Active children: from epidemiology to intervention - PowerPoint Presentation

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Active children: from epidemiology to intervention

sally.barber@bthft.nhs.uk

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Overview

What is Born in Bradford and who are our familiesOur early years PA researchGlobal and local patterns of PA in childhood

Correlates and determinants of PA (potential components of successful programmes/interventions)BiB’s plans to strengthen the research understandingRecommendations based on current evidence

Questions and discussion

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Describe health and ill-health and their causes;

Develop, design and evaluate interventions to promote health;

Provide a model for integrating research into practice

Build and strengthen local research capacity in Bradford.

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12435 Mothers

13776 pregnancies

3449 Fathers

13471 Singletons

176 sets of twins

3 sets of triplets

All in Primary School

5 this year

9 this year

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Data collection for the cohort

PA & cardio-metabolic

Asthma, Allergies, infection

Pollution & green space

Cognition

&

Learning

Behaviour& wellbeing

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Physical Activity spectrum

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Behavioural epidemiological framework:

early years PA and SB research

5

published studies

refining measurement:

Feasibility and validation of using accelerometers

Reliability and validity of EYPAQ-parent report

3

studies (1 pub)

- relationship between PA, SB, sleep and adiposity

undertaking analysis on relationship between PA and Fundamental Movement Skills

Systematic review of correlates and determinants of

PA (published)

Gender and ethnic differences in correlates of PA at age 2yrs

Modifiable and non-modifiable determinants of screen viewing trajectories from 6 – 36 months

RCTs:

HAPPY

intervention (published)

Pre-schoolers in the Playground: PIP

intervention (published)

Reducing infant screen viewing (in development)

HAPPY and PIP commissioned by Better Start Bradford with on-going evaluations

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S

ex- and age-specific percentile values for levels of physical activity (PA) and sedentary time of European children aged 2.0–10.9 years from eight European countries (Sweden, Germany, Hungary, Italy, Cyprus, Spain, Belgium and Estonia

).

N = 7684 children

RECCOMENDATION

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PA & SB patterns

Grade 2 = age 7 - 8 (Y3)

Grade 3 = age 8 – 9 (Y4)

Grade 4 = age 9 – 10 (Y5)

Grade 5 = age 10 – 11 (Y6)Grade 6 = age 11 – 12 (Y7)

853 Australian children from 29 Elementary schools in the LOOK study

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School day

% of waking day

Classroom

% of waking day

School

day

Break-time

After school

Weekend

day

84 mins

63 mins

9-10 year olds: 64% not reaching an average of 60 min MVPA daily

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Ecological model

Population effect and political difficulty

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30 studies – children 16 years or younger

17 school based10 home/family based

1 community centre1 university gym1 boy scout centre

small to negligible increases in total PA, small improvements (~ 4 minutes/day in MVPA)Clinical effect likely to be minimal – e.g. 2mm reduction in Waist circumference, 0.06mm Hg in systolic BP

Why have interventions failed?

Speculated poor delivery

Specultated poor uptake

Insufficient intervention intensity

Compensatory inactivity

ALL not evidenced in literatureNo reports of adverse eventsPoor detail about dropoutsPer-protocol not intention-to-treatNo process evaluationNo health economic evaluation

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Fundamental movement skills

‘Foster continued learning and development of motor competencies through practice and participation in developmentally appropriate activities that demand more advanced movement patterns and higher levels of performance in a variety of movement contexts’ – Robinson et al. 2015

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Correlates of PA and SB in childhood

480 Caucasian children aged 7 years, from the Gateshead Millennium study (2010)

Family and home correlates in a multi-ethnic UK population, 9-10 year olds – CHASE study (2011)

Systematic Review: 76 observational studies of PA and SB correlates in 10 – 12 year olds; ENERGY study (2012)

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Parental influences in BIB

35 children 6.14 ± 0.27

yrs

, 33 mothers, 16 fathers

1 week of accelerometer

Questionnaire assessed parental supporting and controlling practices

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Family

Kader et al 2015

Group-based activities of relatively high frequency appear to be effective (but low participation and high attrition are a challenge in low SES groups)

Active involvement of parents is required (sending educational information home does not work)

Effectiveness of universal parental support interventions addressing children’s dietary habits, physical activity and bodyweight: a systematic review. Prev Med:77(2015);52-67

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Major green space within 300m

BiB

: N=7547 during pregnancy

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Exposure

Outcome

Outcome

More

green

---

healthier weight

10% increase --- ~16-22g

Dadvand P,

et

al.

Environ

Int. 2014;71:101-8.

But

Only for White British NOT South Asian women

Greenest

area 18-23%

less

likely to report depression

But

Only for those in more deprived groups

Stronger for those already active

McEachan, R, et al

.

J

Epidemiol

Community

Health. 2015;

0:1–7

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Ding Ding et al. Neighbourhood Environment and Physical Activity Among Youth A Review: Am J Prev Med 2011;41(4):442– 455

Access/proximity to recreation facilities

land-use mix (residential, commercial, cultural, institutional, industry – with pedestrian connections)

residential densityWalkability

Walking/biking facilities traffic speed/volumePedestrian safety structures

Incivilities/disordersVegetation (i.e. trees along pavements/paths)

The environmental influence on physical activity is domain & context specific i.e. related to active travel and playing outdoors.

PA is associated with:

Environment

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Environment

To promote physical activity across a wide age range:

Enhance access to parks and recreational facilities

Encourage mixed use developments

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Fun!

When children are asked, the magic ingredient for interventions is fun!

Interventions delivering sustained fun are likely to be engaging and promote ongoing involvement

Van

Sluijs

and Kriemler

2016 reflections on physical activity intervention research in young people – do’s don’ts and critical thoughts. Jour. Behav Nutrit

Phys Act;13:25

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MRC/ESRC/BHF funded to examine determinants of:

Cognition

Social and emotional wellbeing

Cardio-metabolic disease

With a special focus on SES and ethnic differences

9000 BiB mothers, 5000

BiB partners and 9000 BiB children (aged 6-10 years old) in the community

10,000 BiB children & 8,500 non-BiB

in schools

Growing-Up!

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Identifying correlates of activity

SES & ethnic differences

Individual

Perception of FMS

Attitude to activities

Preferences

Enjoyment

Knowledge

Adiposity

InterpersonalEncouragement, support and co-participation in activities with:Friends

Family

Teachers @ school

Parent’s

PA

Parents enjoyment and modelling of PA

Parent’s logistic support for sports

Parent’s knowledge

Parent’s perceived barriers to PA

Environment

Access to safe outdoor space

Park/green space satisfaction

Frequency of park use

School grounds

Proximity/access to green space

Walkability & safety structures

Traffic speed/density

Land use

Residential density

Policy

PE length, freq

PE premium use

Break times length, freq, availability of equipment

Active travel

Activity in classrooms and corridors

Punishment or reward?

Activity and the weather/season

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Recommendations from research evidence

Consider the whole PA/SB spectrumFundamental movement skills

Family focusEnvironment – active travel, outdoor play

FunThorough evaluationsFrequent revisits to academic literature, especially for UK-based research

Keep in touch for updates on progress and emerging results from BiB