ObjectivesThe purpose of this study was to explore the independent associations between multiple lifestyle behaviours (physical activity, sleep, screen time (ST) and diet) and overweight and obesity in UK children. The second objective was to compare body mass index (BMI) z-score between children who meet health guidelines for each lifestyle behaviour and those who do not and to explore the impact of interactions between lifestyle behaviours on BMI z-score.Design, setting and participantsCross-sectional study on children aged 9–11 years in the UK (n=374).Outcome measuresParticipants were classified as overweight or obese using the WHO BMI cut-points. Moderate-to-vigorous intensity physical activity (MVPA) and sleep duration were measured using an ActiGraph GT3X+ accelerometer, whereas ST and dietary habits were assessed using questionnaires. Multilevel multiple logistic regression was employed to analyse associations between lifestyle behaviours and overweight/obesity. Participants were then categorised according to whether or not they met specific health criteria for MVPA, ST, sleep and diet. Multilevel multiple linear regression was used to compare these groupings on the outcome of BMI z-score and interactions were explored.ResultsMVPA and longer sleep duration were associated with lower odds of overweight or obesity, whereas ST and a healthy diet score were associated with increased odds of overweight/obesity. No association was found for an unhealthy diet score. Meeting MVPA guidelines was significantly associated with a lower BMI z-score in all models, and significant two-way interactions were observed for physical activity and sleep, ST and sleep, and physical activity and diet.ConclusionsMVPA, sleep and ST are important lifestyle behaviours associated with overweight/obesity among children. More research is required to confirm the role of diet on adiposity and such work would benefit from objective assessment. Overall, this work suggests that strategies aimed at improving compliance with health guidelines are needed.Trial registration number:NCT01722500.

ObjectivesPhysical activity (PA) can provide numerous physical and psychological health gains, yet a low proportion of children in England are sufficiently active to accrue benefit. Analysing the correlates of PA from a socioecological perspective may help to identify factors that promote versus discourage PA. The purpose of the present study was to: (1) assess the relationships between a wide range of potential correlates and intensity-specific PA and (2) explore which correlates are associated with meeting government PA guidelines.Design, setting and participantsCross-sectional study on children aged 9–11 years from the South West of England (n=425; 183 males).Outcome measuresA mixture of self-reported and objective measures (eg, body mass index (BMI), accelerometer-derived PA, self-reported sport participation, etc) were collected from child participants, parents and school teachers. After adjusting for covariates (ie, age, sex and accelerometer wear time), multilevel modelling techniques were employed to examine the relationships between potential correlates and light-intensity, moderate-intensity and vigorous-intensity PA, as measured with an ActiGraph GT3X+ accelerometer. Generalised linear mixed modelling was used to analyse the correlates associated with government-recommended levels of PA.ResultsComputer use shared a negative association whereas parent support for PA showed a positive relationship with light-intensity PA. In terms of moderate-intensity PA, computer use and BMI z-score shared a negative association whereas positive relationships were found for sport participation, active transport and for outdoor time after school. Children at schools with 25%–49% of pupils attending school sport/PA clubs did more moderate-intensity PA than those attending schools with lower participation rates. For vigorous-intensity PA, a negative relationship was observed for BMI z-score, and positive associations for self-efficacy, active transport, parent support and the presence of crossing guards on routes to school. Correlates associated with meeting the PA guidelines were BMI z-score (negative), sport participation, active transport and outdoor time after school (all positive).ConclusionResults demonstrate that factors pertaining to the individual, home and school environment may play an important role in understanding the correlates of differing PA intensities in children.Trial registration numberNCT01722500.

BackgroundTime spent outdoors is associated with higher physical activity levels among children, yet it may be threatened by parental safety concerns and the attraction of indoor sedentary pursuits. The purpose of this study was to explore the relationships between these factors and outdoor time during children’s discretionary periods (i.e., after school and over the weekend).MethodsData from 462 children aged 9–11 years old were analysed using generalised linear mixed models. The odds of spending > 1 h outdoors after school, and > 2 h outdoors on a weekend were computed, according to demographic variables, screen-based behaviours, media access, and parental safety concerns. Interactions with sex and socioeconomic status (SES) were explored.ResultsBoys, low SES participants, and children who played on their computer for < 2 h on a school day had higher odds of spending > 1 h outside after school than girls, high SES children and those playing on a computer for ≥2 h, respectively. Counterintuitive results were found for access to media devices and crime-related safety concerns as both of these were positively associated with time spent outdoors after school. A significant interaction for traffic-related concerns*sex was found; higher road safety concerns were associated with lower odds of outdoor time after school in boys only. Age was associated with weekend outdoor time, which interacted with sex and SES; older children were more likely to spend > 2 h outside on weekends but this was only significant among girls and high SES participants.ConclusionsOur results suggest that specific groups of children are less likely to spend their free time outside, and it would seem that only prolonged recreational computer use has a negative association with children’s outdoor time after school. Further research is needed to explore potential underlying mechanisms, and parental safety concerns in more detail.

Background:The Active Healthy Kids 2014 England Report Card aims to provide a systematic assessment of how England is performing in relation to engaging and facilitating physical activity (PA) in children and young people.Methods:The systematic methods and processes that underpin the Active Healthy Kids Canada Report Card were used and adapted. Data and evidence were consolidated, reviewed by a panel of content experts, and used to inform the assignment of letter grades (A, B, C, D, F) to 9 core indicators related to PA.Results:Children’s Overall Physical Activity received a grade of C/D. Active Transportation and Organized Sport Participation received grades of C and C-, respectively. The indicators of School and Community and the Built Environment were graded favorable with grades of A- and B, respectively. Active Play, Sedentary Behaviors, Family and Peers, and Government Strategies and Investments were graded as INC (incomplete) due to a lack of nationally representative data and/or as a result of data not mapping onto the benchmarks used to assign the grades.Conclusions:Substantial provision for PA opportunities in England exists. Yet more effort is required to maximize use of these resources to increase PA participation.

Background:Regular physical activity improves physical and mental health, yet children’s physical activity levels were low in England’s 2014 Report Card. Within this paper, we update the 2014 Report Card to assess current information for the 9 indicators of physical activity.Methods:A search for nationally representative data on 9 indicators of physical activity was conducted and the data were assessed by an expert panel. The panel assigned grades [ie, A, B, C, D, F, or INC (incomplete)] to each indicator based on whether children across England were achieving specific benchmarks. The 2016 Report Card was produced and disseminated.Results:The following grades were awarded: Overall Physical Activity Levels: D-; Organized Sport Participation: D; Active Play: INC; Active Transportation: C-; Sedentary Behaviors: INC; Family and Peers: INC; School: B+; Community and the Built Environment: B; Government Strategies and Investment: INC.Conclusions:The grades have not improved since the 2014 Report Card and several gaps in the literature are still present. While children’s physical activity levels remain low alongside competing sedentary choices, further national plans and investment with local actions are urgently needed to promote physical activity especially via active play, active transport, and family support.

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