# Exercise as it relates to Disease/Children’s overall fitness in relation to their exercise behaviour and body composition

This is an analysis of the journal article "Physical fitness of primary school children in relation to overweight prevalence and physical activity habits".

## What is the background to this research?

Many research studies have shown the prevalence of overweight or obese children has risen progressively in not only South Western European Countries, but also worldwide. Italy ranks among the highest in relation to prevalence of excess weight in the age ranges 7–11 years and 13–17 years. It is a concerning trend that could see as many as 254 million children considered obese worldwide in 2030.
This particular research analysed the main conditioning and coordinative abilities in Italian children aged 8-9 years, and their relationship with anthropometric variables and physical activity habits. Evidently studies like these are important for understanding the imperative of getting children active, while potentiating the many positive impacts of consistent sport and physical activity participation.

## Where is the research from?

The research was conducted in the Central Northern Province of Italy from a total of 521 students, all aged 8-9 years old in the third grade. There was 256 boys and 241 girls who participated in the study. Each of the researchers were a part of the Local Health Unit of Bologna in the Department of Public Health Italy and have a vast experience in the public health field.

## What kind of research was this?

The study was cross sectional - a type of observational study whereby the investigator measures the outcome and the exposures in the study participants at the same time.
These studies are fast, inexpensive and don't require participants based on the outcome status (case control) or the exposure status (cohort). They have also been shown to be a useful tool for public health planning, monitoring and evaluation. Other study designs however have been better shown to highlight causal relationships - simply when one event causes another. There are also studies such as systematic reviews and meta analyses that obtain evidence from a range of papers to yield overall conclusions.
This means that the evidence in cross sectional studies like this one does vary and the strength of evidence presented is weaker than most other study designs.

## What did the research involve?

The research was extensive and required each participant to perform three different assessments.
1. Physical Activity Questionnaire
Firstly, participants were required to undertake a self-administered physical activity questionnaire to collect general variables regarding their physical activity and sport participation habits in different settings and times of the day. By virtue of the questionnaire being self-administered, accuracy and validity can be compromised as most individuals tend to overestimate their physical activity levels.
2. Anthropometric Assessment (body composition)
Following the physical activity questionnaire, each participant had their height and weight measured to provide a measurement for body mass index (BMI). Despite the lack of consensus on the use of BMI in growing children, this index represents one of the most appropriate methods to assess adiposity in childhood and it is largely used at an international level. There is conflicting research, particularly in young boys that suggests BMI is not feasible as many boys gain weight in the form of muscle rather than fat.
3. Physical Fitness Assessment
Finally, participants completed a range of physical assessments targeting all components of fitness to get a holistic interpretation of their overall physical fitness levels. The tests included in the study were the standing long jump, 2kg medicine ball throw, 20 metre dash, sit and reach and forward roll.

## What were the basic results?

Each of the relationships (sport participation, physical activity levels and body composition) and their impact on the fitness testing results are summarised below.
Sport Participation
The fitness testing results and their relationship with the self-reported physical activity questionnaire were anticipated. In general, those who reported regular sport participation had a better overall fitness base than those who did not, especially among boys.
Physical Activity Levels
Those who reported to live moderate to moderately active lifestyles performed superior to those who reported as either sedentary or very sedentary. Significant statistical differences were seen in the long jump, 20 metre dash and medicine ball throw tests.
Body Composition
In relation to body composition, the children categorised in the normal weight category outperformed the overweight and obese children in all tests apart from the 2kg medicine ball throw. Statistically significant differences were seen in the 20-metre dash and the standing long jump, arguably the most physically demanding tests undertaken. The relationship between body composition and physical fitness is tabulated above.

## What conclusions should be taken away from this research?

The study is consistent with similar research and reveals that children who can retain consistent sport and exercise habits, while maintaining a healthy weight are fitter and therefore more physically competent.
Several conclusions can be drawn from what the research reveals, including:
1. As the obesity trend continues to increase worldwide, particularly in developed countries, the use of fitness tests which are easy to apply in any school context should be implemented. This will be important within primary schools as a means to identify pupils with a low fitness level and to promote a healthy lifestyle.
2. The need for enforced statutory requirements to meet guidelines and encourage children’s physical activity and education is apparent across the world. Physical education should be prioritised equally with STEM subjects and by creating regular opportunities for physical activity participation in schools, children can stay active and create vital exercise habits into adulthood. Accessibility to positive physical activity experiences is essential as it is well known that if children are able to positively associate with physical activity from a young age, sound exercise habits can be maintained throughout the lifespan.
3. Future research will need to utilise more accurate ‘gold standard’ measures (i.e. skinfolds, DEXA scan) to get a more precise representation of the relationship between body composition and physical fitness. The use of pedometers and other implements to measure physical activity habits should also be considered to remove any personal biases that arise from self reported methods.

## Practical advice

The study highlights that the obesity trend is worsening, meaning it is paramount to get children involved in physical activity from a young age to promote weight control and sound exercise habits moving into adulthood. The amount of children participating in physical activity is largely dependent on parental influence and the emphasis of physical activity and education in schools.
This connotes that both parties, along with sporting organisations need to be collaborative and provide children with ample opportunity to get physically educated and stay active. Failure to do this will result in a continually worsening obesity trend that will eventually increase the amount of premature mortality's and costs arising from physical inactivity.

## Further reading

Italy physical activity fact sheet available at: https://www.euro.who.int/__data/assets/pdf_file/0006/288267/ITALY-Physical-Activity-Factsheet.pdf?ua=1
World Health Organisations (WHO) physical activity guidelines for children aged 5-17 available at: https://www.who.int/dietphysicalactivity/factsheet_young_people/en/

## References

* ↑ Sacchetti, R., Ceciliani, A., Garulli, A., Masotti, A., Poletti, G., Beltrami, P., & Leoni, E. (2012). Physical fitness of primary school children in relation to overweight prevalence and physical activity habits. Journal of sports sciences, 30(7), 633-640.
* ↑ Jackson-Leach, R. and Lobstein, T. 2006. Estimated burden of pediatric obesity and co-morbidities in Europe. Part 1. The increase in the prevalence of child obesity in Europe is itself increasing. International Journal of Pediatric Obesity, 1: 26–32.
* ↑ Janssen, I., Katzmarzyk, P. T., Boyce, W. F., Vereecken, C., Mulvihill, C. and Roberts, C. 2005. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obesity Reviews, 6: 123–132.
* ↑ Lobstein, T. and Millstone, E. 2007. Context for the PorGrow study: Europe's obesity crisis. Obesity Reviews, 8: 7–16.
* ↑ International Obesity Task Force. EU Platform on Diet, Physical Activity and Health. Obesity in Europe EU Platform Briefing Paper. Brussels: European Association for the Study of Obesity.
* ↑ Kelly, T., Yang, W., Chen, C. S., Reynolds, K., & He, J. (2008). Global burden of obesity in 2005 and projections to 2030. International journal of obesity, 32(9), 1431-1437.
* ↑ Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian journal of dermatology, 61(3), 261
* ↑ Daly, J., Willis, K., Small, R., Green, J., Welch, N., Kealy, M., & Hughes, E. (2007). A hierarchy of evidence for assessing qualitative health research. Journal of clinical epidemiology, 60(1), 43-49.
* ↑ Khan, K. S., Kunz, R., Kleijnen, J., & Antes, G. (2003). Five steps to conducting a systematic review. Journal of the royal society of medicine, 96(3), 118-121.
* ↑ Brunet, M., Chaput, J. P. and Tremblay, A. 2007. The association between low physical fitness and high body mass index or waist circumference is increasing with age children: The “Quebec en Forme” project. International Journal of Obesity, 31: 637–643.
* ↑ Castro-Piñero, J., Gonzáles-Montezinos, J. L., Mora, J., Keating, X. D., Girela-Rejón, M. J., Sjöström, M. and Ruiz, J. R. 2009. Percentile values for muscular strength field tests in children aged 6 to 17 years: Influence of weight status. Journal of Strength and Conditioning Research, 23: 2295–2310
* ↑ Telford RD et al. (2018). BMI is a misleading proxy for adiposity in longitudinal studies with adolescent males: the Australian LOOK study. Journal of Science and Medicine in Sport. Ahead of print
* ↑ Fisher, A., Reilly, J. J., Kelly, L. A., Montgomery, C., Williamson, A., Paton, J. Y., & Grant, S. (2005). Fundamental movement skills and habitual physical activity in young children. Med Sci Sports Exerc, 37(4), 684-688.