RESUMEN
BACKGROUND: Children from low-income families experience accelerated BMI gain and learning loss during summer. Healthy Summer Learners (HSL) addresses accelerated BMI gain and academic learning loss during summer by providing academic- and health-focused programming. This manuscript reports the effects of HSL on underlying obesogenic behaviors (i.e., physical activity, screen time, sleep, diet) that lead to accelerated summer BMI gain, a necessary first step to informing a future randomized controlled trial of HSL. METHODS: In the summer of 2018 and 2019 using a quasi-experimental study design, 180 children (90 per summer, 7.9 years [SD = 1.0], 94% non-Hispanic Black, 40% male) at two schools (i.e., one per summer) who were struggling academically (25-75% on a standardized reading test) were provided a free, school-based 6-week health- and academic-focused summer program (i.e., HSL, n = 60), a 4- to 6-week academic-focused summer program (i.e., 21st Century Summer Learning program (21C), n = 60), or no summer program (n = 60). Children wore the Fitbit Charge 2™ over a 10-week period during the summers (June-Aug) of 2018-2019. Differences within (within child days attend vs. not attend) and between (differences between groups attend vs. not attend) were evaluated using mixed effects linear regression. RESULTS: Regression estimates indicated that, on days attending, HSL children experienced a greater reduction in sedentary minutes (- 58.6 [95% CI = - 92.7, - 24.4]) and a greater increase in moderate-to-vigorous physical activity (MVPA) (36.2 [95% CI = 25.1, 47.3]) and steps (2799.2 [95% CI = 2114.2, 3484.2]) compared to 21C children. However, both HSL and 21C children were more active (i.e., greater MVPA, total steps) and less sedentary (i.e., less sedentary minutes and total screen time) and displayed better sleeping patterns (i.e., earlier and less variability in sleep onset and offset) on days they attended than children in the control. CONCLUSIONS: HSL produced greater changes in physical activity than 21C. However, attendance at either HSL or 21C leads to more healthy obesogenic behaviors. Based on the behavioral data in this pilot study, a larger trial may be warranted. These results must be considered along with the pending primary outcomes (i.e., academics and BMI z-score) of the HSL pilot to determine if a full-scale trial is warranted. TRIAL REGISTRATION: NIH-NCT03321071. Registered 25 October 2017.
RESUMEN
BACKGROUND: Population-specific accelerometer cut-points are required to accurately determine the accumulation of physical activity of various intensities. OBJECTIVES: A calibration study was conducted (i) to determine the cut-points for the ActiGraph GT3X+, non-dominant, wrist-mounted accelerometer in children aged 8-12 years and (ii) to compare classification accuracies among the accelerometer's three axes and vector magnitude (VM) values. METHODS: Forty-five children aged 8-12 years performed up to seven activities while wearing accelerometers on their non-dominant wrist. Activities were performed in a summer day camp setting, represented free-living activities, and lasted for 10 min with minutes 5-8.5 used for analysis. Direct observation and percentage of heart rate reserve were used to determine activity intensity. RESULTS: Receiver operator characteristic (ROC) analyses resulted in area under the curve values of all three axes and VM ranging 0.82-0.89, 0.80-0.83, 0.62-0.67 and 0.86-0.89 for light, moderate, vigorous and moderate-to-vigorous activity intensities. Additionally, regression analyses resulted in prediction equations with R2 values ranging from 0.70 to 0.77. CONCLUSION: Results found comparable activity intensity classification accuracies from the ActiGraph GT3X+ wrist-worn accelerometer to previously published studies. Based on ROC and regression analyses, activity intensities can be distilled from this accelerometer using axis 1, axis 2 or VM values with similar classification accuracy.