Cross-sectional associations between 24-hour activity behaviours and mental health indicators in children and adolescents: a compositional data analysis
This study was funded by The Waterloo Foundation and supported by West Lancashire Sport Partnership and schools in Tarleton and Ormskirk.
We aimed to (i) look at the associations between 24-hour activity compositions (i.e., sleep, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA) and sedentary time (ST)) and mental health and cognitive function in children and adolescents; and (ii) investigate predicted differences in mental health and cognitive function when time was reallocated between the activity behaviours.
Two-hundred-and-ten primary school children (aged 10.4 years) and 149 secondary school adolescents (aged 13.0 years) from West Lancashire, England took part in the study. LPA, MVPA, ST, and sleep were assessed using ActiGraph GT9X accelerometers worn on the non-dominant wrist continuously for 7-days. Depressive symptoms, self-esteem, and emotional and behavioural problems were measured using validated questionnaires (MFQ, RSES, and SDQ questionnaires, respectively). The switching, working memory, and inhibition aspects of executive function were assessed with iPads using the CANTAB Connect test battery. Data were analysed using compositional analyses.
Primary school students spent longer sleeping and less time being sedentary than secondary school peers. Less than 25% of the students averaged at least 60 minutes MVPA/day and almost 75% had less than 9 hours sleep/night. Emotional and behavioural mental health scores were in the ‘close to average’ range, there was no presence of depressive symptoms, and self-esteem was in the ‘normal’ range. The secondary school students performed better on each of the cognitive tests of executive function than their younger peers.
The 24-hour activity compositions were significantly associated with internalising problems (all schools), prosocial behaviour, and the switching and inhibition aspects of executive function among primary school students. The compositional isotemporal substitution analyses showed that for all students, time reallocations to ST from either sleep or MVPA were associated with more internalising problems (Figure 1).
Among primary school students there were positive predicted differences in prosocial behaviour when ST was replaced with any of the other three behaviours (Figure 2). In relation to executive function, when LPA replaced sleep, ST, and MVPA unfavourable predicted differences in primary school students’ performances on the switching (Figure 3) and inhibition tasks (Figure 4) were observed. In all of these compositional isotemporal substitution analyses, predicted differences in the outcomes were greatest when MVPA was replaced with either ST or LPA, rather than when time was reallocated to MVPA.
Study limitations include the cross-sectional design, imbalanced sample of primary and secondary school students who were relatively homogenous in respect of area-level socioeconomic status, risk of social desirability bias in the mental health questionnaire responses, and risk of physical activity intensity misclassification due to use of acceleration cutpoints.
Relative to other activity behaviours, ST and LPA had the greatest influence on some mental health and cognitive function outcomes, particularly among primary school students. When time was incrementally reallocated between the activity behaviours, the largest predicted changes in the outcomes occurred when MVPA was replaced by ST or LPA. The results provide further support for schools to promote students’ mental health and cognitive function by enhancing and further integrating opportunities for MVPA throughout the school day, particularly during periods such as classroom lessons that students would traditionally spend being seated and/or moving in very low intensity activity.
This paper reports the process and outcome of a unique project to develop a whole-school physical activity framework. The project was superbly led by Dr Andy Daly-Smith and his team at Leeds Beckett University and involved a two-day stakeholder event that resulted in the development of the Creating Active Schools (CAS) Framework. The paper describes the unique development process and the resultant CAS Framework.
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This paper is part of Liezel Hurter’s excellent PhD project which is expertly supervised by LJMU Physical Activity Exchange colleagues. The paper provides long overdue GENEActiv and ActiGraph raw accelerometer ENMO thresholds for sedentary (and stationary) behaviour for primary school children. The thresholds are included here but read the paper for the full details (it’s open access – click the title above to read on).
In 2014 Alex Rowlands (University of Leicester) and colleagues introduced the Sedentary Sphere for classifying time in sedentary behaviour in adults using the orientation of the GENEActiv accelerometer on the wrist. This 2019 paper from Liezel validates the Sedentary Sphere method in children wearing GENEActiv and ActiGraph accelerometers on the wrist. Click the title above to go to the article on the Journal of Sports Sciences site (paywalled).
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The two Figures show predicted health outcome response surfaces for school day activity compositions. Panel a displays predicted BMI-z score (a measure of body size) and Panel d displays predicted peak oxygen uptake (a measure of cardiorespiratory fitness) at the mean composition of sedentary time, light physical activity, and moderate-to-vigorous physical activity during the school day.
After adjustment for covariates and baseline values of the outcomes, the AS:Sk pilot intervention showed significant effects on sedentary time during the school day. There were no effects on physical activity, fitness, and body size.