Publications

Background: Active video games (AVGs) have been shown to acutely increase energy expenditure when compared with seated video games; however, the influence of AVGs on compensatory adjustments in energy intake and expenditure is largely unknown. Objective: The aim was to examine the acute effects of AVGs on energy intake and expenditure. Design: With the use of a randomized crossover design, 26 male adolescents (mean ± SD age: 14.5 ± 1.4 y) completed three 1-h experimental conditions: resting control, seated video game play (Xbox 360; Microsoft), and AVG play (Kinect Adventures on Xbox 360) followed by an ad libitum lunch. A validated food menu was used to assess food intake immediately after the conditions and for the remainder of the day, and a dietary record was used for the subsequent 3-d period. Energy expenditure was measured by using portable indirect calorimetry throughout each experimental condition, and an accelerometer was used to assess the subsequent 3-d period. Appetite sensations were assessed by using visual analog scales at different time points during the testing day. The primary outcomes were acute (immediately after the conditions and 24-h) and short-term (3-d) energy intake and expenditure. Results: Energy expenditure was significantly higher (∼145%; P < 0.001) during the AVG condition than during the resting control and seated video game conditions; however, no significant differences in energy expenditure were observed 24 h (∼6%; P > 0.49) and 3 d after the experimental conditions (∼3%; P > 0.82). No significant differences were observed in absolute energy intake immediately after the conditions (∼2%; P > 0.94) or in absolute energy intake 24 h (∼5%; P > 0.63) and 3 d (∼9%; P > 0.53) after the experimental conditions. Finally, appetite sensations were similar between conditions at all time points (P > 0.05). Conclusions: The increase in energy expenditure promoted by a single session of Kinect AVG play is not associated with increased food intake but is compensated for after the intervention, resulting in no measurable change in energy balance after 24 h. These results suggest that the potential of Kinect to reduce the energy gap underlying weight gain is offset within 24 h in male adolescents. This trial was registered at clinicaltrials.gov as NCT01655901.

Screen use has become a pervasive behaviour among children and has been linked to adverse health outcomes. The objective of this study was to examine the association between screen time and a comprehensive total cardiometabolic risk (CMR) score in school-aged children (7–12-years), as well as individual CMR factors. In this longitudinal study, screen time was measured over time (average duration of follow-up was 17.4 months) via parent-report. Anthropometric measurements, blood pressure, and biospecimens were collected over time and used to calculate CMR score [sum of age and sex standardized z-scores of systolic blood pressure (SBP), glucose, log-triglycerides, waist circumference (WC), and negative high-density lipoprotein cholesterol (HDL-c)/square-root of 5]. Generalized estimating equations (GEE) were used to examine the association between screen time and total CMR score as well as individual CMR factors. A total of 567 children with repeated measures were included. There was no evidence of an association between parent-reported child screen time and total CMR score (adjusted β = −0.01, 95% CI [−0.03, 0.005], 0.16). Screen time was inversely associated HDL-c (adjusted β = −0.008, 95% CI [−0.011, −0.005], p = 0.016), but there was no evidence that the other CMR components were associated with screen time. Among children 7–12 years, there was no evidence of an association between parent-reported child screen time and total CMR, but increased screen time was associated with slightly lower HDL-c. Research is needed to understand screen-related contextual factors which may be related to CMR factors.

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; The American Academy of Pediatrics recommends developmental surveillance and screening in early childhood in primary care. The 18-month visit may be an ideal time for identification of children with delays in language and communication, or symptoms of autism spectrum disorder (ASD). Little is known about the predictive validity of developmental screening tools administered at 18 months. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at the 18-month health supervision visit, using school readiness at kindergarten age as the criterion measure.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit. Teachers completed the Early Development Instrument (EDI) when the children were in Kindergarten, age 4-6 years.We calculated screening test properties with 95% confidence intervals (CIs). We used multivariable logistic and linear regression analyses adjusted for important covariates.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 293 children (mean age 18 months), 30 (10.2%) had a positive ITC including: concern for speech delay (n=11, 3.8%), concern for other communication delay (n=13, 4.4%), and concern for both (n=6, 2.0%). At follow-up (mean age 5 years), 54 (18.4%) had overall EDI vulnerability, 19 (6.5%) had vulnerability on the 2 EDI communication domains. The ITC sensitivity ranged from 11%-32%, specificity from 91%-96%, false positive rates from 4%-9%, PPV from 16%-35%, NPV from 83%-95%. A positive ITC screen and ITC concern for speech delay were associated with lower scores in EDI communication skills and general knowledge (β= −1.08; 95% CI: −2.10, −0.17; β= −2.35; 95% CI: −3.63, −1.32) and EDI language and cognitive development (β= −0.62; 95% CI: −1.25, −0.18; β= −1.22; 95% CI: −2.11, −0.58). &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The ITC demonstrated high specificity suggesting that most children with a negative ITC screen will demonstrate school readiness at 4-6 years, and low false positive rates, minimizing over-diagnosis. The ITC had low sensitivity highlighting the importance of ongoing developmental surveillance and screening. &lt;/p&gt;

<title>Abstract</title> Participation in outdoor play is beneficial for the health, well-being, and development of children. Early childhood education centers (ECECs) can provide equitable access to outdoor play. The PROmoting Early Childhood Outside (PRO-ECO) study is a pilot randomized trial that evaluates the PRO-ECO intervention on children’s outdoor play participation. The PRO-ECO intervention included four components: ECEC outdoor play policy; educator training; ECEC outdoor space modification; and parent engagement. This study included eight ECECs delivering licensed care to children (n = 217) aged 2.5 to 6 years in Greater Vancouver, British Columbia, Canada. Using a wait-list control cluster randomized trial design, ECECs were randomly allocated to either the intervention arm (n = 4) or the wait-list control arm (n = 4). Change in the proportion and diversity of observed outdoor play behaviour during scheduled outdoor time was measured. Outcome data were collected at baseline, 6-month follow-up, and 12-month follow-up. The intervention effect on children’s outdoor play participation was examined using logistic regression mixed effect models. Controlling for gender, weather and temperature, there were no changes in children’s outdoor play participation following implementation of the PRO-ECO intervention in the between-group analysis. Within-group comparisons also revealed no change in play participation following the PRO-ECO intervention, however, the intervention group showed a positive effect (OR = 1.28, 95% CI = 0.97, 1.70) in play participation 6 months after implementation of the intervention. The findings indicate that further analyses on child- and ECEC-level outcomes collected as part of the PRO-ECO study, including the diversity of children’s play, is required to effectively assess the impact of this intervention.

Like many places globally, the health and well-being of children and youth living in Canada were significantly affected by the COVID-19 pandemic. Restricted access to the outdoors, schools, and public green spaces impacted children's physical activity (PA), sedentary behaviour, and sleep. Restrictions changed throughout the pandemic, and children's and youth's movement behaviours may have been differentially affected based on time and place. This paper aimed to examine the impact of the COVID-19 pandemic on the movement behaviours of children and youth living in Nova Scotia (NS), Canada, over time and by geographic region using mixed methods. This study employed an explanatory sequential mixed-methods design. Secondary data from three repeated cross-sectional surveys of parent-reported demographic, movement, and geographic data of 291 children and youth aged 5-17 years were analyzed. Spatial cluster analyses were applied to identify geographic concentrations of children and youth who were more or less likely to meet the moderate-vigorous PA (MVPA) guideline during the pandemic. Semi-structured interviews were conducted with 14 Nova Scotian parents to understand their perspectives on their child's movement behaviours during the pandemic. Interviews were analyzed deductively based on quantitative results using reflexive thematic analysis. Our findings showed only 5.5% of children and youth were meeting all guidelines throughout the pandemic. Of the movement behaviours, screen time (ST) differed across the pandemic and by age and gender. Clusters of children and youth meeting the MVPA recommendation on fewer days were found in regions within NS's three largest population centres (Truro, Sydney, and the Halifax Regional Municipality (HRM)), and clusters of those meeting the MVPA recommendation on more days were also identified in the HRM. From semi-structured interviews, themes indicated: (1) escaping screens during early parts of the COVID-19 pandemic and when weather was colder was hard; (2) having access to spaces to be active near the home helped facilitate children's movement; and (3) higher socioeconomic status enabled more opportunities for movement. Overall, fewer public health restrictions led to more favourable movement behaviours and spatial and sociodemographic factors may have been at play. Decision-makers should consider these factors when identifying strategies to keep children active during future health crises.

The objective of this scoping review was to summarize systematically the available literature investigating the relationships between the coronavirus disease 2019 (COVID-19) pandemic and movement behaviors (physical activity, sedentary behavior, and sleep) of school-aged children (aged 5-11 years) and youth (aged 12-17 years) in the first year of the COVID-19 outbreak.

Accumulating evidence suggests that young children spend excessive time being sedentary. The purpose of this systematic review was to determine the relationship between sedentary behaviours and health indicators during the early years (ages 0-4 years). Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, this review aimed to present the best available evidence on the threshold of sedentary behaviour associated with healthy measures of adiposity, bone health, motor skill development, psychosocial health, cognitive development, and cardiometabolic health indicators in infants, toddlers, and preschoolers. Online databases, personal libraries, and government documents were searched for relevant studies. Studies that included an intervention (or experimental) group or prospective analysis were included. Twenty-one unique studies, representing 23 papers and 22 417 participants, met inclusion criteria; 7 studies included information on infants, 13 on toddlers, and 10 on preschoolers. Of these, 11, 6, and 8 studies reported data on adiposity, psychosocial health, and cognitive development, respectively. No included study reported on motor skill development, bone, or cardiometabolic health indicators. In conclusion, this review found low- to moderate-quality evidence to suggest that increased television viewing is associated with unfavourable measures of adiposity and decreased scores on measures of psychosocial health and cognitive development. No evidence existed to indicate that television viewing is beneficial for improving psychosocial health or cognitive development. In several instances a dose-response relationship was evident between increased time spent watching television and decreased psychosocial health or cognitive development. This work may be used as evidence to inform public health guidelines. (PROSPERO registration: CRD4011001280.).

Introduction The ParticipACTION Report Card on Physical Activity for Children and Youth is the most comprehensive national assessment of physical activity and related behaviors, characteristics, and opportunities for children and youth. The 2022 Report Card assigned grades based on data gathered during the COVID-19 pandemic to reflect this extraordinary time-period in Canada. Further, while not graded, efforts were made to summarize key findings for early years children and those identifying as: having a disability, Indigenous, 2SLGBTQ+, newcomers to Canada, racialized, or girls. The purpose of this paper is to summarize the 2022 ParticipACTION Report Card on Physical Activity for Children and Youth. Methods The best available physical activity data captured during the whole COVID-19 pandemic was synthesized across 14 different indicators in four categories. The 2022 Report Card Research Committee assigned letter grades (i.e., A–F) based on expert consensus of the evidence. Synthesis Grades were assigned for: Daily Behaviors ( Overall Physical Activity : D; Active Play : D−; Active Transportation : C−; Organized Sport : C+; Physical Education : Incomplete [INC]; Sedentary Behaviors : F; Sleep : B; 24-Hour Movement Behaviors : F), Individual Characteristics ( Physical Literacy : INC; Physical Fitness : INC), Spaces and Places ( Household : C, School : B−, Community and Environment : B), and Strategies and Investments ( Government : B−). Compared to the 2020 Report Card, the COVID-19 specific grades increased for Active Play and Active Transportation ; and decreased for Overall Physical Activity , Sedentary Behaviors , Organized Sport , and Community and Environment . There were many data gaps for equity-deserving groups. Conclusion During the COVID-19 pandemic, the grade for Overall Physical Activity decreased from a D+ (2020) to a D, coinciding with decreases in grades reflecting fewer opportunities for sport and community/facility-based activities as well as higher levels of sedentary behaviors. Fortunately, improvements in Active Transportation and Active Play during COVID-19 prevented a worse shift in children’s health behaviors. Efforts are needed to improve physical activity for children and youth during and post-pandemic, with a greater emphasis on equity-deserving groups.

Physical inactivity and childhood obesity are well-recognized public health concerns that are associated with a range of adverse health outcomes. Historically, the benefits of physical activity (e.g., moderate-to-vigorous physical activity-MVPA) to overall health have dominated discussions and emerging evidence indicates that a broader, more integrated approach is needed to better understand and address current public health crises. Existing guidelines for children and youth around the world only focus on MVPA, and recently sedentary behavior, despite an accumulating body of evidence showing that light-intensity physical activity (LPA) such as walking can provide important health benefits. Furthermore, there is accumulating support for the importance of adequate sleep and that these behaviors moderate the health impact of each other. Ignoring the other components of the movement continuum (i.e., sleep, sedentary time, LPA) while focusing efforts exclusively on MVPA (accounting for <5% of the time in a 24 h period) limits the potential to optimize the health benefits of movement behaviors. In order to address this limitation, experts in Canada are currently developing the world's first Integrated 24 Hour Movement Behaviour Guidelines for Children and Youth to help advance an integrated healthy active living agenda that has the potential to significantly improve the overall health and well-being of children and youth.

In this cross-sectional follow-up study, we explored Canadian's awareness of ParticipACTION and their levels of physical activity (PA) after seven years of campaigns.A population-based survey was conducted with 7282 adults over a period of 14 months from February 2014 to May 2015. The survey consisted of questions on the 2014-2015 Physical Activity Monitor relating to awareness and knowledge of ParticipACTION. Weighted logistic models were constructed to examine whether awareness was associated with PA-related beliefs, intentions, and leisure time physical activity (LTPA).Approximately 20% of Canadians reported unprompted awareness of ParticipACTION and 82% reported prompted awareness. Education, income, and having children were significant correlates of awareness among Canadians. The adjusted odds of people being aware of ParticipACTION (prompted and unprompted) were greater if they were more educated (OR = 1.57, 95% CI: 1.04-2.39; OR = 2.00, 95% CI: 1.24-3.24), reported higher income (OR = 3.92, 95% CI: 2.35-6.53; OR = 2.29, 95% CI: 1.44-3.62), and had children (OR = 1.93, 95% CI: 1.40-2.66; OR = 1.70, 95% CI: 1.26-2.30). Furthermore, awareness of ParticipACTION was positively associated with outcome expectations and self-efficacy, and negatively associated with LTPA status.Levels of unprompted awareness of ParticipACTION are higher than previously reported and, in comparison to active Canadians, inactive Canadians are more likely to be aware of the organization. Given that it had primarily targeted parents of inactive children over the past seven years, it appears the organization has been partially effective in achieving its communication goals.Dans cette étude de suivi transversale, nous avons exploré la notoriété de ParticipACTION et le niveau d’activité physique chez les Canadiens après sept ans de campagnes.Une enquête à l’échelle de la population a été menée auprès de 7 282 adultes entre février 2014 et mai 2015. Elle a consisté en une série de questions destinées à évaluer la notoriété de ParticipACTION dans le Sondage indicateur de l’activité physique de 2014-2015. Divers modèles de régression logistique pondérée ont été établis pour déterminer si cette notoriété était associée aux croyances à propos de l’activité physique, aux intentions et à l’activité physique pratiquée durant les loisirs.Environ 20 % des Canadiens avaient une connaissance spontanée de ParticipACTION et le taux de notoriété assistée de ParticipACTION était de 82 %. L’éducation, le revenu et le fait d’avoir des enfants étaient significativement corrélés à la notoriété au sein de la population canadienne. Le rapport de cotes (RC) ajusté de la notoriété (assistée et spontanée) de ParticipACTION était plus élevé chez les personnes à haut niveau de scolarité (RC = 1,57, IC à 95 % : 1,04 à 2,39; RC = 2,00, IC à 95 % : 1,24 à 3,24), à revenu élevé (RC = 3,92, IC à 95 % : 2,35 à 6,53; RC = 2,29, IC à 95 % : 1,44 à 3,62) et ayant des enfants (RC = 1,93, IC à 95 % : 1,40 à 2,66; RC = 1,70, IC à 95 % : 1,26 à 2,30). La notoriété de ParticipACTION était également positivement associée aux attentes en matière de résultats et à l’auto-efficacité, et négativement associée à l’activité physique durant les loisirs.Le taux de notoriété non assistée de ParticipACTION est plus élevé qu’auparavant et, par ailleurs, les Canadiens inactifs sont plus nombreux que les Canadiens actifs à connaître l’organisme. Étant donné que ParticipACTION a principalement ciblé les parents d’enfants inactifs au cours des sept dernières années, il semble que l’organisme ait partiellement atteint ses objectifs en matière de communication.