아동의 신체 활동과 장내 미생물군집 (PA-마이크로바이옴 키즈) (PA-Microbiome)

실험적: MVPA 프로그램

참가자들은 주 3회, 회당 45~60분 동안 진행되는 16주간의 구조화된 중등도-고강도 신체 활동(MVPA) 프로그램에 참여합니다. 세션에는 워밍업, 유산소 게임, 체중을 이용한 근력 회로 운동, 그리고 쿨다운이 포함되며, 훈련된 강사들의 감독 하에 진행됩니다.

행동: 16주 구조화된 MVPA 프로그램

16주 동안의 체계적인 중간에서 격렬한 신체 활동 프로그램.

다른: Attention Control + Waitlist

Participants engage in time-matched sedentary activities such as reading, science experiments, or crafts, three times per week, and are instructed to maintain their usual physical activity levels. After the 16-week trial period, they are offered a comparable MVPA program (waitlist).

행동: 주의 통제 활동 없는 활동

독서, 과학 실험 또는 공예와 같은 시간이 맞춰진 좌식 활동.

종합 체력 Z-점수 변화

기저선에서 16주까지의 복합 체력 z-점수 변화. 이 점수는 "국가학생체력건강표준(2014년 개정)"의 연령에 적합한 항목과 가중치를 기반으로 계산됩니다. 척도는 참조 인구를 기반으로 평균이 0이고 표준 편차가 1인 표준화된 z-점수입니다. 이론적인 상한 또는 하한은 없지만 값은 일반적으로 -3에서 +3 사이의 범위를 가집니다. 점수가 높을수록 전반적인 체력이 더 좋음을 나타냅니다.

장내 미생물 군집 알파 다양성 변화

장내 미생물군의 알파 다양성 지수(Shannon 및 Chao1)의 기준선 대비 16주간 변화, 16S rRNA 유전자 시퀀싱을 통해 평가됨. Shannon 지수는 최소값이 0이며 이론적 최대값은 없음. Chao1 지수는 관찰된 종 수와 동일한 최소값으로 종 풍부도를 추정하며, 이론적 최대값 역시 없음. 두 지수 모두 더 높은 값은 더 큰 다양성을 나타내며 일반적으로 더 건강한 장 미생물군을 반영하는 것으로 간주됨.

장내 미생물군 베타 다양성의 차이

MVPA군과 대조군 간의 장내 미생물 군집 구조 차이(베타 다양성). 이는 Bray-Curtis 및 UniFrac 거리 행렬에 대한 순열 다변량 분산 분석(PERMANOVA)을 사용하여 평가됩니다. 결과는 군 할당에 의해 설명되는 군집 구조의 분산 백분율을 나타내는 R-제곱 값과 p-값으로 보고됩니다. 더 큰 R-제곱 값과 더 작은 p-값은 군 간의 더 유의미한 차이를 나타냅니다.

체질량 지수(BMI) Z-점수 변화

기준점에서 16주 후까지의 연령 및 성별 특이적 BMI z-점수의 변화. 이 점수는 참조 인구를 기준으로 평균이 0인 표준화된 점수이며, 이론적인 상한선 또는 하한선이 없습니다. 더 높은 점수는 동료에 비해 더 높은 BMI를 나타냅니다. 건강한 체중에 초점을 맞춘 본 연구의 맥락에서, z-점수의 증가는 일반적으로 더 나쁜 결과로 간주됩니다.

Heterogeneity of Treatment Effect Across Baseline PA×PF Quadrants

Heterogeneity of treatment effect (HTE) of the MVPA intervention on primary and secondary outcomes across the four pre-specified baseline phenotype groups (P1: low PA-low PF; P2: high PA-low PF; P3: low PA-high PF; P4: high PA-high PF) defined in the 2023 cross-sectional study. HTE will be assessed by including a Treatment × Baseline Quadrant interaction term in mixed-effects models. A statistically significant interaction (p < 0.05) would indicate that the intervention effect differs across baseline microbiome phenotypes. Effect sizes will be reported separately for each quadrant with 95% confidence intervals.

Baseline Microbial Taxa as Effect Modifiers of Intervention Response

Pre-specified analysis of whether baseline relative abundance (continuous, log-transformed) of Akkermansia, Faecalibacterium, Subdoligranulum, and Bacteroides coprocola modifies the MVPA intervention effect on composite physical fitness z-score and alpha diversity. Interaction terms (Treatment × Baseline Taxon Abundance) will be tested in mixed-effects models.

Change in Body Fat Percentage

Change from baseline to 16 weeks in body fat percentage. Higher values indicate greater adiposity.

Change in Waist Circumference and Waist-to-Hip Ratio

Change from baseline to 16 weeks in waist circumference (cm) and waist-to-hip ratio. Higher values indicate greater central adiposity.

Change in Resting Heart Rate

Change from baseline to 16 weeks in resting heart rate (beats per minute) measured after seated rest. Lower values generally indicate better cardiovascular fitness.

Change in Blood Pressure

Change from baseline to 16 weeks in resting systolic and diastolic blood pressure (mmHg).

Change in Vital Capacity

Change from baseline to 16 weeks in vital capacity (mL) measured by spirometry. Higher values indicate greater lung function.

Change in Stool Form and Defecation Frequency

Change from baseline to 16 weeks in stool form assessed by the Bristol Stool Form Scale (types 1 to 7) and in self-reported weekly defecation frequency.

Change in Resilience (CD-RISC-10)

Change from baseline to 16 weeks in resilience measured by the 10-item Connor-Davidson Resilience Scale. Scores range from 0 to 40; higher scores indicate greater resilience.

Change in Well-Being (WHO-5)

Change from baseline to 16 weeks in subjective well-being measured by the WHO-5 Well-Being Index. Raw scores (0 to 25) are transformed to a 0 to 100 scale; higher scores indicate better well-being.

Change in Anxiety Symptoms (SCARED)

Change from baseline to 16 weeks in anxiety symptoms measured by the child self-report Screen for Child Anxiety Related Emotional Disorders. Higher scores indicate more anxiety symptoms.

Change in Depressive Symptoms (CES-D)

Change from baseline to 16 weeks in depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale. Higher scores indicate more depressive symptoms.

Change in Strengths and Difficulties (SDQ)

Change from baseline to 16 weeks measured by the Strengths and Difficulties Questionnaire. Higher total difficulties scores indicate more difficulties; higher prosocial subscale scores indicate more prosocial behaviour.

Change in Coping Style (SCSQ)

Change from baseline to 16 weeks in coping style measured by the Simplified Coping Style Questionnaire, reported as positive and negative coping subscale scores.

Change in Self-Concept

Change from baseline to 16 weeks in self-concept measured by an age-appropriate self-concept questionnaire for younger children. Higher scores indicate more positive self-concept.

Change in Emotion Regulation (ERQ-CA)

Change from baseline to 16 weeks in emotion regulation measured by the Emotion Regulation Questionnaire for Children and Adolescents, reported as cognitive reappraisal and expressive suppression subscale scores.

Change in Objective Sleep

Change from baseline to 16 weeks in accelerometer-derived sleep, including total sleep time and sleep efficiency.

Change in Physical Literacy

Change from baseline to 16 weeks in physical literacy measured by a physical literacy questionnaire. Higher scores indicate greater physical literacy.

Change in Exercise Self-Efficacy

Change from baseline to 16 weeks in exercise self-efficacy measured by an 18-item exercise self-efficacy questionnaire. Higher scores indicate greater self-efficacy.

Change in Dietary Self-Efficacy

Change from baseline to 16 weeks in dietary self-efficacy measured by a 16-item dietary self-efficacy questionnaire. Higher scores indicate greater self-efficacy.

Change in Physical Activity Enjoyment (PACES)

Change from baseline to 16 weeks in physical activity enjoyment measured by the Physical Activity Enjoyment Scale. Higher scores indicate greater enjoyment.

Change in Eating Behaviour (CEBQ)

Change from baseline to 16 weeks in eating behaviour measured by the Children's Eating Behaviour Questionnaire, reported by subscale.

Change in Executive Function and Attention

Change in Objective Physical Activity and Sedentary Time

Change from baseline to 16 weeks in accelerometer-derived moderate-to-vigorous physical activity (minutes per day) and sedentary time (minutes per day), used to verify intervention-induced change in activity.