0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Physical Activity and Screen-Time Viewing Among Elementary School–Aged Children in the United States From 2009 to 2010 FREE

Tala H. I. Fakhouri, PhD, MPH; Jeffery P. Hughes, MPH; Debra J. Brody, MPH; Brian K. Kit, MD, MPH; Cynthia L. Ogden, PhD
[+] Author Affiliations

Author Affiliations: Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville (Drs Fakhouri, Kit, and Ogden, Mr Hughes, and Ms Brody), and US Public Health Service, Rockville (Dr Kit), Maryland; and Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Fakhouri).


JAMA Pediatr. 2013;167(3):223-229. doi:10.1001/2013.jamapediatrics.122.
Text Size: A A A
Published online

Objectives To describe the percentage of children who met physical activity and screen-time recommendations and to examine demographic differences. Recommendations for school-aged children include 60 minutes of daily moderate-to-vigorous physical activity and no more than 2 hours per day of screen-time viewing.

Design Cross-sectional study.

Setting Data from the 2009-2010 National Health and Nutrition Examination Survey, a representative sample of the US population.

Participants Analysis included 1218 children 6 to 11 years of age.

Main Exposures Age, race/ethnicity, sex, income, family structure, and obesity status.

Main Outcome Measures Proxy-reported adherence to physical activity and screen-time recommendations, separately and concurrently.

Results Based on proxy reports, overall, 70% of children met physical activity recommendations, and 54% met screen-time viewing recommendations. Although Hispanics were less likely to meet physical activity recommendations (adjusted odds ratio [aOR], 0.60 [95% CI, 0.38-0.95]), they were more likely to meet screen-time recommendations compared with non-Hispanic whites (aOR, 1.69 [95% CI, 1.18-2.43]). Only 38% met both recommendations concurrently. Age (9-11 years vs 6-8 years: aOR, 0.57 [95% CI, 0.38-0.85]) and obesity (aOR, 0.53 [95% CI, 0.38-0.73]) were inversely associated with concurrent adherence to both recommendations.

Conclusions Fewer than 4 in 10 children met both physical activity and screen-time recommendations concurrently. The prevalence of sedentary behavior was higher in older children. Low levels of screen-time viewing may not necessarily predict higher levels of physical activity.

Figures in this Article

Physical activity and sedentary behaviors in children are associated with overall physical, psychological, and psychosocial well-being.112 Children who are physically active have a lower adiposity, more favorable lipid profiles, and increased cognitive function compared with their inactive counterparts.2,3 Independent of moderate-to-vigorous physical activity (MVPA), sedentary behaviors, such as watching television (TV), playing video games, and using a computer, have been associated with being overweight and obese and having higher serum cholesterol levels, blood pressure, and glycohemoglobin levels.4 Importantly, physical activity and sedentary behaviors track from childhood to adulthood.1316

The 2008 Physical Activity Guidelines for Americans,1 a National Heart, Lung, and Blood Institute–supported Expert Panel, and the American Academy of Pediatrics2,17,18 recommend that children participate in daily MVPA for at least 60 minutes. The National Heart, Lung, and Blood Institute–supported Expert Panel and the American Academy of Pediatrics also recommend that children limit leisure screen-time viewing to 2 hours per day or less.2,1719 However, little is known about adherence to physical activity and screen-time recommendations among US children.2024 We used nationally representative data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) to provide the most recent prevalence estimates of elementary school–aged children who meet recommendations for physical activity and screen-time viewing. We also examined associations between adherence to recommendations and previously described correlates of physical activity and screen-time viewing, including age, sex, race/ethnicity, family income to poverty level ratio, family structure, and obesity.

STUDY DESIGN AND POPULATION

Data from the 2009-2010 NHANES were used in this analysis.25 The NHANES is a continuous survey conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention to assess the health and nutritional status of the US noninstitutionalized population. The survey combines both an in-home interview and a physical examination in specially designed and equipped mobile trailers, which travel to locations throughout the country. The NHANES uses a complex, multistage, probability sampling design to select participants. The survey is designed to sample larger numbers of certain subgroups. In 2009-2010, non-Hispanic blacks, Hispanics, and low-income persons were oversampled among other groups. The oversampling of these specific subgroups increases the reliability and precision of estimates. Our analysis was restricted to elementary school–aged children (6-11 years of age) for 3 reasons. First, physical activity guidelines for preschool-aged children (2-5 years of age) are not well defined.26 Second, physical activity was assessed differently for adolescents 12 to 19 years of age in 2009-2010. Lastly, screen-time viewing was not assessed for those 12 to 19 years of age in 2009-2010. Of the school-aged children selected to participate in the 2009-2010 NHANES, 88% were interviewed, and 84% were interviewed and examined.27 The NHANES protocol was approved by the National Center for Health Statistics ethics review board. Informed parental consent was obtained for children 6 years of age, and both parental consent and child assent were obtained for children 7 to 11 years of age. A proxy respondent, most often a parent, answered interview questions.

PHYSICAL ACTIVITY AND SCREEN-TIME VARIABLES

In the 2009-2010 NHANES, physical activity and screen-time viewing by children 6 to 11 years of age were assessed using proxy reports only; accelerometer data were not included in the 2009-2010 survey. Proxy respondents were asked several questions using the Computer-Assisted Personal Interviewing system during the household interview. The proxy respondent answered the following question: “During the past 7 days, on how many days was [child's name] physically active for a total of at least 60 minutes per day? Add up all the time [child's name] spent in any kind of physical activity that increased [his/her] heart rate and made [him/her] breathe hard some of the time.” Responses ranged from 0 to 7 days. Children were categorized as meeting recommendations if the response to the physical activity question was 7 days per week.

Screen time was defined as time spent watching TV or videos, playing computer games, or using a computer outside of school. Screen time was estimated from responses to 2 separate questions: (1) “Over the past 30 days, on average how many hours per day did [child's name] sit and watch TV or videos?” (2) “Over the past 30 days, on average about how many hours per day did [child's name] use a computer or play computer games outside of school?” For both questions, response options were as follows: none, less than 1 hour, 1 hour, 2 hours, 3 hours, 4 hours, and 5 or more hours. The options “none” and “less than 1 hour” were combined for this analysis and treated as less than 1 hour. Screen time was calculated by adding the time contributed from both questions. Children were categorized as meeting screen-time recommendations if the combined screen time was 2 hours or less per day.

DEMOGRAPHIC VARIABLES, FAMILY INCOME TO POVERTY LEVEL RATIO, FAMILY STRUCTURE, AND OBESITY STATUS

Demographic and socioeconomic questions were also asked in the household interview. The proxy respondent reported race/ethnicity for the child. For our analysis, racial/ethnic groups were categorized as non-Hispanic white, non-Hispanic black, Hispanic, and other (primarily individuals of Asian descent, American Indians, Alaska Natives, and multiracial participants). Analyses of the total analytic sample included the “other” group; however, this group did not have a sufficient sample size to be analyzed separately. Age was categorized as 6 to 8 years of age and 9 to 11 years of age. Finer 1-year stratifications of age were not possible owing to the small sample size.

Three measures of socioeconomic status and family structure were included in the analysis: family income to poverty level ratio (FIPR), the highest level of education attained by the head of household, and the marital status of the head of household. The head of household was defined as the person who rents or owns the residence where members of the household live. The FIPR was calculated by dividing family income by a poverty threshold specific for family size. The US Department of Health and Human Services' poverty guidelines were used as the poverty measure to calculate the FIPR.28 Income eligibility for participation in the Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program) is 130% of the FIPR (<130% FIPR).29 We used this cut point in our analyses: larger FIPRs indicate greater income. The level of education attained by the head of household was classified as less than high school, completed high school or general equivalency diploma, and more than high school. The marital status of the head of household was dichotomized into married or living with a partner and single. The “single” category includes those heads of households who were never married, those separated, those divorced, and those widowed. The dichotomization of marital status was performed to investigate whether meeting recommendations was associated with living in a single- vs dual-parent household.

Obesity status was defined based on body mass index (calculated as weight in kilograms divided by height in meters squared). Body mass index was calculated using measured height and weight obtained during the standardized physical examination in the mobile examination center. Children at or above the sex-specific 95th percentile on the Centers for Disease Control and Prevention 2000 body mass index–for–age growth charts were considered obese.30

STATISTICAL ANALYSIS

Statistical analyses were conducted using SAS version 9.2 (SAS Institute Inc) and SAS-callable SUDAAN version 10 (Research Triangle Institute). SUDAAN was used to adjust for the complex sample design, and the estimation of standard errors was performed by Taylor series linearization. Data were analyzed using sample weights to account for differential probabilities of selection, nonresponse, and noncoverage. Sample weights can be considered as measures of the number of persons represented by the particular sample observation and are required to produce nationally representative estimates.31

The prevalence of adherence to recommendations was calculated by age, sex, race/ethnicity, FIPR, head-of-household education level and marital status, and obesity status. Differences in adherence to recommendations were examined using multiple logistic regression models. All covariates in the multiple logistic regression models were included as categorical variables. Adjusted odds ratios (aORs) and 95% CIs of meeting recommendations were calculated. The P values from the Satterthwaite-adjusted F statistic are also presented. P < .05 was considered statistically significant.

Our analysis included 1218 children 6 to 11 years of age who participated in both the in-home interview and the physical examination portions of the survey. Sample sizes by demographic characteristics are shown in Table 1.

Table Graphic Jump LocationTable 1. Data on Children Who Met Physical Activity or Screen-Time Recommendations or Both in the 2009-2010 NHANES

The distributions of responses to the physical activity question, the TV- or video-viewing question, and the out-of-school computer use question are shown in our Figure. Based on proxy reports, the majority of children were physically active for at least 60 minutes each day of the week, whereas only 3% were not active for 60 minutes on any day of the week (Figure, A). For screen time, the majority of children did not use a computer or play computer games outside of school in the last 30 days; however, almost a third of children watched TV or videos for an average of 2 hours per day in the past month (Figure, B).

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Distributions of responses to questions about physical activity, television (TV) or video viewing, and computer use. The percentage of children with proxy-reported number of days (ie, 0, 1-3, 4-6, or 7 days) of 60 minutes or more of moderate-to-vigorous physical activity (MVPA) per week (A) and the percentage of children with proxy-reported number of hours per day (ie, <1, 1, 2, 3, 4, or ≥5 h/d) of TV or video viewing or computer use are shown. *Does not meet standard of statistical reliability and precision (relative SE of ≥30% but <40%).

The prevalence of adherence to recommendations by demographic characteristics is shown in Table 1. In 2009-2010, a mean (SE) 70.4% (2.3%) of school-aged children met physical activity recommendations, and a mean (SE) 53.5% (2.6%) met screen-time recommendations, whereas only a mean (SE) 38.3% (2.0%) met both recommendations concurrently.

Differences in adherence to physical activity recommendations by demographic characteristics and obesity status were examined using logistic regression models (Table 2). The odds of meeting recommendations were significantly lower for children 9 to 11 years of age compared with those 6 to 8 years of age (aOR, 0.60 [95% CI, 0.42-0.86]). Girls (aOR, 0.68 [95% CI, 0.51-0.92]), Hispanics (aOR, 0.60 [95% CI, 0.38-0.95]), children in households with an income 130% to 349% of the poverty line (aOR, 0.59 [95% CI, 0.35-0.99]), and those in households with an income 350% or more of the poverty line (aOR, 0.46 [95% CI, 0.26-0.81]) were less likely to meet physical activity recommendations compared with boys, non-Hispanic whites, and those living in households with an income below 130% of the poverty line, respectively. In addition, obese children had lower odds of adherence to physical activity recommendations when compared with their nonobese counterparts (aOR, 0.44 [95% CI, 0.32-0.60]). The odds of meeting physical activity recommendations did not differ between those who met and those who failed to meet screen-time recommendations (data not shown).

Table Graphic Jump LocationTable 2. Logistic Regression Analysis of Meeting Recommendations in the 2009-2010 NHANES

The odds of meeting screen-time recommendations differed by age, race/ethnicity, and obesity status (Table 2). As with physical activity, children 9 to 11 years of age had lower odds of adherence to screen-time recommendations compared with children 6 to 8 years of age (aOR, 0.61 [95% CI, 0.42-0.89]). The odds of meeting recommendations were lower in non-Hispanic blacks (aOR, 0.57 [95% CI, 0.34-0.94]) but higher in Hispanics (aOR, 1.69 [95% CI, 1.18-2.43]), compared with non-Hispanic whites. Obese children were less likely to meet recommendations compared with nonobese children (aOR, 0.65 [95% CI, 0.48-0.88]). Separate from computer use, the odds of watching TV and videos for 2 hours or less were lower for children 9 to 11 years of age compared with those 6 to 8 years of age (aOR, 0.66 [95% CI, 0.45-0.97]), and for non-Hispanic black children compared with non-Hispanic whites (aOR, 0.46 [95% CI, 0.30-0.72]) (data not shown).

There were fewer differences between groups in meeting both physical activity and screen-time recommendations concurrently compared with meeting the recommendations separately. The only differences were between age groups and between obese and nonobese children. The 9- to 11-year-old children and the obese children were less likely to meet both recommendations concurrently compared with the 6- to 8-year-old children and the nonobese children (children 9-11 years of age: aOR, 0.57 [95% CI, 0.38-0.85]; obese children: aOR, 0.53 [95% CI, 0.38-0.73]).

Based on proxy reports, in 2009-2010, approximately 70% of elementary school–aged children met physical activity guidelines, and about 54% met screen-time viewing guidelines. However, fewer than 4 in 10 children met both recommendations concurrently.

Older children (9-11 years of age) were less likely to meet physical activity and screen-time viewing recommendations compared with children 6 to 8 years of age. Our observations are consistent with a large number of studies that have reported a decline in physical activity levels with age21,3236 and an increase in screen-based sedentary behaviors during childhood.23,37 For example, using data from the 2001-2006 NHANES, Sisson et al23 showed that the proportion of children exceeding 2 hours of daily screen-time viewing increased from 35% of 2- to 5-year-old children to 49% of 6- to 11-year-old children and 56% of 12- to 15-year-old children.

In our study, girls were less likely to meet physical activity guidelines compared with boys. Previous studies,20,21,32 based on objective and reported measures of physical activity, have consistently shown boys to be more physically active than girls. However, we did not observe significant differences by sex in adherence to screen-time recommendations. Previous analyses of NHANES data showed that sex was only weakly correlated with screen-time viewing.20,23 For example, Sisson et al23 showed that 49.4% of boys and 45.0% of girls exceeded 2 hours of daily screen-time viewing in 2001-2006, whereas in our analysis, 47.3% of boys and 45.7% of girls exceeded 2 hours of daily screen-time viewing.

Previous research has described differences in physical activity and sedentary behaviors by race and ethnicity. Using objectively measured data from the 2003-2004 NHANES, Troiano et al21 reported that 6- to 11-year-old Mexican American boys did not differ from other racial/ethnic groups in their physical activity levels; however, Mexican American girls were less active than non-Hispanic black girls. Studies of reported physical activity and screen time have observed lower physical activity levels in Mexican American children20,38 and higher levels of screen time in non-Hispanic blacks compared with non-Hispanic whites.20 Consistent with these observations, Hispanics were less likely to meet physical activity recommendations in our analyses, whereas non-Hispanic blacks were less likely to meet screen-time recommendations compared with non-Hispanic whites.

Although Hispanics were less likely to meet the physical activity guidelines in our study, they were more likely to meet screen-time recommendations compared with non-Hispanic whites. These results suggest that screen-time viewing and physical activity may be separate constructs and that low levels of screen-time viewing do not necessarily predict higher levels of physical activity. In agreement, the odds of meeting physical activity guidelines did not differ between those who met and those who failed to meet screen-time recommendations (data not shown). Our findings are consistent with published studies from other countries.3943 For example, a cross-sectional study43 of Canadian adolescents found no association between reported physical activity levels and the amount of time spent in screen-based sedentary behaviors. In addition, a study40 of European youth also found no association between accelerometer-measured MVPA and the amount of time spent watching TV and showed that TV viewing and physical activity may be differently associated with adiposity and metabolic risk. Using data from a large prospective cohort of US children and adolescents, Taveras et al showed that TV viewing was not associated with changes in MVPA and suggested that “clinical and public health programs should consider television viewing reduction and physical activity promotion as 2 separate foci of behavior change interventions.”44(pe318)

In our analysis, family income was associated with proxy-reported physical activity. The odds of meeting physical activity recommendations were lower in children living in households with higher vs lower income. An inverse association between income and physical activity has been previously reported. Using 2001-2004 NHANES data, Anderson et al20 reported that higher income was associated with increased likelihood of reduced active play (defined as reported MVPA of <7 d/wk) in children 4 to 11 years of age.

Obese children were less likely to meet physical activity and screen-time recommendations. However, because our analysis is cross-sectional, we are unable to infer causality. Although obesity has been partially attributed to physical inactivity,45 recent longitudinal analysis by Metcalf et al46 suggests that physical inactivity may be the result of obesity.

In the 2009-2010 NHANES, physical activity of children 6 to 11 years of age was assessed via proxy reports only. Social desirability may lead parents to overreport the number of days of physical activity, which may bias our estimates.47 In addition, the accuracy of proxy reports may differ substantially depending on the amount of time spent with the child. For example, parents may not be able to report their child's physical activity while at school. Despite these limitations, proxy reports of physical activity of young children may be more accurate than self-reports because young children are unable to recall accurately the length of time spent in physical activity.4850 Consequently, many researchers do not recommend the use of self-reports for physical activity time among children younger than 10 years of age.47,49

Although objectively measured physical activity using an accelerometer may circumvent issues related to proxy reporting, accelerometers have their limitations, especially when used to measure the physical activity of young children. The use of numerous intensity cutoff values and different epoch lengths (time-sampling intervals) has led to large differences in estimates of adherence to physical activity guidelines.26,51,52 In addition, conventional accelerometers may fail to adequately capture certain movements such as swimming, cycling, and climbing, which may lead to an underestimation of total physical activity. This may explain some of the difference between our adherence prevalence estimates (about 70% of 6- to 11-year-old children meet physical activity recommendations) and those assessed by an accelerometer in the 2003-2004 NHANES (about 42% of 6- to 11-year-old children meet physical activity recommendations).18 Because of these measurement issues, many researchers and physical activity experts are now advocating for the use of multiple methods to assess physical activity accurately. Finally, surveillance of physical activity on a population level using an accelerometer is expensive and logistically complex, whereas reported physical activity is less expensive and less burdensome in large population studies.

In summary, our analysis of the most recent national data showed that, although the majority of school-aged children met physical activity and screen-time recommendations separately, fewer than 4 in 10 children met both recommendations concurrently in 2009-2010. Our results also suggest that low levels of screen time do not necessarily predict higher levels of physical activity. Nonetheless, both were independently associated with obesity status. These findings support the distinct recommendations for screen-time viewing and physical activity by the American Academy of Pediatrics2,1719 and may inform interventions designed to prevent childhood obesity, such as the First Lady Michelle Obama's program to end childhood obesity within a generation (ie, the Let's Move! initiative).53 Future research from longitudinal studies may further clarify the association between physical activity, screen-time viewing, and obesity.

Correspondence: Tala H. I. Fakhouri, PhD, MPH, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd, Room 4304, Hyattsville, MD 20782 (tfakhouri@cdc.gov).

Accepted for Publication: August 1, 2012.

Published Online: January 7, 2013. doi:10.1001/2013.jamapediatrics.122

Author Contributions: Dr Fakhouri had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Fakhouri, Hughes, Brody, and Ogden. Acquisition of data: Fakhouri and Brody. Analysis and interpretation of data: Fakhouri, Kit, and Ogden. Drafting of the manuscript: Fakhouri and Hughes. Critical revision of the manuscript for important intellectual content: Fakhouri, Brody, Kit, and Ogden. Statistical analysis: Fakhouri, Hughes, Kit, and Ogden. Study supervision: Ogden.

Conflict of Interest Disclosures: None reported.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Center for Health Statistics, Centers for Disease Control and Prevention.

US Department of Health and Human Services; Physical Activity guidelines Advisory Committee; . Physical Activity Guidelines Advisory Committee Report, 2008: To the Secretary of Health and Human Services. US Department of Health and Human Services website. http://www.health.gov/paguidelines/Report/pdf/CommitteeReport.pdf. Accessed July 25, 2012
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute.  Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary report.  Pediatrics. 2011;128:(suppl 5)  S213-S256
PubMed   |  Link to Article
Strong WB, Malina RM, Blimkie CJ,  et al.  Evidence based physical activity for school-age youth.  J Pediatr. 2005;146(6):732-737
PubMed   |  Link to Article
Tremblay MS, LeBlanc AG, Kho ME,  et al.  Systematic review of sedentary behaviour and health indicators in school-aged children and youth.  Int J Behav Nutr Phys Act. 2011;8:98
PubMed   |  Link to Article
Berkey CS, Rockett HR, Field AE,  et al.  Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls.  Pediatrics. 2000;105(4):E56
PubMed   |  Link to Article
Raitakari OT, Taimela S, Porkka KVK,  et al.  Associations between physical activity and risk factors for coronary heart disease: the Cardiovascular Risk in Young Finns Study.  Med Sci Sports Exerc. 1997;29(8):1055-1061
PubMed   |  Link to Article
Gutin B, Barbeau P, Owens S,  et al.  Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents.  Am J Clin Nutr. 2002;75(5):818-826
PubMed
Luepker RV, Perry CL, McKinlay SM,  et al.  Outcomes of a field trial to improve children's dietary patterns and physical activity: the Child and Adolescent Trial for Cardiovascular Health (CATCH).  JAMA. 1996;275(10):768-776
PubMed   |  Link to Article
Harrell JS, Gansky SA, McMurray RG, Bangdiwala SI, Frauman AC, Bradley CB. School-based interventions improve heart health in children with multiple cardiovascular disease risk factors.  Pediatrics. 1998;102(2, pt 1):371-380
PubMed   |  Link to Article
Kriemler S, Zahner L, Schindler C,  et al.  Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial.  BMJ. 2010;340:c785
PubMed   |  Link to Article
Burdette HL, Whitaker RC. Resurrecting free play in young children: looking beyond fitness and fatness to attention, affiliation, and affect.  Arch Pediatr Adolesc Med. 2005;159(1):46-50
PubMed   |  Link to Article
Ginsburg KR.American Academy of Pediatrics Committee on Communications; American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health.  The importance of play in promoting healthy child development and maintaining strong parent-child bonds.  Pediatrics. 2007;119(1):182-191
PubMed   |  Link to Article
Telama R, Yang X, Viikari J, Välimäki I, Wanne O, Raitakari O. Physical activity from childhood to adulthood: a 21-year tracking study.  Am J Prev Med. 2005;28(3):267-273
PubMed   |  Link to Article
Telama R. Tracking of physical activity from childhood to adulthood: a review.  Obes Facts. 2009;2(3):187-195
PubMed   |  Link to Article
Raitakari OT, Porkka KV, Taimela S, Telama R, Räsänen L, Viikari JS. Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults: the Cardiovascular Risk in Young Finns Study.  Am J Epidemiol. 1994;140(3):195-205
PubMed
Biddle SJ, Pearson N, Ross GM, Braithwaite R. Tracking of sedentary behaviours of young people: a systematic review.  Prev Med. 2010;51(5):345-351
PubMed   |  Link to Article
Expert Panel on Integrated Pediatric Guideline for Cardiovascular Health and Risk Reduction.  Expert Panel on Integrated Pediatric Guideline for Cardiovascular Health and Risk Reduction.  Pediatrics. 2012;129(4):e1111Link to Article
Link to Article
Barlow SE.Expert Committee.  Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.  Pediatrics. 2007;120:(suppl 4)  S164-S192
PubMed   |  Link to Article
Strasburger VC.Council on Communications and Media.  Children, adolescents, obesity, and the media.  Pediatrics. 2011;128(1):201-208
PubMed   |  Link to Article
Anderson SE, Economos CD, Must A. Active play and screen time in US children aged 4 to 11 years in relation to sociodemographic and weight status characteristics: a nationally representative cross-sectional analysis.  BMC Public Health. 2008;8:366
PubMed   |  Link to Article
Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer.  Med Sci Sports Exerc. 2008;40(1):181-188
PubMed
Sisson SB, Broyles ST, Baker BL, Katzmarzyk PT. Screen time, physical activity, and overweight in U.S. youth: national survey of children's health 2003.  J Adolesc Health. 2010;47(3):309-311
PubMed   |  Link to Article
Sisson SB, Church TS, Martin CK,  et al.  Profiles of sedentary behavior in children and adolescents: the US National Health and Nutrition Examination Survey, 2001-2006.  Int J Pediatr Obes. 2009;4(4):353-359
PubMed   |  Link to Article
Sisson SB, Broyles ST, Brittain DR, Short K. Obesogenic behaviors in U.S. school children across geographic regions from 2003-2007.  OJPM. 2011;1(2):25-33Link to Article
Link to Article
National Center for Health Statistics.  National Health and Nutrition Examination Survey (NHANES) 2009-2010. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nhanes/nhanes2009-2010/nhanes09_10.htm. Accessed July 25, 2012
Beets MW, Bornstein D, Dowda M, Pate RR. Compliance with national guidelines for physical activity in U.S. preschoolers: measurement and interpretation.  Pediatrics. 2011;127(4):658-664
PubMed   |  Link to Article
National Center for Health Statistics.  National Health and Nutrition Examination Survey (NHANES). NHANES Response Rates and CPS Totals. 2009-2010 Response Rates. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nhanes/response_rates_CPS.htm. Accessed July 25, 2012
US Department of Health and Human Services.  Poverty Guidelines, Research, and Measurement. US Department of Health and Human Services website. http://aspe.hhs.gov/POVERTY/index.shtml. Accessed July 25, 2012
US Department of Agriculture (USDA).  Supplemental Nutrition Assistance Program: eligibility. USDA website. http://www.fns.usda.gov/snap/applicant_recipients/eligibility.htm. Accessed July 25, 2012
Ogden CL, Flegal KM. Changes in terminology for childhood overweight and obesity.  Natl Health Stat Report. 2010;(25):1-5
PubMed
Curtin LR, Mohadjer LK, Dohrmann SM,  et al.  The National Health and Nutrition Examination Survey: Sample Design, 1999-2006.  Vital Health Stat 2. 2012;(155):1-39
PubMed
Chung AE, Skinner AC, Steiner MJ, Perrin EM. Physical activity and BMI in a nationally representative sample of children and adolescents.  Clin Pediatr (Phila). 2012;51(2):122-129
PubMed   |  Link to Article
Kimm SY, Glynn NW, Kriska AM,  et al.  Decline in physical activity in black girls and white girls during adolescence.  N Engl J Med. 2002;347(10):709-715
PubMed   |  Link to Article
Nader PR, Bradley RH, Houts RM, McRitchie SL, O’Brien M. Moderate-to-vigorous physical activity from ages 9 to 15 years.  JAMA. 2008;300(3):295-305
PubMed   |  Link to Article
Sallis JF. Age-related decline in physical activity: a synthesis of human and animal studies.  Med Sci Sports Exerc. 2000;32(9):1598-1600
PubMed
Gortmaker SL, Lee R, Cradock AL, Sobol AM, Duncan DT, Wang YC. Disparities in youth physical activity in the United States: 2003-2006.  Med Sci Sports Exerc. 2012;44(5):888-893
PubMed   |  Link to Article
Marshall SJ, Gorely T, Biddle SJ. A descriptive epidemiology of screen-based media use in youth: a review and critique.  J Adolesc. 2006;29(3):333-349
PubMed   |  Link to Article
Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey.  JAMA. 1998;279(12):938-942
PubMed   |  Link to Article
Serrano-Sanchez JA, Martí-Trujillo S, Lera-Navarro A, Dorado-García C, González-Henríquez JJ, Sanchís-Moysi J. Associations between screen time and physical activity among Spanish adolescents.  PLoS One. 2011;6(9):e24453
PubMed   |  Link to Article
Ekelund U, Brage S, Froberg K,  et al.  TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study.  PLoS Med. 2006;3(12):e488
PubMed   |  Link to Article
Karaca A, Caglar E, Bilgili N, Ayaz S. Screen time of adolescents in an economically developing country: the case of Turkey.  Ann Hum Biol. 2011;38(1):28-33
PubMed   |  Link to Article
Santos MP, Gomes H, Mota J. Physical activity and sedentary behaviors in adolescents.  Ann Behav Med. 2005;30(1):21-24
PubMed   |  Link to Article
Feldman DE, Barnett T, Shrier I, Rossignol M, Abenhaim L. Is physical activity differentially associated with different types of sedentary pursuits?  Arch Pediatr Adolesc Med. 2003;157(8):797-802
PubMed   |  Link to Article
Taveras EM, Field AE, Berkey CS,  et al.  Longitudinal relationship between television viewing and leisure-time physical activity during adolescence.  Pediatrics. 2007;119(2):e314-e319
PubMed   |  Link to Article
Wareham NJ, van Sluijs EM, Ekelund U. Physical activity and obesity prevention: a review of the current evidence.  Proc Nutr Soc. 2005;64(2):229-247
PubMed   |  Link to Article
Metcalf BS, Hosking J, Jeffery AN, Voss LD, Henley W, Wilkin TJ. Fatness leads to inactivity, but inactivity does not lead to fatness: a longitudinal study in children (EarlyBird 45).  Arch Dis Child. 2011;96(10):942-947
PubMed   |  Link to Article
Dollman J, Okely AD, Hardy L, Timperio A, Salmon J, Hills AP. A hitchhiker's guide to assessing young people's physical activity: deciding what method to use.  J Sci Med Sport. 2009;12(5):518-525
PubMed   |  Link to Article
Sithole F, Veugelers PJ. Parent and child reports of children's activity.  Health Rep. 2008;19(3):19-24
PubMed
Kohl HW III, Fulton JE, Caspersen CJ. Assessment of physical activity among children and adolescents: a review and synthesis.  Prev Med. 2000;31(2):S54-S76Link to Article
Link to Article
Baranowski T. Validity and reliability of self report measures of physical-activity: an information-processing perspective.  Res Q Exerc Sport. 1988;59(4):314-327
Guinhouya CB, Hubert H, Soubrier S, Vilhelm C, Lemdani M, Durocher A. Moderate-to-vigorous physical activity among children: discrepancies in accelerometry-based cut-off points.  Obesity (Silver Spring). 2006;14(5):774-777
PubMed   |  Link to Article
Cliff DP, Okely AD. Comparison of two sets of accelerometer cut-off points for calculating moderate-to-vigorous physical activity in young children.  J Phys Act Health. 2007;4(4):509-513
PubMed
Let's Move!.  Accessed July 25, 2012. http://www.letsmove.gov/

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Distributions of responses to questions about physical activity, television (TV) or video viewing, and computer use. The percentage of children with proxy-reported number of days (ie, 0, 1-3, 4-6, or 7 days) of 60 minutes or more of moderate-to-vigorous physical activity (MVPA) per week (A) and the percentage of children with proxy-reported number of hours per day (ie, <1, 1, 2, 3, 4, or ≥5 h/d) of TV or video viewing or computer use are shown. *Does not meet standard of statistical reliability and precision (relative SE of ≥30% but <40%).

Tables

Table Graphic Jump LocationTable 1. Data on Children Who Met Physical Activity or Screen-Time Recommendations or Both in the 2009-2010 NHANES
Table Graphic Jump LocationTable 2. Logistic Regression Analysis of Meeting Recommendations in the 2009-2010 NHANES

References

US Department of Health and Human Services; Physical Activity guidelines Advisory Committee; . Physical Activity Guidelines Advisory Committee Report, 2008: To the Secretary of Health and Human Services. US Department of Health and Human Services website. http://www.health.gov/paguidelines/Report/pdf/CommitteeReport.pdf. Accessed July 25, 2012
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute.  Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary report.  Pediatrics. 2011;128:(suppl 5)  S213-S256
PubMed   |  Link to Article
Strong WB, Malina RM, Blimkie CJ,  et al.  Evidence based physical activity for school-age youth.  J Pediatr. 2005;146(6):732-737
PubMed   |  Link to Article
Tremblay MS, LeBlanc AG, Kho ME,  et al.  Systematic review of sedentary behaviour and health indicators in school-aged children and youth.  Int J Behav Nutr Phys Act. 2011;8:98
PubMed   |  Link to Article
Berkey CS, Rockett HR, Field AE,  et al.  Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls.  Pediatrics. 2000;105(4):E56
PubMed   |  Link to Article
Raitakari OT, Taimela S, Porkka KVK,  et al.  Associations between physical activity and risk factors for coronary heart disease: the Cardiovascular Risk in Young Finns Study.  Med Sci Sports Exerc. 1997;29(8):1055-1061
PubMed   |  Link to Article
Gutin B, Barbeau P, Owens S,  et al.  Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents.  Am J Clin Nutr. 2002;75(5):818-826
PubMed
Luepker RV, Perry CL, McKinlay SM,  et al.  Outcomes of a field trial to improve children's dietary patterns and physical activity: the Child and Adolescent Trial for Cardiovascular Health (CATCH).  JAMA. 1996;275(10):768-776
PubMed   |  Link to Article
Harrell JS, Gansky SA, McMurray RG, Bangdiwala SI, Frauman AC, Bradley CB. School-based interventions improve heart health in children with multiple cardiovascular disease risk factors.  Pediatrics. 1998;102(2, pt 1):371-380
PubMed   |  Link to Article
Kriemler S, Zahner L, Schindler C,  et al.  Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial.  BMJ. 2010;340:c785
PubMed   |  Link to Article
Burdette HL, Whitaker RC. Resurrecting free play in young children: looking beyond fitness and fatness to attention, affiliation, and affect.  Arch Pediatr Adolesc Med. 2005;159(1):46-50
PubMed   |  Link to Article
Ginsburg KR.American Academy of Pediatrics Committee on Communications; American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health.  The importance of play in promoting healthy child development and maintaining strong parent-child bonds.  Pediatrics. 2007;119(1):182-191
PubMed   |  Link to Article
Telama R, Yang X, Viikari J, Välimäki I, Wanne O, Raitakari O. Physical activity from childhood to adulthood: a 21-year tracking study.  Am J Prev Med. 2005;28(3):267-273
PubMed   |  Link to Article
Telama R. Tracking of physical activity from childhood to adulthood: a review.  Obes Facts. 2009;2(3):187-195
PubMed   |  Link to Article
Raitakari OT, Porkka KV, Taimela S, Telama R, Räsänen L, Viikari JS. Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults: the Cardiovascular Risk in Young Finns Study.  Am J Epidemiol. 1994;140(3):195-205
PubMed
Biddle SJ, Pearson N, Ross GM, Braithwaite R. Tracking of sedentary behaviours of young people: a systematic review.  Prev Med. 2010;51(5):345-351
PubMed   |  Link to Article
Expert Panel on Integrated Pediatric Guideline for Cardiovascular Health and Risk Reduction.  Expert Panel on Integrated Pediatric Guideline for Cardiovascular Health and Risk Reduction.  Pediatrics. 2012;129(4):e1111Link to Article
Link to Article
Barlow SE.Expert Committee.  Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.  Pediatrics. 2007;120:(suppl 4)  S164-S192
PubMed   |  Link to Article
Strasburger VC.Council on Communications and Media.  Children, adolescents, obesity, and the media.  Pediatrics. 2011;128(1):201-208
PubMed   |  Link to Article
Anderson SE, Economos CD, Must A. Active play and screen time in US children aged 4 to 11 years in relation to sociodemographic and weight status characteristics: a nationally representative cross-sectional analysis.  BMC Public Health. 2008;8:366
PubMed   |  Link to Article
Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer.  Med Sci Sports Exerc. 2008;40(1):181-188
PubMed
Sisson SB, Broyles ST, Baker BL, Katzmarzyk PT. Screen time, physical activity, and overweight in U.S. youth: national survey of children's health 2003.  J Adolesc Health. 2010;47(3):309-311
PubMed   |  Link to Article
Sisson SB, Church TS, Martin CK,  et al.  Profiles of sedentary behavior in children and adolescents: the US National Health and Nutrition Examination Survey, 2001-2006.  Int J Pediatr Obes. 2009;4(4):353-359
PubMed   |  Link to Article
Sisson SB, Broyles ST, Brittain DR, Short K. Obesogenic behaviors in U.S. school children across geographic regions from 2003-2007.  OJPM. 2011;1(2):25-33Link to Article
Link to Article
National Center for Health Statistics.  National Health and Nutrition Examination Survey (NHANES) 2009-2010. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nhanes/nhanes2009-2010/nhanes09_10.htm. Accessed July 25, 2012
Beets MW, Bornstein D, Dowda M, Pate RR. Compliance with national guidelines for physical activity in U.S. preschoolers: measurement and interpretation.  Pediatrics. 2011;127(4):658-664
PubMed   |  Link to Article
National Center for Health Statistics.  National Health and Nutrition Examination Survey (NHANES). NHANES Response Rates and CPS Totals. 2009-2010 Response Rates. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nhanes/response_rates_CPS.htm. Accessed July 25, 2012
US Department of Health and Human Services.  Poverty Guidelines, Research, and Measurement. US Department of Health and Human Services website. http://aspe.hhs.gov/POVERTY/index.shtml. Accessed July 25, 2012
US Department of Agriculture (USDA).  Supplemental Nutrition Assistance Program: eligibility. USDA website. http://www.fns.usda.gov/snap/applicant_recipients/eligibility.htm. Accessed July 25, 2012
Ogden CL, Flegal KM. Changes in terminology for childhood overweight and obesity.  Natl Health Stat Report. 2010;(25):1-5
PubMed
Curtin LR, Mohadjer LK, Dohrmann SM,  et al.  The National Health and Nutrition Examination Survey: Sample Design, 1999-2006.  Vital Health Stat 2. 2012;(155):1-39
PubMed
Chung AE, Skinner AC, Steiner MJ, Perrin EM. Physical activity and BMI in a nationally representative sample of children and adolescents.  Clin Pediatr (Phila). 2012;51(2):122-129
PubMed   |  Link to Article
Kimm SY, Glynn NW, Kriska AM,  et al.  Decline in physical activity in black girls and white girls during adolescence.  N Engl J Med. 2002;347(10):709-715
PubMed   |  Link to Article
Nader PR, Bradley RH, Houts RM, McRitchie SL, O’Brien M. Moderate-to-vigorous physical activity from ages 9 to 15 years.  JAMA. 2008;300(3):295-305
PubMed   |  Link to Article
Sallis JF. Age-related decline in physical activity: a synthesis of human and animal studies.  Med Sci Sports Exerc. 2000;32(9):1598-1600
PubMed
Gortmaker SL, Lee R, Cradock AL, Sobol AM, Duncan DT, Wang YC. Disparities in youth physical activity in the United States: 2003-2006.  Med Sci Sports Exerc. 2012;44(5):888-893
PubMed   |  Link to Article
Marshall SJ, Gorely T, Biddle SJ. A descriptive epidemiology of screen-based media use in youth: a review and critique.  J Adolesc. 2006;29(3):333-349
PubMed   |  Link to Article
Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey.  JAMA. 1998;279(12):938-942
PubMed   |  Link to Article
Serrano-Sanchez JA, Martí-Trujillo S, Lera-Navarro A, Dorado-García C, González-Henríquez JJ, Sanchís-Moysi J. Associations between screen time and physical activity among Spanish adolescents.  PLoS One. 2011;6(9):e24453
PubMed   |  Link to Article
Ekelund U, Brage S, Froberg K,  et al.  TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study.  PLoS Med. 2006;3(12):e488
PubMed   |  Link to Article
Karaca A, Caglar E, Bilgili N, Ayaz S. Screen time of adolescents in an economically developing country: the case of Turkey.  Ann Hum Biol. 2011;38(1):28-33
PubMed   |  Link to Article
Santos MP, Gomes H, Mota J. Physical activity and sedentary behaviors in adolescents.  Ann Behav Med. 2005;30(1):21-24
PubMed   |  Link to Article
Feldman DE, Barnett T, Shrier I, Rossignol M, Abenhaim L. Is physical activity differentially associated with different types of sedentary pursuits?  Arch Pediatr Adolesc Med. 2003;157(8):797-802
PubMed   |  Link to Article
Taveras EM, Field AE, Berkey CS,  et al.  Longitudinal relationship between television viewing and leisure-time physical activity during adolescence.  Pediatrics. 2007;119(2):e314-e319
PubMed   |  Link to Article
Wareham NJ, van Sluijs EM, Ekelund U. Physical activity and obesity prevention: a review of the current evidence.  Proc Nutr Soc. 2005;64(2):229-247
PubMed   |  Link to Article
Metcalf BS, Hosking J, Jeffery AN, Voss LD, Henley W, Wilkin TJ. Fatness leads to inactivity, but inactivity does not lead to fatness: a longitudinal study in children (EarlyBird 45).  Arch Dis Child. 2011;96(10):942-947
PubMed   |  Link to Article
Dollman J, Okely AD, Hardy L, Timperio A, Salmon J, Hills AP. A hitchhiker's guide to assessing young people's physical activity: deciding what method to use.  J Sci Med Sport. 2009;12(5):518-525
PubMed   |  Link to Article
Sithole F, Veugelers PJ. Parent and child reports of children's activity.  Health Rep. 2008;19(3):19-24
PubMed
Kohl HW III, Fulton JE, Caspersen CJ. Assessment of physical activity among children and adolescents: a review and synthesis.  Prev Med. 2000;31(2):S54-S76Link to Article
Link to Article
Baranowski T. Validity and reliability of self report measures of physical-activity: an information-processing perspective.  Res Q Exerc Sport. 1988;59(4):314-327
Guinhouya CB, Hubert H, Soubrier S, Vilhelm C, Lemdani M, Durocher A. Moderate-to-vigorous physical activity among children: discrepancies in accelerometry-based cut-off points.  Obesity (Silver Spring). 2006;14(5):774-777
PubMed   |  Link to Article
Cliff DP, Okely AD. Comparison of two sets of accelerometer cut-off points for calculating moderate-to-vigorous physical activity in young children.  J Phys Act Health. 2007;4(4):509-513
PubMed
Let's Move!.  Accessed July 25, 2012. http://www.letsmove.gov/

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 8

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles