Begreppet fysisk aktivitet. Ung Livsstil 2009 (Blomdahl och medarbetare) Trender hos barn och unga

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1 Begreppet fysisk aktivitet - Frekvens Stillasittande - Breaks Prestation Örjan Ekblom, docent Åstrandlaboratoriet, GIH Hjärta/kärl Kolesteroler Insulin LPL Muskel Myokiner Transportörer DNA Telomerer - VO2 CNS - Styrka BDNF Plaque Hypertoni Dålig sockerkontroll Obesitas Hormonella rubbningar Blodfettrubbningar CVD Utfall - Typ Riskfaktorer - Intensitet Mekanism Exponering Fysisk aktivitet Fysisk aktivitet för barn och ungdomar NIDDM Kognitiva förmågor Depression Demens Cancer - Balans Prestationsförmåga Kondition Styrka Koordination Percentage of 11, 13 and 15 year olds being vigorously physically active at least four times a week, by country, gender and year. Kognition Metabola risker Blodfetter Sockerkänslighet BMI Mental hälsa Livskvalitet Sömn The Author(s) Samdal O et al. Eur J Public Health 2007;17: Ung Livsstil 2009 (Blomdahl och medarbetare) Trender hos barn och unga Pojkar Mellan Flickor Mellan Pojkar Hög Flickor hög Hos 15 åringar minskade tiden i MVPA från 52 till 40 minuter per dag hos flickor och från 56 till 46 minuter per dag hos pojkar mellan 1998 till 2004 Ca 20 minuter ökning i tid i stillasittande under samma tid. Pojkar Gy Flickor Gy Räcker medlemskap? Hos nioåringar ger en fotbollsmatch ca 25% av behovet MVPA (= träning )! (Schaeck et al 2011) Ortega et al PLoS One 2013) 1

2 Metabola konsekvenser Gäller detta även barn? Hong et al Int J Sports Med 2009 Indirekta tecken på trender i aktivitet Andel överviktiga och feta Kondition kan tränas hos barn. Kontinuerlig träning och intervallträning, exempelvis löpning, simning, cykling. Intensitet: I medeltal 85 procent av maximal puls under passet. Duration: minuter per gång. Frekvens: 3 4 dagar i veckan. Träningsperiodens längd: Minst 12 veckor Janssen I, Leblanc AG. IJBNPA, Armstrong N, Medicine and sport science 2011 Indirekta tecken på trender i aktivitet Est. VO Kondition och metabola konsekvenser Relative aerobic fitness (ml/min/kg), 95% CI Year Girls Boys Aerobic capacity (1/min), 95% CI Girls Boys Year Ekblom,et al Acta Paediatrica 2011 Rizzo et al J Pediatr 2007 HUR KAN DESSA SKILLNADER UPPKOMMA? 2

3 Study (year) Norris et al., [35] 1992 Melnyk et al., [33] 2009 Bonhauser et al., [36] 2005 Mendelson et al., [34] 2010 Hilyer et al., [31] 1982 Petty et al., [32] 2009 Annesi, [38] 2005 MacMahon and Gross, [37] 1988 Daley et al., [30] 2006 Subgroups within study Comparison Outcome Hedges g Standard error Statistics for each study Variance Lower limit Upper limit Z-value Combined Control Depression Combined Combined Depression Experimental Control Depression Intervention Control Depression Combined Combined Combined Combined Combined Depression Treatment Control Depression Combined Combined Depression Combined Combined Depression p-value Hedges g and 95% CI Styrketräning Det finns i tvärsnittsstudier ett positivt samband mellan muskelstärkande träning och muskelstyrka hos både barn och ungdomar. 2 3 gånger i vecka i minst 8 veckor Tyngden på vikterna/motståndet hade ingen säkerställd betydelse. Behringer M. Pediatrics 2010 Muskelmassa och typ är kopplat till skeletthälsa, sockertålighet och hjärthälsa. Styrka är viktigt för att klara rörelser och minska skaderisk Skeletthälsa Friska barn som i experimentella studier utför regelbunden och viktbelastande aktivitet (exempelvis hopp, styrketräning, acceleration och inbromsning) har uppvisat positiva effekter på benmineraltäthet. Aktiviteten utfördes minst 2 3 gånger i veckan och durationen var 3 60 minuter. Träningsperiodens längd var 2 månader till 2 år. Janssen IJBNPA, 2008 Funktion i ämnesomsättningen Insulinkänslighet Styrketräning och konditionsträning påverkar gynnsamt Fedawa FA Pediatrics 2014, Berman LJ, Diabetes 2012,Kim Y, Int J Edocrin 2013 Blodtryck Konditionsträning tycks ge säkrast blodtryckssänkande effekt, men träningens utformning behöver undersökas närmare. Blodfetter Gynnsamma effekter av konditionsträning i kombination med kostrestriktioner på HDL och LDL, större än de som erhölls av enbart kostrestriktioner. Ho M, et al JAMA, 2013 Mental hälsa hur barn mår Studier på samband mellan mental hälsa/ohälsa hos barn och ungdomar och fysisk aktivitet är ännu förhållandevis få. I de studier som redovisats finner man positiva effekter av fysisk aktivitet på självkänsla och självuppfattning. Brown HE Sports Med 2013, Biddle, S, Br J Sport Med 2011, Larun L Cochrane Rev 2006 Sammanslagning av studier, meta-analys Brown et al Sport Med, 2013 Favours A Bättre Favours B Sämre 3

4 Kognition hur barn lär Interventioner hos barn Kamijo at al 2011 Hillman, Erickson och Kraemer CONCLUSIONS Skolprestation eller kognition Begränsat vetenskapligt underlag. Castelli DM, Journal of sport & exercise psychology Fedewa AL Research quarterly for exercise and sport Hillman CHDevelopmental psychology Hillman CH, Neuroscience Kamijo K. Developmental science Icke-linjärt samband kondition-kognition Corder et al. International Journal of Behavioral Nutrition and Physical Activity (2015) 12:106 Table 2 Adjusted associations between academic achievement and physical activity/sedentary variables from multiple multilevel linear regression models Total pointsa Β (95 % CI) Något mer osäkert är sambandet mellan kognition och total fysisk aktivitet. Effekter av motorikträning och muskelstyrka är inte tillräckligt undersökta för att slutsatser ska kunna dras. De genomförda studierna har generellt metodologiska brister. P value In separate models Sedentary time MVPA (min/day) Screen time Non-screen sedentary 6 9 (1 5, 12 4) ( 14 3, 4 3) FIGURE 1 Predicted achievement scores and trend lines for mathe 1 8 ( 7 5, 3 8) matics and spelling <0 001 In this study, PA(14 6, was31 6) not significantly correlated with AA, either linearly or nonlinearly. There could be several reasons for this null6 2finding. not have a direct relahansen almay MSSE 2014 (0 6, 11 9)First,etPA tion with AA. However, given the obvious role that moderatemvpa (min/day) to-vigorous 1 0 PA( 5 7, over 5 8) time plays in improving or maintaining aerobic fitness, seems 3 7) more likely that this null finding Screen time 9 1it( 14 5, is attributable to other factors. Non-screen sedentary 24 7 (17 3, 32 0) It could be that the unit of measure <0 001 for PA in this study aggregate of 3 4 d of accelerometer data Quadratic functions with valid data across four consecutive days may not have adequately 8 3 represented the full scope of these children s Non-screen sedentary quadratic ^2 ( 12 3, 4 3) <0 001 typical activity levels. Non-screen sedentary 67 6 (44 8, 90 3)Valid PA data were also missing <0 001for a substantial proportion of children in this study (41.5%), and All models clustered for school and adjusted for MFQ, BMI z-score, deprivation, season of physical activity measurement, and sex thus, this smaller subsample may not have adequately reprea Calculated to include GCSE and GNVQ results e.g., for GCSEs A* = 58, A = 52 G = 16, and similar for GNVQ grades sented the relation of PA and AA for the entire sample. The Sedentary hr/day spent <1.5 METS present findings, however, point to the need for longitudinal MVPA mean mins/day spent in moderate and vigorous physical activity above 4 METS Screen time sedentary includes self-reported time spent in TV/DVD, Internet and Computer games designs that assess PA over longer periods or on multiple ocnon Screen time sedentary includes self-reported time spent in homework and reading casions to unmask any potential relation between PA and AA. Mutually adjusted Sedentary time Quadratic functions are only shown if significant Skolprestation eller kognition Page 5 of 8 more GCSE points (equivalent to one whole GCSE (e.g., Grade F = 22 points)). These associations are independent suggesting that irrespective of the amount of reading and homework, screen time is still detrimental to GCSE performance, to the extent of 9 points or half a GCSE (at Grade G). APPLIED SCIENCES I tvärsnittsstudier liksom i experimentella studier har man funnit tydliga positiva samband mellan kondition och skolprestation, men mer sällan direkta, tydliga samband mellan grad av total fysisk aktivitet och skolprestation. Experimentella studier avseende skolprestation och/ eller kognition visar att de tydligaste effekterna på kognitiva förmågor uppnås vid förbättrad kondition. Contrary to our hypothesis, but similar to some recent REFERENCES findings [18], there was no association between academic 1. Ahamed Macdonald H, Reed K, Naylor Liu-Ambrose performance andy,mvpa. Our findings are PJ, contrary to at, McKay H. School-based physical activity does not compromise recent British study which concluded a positive association between MVPA at 11y and GCSE results (at 16y) in English for boys and Science for girls [19]. These associations This study has particular strengths and limit should be noted. Although the cross-sectional de any evaluation of how/if PA and aerobic fitness le to AA over time, the findings indicated that man in this study were below the recommended PA levels. Barring hereditary and maturational limi dren s fitness levels, most children should be capab ing recommended levels of PA and aerobic fitness (3 present findings suggest that increases in these le benefit their AA. (Increasing PA is argued as a re increasing fitness.) The use of salient covariates in ses, including gender, race, ethnicity, parental educ household income, and BMI, strengthened the f ruling out their potential influence on the relation aerobic fitness with AA. We suggest that researche mum, measure and evaluate the influence of these c future studies in which AA is included. It should al that this study s sample was homogeneous in ter (predominantly White) and there was a relatively h tion of high-income families (21%), which limits ability. Lastly, there is limited validity evidence avail 20-m PACER in 7- to 8-yr-old children and the p confounding by motivation to perform or other c due to the age of the sample is possible. Overall, the present study contributes to an em erature linking aerobic fitness and PA with AA search implies that providing more opportunities t and improve fitness could improve AA, at leas and schools are uniquely situated to provide suc nities. With recent financial constraints on educa gets and increased pressures on schools to meet achievement standards, educators may be tempted their focus on academics, perhaps to the detriment portunities for children in school. The findings of along with existing research, suggest that this resp ultimately be detrimental to children s AA. Altho research is needed to better understand the longitud of increasing aerobic fitness and PA on children s le present findings suggest that a more proactive a increasing fitness is warranted. We wish to express our appreciation to the schools pated in this study. This study was supported by the National Institute (R01-DK85317). This trial was registered at the US Natio of Health Clinical Trials, NCT The authors declare that they have no competing i form of payment was given to anyone to produce this m The results of the present study do not constitute end the American College of Sports Medicine. children s academic performance. Med Sci Sports E 39(2): Stillasittande och skolprestation 2284 Official Journal of the American College of Sports Medicine Copyright 2014 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited. Stroth S. Brain research 2009, Themanson JR Neuroscience 2006., Martin A Cochrane Rev Fig. 1 Results are from two level linear regression models adjusted for MFQ, BMI z-score, deprivation, season of physical activity measurement and sex. Results are shown for objectively measured sedentary time and moderate and vigorous physical activity (MVPA), and self-reported separate and composite screen time (TV, Internet and Computer Games) and non-screen sedentary behaviours (homework and reading). Values represent adjusted associations (Beta (95 % CI)) between academic achievement (total GCSE points) and sedentary variables (hours/day) and MVPA (mins/day) 4

5 Endotelfunktion ett test Endotelfunktion hos ungdomar Figure 1. Superficial femoral artery flow mediated dilation (FMD, %) before (Pre) and after (Post) the SIT and EX condition. Values are mean and standard deviations. The P values denote significance for the post-hoc pairwise comparison, Pre vs. Post EX and SIT. Figure 1. Superficial femoral artery flow mediated dilation (FMD, %) before (Pre) and after (Post) the SIT and EX condition. Values are mean and standard deviations. The P values denote for the post-hoc pairwise Effekt av tresignificance timmars sittande (9 årcomparison, gamla)pre vs. Post EX and SIT. Stillasittande Vid mätning med objektiva metoder har man inte kunnat finna ett samband mellan TV-tittande och tid i stillasittande hos barn och ungdomar. TV-tittande har däremot till exempel visats vara förenat med ohälsosamma matvanor såsom läskintag och småätande. Samband mellan ohälsa och objektivt uppmätt total inaktivitet (med accelerometer) har inte kunnat bevisas i den här åldersgruppen Ekelund et al McManus et al Exp Phys 2015 This article is protected by copyright. All rights reserved. 28 Övervikt följer inte med sittande, men med aktivitet Väistö et al. International Journal of Behavioral Nutrition and Physical Activity 2014, 11:55 Page 7 of 10 Kombinationen This article is protected by copyright. All rights reserved Lowest third N=158 Middle third N=153 Highest third N= P=0.022 for difference between groups analysed by GLM Discussion found that lower levels of total PA, particularly unstructured PA, and higher levels of SB, especially watching TV and videos and resting, were associated with an increased cardiometabolic risk. The combination of lower levels of total PA and higher levels of EMT was related to the highest cardiometabolic risk. There are a number of studies on the associations of PA and SB with overall cardiometabolic risk and overweight among children [12,13,16-20]. However, few studies have addressed the question, whether PA and SB are related to overall cardiometabolic risk and body adiposity independent of other health behaviours or individual cardiometabolic risk factors in children [27]. In the European Youth Heart Study We Ekelund et al JAMA Cardiometabolic risk score Lowest third N=167 Middle third N=149 Highest third N= Figure 1 Means of cardiometabolic risk score in thirds of total physical activity. Means of cardiometabolic risk score in lowest (<87 min/day), middle ( min/day) and highest (> 127 min/ day) third of total physical activity adjusted for age and gender Cardiometabolic risk score Cardiometabolic risk score P=0.002 for difference between groups analysed by GLM P=0.001 for difference between groups analysed by GLM Low EMT High PA N=122 Low EMT Low PA N=109 High EMT High PA N=110 High EMT Low PA N=126 Figure 3 Combined association physical activity and electronic media time with cardiometabolic risk score. Combined association of total physical activity (categorised at median of 107 min/day) and electronic media time (categorised at median of 96 min/day) with cardiometabolic risk score adjusted for age and gender. among children and adolescents, PA was not associated with body adiposity, but it was inversely related to overall cardiometabolic risk independent of watching TV and body adiposity [27]. However, watching TV was directly related to body adiposity and the direct association of watching TV with overall cardiometabolic risk was partly accounted for body adiposity and the frequency of meals. In contrast to the results of the European Youth Heart Study [27], our findings suggest that the inverse association of PA with overall cardiometabolic risk is largely explained by body adiposity. Consistent with the results of the European Youth Heart Study, however, the direct relationship of SB with overall cardiometabolic risk was partly accounted for body adiposity and the number of meals. We also observed that the direct association of watching TV with body adiposity was partly explained by total PA. These findings together suggest that some unhealthy eating behaviours accumulate in children with higher levels of SB. We found that total, unstructured and recess PA were inversely associated with fasting insulin independent of total SB, but the relationship between total PA and fasting insulin was largely explained by body adiposity. These results are consistent with the observation that PA improves insulin sensitivity by reducing body adiposity [28]. PA has been inversely associated and SB has been directly related to fasting insulin regardless of body adiposity among children in some earlier studies 5

6 Stillasittande Det finns otillräcklig evidens rörande stillasittande och dess effekter på hälsan under barn- och ungdomsåren. Ofta har skärmtid likställs med stillasittande tid. Skärmtid utgörs då av såväl TV-tittande som datoranvändning. Studier tyder på ett samband mellan över två timmars TV- tittande/dag och ohälsosam kroppssammansättning, metabola riskfaktorer, sämre fysisk kondition, lägre självförtroende, utåtagerande beteende och lägre skolprestation Tremblay et al 2011, LeBlanc et al 2012 Vi är en bra bit på väg - Liknande utveckling för behandling och förebyggande - En god grund att stå på avseende implementering. - SPECIFICERING! Tack för er tid. 6