Fitness, fatness and the reallocation of time between children's daily movement behaviours: an analysis of compositional data

Stuart J Fairclough, Dorothea Dumuid, Sarah Taylor, Whitney Curry, Bronagh McGrane, Gareth Stratton, Carol Maher, Timothy Olds, Stuart J Fairclough, Dorothea Dumuid, Sarah Taylor, Whitney Curry, Bronagh McGrane, Gareth Stratton, Carol Maher, Timothy Olds

Abstract

Background: Movement behaviours performed over a finite period such as a 24 h day are compositional data. Compositional data exist in a constrained simplex geometry that is incongruent with traditional multivariate analytical techniques. However, the expression of compositional data as log-ratio co-ordinate systems transfers them to the unconstrained real space, where standard multivariate statistics can be used. This study aimed to use a compositional data analysis approach to examine the adiposity and cardiorespiratory fitness predictions of time reallocations between children's daily movement behaviours.

Methods: This study used cross-sectional data from the Active Schools: Skelmersdale study, which involved Year 5 children from a low-income community in northwest England (n = 169). Measures included accelerometer-derived 24 h activity (sedentary time [ST], light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and sleep), cardiorespiratory fitness determined by the 20 m shuttle run test, objectively measured height, weight and waist circumference (from which zBMI and percent waist circumference-to-height ratio (%WHtR) were derived) and sociodemographic covariates. Log-ratio multiple linear regression models were used to predict adiposity and fitness for the mean movement behaviour composition, and for new compositions where fixed durations of time had been reallocated from one behaviour to another, while the remaining behaviours were unchanged. Predictions were also made for reallocations of fixed durations of time using the mean composition of three different weight status categories (underweight, normal-weight, and overweight/obese) as the starting point.

Results: Replacing MVPA with any other movement behaviour around the mean movement composition predicted higher adiposity and lower CRF. The log-ratio model predictions were asymmetrical: when time was reallocated to MVPA from sleep, ST, or LPA, the estimated detriments to fitness and adiposity were larger in magnitude than the estimated benefits of time reallocation from MVPA to sleep, ST or LPA. The greatest differences in fitness and fatness for reallocation of fixed duration of MVPA were predicted at the mean composition of overweight/obese children.

Conclusions: Findings reinforce the key role of MVPA for children's health. Reallocating time from ST and LPA to MVPA in children is advocated in school, home, and community settings.

Keywords: Accelerometer; LPA; MVPA; Physical activity; Sedentary time; Sleep.

Figures

Fig. 1
Fig. 1
Difference in predicted CRF (VO2 peak) with reallocation of MVPA. Note. All analyses adjusted for IMD decile, age, sex, and zBMI
Fig. 2
Fig. 2
Difference in predicted CRF (VO2 peak) with reallocation of MVPA at various baseline compositions. Note. All analyses adjusted for IMD decile, age, sex, and zBMI

References

    1. Janssen I, Leblanc A. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40. doi: 10.1186/1479-5868-7-40.
    1. Tremblay M, LeBlanc A, Kho M, Saunders T, Larouche R, Colley R, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. 2011;8:98. doi: 10.1186/1479-5868-8-98.
    1. Carson V, Ridgers ND, Howard BJ, Winkler EAH, Healy GN, Owen N, et al. Light-intensity physical activity and cardiometabolic biomarkers in US adolescents. PLoS One. 2013;8:1–7.
    1. Denton SJ, Trenell MI, Plötz T, Savory LA, Bailey DP, Kerr CJ. Cardiorespiratory fitness is associated with hard and light intensity physical activity but not time spent sedentary in 10–14 year old schoolchildren: the HAPPY study. PLoS One. 2013;8:e61073. doi: 10.1371/journal.pone.0061073.
    1. Kim J, Tanabe K, Yokoyama N, Zempo H, Kuno S. Objectively measured light-intensity lifestyle activity and sedentary time are independently associated with metabolic syndrome: a cross-sectional study of Japanese adults. Int J Behav Nutr Phys Act. 2013;10:30. doi: 10.1186/1479-5868-10-30.
    1. Kwon S, Janz KF, Burns TL, Levy SM. Association between light-intensity physical activity and adiposity in childhood. Pediatr Exerc Sci. 2011;23:218–229. doi: 10.1123/pes.23.2.218.
    1. van Ekris E, Altenburg TM, Singh A, Proper K, Heymans MW, Chinapaw M. An evidence-update on the prospective relationship between childhood sedentary behaviour and biomedical health indicators: a systematic review and meta-analysis. Obes Rev. 2016;17:833–849. doi: 10.1111/obr.12426.
    1. Hoare E, Milton K, Foster C, Allender S. The associations between sedentary behaviour and mental health among adolescents: a systematic review. Int J Behav Nutr Phys Act. 2016;13:108. doi: 10.1186/s12966-016-0432-4.
    1. Carson V, Hunter S, Kuzik N, Gray CE, Poitras VJ, Chaput J-P, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41:S240–S265. doi: 10.1139/apnm-2015-0630.
    1. Department of Health. Start Active, Stay Active. A report on physical activity for health from the four home countries. London: Department of Health; 2011.
    1. Canadian Society for Exercise Physiology . Canadian physical activity guidelines. Canadian sedentary behaviour guidelines. Ottawa: Canadian Society for Exercise Physiology; 2012.
    1. Australian Government Department of Health . Does your child get 60 minutes of physical activity every day? Canberra: Commonwealth of Australia; 2014.
    1. Tremblay MS, Carson V, Chaput J-P, Connor Gorber S, Dinh T, Duggan M, et al. Canadian 24-hour movement guidelines for children and youth: an integration of physical Activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2016;41:S311–S327. doi: 10.1139/apnm-2016-0151.
    1. Chaput J-P, Gray CE, Poitras VJ, Carson V, Gruber R, Olds T, et al. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41:S266–S282. doi: 10.1139/apnm-2015-0627.
    1. Chaput J-P, Carson V, Gray C, Tremblay M. Importance of all movement behaviors in a 24 hour period for overall health. Int J Env Res Pub Health. 2014;11:12575–12581. doi: 10.3390/ijerph111212575.
    1. Saunders TJ, Gray CE, Poitras VJ, Chaput J-P, Janssen I, Katzmarzyk PT, et al. Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41:S283–S293. doi: 10.1139/apnm-2015-0626.
    1. Aitchison J. The statistical analysis of compositional data. J Roy Statistical Soc. 1982;44:139–177.
    1. Pedisic Z. Measurement issues and poor adjustments for physical activity and sleep undermine sedentary behaviour research—the focus should shift to the balance between sleep, sedentary behaviour, standing and activity. Kinesiology. 2014;46:135–146.
    1. Carson V, Tremblay MS, Chaput J-P, Chastin SFM. Associations between sleep duration, sedentary time, physical activity, and health indicators among Canadian children and youth using compositional analyses. Appl Physiol Nutr Metab. 2016;41:S294–S302. doi: 10.1139/apnm-2016-0026.
    1. Chastin SFM, Palarea-Albaladejo J, Dontje ML, Skelton DA. Combined effects of time spent in physical activity, sedentary behaviors and sleep on obesity and cardio-metabolic health markers: a novel compositional data analysis approach. PLoS One. 2015;10:e0139984. doi: 10.1371/journal.pone.0139984.
    1. Collins S. The seven wards: a focus on Skelmersdale. Preston: Lancashire County Council; 2015.
    1. Cole T, Freeman J, Preece M. Body mass index reference curves for the UK, 1990. Arch Dis Child. 1995;73:25–29. doi: 10.1136/adc.73.1.25.
    1. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–1244. doi: 10.1136/bmj.320.7244.1240.
    1. Mehta SK. Waist circumference to height ratio in children and adolescents. Clin Pediatr. 2015;54:652–658. doi: 10.1177/0009922814557784.
    1. Department for Communities and Local Government . The English indices of deprivation. Statistical release. London: DCLG; 2015.
    1. Leger LA, Mercier D, Gadoury C, Lambert J. The multistage 20 metre shuttle run test for aerobic fitness. J Sports Sci. 1988;6:93–101. doi: 10.1080/02640418808729800.
    1. Boddy LM, Fairclough SJ, Atkinson G, Stratton G. Changes in cardiorespiratory fitness in 9- to 10.9-year-old children: SportsLinx 1998–2010. Med Sci Sports Exerc. 2012;44:481–486. doi: 10.1249/MSS.0b013e3182300267.
    1. Tomkinson GR, Lang JJ, Tremblay MS, Dale M, LeBlanc AG, Belanger K, et al. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med. 2016. doi: 10.1136/bjsports-2016-095987
    1. van Hees VT, Fang Z, Langford J, Assah F, Mohammad A, da Silva IC, et al. Autocalibration of accelerometer data for free-living physical activity assessment using local gravity and temperature: an evaluation on four continents. J Appl Physiol (1985) 2014;117:738–744. doi: 10.1152/japplphysiol.00421.2014.
    1. van Hees VT, Gorzelniak L, León EC, Eder M, Pias M, Taherian S, et al. Separating movement and gravity components in an acceleration signal and implications for the assessment of human daily physical activity. PLoS One. 2013;8:e61691. doi: 10.1371/journal.pone.0061691.
    1. Fairclough SJ, Noonan R, Rowlands AV, Van Hees V, Knowles Z, Boddy LM. Wear compliance and activity in children wearing wrist- and hip-mounted accelerometers. Med Sci Sports Exerc. 2016;48:245–253. doi: 10.1249/MSS.0000000000000771.
    1. Rowlands AV, Fraysse F, Catt M, Stiles VH, Stanley RM, Eston RG, et al. Comparability of measured acceleration from accelerometry-based activity monitors. Med Sci Sports Exerc. 2015;47:201–210. doi: 10.1249/MSS.0000000000000394.
    1. Noonan RJ, Boddy LM, Kim Y, Knowles ZR, Fairclough SJ. Comparison of children’s free-living physical activity derived from wrist and hip raw accelerations during the segmented week. J Sports Sci. 2016:1–6. doi: 10.1080/02640414.2016.1255347
    1. Catellier DJ, Hannan PJ, Murray DM, Addy CL, Conway TL, Yang S, et al. Imputation of missing data when measuring physical activity by accelerometry. Med Sci Sports Exerc. 2005;37:S555–S562. doi: 10.1249/01.mss.0000185651.59486.4e.
    1. Sabia S, Cogranne P, van Hees VT, Bell JA, Elbaz A, Kivimaki M, et al. Physical activity and adiposity markers at older ages: accelerometer vs questionnaire data. J Am Med Dir Assoc. 2015;16:438. doi: 10.1016/j.jamda.2015.01.086.
    1. Hildebrand M, Van Hees VT, Hansen BH, Ekelund U. Age-group comparibility of raw accelerometer output from wrist- and hip-worn monitors. Med Sci Sports Exerc. 2014;46:1816–1824. doi: 10.1249/MSS.0000000000000289.
    1. Saint-Maurice PF, Kim Y, Welk GJ, Gaesser GA. Kids are not little adults: what MET threshold captures sedentary behavior in children? Eur J Appl Physiol. 2016;116:29–38. doi: 10.1007/s00421-015-3238-1.
    1. Ridley K, Olds TS. Assigning energy costs to activities in children: a review and synthesis. Med Sci Sports Exerc. 2008;40:1439–1446. doi: 10.1249/MSS.0b013e31817279ef.
    1. van Hees VT, Sabia S, Anderson KN, Denton SJ, Oliver J, Catt M, et al. A novel, open access method to assess sleep duration using a wrist-worn accelerometer. PLoS One. 2015;10:e0142533. doi: 10.1371/journal.pone.0142533.
    1. van den Boogaart KG, Tolosana-Delgado R. ‘Compositions’: a unified R package to analyze compositional data. Comput Geosci. 2008;34:320–338. doi: 10.1016/j.cageo.2006.11.017.
    1. Pawlowsky-Glahn V, Buccianti A. Compositional data analysis: theory and applications. Chichester: John Wiley & Sons, Ltd; 2011.
    1. Fox J, Weisberg S. An R companion to applied regression. London: Sage Publications; 2011.
    1. Mekary RA, Willett WC, Hu FB, Ding EL. Isotemporal substitution paradigm for physical activity epidemiology and weight change. Am J Epidemiol. 2009;170:519–527. doi: 10.1093/aje/kwp163.
    1. Brooke HL, Corder K, Griffin SJ, van Sluijs EMF. Physical activity maintenance in the transition to adolescence: a longitudinal study of the roles of sport and lifestyle activities in British youth. PLoS One. 2014;9:e89028. doi: 10.1371/journal.pone.0089028.
    1. Cooper AR, Jago R, Southward EF, Page AS. Active travel and physical activity across the school transition: the PEACH project. Med Sci Sports Exerc. 2012;44:1890–1897. doi: 10.1249/MSS.0b013e31825a3a1e.
    1. Sherar LB, Esliger DW, Baxter-Jones ADG, Trembaly MS. Age and gender differences in youth physical activity: does physical maturity matter? Med Sci Sports Exerc. 2007;39:830–835. doi: 10.1249/mss.0b013e3180335c3c.
    1. Fairclough SJ, Boddy LM, Ridgers ND, Stratton G. Weight status associations with physical activity intensity and physical self-perceptions in 10 to 11 year old children. Ped Exerc Sci. 2012;24:100–112. doi: 10.1123/pes.24.1.100.
    1. Morton KL, Corder K, Suhrcke M, Harrison F, Jones AP, van Sluijs EMF, et al. School polices, programmes and facilities, and objectively measured sedentary time, LPA and MVPA: associations in secondary school and over the transition from primary to secondary school. Int J Behav Nutr Phys Act. 2016;13:1–11. doi: 10.1186/s12966-016-0378-6.
    1. De Meester F, Van Dyck D, De Bourdeaudhuij I, Deforche B, Cardon G. Changes in physical activity during the transition from primary to secondary school in Belgian children: what is the role of the school environment? BMC Public Health. 2014;14:261. doi: 10.1186/1471-2458-14-261.
    1. Kolsgaard MLP, Joner G, Brunborg C, Anderssen SA, Tonstad S, Andersen LF. Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo adiposity intervention study - a hospital/public health nurse combined treatment. BMC Pediat. 2011;11:47. doi: 10.1186/1471-2431-11-47.
    1. Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatr. 2012;130:e1647–e1671. doi: 10.1542/peds.2012-1176.
    1. Watson PM, Dugdill L, Pickering K, Owen S, Hargreaves J, Staniford LJ, et al. Service evaluation of the GOALS family-based childhood obesity treatment intervention during the first 3 years of implementation. BMJ Open. 2015;5:e006519. doi:10.1136/bmjopen-2014-006519.
    1. Larsen LM, Hertel NT, Mølgaard C, Christensen RD, Husby S, Jarbøl DE. Early intervention for childhood overweight: a randomized trial in general practice. Scan J Prim Health Care. 2015;33:184–190. doi: 10.3109/02813432.2015.1067511.
    1. Fairclough S, Hackett A, Davies I, Gobbi R, Mackintosh K, Warburton G, et al. Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! Randomised intervention study. BMC Public Health. 2013;13:626. doi: 10.1186/1471-2458-13-626.
    1. Taylor RW, McAuley KA, Barbezat W, Farmer VL, Williams SM, Mann JI. Two-year follow-up of an obesity prevention initiative in children: the APPLE project. Am J Clin Nutr. 2008;88:1371–1377.
    1. Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev. 2015;16:547–565. doi: 10.1111/obr.12277.
    1. Liu W, Nichols RA, Zillifro TD. Comparison and comparability: fitness tracking between youths with different physical activity levels. Meas Phys Educ Exerc Sci. 2013;17:295–309. doi: 10.1080/1091367X.2013.831764.
    1. Freitas D, Beunen G, Maia J, Claessens A, Thomis M, Marques A, et al. Tracking of fatness during childhood, adolescence and young adulthood: a 7-year follow-up study in Madeira Island. Portugal Ann Hum Biol. 2012;39:59–67. doi: 10.3109/03014460.2011.638322.
    1. Sorić M, Jembrek Gostović M, Gostović M, Hočevar M, Mišigoj-Duraković M. Tracking of BMI, fatness and cardiorespiratory fitness from adolescence to middle adulthood: the Zagreb growth and development longitudinal study. Ann Hum Biol. 2014;41:238–243. doi: 10.3109/03014460.2013.851739.
    1. Bailey DP, Savory LA, Denton SJ, Kerr CJ. The association between cardiorespiratory fitness and cardiometabolic risk in children is mediated by abdominal adiposity: the HAPPY study. J Phys Act Health. 2015;12:1148–1152. doi: 10.1123/jpah.2014-0311.
    1. Jago R, Drews KL, McMurray RG, Baranowski T, Galassetti P, Foster GD, et al. BMI change, fitness change and cardiometabolic risk factors among 8th grade youth. Pediatr Exerc Sci. 2013;25:52–68. doi: 10.1123/pes.25.1.52.
    1. Roman-Viñas B, Chaput J-P, Katzmarzyk PT, Fogelholm M, Lambert EV, Maher C, et al. Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study. Int J Behav Nutri Phys Act. 2016;13:123. doi: 10.1186/s12966-016-0449-8.
    1. Gruber R, Carrey N, Weiss SK, Frappier JY, Rourke L, Brouillette RT, et al. Position statement on pediatric sleep for psychiatrists. J Can Acad Child Adolesc Psychiatry. 2014;23:174–195.
    1. Aggio D, Smith L, Hamer M. Effects of reallocating time in different activity intensities on health and fitness: a cross sectional study. Int J Behav Nutri Phys Act. 2015;12:83. doi: 10.1186/s12966-015-0249-6.
    1. Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput J-P, Janssen I, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41:S197–S239. doi: 10.1139/apnm-2015-0663.
    1. Boddy LM, Thomas NE, Fairclough SJ, Tolfrey K, Brophy S, Rees A, et al. ROC generated thresholds for field-assessed aerobic fitness related to body size and cardiometabolic risk in schoolchildren. PLoS One. 2012;7
    1. O’ Brien W, Belton S, Issartel J. The relationship between adolescents’ physical activity, fundamental movement skills and weight status. J Sports Sci. 2016;34(12): 1159-67. doi:10.1080/02640414.2015.1096017.
    1. Bryant ES, James RS, Birch SL, Duncan M. Prediction of habitual physical activity level and weight status from fundamental movement skill level. J Sports Sci. 2014;32:1775–1782. doi: 10.1080/02640414.2014.918644.
    1. Morano M, Colella D, Robazza C, Bortoli L, Capranica L. Physical self-perception and motor performance in normal-weight, overweight and obese children. Scan J Med Sci Sports. 2011;21:465–473. doi: 10.1111/j.1600-0838.2009.01068.x.
    1. McCullough N, Muldoon O, Dempster M. Self-perception in overweight and obese children: a cross-sectional study. Child Care Health Dev. 2009;35:357–364. doi: 10.1111/j.1365-2214.2008.00924.x.
    1. Dorsey KB, Herrin J, Krumholz HM. Patterns of moderate and vigorous physical activity in obese and overweight compared with non-overweight children. Int J Pediatr Obes. 2011;6:e547–e555. doi: 10.3109/17477166.2010.490586.
    1. Soric M, Misigoj-Durakovic M. Physical activity levels and estimated energy expenditure in overweight and normal-weight 11-year-old children. Acta Paediatr. 2010;99:244–250.
    1. Parikh T, Stratton G. Influence of intensity of physical activity on adiposity and cardiorespiratory fitness in 5-18 year olds. Sports Med. 2011;41:477–488. doi: 10.2165/11588750-000000000-00000.
    1. Peterhans E, Worth A, Woll A. Association between health behaviors and cardiorespiratory fitness in adolescents: results from the cross-sectional MoMo-study. J Adol Health. 2013;53:272–279. doi: 10.1016/j.jadohealth.2013.02.011.
    1. Telford RM, Telford RD, Cochrane T, Cunningham RB, Olive LS, Davey R. The influence of sport club participation on physical activity, fitness and body fat during childhood and adolescence: the LOOK longitudinal study. J Sci Med Sport. 2016;19:400–406. doi: 10.1016/j.jsams.2015.04.008.
    1. Cattuzzo MT, dos Santos HR, Ré AHN, de Oliveira IS, Melo BM, de Sousa MM, et al. Motor competence and health related physical fitness in youth: a systematic review. J Sci Med Sport. 2016;19:123–129. doi: 10.1016/j.jsams.2014.12.004.
    1. Sandercock GRH, Ogunleye AA. Screen time and passive school travel as independent predictors of cardiorespiratory fitness in youth. Prev Med. 2012;54:319–322. doi: 10.1016/j.ypmed.2012.03.007.
    1. Schaefer L, Plotnikoff RC, Majumdar SR, Mollard R, Woo M, Sadman R, et al. Outdoor time is associated with physical activity, sedentary time, and cardiorespiratory fitness in youth. J Pediatr. 2014;165:516–521. doi: 10.1016/j.jpeds.2014.05.029.
    1. Chaput JP, Saunders TJ, Carson V. Interactions between sleep, movement and other non-movement behaviours in the pathogenesis of childhood obesity. Obes Rev. 2017;18:7–14. doi: 10.1111/obr.12508.
    1. Cooper A, Goodman A, Page A, Sherar L, Esliger D, van Sluijs E, et al. Objectively measured physical activity and sedentary time in youth: the international children’s accelerometry database (ICAD) Int J Behav Nutr Phys Act. 2015;12:113. doi: 10.1186/s12966-015-0274-5.
    1. Beets MW, Okely A, Weaver RG, Webster C, Lubans D, Brusseau T, et al. The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion. Int J Behav Nutr Phys Act. 2016;13:120. doi: 10.1186/s12966-016-0442-2.
    1. Brusseau TA, Hannon J, Burns R. The effect of a comprehensive school physical activity program on physical activity and health-related fitness in children from low-income families. J Phys Act Health. 2016;13:888–894. doi: 10.1123/jpah.2016-0028.
    1. Burns RD, Brusseau TA, Hannon JC. Effect of a comprehensive school physical activity program on school day step counts in children. J Phys Act Health. 2015;12:1536–1542. doi: 10.1123/jpah.2014-0578.
    1. Erwin H, Beighle A, Carson RL, Castelli DM. Comprehensive school-based physical activity promotion: a review. Quest. 2013;65:412–428. doi: 10.1080/00336297.2013.791872.
    1. Institute of Medicine . Educating the student Body. Taking physical Activity and physical education to school. Washington DC: Institute of Medicine; 2013.
    1. Fairclough SJ, Boddy LM, Mackintosh KA, Valencia-Peris A, Ramirez-Rico E. Weekday and weekend sedentary time and physical activity in differentially active children. J Sci Med Sport. 2015;18:444–449. doi: 10.1016/j.jsams.2014.06.005.
    1. Comte M, Hobin E, Majumdar SR, Plotnikoff RC, Ball GDC, McGavock J. Patterns of weekday and weekend physical activity in youth in 2 Canadian provinces. Appl Physiol Nutr Metab. 2013;38:115–119. doi: 10.1139/apnm-2012-0100.
    1. Van der Ploeg K, Kuhle S, Maximova K, McGavock J, Wu B, Veugelers P. The importance of parental beliefs and support for pedometer-measured physical activity on school days and weekend days among Canadian children. BMC Public Health. 2013;13:1132. doi: 10.1186/1471-2458-13-1132.
    1. McMinn AM, Griffin SJ, Jones AP, van Sluijs EMF. Family and home influences on children’s after-school and weekend physical activity. Eur J Pub Health. 2013;23:805–810. doi: 10.1093/eurpub/cks160.
    1. Corder K, Craggs C, Jones A, Ekelund U, Griffin S, van Sluijs E. Predictors of change differ for moderate and vigorous intensity physical activity and for weekdays and weekends: a longitudinal analysis. Int J Behav Nutr Phys Act. 2013;10:69. doi: 10.1186/1479-5868-10-69.
    1. Colley RC, Wong SL, Garriguet D, Janssen I, Gorber SC, Tremblay MS. Physical activity, sedentary behaviour and sleep in Canadian children: parent-report versus direct measures and relative associations with health risk. Health Rep. 2012;23:45–52.

Source: PubMed

3
Suscribir