assessed prior to Tx and six wk post-Tx. A supervised exercise program was offered five days per week during the inpatient period and feasibility assessed through uptake rate. The study had 100% program completion and 60% uptake rate of exercise sessions. The mean (±s.d.) weekly activity was 117.5 (±79.3) minutes. Younger children performed significantly more minutes of exercise than adolescents. At reassessment, strength and fatigue were stabilized while aerobic fitness and balance decreased. QOL revealed a non-statistical trend towards improvement. No exercise-related adverse events were reported. A supervised inpatient exercise program is safe and feasible, with potential physiological and psychosocial benefits.

Weight bearing physical activity for performance and bone health in prepubertal girls

This study assessed the status of bone and cardiovascular health in young, prepubertal females (aged 9 to 11 years) during a school based intervention program involving weight bearing physical activity. A study of 10 months duration was conducted in four primary schools in the Melbourne suburbs. It involved a physical activity group (n=38) and an aged-matched control group (n=33). Baseline data including pubertal status, health-related fitness, bone mass and body composition were obtained pre and post the intervention programme. All children had their bone mineral density monitored. Bone mineral density and body composition measurements were performed by DXA using the Hologic QDR 2000 bone densitometer. At the completion of the program the activity group had accrued significantly greater bone mass at total body, lumbar spine, leg and femoral neck when expressed as BMC or BMD.

The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: A Markov model informed by a randomised controlled trial

Objectives: To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active, primarily through the use of personalised SMS text-messages. Design: A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. Setting: This study considers the cost-effectiveness of MobileMums in Queensland, Australia. Participants: A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland, Australia. Data sources: The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort, treatment effects and resource utilisation were all informed by this trial. Main outcome measures: The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. Results: The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. Conclusions: At a cost-effectiveness threshold of 64 000 AUD, MobileMums would likely be a cost-effective use of healthcare resources in Queensland, Australia. Trial registration number: Australian Clinical Trials Registry; ACTRN12611000481976.

Maternal and paternal support for physical activity and healthy eating in preschool children: A cross-sectional study

BACKGROUND Parental support is a key influence on children's health behaviours; however, no previous investigation has simultaneously explored the influence of mothers' and fathers' social support on eating and physical activity in preschool-aged children. This study evaluated the singular and combined effects of maternal and paternal support for physical activity (PA) and fruit and vegetable consumption (FV) on preschoolers' PA and FV. METHODS A random sample comprising 173 parent-child dyads completed validated scales assessing maternal and paternal instrumental support and child PA and FV behaviour. Pearson correlations, controlling for child age, parental age, and parental education, were used to evaluate relationships between maternal and paternal support and child PA and FV. K-means cluster analysis was used to identify families with distinct patterns of maternal and paternal support for PA and FV, and one-way ANOVA examined the impact of cluster membership on child PA and FV. RESULTS Maternal and paternal support for PA were positively associated with child PA (r = 0.37 and r = 0.36, respectively; P < 0.001). Maternal but not paternal support for FV was positively associated with child FV (r = 0.35; P < 0.001). Five clusters characterised groups of families with distinct configurations of maternal and paternal support for PA and FV: 1) above average maternal and paternal support for PA and FV, 2) below average maternal and paternal support for PA and FV, 3) above average maternal and paternal support for PA but below average maternal and paternal support for FV, 4) above average maternal and paternal support for FV but below average maternal and paternal support for PA, and 5) above average maternal support but below average paternal support for PA and FV. Children from families with above average maternal and paternal support for both health behaviours had higher PA and FV levels than children from families with above average support for just one health behaviour, or below average support for both behaviours. CONCLUSIONS The level and consistency of instrumental support from mothers and fathers for PA and FV may be an important target for obesity prevention in preschool-aged children.

Step based physical activity guidelines for preschool-aged children

OBJECTIVE Public health organizations recommend that preschool-aged children accumulate at least 3h of physical activity (PA) daily. Objective monitoring using pedometers offers an opportunity to measure preschooler's PA and assess compliance with this recommendation. The purpose of this study was to derive step-based recommendations consistent with the 3h PA recommendation for preschool-aged children. METHOD The study sample comprised 916 preschool-aged children, aged 3 to 6years (mean age=5.0+/-0.8years). Children were recruited from kindergartens located in Portugal, between 2009 and 2013. Children wore an ActiGraph GT1M accelerometer that measured PA intensity and steps per day simultaneously over a 7-day monitoring period. Receiver operating characteristic (ROC) curve analysis was used to identify the daily step count threshold associated with meeting the daily 3hour PA recommendation. RESULTS A significant correlation was observed between minutes of total PA and steps per day (r=0.76, p<0.001). The optimal step count for >/=3h of total PA was 9099 steps per day (sensitivity (90%) and specificity (66%)) with area under the ROC curve=0.86 (95% CI: 0.84 to 0.88). CONCLUSION Preschool-aged children who accumulate less than 9000 steps per day may be considered Insufficiently Active.

Physical activity, obesity status, and blood pressure in preschool children

Objective To examine the combined effects of physical activity and weight status on blood pressure (BP) in preschool-aged children. Study design The sample included 733 preschool-aged children (49% female). Physical activity was objectively assessed on 7 consecutive days by accelerometry. Children were categorized as sufficiently active if they met the recommendation of at least 60 minutes daily of moderate-to-vigorous physical activity (MVPA). Body mass index was used to categorize children as nonoverweight or overweight/obese, according to the International Obesity Task Force benchmarks. BP was measured using an automated BP monitor and categorized as elevated or normal using BP percentile-based cut-points for age, sex, and height. Results The prevalence of elevated systolic BP (SBP) and diastolic BP was 7.7% and 3.0%, respectively. The prevalence of overweight/obese was 32%, and about 15% of children did not accomplish the recommended 60 minutes of daily MVPA. After controlling for age and sex, overweight/obese children who did not meet the daily MVPA recommendation were 3 times more likely (OR 3.8; CI 1.6-8.6) to have elevated SBP than nonoverweight children who met the daily MVPA recommendation. Conclusions Overweight or obese preschool-aged children with insufficient levels of MVPA are at significantly greater risk for elevated SBP than their nonoverweight and sufficiently active counterparts.

Children's physical activity and psychological health: the relevance of intensity

Aim To examine the relevance of physical activity intensity when assessing the relationship between activity and psychological health in 9–10-year-old children. Methods Activity was assessed by accelerometry in 57 boys (n = 23) and girls (n = 34). Total activity and time spent in very light (≤1.9 METs) through to vigorous activity (≥6 METs) were recorded. Psychological health inventories to assess anxiety, depression and aspects of self-worth were completed. Results Time accumulated in very light activity had positive correlations with anxiety and depression (r > 0.30, p < 0.05) and negative correlations with aspects of physical self-worth (r > −0.29, p < 0.05). Time accumulated in vigorous activity had negative correlations with anxiety and behavioural conduct (r > −0.30, p < 0.05) and positive correlation with aspects of physical self-worth (r > 0.28, p < 0.05). Children spending over 4 h in very light intensity activity had more negative psychological profiles than children spending under 4 h at this intensity. Conclusion Aspects of psychological health were negatively correlated with very light intensity activity and positively correlated with vigorous intensity activity. Further research should investigate whether reducing time spent in very light intensity activity and increasing time spent in vigorous intensity activity improves psychological health in children.