Comparison of accelerometer measured levels of physical activity and sedentary time between obese and non-obese children and adolescents: a systematic review.

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childhood obesity 3160 obesity face a number of health, social, and psychological problems [[2], [5], [6]]. Prevention of childhood obesity is a public health priority while treatment is becoming an increasingly important clinical issue.A number
obesity 629 whether, and the extent to which, levels of MVPA and ST are suboptimal among children and adolescents with obesity . The primary objective of this study was to examine accelerometer-measured time spent in MVPA and ST
obesity 771 study was to examine accelerometer-measured time spent in MVPA and ST of children and adolescents with obesity , compared with MVPA recommendations, and with non-obese peers.MethodsAn extensive search was carried
obesity 1481 outcomes.ResultsOut of 1503 records, 26 studies were eligible (n = 14,739 participants; n = 3523 with obesity ); 6/26 studies involved children aged 0 to 9 years and 18/26 involved adolescents aged 10.1 to19 years.
obesity 1620 children aged 0 to 9 years and 18/26 involved adolescents aged 10.1 to19 years. In the participants with obesity , the time spent in MVPA was consistently below the recommended 60 min/day and ST was generally high
obesity 1899 controls suggested that the time spent in MVPA was significantly lower in children and adolescents with obesity , though differences were relatively small. Levels of MVPA in the obese and non-obese were consistently
obesity 2155 differences in ST between obese and non-obese peers.ConclusionsMVPA in children and adolescents with obesity tends to be well below international recommendations. Substantial effort is likely to be required to
obesity 2330 effort is likely to be required to achieve the recommended levels of MVPA among obese individuals in obesity treatment interventions.This systematic review has been registered on PROSPERO (International Database
obesity 2717 contains supplementary material, which is available to authorized users.BackgroundThe prevalence of obesity among children and adolescents is now very high in both developing and developed countries [[1], [2]]
obesity 3061 have a significant impact on both physical and psychological health and children and adolescents with obesity face a number of health, social, and psychological problems [[2], [5], [6]]. Prevention of childhood
obesity 3170 face a number of health, social, and psychological problems [[2], [5], [6]]. Prevention of childhood obesity is a public health priority while treatment is becoming an increasingly important clinical issue.A number
obesity 3338 increasingly important clinical issue.A number of health behaviors have been associated with risk of obesity [[7]]. Poor diet, lack of physical activity (PA) and increased sedentary time (ST) have been linked
obesity 3509 sedentary time (ST) have been linked to the development and maintenance of childhood and adolescent obesity [[8]–[11]]. Many evidence-based guidelines focusing on the amount of PA, particularly moderate–to-vigorous
obesity 4258 children and adolescents [[18], [19]]. Since MVPA and ST are also important to health in those with obesity , and since obesity has been hypothesized to be associated with reduced MVPA [[20]] these variables need
obesity 4277 adolescents [[18], [19]]. Since MVPA and ST are also important to health in those with obesity, and since obesity has been hypothesized to be associated with reduced MVPA [[20]] these variables need to be reviewed
obesity 4419 associated with reduced MVPA [[20]] these variables need to be reviewed for children and adolescents with obesity . Whether and to what extent obesity in childhood and adolescence is associated with reduced objectively
obesity 4455 variables need to be reviewed for children and adolescents with obesity. Whether and to what extent obesity in childhood and adolescence is associated with reduced objectively measured MVPA and ST/SB remains
obesity 4943 important to assess objectively measured time spent in MVPA and ST in children and adolescents with obesity . The primary aim of the present systematic review was therefore to determine obese children’s and
obesity 5143 children’s and adolescents’ habitual amount of time spent in MVPA, and examine whether those living with obesity met the current MVPA recommendation for health of a minimum of 60 min per day [[14], [21]]. Secondary
obesity 5348 Secondary aims were to examine time spent in accelerometer-measured SB by children and adolescents with obesity , and to determine whether MVPA and ST in obese children and adolescents were different from the non-obese
obesity 12248 the subgroups as those are factors known to be strongly associated with both the exposure variable, obesity , and the outcomes, MVPA and ST, and so might explain some of the observed findings. The age subgroup
obesity 37847 two studies involved both children and adolescents. Further, 22/26 compared MVPA data in those with obesity with a non-obese peers, while 13/26 studies also provided data on accelerometer measured ST; 10/13 studies
obesity 37993 studies also provided data on accelerometer measured ST; 10/13 studies compared ST data in those with obesity with non-obese peers.Measurement protocolThe ActiGraph was the most common accelerometer type used to
obesity 38582 childrenEight eligible studies involved obese children, with a total sample size of 2138 children (478 with obesity ; 131 boys, 136 girls and 211 no sex specified). Two of the eligible studies were clinical samples with
obesity 39297 time spent in MVPA was < 60 min/day. Furthermore, in 2/7 of the eligible studies, children with obesity reached or exceeded 60 min of MVPA per day [[37], [38]], while in one study they came close to a mean
obesity 39715 in both groups [[37]]; in three studies, time spent in MVPA was significant lower in children with obesity than in the comparison group [[35], [36], [39]], while in two studies time spent in MVPA of children
obesity 39829 in the comparison group [[35], [36], [39]], while in two studies time spent in MVPA of children with obesity was lower than the comparison group but differences were not significant [[38], [40]]. In the other
obesity 39984 differences were not significant [[38], [40]]. In the other 2 studies, time spent in MVPA of children with obesity was different in terms of gender compared to the comparison group: Hussey et al. reported that mean
obesity 40134 to the comparison group: Hussey et al. reported that mean MVPA was significantly lower in boys with obesity but not in girls [[32]]; while Vale et al. reported that mean time spent in MVPA was significantly lower
obesity 40261 [[32]]; while Vale et al. reported that mean time spent in MVPA was significantly lower in girls with obesity but not in boys [[41]] compared to the comparison groups.With respect to ST, 4/8 eligible studies reported
obesity 40436 respect to ST, 4/8 eligible studies reported on accelerometer-measured time spent in SB of children with obesity with a total sample size of 536 children (191 with obesity; 28 boys, 32 girls and 131 no sex specified).
obesity 40495 accelerometer-measured time spent in SB of children with obesity with a total sample size of 536 children (191 with obesity ; 28 boys, 32 girls and 131 no sex specified). In one study, ST data of boys and girls was reported separately
obesity 40928 the obese than the non-obese groups, although, in one study it was significantly higher in boys with obesity but not in girls [[32]]. In one study ST was similar in both groups [[39]].MVPA and ST in obese adolescentsTwenty
obesity 41154 the eligible studies involved adolescents, with a total sample size of 12,601 adolescents (3045 with obesity ; 1615 boys, 1575 girls and 195 no sex specified). Four of the eligible studies were clinical samples
obesity 42091 adolescents who were obese. A total of 16/20 eligible studies compared time spent in MVPA of those with obesity with a comparison group: in 3/16 time spent in MVPA was similar between obese and non-obese groups,
obesity 42282 non-obese groups, while in 10/16 mean time spent in MVPA was significantly lower in adolescents with obesity than in non-obese peers.In regard to time spent in SB, nine out of the 20 eligible studies reported
obesity 42439 in SB, nine out of the 20 eligible studies reported on accelerometer measured ST in adolescents with obesity with a total sample size of 5484 adolescents (1101 with obesity; 546 boys and 555 girls), as summarised
obesity 42503 accelerometer measured ST in adolescents with obesity with a total sample size of 5484 adolescents (1101 with obesity ; 546 boys and 555 girls), as summarised in Table 3. In 8/9 studies, ST data of boys and girls were reported
obesity 43040 in obese and non-obese groups [[42], [45]]; in 2/6 studies ST was significantly higher in those with obesity than in the non-obese comparison groups [[34], [46]], while in the other 2/6 studies it was higher in
obesity 43171 comparison groups [[34], [46]], while in the other 2/6 studies it was higher in the adolescents with obesity , but not significantly so [[47], [48]].A graphical synthesis of the mean differences and 95% CI of time
obesity 43343 the mean differences and 95% CI of time spent in MVPA by sex for both children and adolescents with obesity and non-obese groups, is shown in Fig. 2. A summary of the mean differences and 95% CI of time spent
obesity 43505 of the mean differences and 95% CI of time spent in SB by sex for both children and adolescents with obesity and non-obese groups, is shown in Fig. 3.Fig. 2Forest plot of the comparison of moderate-to-vigorous
obesity 43681 comparison of moderate-to-vigorous intensity physical activity between children and adolescents with obesity and non-obese participants by sex. SD: standard deviation; CI: 95% Confidence intervalFig. 3Forest plot
obesity 43867 intervalFig. 3Forest plot of the comparison of sedentary time between children and adolescents with obesity and non-obese participants by sex. SD: standard deviation; CI: 95% Confidence intervalStudy quality
obesity 44228 quality.DiscussionThis systematic review provided clear evidence that children and adolescents with obesity have lower than the recommended levels of MVPA. In most of the eligible studies, daily time spent in
obesity 44552 non-obese peers, the findings indicated that daily MVPA was lower in children and adolescents with obesity .In reviewing the methodology of the studies, it is noteworthy that the precise accelerometer methodology
obesity 45223 al. [[46]], age 12–17 year olds) mean daily time spent in MVPA was 60 min/day in the boys with obesity in the sample studied by Ruiz et al. [[46]], and 60 min/day in the boys with obesity studied by Maggio
obesity 45309 the boys with obesity in the sample studied by Ruiz et al. [[46]], and 60 min/day in the boys with obesity studied by Maggio et al. [[40]]. Both of these studies might suggest the tentative conclusion that time
obesity 45528 in MVPA is relatively high in adolescents who are obese, possibly suggesting that adolescence and/or obesity do not present major barriers to MVPA. In contrast, three of the eligible Actigraph studies used higher
obesity 45925 These studies found that mean daily time spent in MVPA was 30 min in boys and 19 min in girls with obesity [[47]] and a median of 16 min for both sexes combined in the study by Hughes et al. [[39]] and 5 min/day
obesity 46122 [[39]] and 5 min/day in the study by Wafa et al. [[35]]. The majority of children and adolescents with obesity achieved means of < 30 min of daily time spent in MVPA in studies with cut-offs of ≥2912 cpm [[32],
obesity 46957 the present review found that studies fairly consistently reported that children and adolescents with obesity accumulated a high amount of ST during their waking hours, ranging typically between 65 and 90% of their
obesity 47656 The heterogeneity noted was due to differences in the location of the studies, differences in the way obesity was defined (different BMI cut-off points and different reference data), or differences in accelerometer
obesity 48339 whether or not levels of accelerometer measured MVPA are adequate in children and adolescents with obesity , and whether time spent in MVPA and ST differed between obese and comparison groups based on accelerometer
obesity 48678 correlates and determinants of objectively MVPA [[52], [53]], and consistent with a growing belief that obesity is associated with reduced MVPA and that low MVPA could be both a cause of obesity and a consequence
obesity 48761 growing belief that obesity is associated with reduced MVPA and that low MVPA could be both a cause of obesity and a consequence of obesity, i.e., “bidirectional causation” [[20], [54], [55]].Review and evidence
obesity 48790 associated with reduced MVPA and that low MVPA could be both a cause of obesity and a consequence of obesity , i.e., “bidirectional causation” [[20], [54], [55]].Review and evidence strengths and weaknessesThe
obesity 49074 investigated the accelerometer-measured time spent in MVPA and ST of children and adolescents with obesity , with clear definitions of obesity so that samples included in the review were not contaminated by the
obesity 49109 accelerometer-measured time spent in MVPA and ST of children and adolescents with obesity, with clear definitions of obesity so that samples included in the review were not contaminated by the inclusion of overweight but non-obese
obesity 50806 samples of obese children and adolescents with a total (n = 14,739 participants; n = 3523 with obesity ) and their power to estimate habitual MVPA might have been limited, and thus the extent to which the
obesity 53165 what appeared to be the vast majority of their waking hours sedentary. Children and adolescents with obesity were generally slightly less physically active and slightly more sedentary compared to comparison groups,
obesity 53705 highlights the need to focus on increasing MVPA and reducing ST among children and adolescents with obesity , and the importance of raising these issues in clinical settings as part of treatment for obesity. Treatment
obesity 53803 with obesity, and the importance of raising these issues in clinical settings as part of treatment for obesity . Treatment of childhood and adolescent obesity should clearly involve a focus on increasing MVPA and
obesity 53850 issues in clinical settings as part of treatment for obesity. Treatment of childhood and adolescent obesity should clearly involve a focus on increasing MVPA and reducing ST as recommended in multiple evidence

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