Conceptualizing, Defining, and Measuring Before-School Physical Activity: A Review With Exploratory Analysis of Adolescent Data

Abstract

Physical activity (PA) among children and adolescents is often reported by time segments centered around the school day, including before school. However, there is no consistent approach to defining the before-school segment, to accurately capture PA levels and facilitate synthesis of results across studies. Therefore, this study aimed to (a) examine how studies with children and adolescents have defined the before-school segment, and (b) compare adolescents’ before-school PA using various segment definitions. We conducted a systematic search and review of literature from six databases, and subsequently analyzed accelerometer data from Australia (n = 472, mean age 14.9 years, 40% male), to compare PA across five before-school definitions. Our review found 69 studies reporting before-school PA, 59 of which used device-based measures. Definitions ranged widely, but justifications were rarely reported. Our empirical comparison of definitions resulted in a range of participants meeting wear time criteria (≥3 days at >50% of segment length) from the latest-starting definition (30 min prior to school; n = 443) to the earliest-starting definition (6:00 a.m.–school start; n = 155), implying that for many participants, accelerometer wear was low in the early hours due to sleep or noncompliance. Statistically significant differences in light and moderate-to-vigorous PA (mean minutes/school day, proportion of segment length, and proportion of wear time) were found between definitions, indicating that before-school PA could potentially be underestimated depending on definition choice. We recommend that future studies clearly report and justify segment definition, apply segment-specific wear time criteria, and collect wake time data to enable individualized segment start times and minimize risk of data misclassification.