1. Active children: from epidemiology to intervention sally. barber@bthft
Active children: from epidemiology to intervention

2. Overview What is Born in Bradford and who are our families
Our early years PA research
Global and local patterns of PA in childhood
Correlates and determinants of PA (potential components of successful programmes/interventions)
BiB’s plans to strengthen the research understanding
Recommendations based on current evidence
Questions and discussion

3. Describe health and ill-health and their causes;
Develop, design and evaluate interventions to promote health;
Provide a model for integrating research into practice
Build and strengthen local research capacity in Bradford.
Born in Bradford aims to…

4. 9 this year 12435 Mothers 13776 pregnancies 3449 Fathers
All in Primary School
3 sets of triplets
176 sets of twins
12435 Mothers
13776 pregnancies
3449 Fathers
13471 Singletons
This is the BiB cohort in numbers and pictures

5. Data collection for the cohort
Baseline Questionnaire (mother during pregnancy)
Lifestyle
Environment
Wellbeing
Health
Socio-economic
Genetic
Biological
Sub-cohorts & routinely collected data & postcode mapping
BiB1000 – obesity
MEDALL & All-In – Asthma & allergies
Health visitor/school nurse
Hospital Admissions
GP records
Bradford Education
LA data
Full
6-10 yrs
Environmental
Cognition
PA & cardio-metabolic
Asthma, Allergies, infection
Pollution & green space
Cognition & Learning
Behaviour& wellbeing

6. Physical Activity spectrum
If sedentary behaviour is reduced there is more availability for PA – children who do less SB are more likely to substitute at least some of this time with MVPA

7. Behavioural epidemiological framework: early years PA and SB research
Establish links between behaviour and health
Correlates and determinants of behaviour
Interventions
Translating research into practice
Measure behaviour
3 studies (1 pub) - relationship between PA, SB, sleep and adiposity
undertaking analysis on relationship between PA and Fundamental Movement Skills
Systematic review of correlates and determinants of PA (published)
Gender and ethnic differences in correlates of PA at age 2yrs
Modifiable and non-modifiable determinants of screen viewing trajectories from 6 – 36 months
HAPPY and PIP commissioned by Better Start Bradford with on-going evaluations
5 published studies refining measurement:
Feasibility and validation of using accelerometers
Reliability and validity of EYPAQ-parent report
RCTs:
HAPPY intervention (published)
Pre-schoolers in the Playground: PIP intervention (published)
Reducing infant screen viewing (in development)

8. Sex- and age-specific percentile values for levels of physical activity (PA) and sedentary time of European children aged 2.0–10.9 years from eight European countries (Sweden, Germany, Hungary, Italy, Cyprus, Spain, Belgium and Estonia).
N = 7684 children
RECCOMENDATION
Around the age of 7 yrs the trajectory of PA slows down

9. PA & SB patterns
853 Australian children from 29 Elementary schools in the LOOK study
Grade 2 = age (Y3)
Grade 3 = age 8 – 9 (Y4)
Grade 4 = age 9 – 10 (Y5)
Grade 5 = age 10 – 11 (Y6)
Grade 6 = age 11 – 12 (Y7)
~25% difference between week and weekend days
Primary school – critial time to intervene before children reach adolescents and high school
Children in transition from childhood to adolescents gain more autonomy and decision making power

10. 9-10 year olds: 64% not reaching an average of 60 min MVPA daily
% of waking day
School day
Weekend day
School day
% of waking day
Classroom
Break-time
After school
84 mins
63 mins
~25% difference between week and week

11. Ecological model
Population effect and political difficulty

12. 30 studies – children 16 years or younger 17 school based
10 home/family based
1 community centre
1 university gym
1 boy scout centre
small to negligible increases in total PA, small improvements (~ 4 minutes/day in MVPA)
Clinical effect likely to be minimal – e.g. 2mm reduction in Waist circumference, 0.06mm Hg in systolic BP
Why have interventions failed?
Speculated poor delivery
Specultated poor uptake
Insufficient intervention intensity
Compensatory inactivity
ALL not evidenced in literature
No reports of adverse events
Poor detail about dropouts
Per-protocol not intention-to-treat
No process evaluation
No health economic evaluation
Physical activity interventions in childhood consistently focus on improving body composition but these have been largely unsuccessful 12

14. Fundamental movement skills
‘Foster continued learning and development of motor competencies through practice and participation in developmentally appropriate activities that demand more advanced movement patterns and higher levels of performance in a variety of movement contexts’ – Robinson et al. 2015

15. Correlates of PA and SB in childhood
MVPA SB
Child Weight status
Active travel to school
Child interest in PA
Season
Parent modelling (SB only)
480 Caucasian children aged 7 years, from the Gateshead Millennium study (2010) PA
Car ownership
Family support for PA
Having a pet
Home internet access
No. of siblings
+ve in white Europeans
-ve in SA
Family and home correlates in a multi-ethnic UK population, 9-10 year olds – CHASE study (2011)
PA & SB
Parent rules &restriction of SB
Parent doing PA with child (PA only)
Parental logistic support (PA only)
Walking to school
(PA only)
Systematic Review: 76 observational studies of PA and SB correlates in 10 – 12 year olds; ENERGY study (2012)
Family correlates

16. Parental influences in BIB
35 children 6.14 ± 0.27 yrs, 33 mothers, 16 fathers
1 week of accelerometer
Questionnaire assessed parental supporting and controlling practices
↑Child MVPA
Mother gives logistic support for sport
Father has rules around out door play
↓Child SB
Mother models and enjoys PA
Mother gives logistic support for sport
Father has rules around out door play
Improved access to PA and sporting opportunities after school and at weekends
Weekend access & provision
Improving parental attitudes and PA/sporting behaviours
Family opportunities to be active
Undergraduate students from Leeds University (on placement with BiB)

17. Family
Kader et al 2015
Group-based activities of relatively high frequency appear to be effective (but low participation and high attrition are a challenge in low SES groups)
Active involvement of parents is required (sending educational information home does not work)
Effectiveness of universal parental support interventions addressing children’s dietary habits, physical activity and bodyweight: a systematic review. Prev Med:77(2015);52-67

18. Major green space within 300m
BiB: N=7547 during pregnancy

19. More green --- healthier weight 10% increase --- ~16-22g
Exposure
Outcome
More green --- healthier weight
10% increase --- ~16-22g
But
Only for White British NOT South Asian women
Birth weight below 2.5kg
Greenest area 18-23% less likely to report depression
Outcome
But
Only for those in more deprived groups
Stronger for those already active
Dadvand P, et al. Environ Int. 2014;71:101-8.
McEachan, R, et al. J Epidemiol Community Health. 2015; 0:1–7

20. Environment
The environmental influence on physical activity is domain & context specific i.e. related to active travel and playing outdoors.
PA is associated with:
Access/proximity to recreation facilities
land-use mix (residential, commercial, cultural, institutional, industry – with pedestrian connections)
residential density
Walkability
Walking/biking facilities
traffic speed/volume
Pedestrian safety structures
Incivilities/disorders
Vegetation (i.e. trees along pavements/paths)
The environmental correlates of PA in children are less researched than in adults and understanding them is especially important as children have less autonomy and are more likely than adults to be influences by their environment directly or indirectly (through parents and peers)
Ding Ding et al. Neighbourhood Environment and Physical Activity Among Youth A Review: Am J Prev Med 2011;41(4):442– 455

21. Environment To promote physical activity across a wide age range:
Enhance access to parks and recreational facilities
Encourage mixed use developments

22. When children are asked, the magic ingredient for interventions is fun!
Interventions delivering sustained fun are likely to be engaging and promote ongoing involvement
Fun!
Van Sluijs and Kriemler 2016 reflections on physical activity intervention research in young people – do’s don’ts and critical thoughts. Jour. Behav Nutrit Phys Act;13:25

23. Growing-Up! MRC/ESRC/BHF funded to examine determinants of: Cognition
Social and emotional wellbeing
Cardio-metabolic disease
With a special focus on SES and ethnic differences
9000 BiB mothers, 5000 BiB partners and 9000 BiB children (aged 6-10 years old) in the community
10,000 BiB children & 8,500 non-BiB in schools
We have secured prestigious funding from the Medical Research Council, and Economic and Social Research council to re-visit all our families and conduct a new wave of data collection when children are aged between 6-9 years old. This will allow us to explore how lives have changed for our families and help us answer important questions about what factors influence health, ill-health and educational attainment. Ultimately, our research will be used to help policy makers, health professionals and educationalists improve service provision locally and nationally, based on rigorous evidence. 23

24. Establish links between behaviour and health
Correlates and determinants of behaviour
Interventions
Translating research into practice
Measure behaviour

25. Identifying correlates of activity SES & ethnic differences
Individual
Perception of FMS
Attitude to activities
Preferences
Enjoyment
Knowledge
Adiposity
Policy
PE length, freq
PE premium use
Break times length, freq, availability of equipment
Active travel
Activity in classrooms and corridors
Punishment or reward?
Activity and the weather/season
Interpersonal
Encouragement, support and co-participation in activities with:
Friends
Family
school
Parent’s PA
Parents enjoyment and modelling of PA
Parent’s logistic support for sports
Parent’s knowledge
Parent’s perceived barriers to PA
Environment
Access to safe outdoor space
Park/green space satisfaction
Frequency of park use
School grounds
Proximity/access to green space
Walkability & safety structures
Traffic speed/density
Land use
Residential density

26. Recommendations from research evidence
Consider the whole PA/SB spectrum
Fundamental movement skills
Family focus
Environment – active travel, outdoor play
Fun
Thorough evaluations
Frequent revisits to academic literature, especially for UK-based research
Keep in touch for updates on progress and emerging results from BiB