Are school-based physical activity interventions effective and equitable? A meta-analysis of cluster randomized controlled trials with accelerometer-assessed activity.
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SUBMITTER: Love R
PROVIDER: S-EPMC6563481 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Self-reported physical activity measures continue to be validated against accelerometers; however, the absence of standardized, accelerometer moderate-to-vigorous physical activity (MVPA) definitions has made comparisons across studies difficult. Furthermore, recent accelerometer models assess accelerations in three axes, instead of only the vertical axis, but validation studies have yet to take incorporate triaxial data.Participants (n = 10 115) from the Women's Health Study wore a hip-worn accelerometer (ActiGraph GT3X+) for seven days during waking hours (2011-2014). Women then completed a physical activity questionnaire. We compared self-reported with accelerometer-assessed MVPA, using four established cutpoints for MVPA: three using only vertical axis data (760, 1041 and 1952 counts per minute (cpm)) and one using triaxial data (2690 cpm).According to self-reported physical activity, 66.6% of women met the US federal physical activity guidelines, engaging in ?150 minutes per week of MVPA. The percent of women who met guidelines varied widely depending on the accelerometer MVPA definition (760 cpm: 50.0%, 1041 cpm: 33.0%, 1952 cpm: 13.4%, and 2690 cpm: 19.3%).Triaxial count data do not substantially reduce the difference between self-reported and accelerometer-assessed MVPA.
| S-EPMC4694656 | biostudies-literature
Project description:The lack of consensus on meaningful and interpretable physical activity outcomes from accelerometer data hampers comparison across studies. Cut-point analyses are simple to apply and easy to interpret but can lead to results that are not comparable. We propose that the optimal accelerometer metrics for data analysis are not the same as the optimal metrics for translation. Ideally, analytical metrics are precise continuous variables that cover the intensity spectrum, while translational metrics facilitate meaningful, public-health messages and can be described in terms of activities (e.g. brisk walking) or intensity (e.g. moderate-to-vigorous physical activity). Two analytical metrics that capture the volume and intensity of the 24-h activity profile are average acceleration (volume) and intensity gradient (intensity distribution). These allow investigation of independent, additive and interactive associations of volume and intensity of activity with health; however, they are not immediately interpretable. The MX metrics, the acceleration above which the most active X minutes are accumulated, are translational metrics that can be interpreted in terms of indicative activities. Using a range of MX metrics illustrates the intensity gradient and average acceleration (i.e. 24-h activity profile). The M120, M60, M30, M15 and M5 illustrate the most active accumulated minutes of the day, the M1/3DAY the most active accumulated 8?h of the day. We demonstrate how radar plots of MX metrics can be used to interpret and translate results from between- and within-group comparisons, provide information on meeting guidelines, assess individual activity profiles relative to percentiles and compare activity profiles between domains and/or time periods.
| S-EPMC6895365 | biostudies-literature
Project description:BackgroundOverweight and low levels of physical activity (PA) in preschoolers are major public health concerns. However, to date only few studies have investigated subjective and objective correlates of PA across different socioecological domains in preschoolers. We therefore simultaneously investigate associations between preschoolers' objectively measured leisure-time PA and a comprehensive set of subjective and objective potential PA correlates across the behavioral, social and physical environmental domains on both family- and community-level.MethodsIn this cross-sectional study time spent in moderate-to-vigorous PA (MVPA) and total PA (TPA) were measured by combined accelerometry and heart rate monitoring in 735 3-6 year-old children from 52 preschools in Southern Germany. Family- and community-level potential correlates of PA from different domains (behavioral, social and physical environmental) were subjectively (i.e. by parent proxy-report) and objectively assessed. Their associations with PA on weekend days and weekday afternoons were tested by covariate-adjusted multilevel regression models.ResultsWhile none of the objective social and physical environmental factors showed associations with PA, subjective parental traffic safety perceptions were positively associated with MVPA and TPA on weekends. Also, preschoolers' participation in organized sports was positively correlated with MVPA (on weekends) and TPA (both on weekends and weekday afternoons).ConclusionSubjective traffic safety perceptions and participation in organized sports, an indicator and a result of parental support towards PA - i.e. subjective parental perceptions of environmental factors and family-level correlates which are more proximal to preschoolers - might be more central to PA in preschool age than objectively assessed community-level environmental features which tend to be more distal correlates. If replicable, targeting parental perceptions of environmental factors and parental support for PA in preschool age might be powerful leverages for public health policy.
| S-EPMC5674851 | biostudies-literature
Project description:ObjectivesPopular methods for analyzing accelerometer data often use a single physical activity outcome variable such as average-weekly or total physical activity. These approaches limit the types of research questions that can be answered and fail to utilize the detailed, time-specific information available from accelerometers. This study proposes the use of multilevel modeling, which tested intervention effects at specific time periods.DesignThe motivating example was the Active by Choice Today trial. Simulations were used to test whether the application of time-specific hypotheses about when physical activity intervention treatment effects were expected to occur (e.g., after-school hours) increased power to detect effects compared to traditional methods.MethodsSix simulation conditions were tested: (1) no treatment effects (to test the type 1 error rate), (2) time-specific effects, but no traditionally-tested effects, (3) traditionally-tested effects, but no time-specific effects, and (4) combinations of traditional and time-specific effects in 3 proportions.ResultsResults showed the proposed multilevel approach demonstrated appropriate type 1 error rates and increased power to detect treatment effects during hypothesized times by 31-38 percentage points compared to traditional approaches. This was consistent across varying proportions of traditional versus time-specific effects, and there was no loss of power using the multilevel approach when only traditional effects were present.ConclusionsThe current study showed potential advantages of testing time-specific hypotheses about intervention effects using a multilevel time-specific approach. This approach may show intervention effects when traditional approaches do not. Future research should explore the application of this additional analytic tool for accelerometer physical activity estimates.
| S-EPMC4362866 | biostudies-literature
Project description:BackgroundThe aerobic part of the recently updated physical activity (PA) guidelines for adults recommends at least 150 min of moderate or at least 75 of vigorous-intensity PA or an equivalent combination of both. PA can be accumulated of any bout duration. On an absolute scale, moderate-intensity threshold is 3 metabolic equivalents (METs) and vigorous 6 METs. On a scale relative to individual's personal capacity, moderate-intensity threshold is 40% and vigorous 60% of the oxygen uptake reserve. In this study, the adherence to the new guidelines was evaluated using both absolute and relative thresholds.MethodsTotally, 1645 adults aged 20-64 years, participated in this population-based study and their cardiorespiratory fitness (CRF) was estimated with 6-min walking test. The participants with estimated maximal oxygen uptake <7.9 MET were categorized as low CRF group and the others as adequate CRF group. The participants were instructed to wear a triaxial hip-worn accelerometer for 1 week and their adherence to PA guidelines was assessed from the accelerometer data.ResultsThe adequate CRF group had higher adherence to PA guidelines with the absolute thresholds, but the use of relative thresholds inverted the results. The adherence varied from 20% to 99% in the total sample depending on the analysis parameters of accelerometer data.ConclusionsThe absolute thresholds provide a more appropriate basis to assess the adherence to PA guidelines in population-based samples and interventions. The use of individually determined relative thresholds may be more useful for individual exercise prescriptions in PA counseling.
| S-EPMC9421411 | biostudies-literature
Project description:BackgroundRandomised, cluster-based study designs in schools are commonly used to evaluate children's physical activity interventions. Sample size estimation relies on accurate estimation of the intra-cluster correlation coefficient (ICC), but published estimates, especially using accelerometry-measured physical activity, are few and vary depending on physical activity outcome and participant age. Less commonly-used cluster-based designs, such as stepped wedge designs, also need to account for correlations over time, e.g. cluster autocorrelation (CAC) and individual autocorrelation (IAC), but no estimates are currently available. This paper estimates the school-level ICC, CAC and IAC for England children's accelerometer-measured physical activity outcomes by age group and gender, to inform the design of future school-based cluster trials.MethodsData were pooled from seven large English datasets of accelerometer-measured physical activity data between 2002-18 (> 13,500 pupils, 540 primary and secondary schools). Linear mixed effect models estimated ICCs for weekday and whole week for minutes spent in moderate-to-vigorous physical activity (MVPA) and being sedentary for different age groups, stratified by gender. The CAC (1,252 schools) and IAC (34,923 pupils) were estimated by length of follow-up from pooled longitudinal data.ResultsSchool-level ICCs for weekday MVPA were higher in primary schools (from 0.07 (95% CI: 0.05, 0.10) to 0.08 (95% CI: 0.06, 0.11)) compared to secondary (from 0.04 (95% CI: 0.03, 0.07) to (95% CI: 0.04, 0.10)). Girls' ICCs were similar for primary and secondary schools, but boys' were lower in secondary. For all ages, combined the CAC was 0.60 (95% CI: 0.44-0.72), and the IAC was 0.46 (95% CI: 0.42-0.49), irrespective of follow-up time. Estimates were higher for MVPA vs sedentary time, and for weekdays vs the whole week.ConclusionsAdequately powered studies are important to evidence effective physical activity strategies. Our estimates of the ICC, CAC and IAC may be used to plan future school-based physical activity evaluations and were fairly consistent across a range of ages and settings, suggesting that results may be applied to other high income countries with similar school physical activity provision. It is important to use estimates appropriate to the study design, and that match the intended study population as closely as possible.
| S-EPMC11313128 | biostudies-literature
Project description:ObjectiveTo quantify the association between accelerometer-assessed physical activity and coronavirus disease 2019 (COVID-19) outcomes.MethodsData from 82,253 UK Biobank participants with accelerometer data (measured 2013-2015), complete covariate data, and linked COVID-19 data from March 16, 2020, to March 16, 2021, were included. Two outcomes were investigated: severe COVID-19 (positive test result from in-hospital setting or COVID-19 as primary cause of death) and nonsevere COVID-19 (positive test result from community setting). Logistic regressions were used to assess associations with moderate to vigorous physical activity (MVPA), total activity, and intensity gradient. A higher intensity gradient indicates a higher proportion of vigorous activity.ResultsAverage MVPA was 48.1 (32.7) min/d. Physical activity was associated with lower odds of severe COVID-19 (adjusted odds ratio per standard deviation increase: MVPA, 0.75 [95% CI, 0.67 to 0.85]; total, 0.83 [0.74 to 0.92]; intensity, 0.77 [0.70 to 0.86]), with stronger associations in women (MVPA, 0.63 [0.52 to 0.77]; total, 0.76 [0.64 to 0.90]; intensity, 0.63 [0.53 to 0.74]) than in men (MVPA, 0.84 [0.73 to 0.97]; total, 0.88 [0.77 to 1.01]; intensity, 0.88 [0.77 to 1.00]). In contrast, when mutually adjusted, total activity was associated with higher odds of a nonsevere infection (1.10 [1.04 to 1.16]), whereas the intensity gradient was associated with lower odds (0.91 [0.86 to 0.97]).ConclusionOdds of severe COVID-19 were approximately 25% lower per standard deviation (∼30 min/d) MVPA. A greater proportion of vigorous activity was associated with lower odds of severe and nonsevere infections. The association between total activity and higher odds of a nonsevere infection may be through greater community engagement and thus more exposure to the virus. Results support calls for public health messaging highlighting the potential of MVPA for reducing the odds of severe COVID-19.
| S-EPMC8376658 | biostudies-literature
Project description:Objective methods to measure physical activity (PA) have become available and widely used given the high degree of precision to evaluate PA. However, few studies have used accelerometers to measure PA during pregnancy, especially in low- and middle-income countries. We assessed overall PA, moderate, vigorous, and moderate-to-vigorous physical activity (MVPA) objectively measured among pregnant women and their correlates in a population-based study. PA was assessed for seven consecutive days using a raw triaxial wrist-worn accelerometer in women interviewed around 16 and 24 weeks of gestation in the 2015 Pelotas (Brazil) Birth Cohort Study. The average acceleration, which expresses overall PA, was presented in milli-g (1 mg = 0.001 g), and average time (min/day) spent in MVPA (>100 mg) was also analyzed in 5- and 10-min bouts. Analyses were performed using linear regression. In total, 2317 women were included in the analyses. Overall PA was 27.6 mg. Pregnant women spent on average 14 min/day in MVPA and 0.4 min in vigorous PA. Time spent in MVPA and total PA were inversely associated with years in school and income, and were lower among women receiving advice to not exercise. MVPA was also inversely associated with age, lower among women living with a partner, and higher among non-white women. The study indicated low levels of PA among pregnant women. The identified correlates may provide a framework to better understand factors influencing PA during pregnancy and thus inform future interventions.
| S-EPMC6055654 | biostudies-literature
Project description:BackgroundEvidence of intra-family resemblance in physical activity (PA) is lacking. The association between parent and child PA appears weak, the influence of age and gender on this association is uncertain, and no studies have investigated the degree of resemblance in family members' PA behaviours such as walking, sitting/lying, and biking. Thus, the aims of the study were to examine the degree of resemblance in PA within families, specifically between parents and children, and to explore the size of resemblance across age of children, gender of parents and children, and intensity and type of PA.MethodThe study is a cross-sectional analysis of a subsample (902 parents and 935 children nested within 605 families) of the Danish population study Lolland-Falster Health Study. PA was measured using a dual-accelerometer system (Axivity AX3) with subsequent processing of time spent in light PA (LPA), moderate-to-vigorous PA (MVPA), and vigorous PA and classification of PA behaviour types. Families with at least one son/daughter aged 0-22 years and one parent providing minimum 4 days of valid accelerometer data were included in the analysis. A linear mixed model regression analysis was used to determine the intraclass correlation coefficient (ICC) of clustering among family members for PA intensities and PA behaviours, adjusted for sex, age, parental education, and the interaction between sex and age.ResultsIn the analysis of within-family variation in PA, the ICCs across PA intensities and PA behaviours ranged from 0.06 to 0.34. We found stronger clustering in family members' PA for LPA and behaviours requiring low energy expenditure (LPA: ICC 0.22 (95% confidence interval (CI) 0.17; 0.28), sitting/lying: ICC 0.34 (95% CI 0.28; 0.40)), and walking: ICC 0.24 (95% CI 0.19; 0.30) than for higher intensities (e.g. MVPA: ICC 0.07 (95% CI 0.03; 0.14)). The ICC for biking was 0.23 (95% CI 0.18; 0.29). Analyses on parent-child dyads gave similar results. No interaction effects for gender and age (except for biking) were found.ConclusionParents and children's time spent in PA behaviours requiring low energy expenditure had moderate resemblance within families, whereas engagement in PA with higher intensities showed small or close-to-zero resemblance.
| S-EPMC7718708 | biostudies-literature
Project description:AimsPatients with heart failure often display a distinct pattern of walking characterized by short step-length and frequent short pauses. In the current study we sought to explore if qualitative aspects of movement have any additive value to established factors to predict all-cause mortality in patients with advanced heart failure.Methods and results60 patients with advanced heart failure (NYHA III, peak VO2 <20 ml/kg and LVEF <35%) underwent symptom-limited CPX, echocardiography and routine chemistry. Physical activity was assessed using an accelerometer worn attached to the waist during waking hours for 7 consecutive days. The heart-failure survival score (HFSS) was calculated for each patient. All accelerometer-derived variables were analyzed with regard to all-cause mortality and added to a baseline model utilizing HFSS scores. HFSS score was significantly associated with the incidence of death (P<0.001; c-index 0.71; CI, 0.67-0.73). The addition of peak skewness to the HFSS model significantly improved the predictive ability with an increase in c-index to 0.74 (CI, 0.69-0.78), likelihood ratio P<0.02, establishing skewness as a predictor of increased event rates when accounting for baseline risk.ConclusionThe feature skewness, a measure of asymmetry in the intensity level of periods of high physical activity, was identified to be predictive of all-cause mortality independent of the established prognostic model-HFSS and peak VO2. The findings from the present study emphasize the use of accelerometer analysis in clinical practice to make more accurate prognoses in addition to extract features of physical activity relevant to functional classification.
| S-EPMC4824362 | biostudies-literature