Res Exerc Epidemiol 2014; 16(2): 71-5.
c 2014 by the Japanese Association of Exercise Epidemiology
Copyright ○【Review Article】

Increasing Global Research Capacity in Physical Activity
for Children and YouthPeter T. Katzmarzyk1)
1）Pennington Biomedical Research Center

ABSTRACT Physical activity is associated with improved health status in children and youth. However, alarge proportion of the world’s children are currently not physically active, and children in countries undergoing
epidemiological transition may be vulnerable to decreasing physical activity levels. Thus, a research priority is
the development of effective interventions that can be adapted and deployed in low, middle and high income
countries. Given that most current research evidence is from studies conducted in high income countries, further
work is required to understand the determinants and correlates of physical activity among children across low
and middle income countries. This will require investments in large multi-national studies and in developing
research infrastructure and capacity in regions of the world that have not yet conducted physical activity
research.
Key words: pediatric, epidemiologic transition, research capacity, international

Introduction

understand the correlates of physical activity amongchildren from low and middle income countries
around the world. This will require an investment inlarge multi-country studies and in developing research
capacity in low and middle income countries thattypically have not yet participated in physical activity
research to a large extent, particularly in regions thatare undergoing rapid economic and demographic
changes.

Considerable research has highlighted theimportance of physical activity for achieving optimal
health in childhood.1) However, a large proportion of
the world’s pediatric population is not physicallyactive. For example, across 105 countries, approximately 80% of 13-15 year olds are not meeting therecommendation of 60 min/day of moderate-tovigorous physical activity.2) In order to develop
effective physical activity interventions for children
living in different settings, a better understanding of
the correlates and determinants of physical activity isrequired. To date, a large majority of physical activity
research has been conducted in middle and upperincome countries, which limits the generalizability toother countries and regions. 3) Thus, the degree towhich an intervention that was developed in one
country or region can be implemented or adapted for
implementation in another country or region is notwell understood. Further research is required to better

The Physical Activity Transition
The “physical activity transition” is a model that
describes long terms shifts in physical activity
patterns and levels as a consequence of economic anddemographic changes in a country or region. 4) The
physical activity transition builds upon concepts
described in models of epidemiological 5,6) andnutritional transition. 7)
The epidemiological transition is a model that
explains long-term shifts in population morbidity andmortality rates that are tied to economic anddemographic changes.5,6) The model is described interms of four stages or ages: 1) pestilence and famine,2) receding pandemics, 3) degenerative and man-madeAddress for correspondence: Peter T. Katzmarzyk;
Pennington Biomedical Research Center; 6400 Perkins
Road, Baton Rouge, LA, United States, 70808-4124;
Peter.Katzmarzyk@pbrc.edu

71Res Exerc Epidemiol 2014; 16(2): 71-5.

diseases, and 4) delayed degenerative diseases. The
age of pestilence and famine is associated with highmortality rates and low life expectancy, and ischaracterized by infecti ous di sease epidemics
and famines. The age of receding pandemics ischaracterized by increases in life expectancy, largely
due to lower mortality rates at young ages. Thesechanges are often brought about by targeting thespread of infectious disease through improvements insanitation and by stabilizing the food supply. The ageof degenerative and man-made diseases is associatedwith increases in life expectancy as the mortality
burden from cardiovascular disease and cancer shiftsto older ages. The final stage of epidemiologicaltransition, the age of delayed degenerative diseases,
sees further increases in life expectancy achievedlargely by improvements in health at older ages,
mainly through improved prevention and the treatmentof chronic diseases.
The theory of nutritional transition builds upon the
demographic and economic shifts associated with theepidemiological transition and seeks to explain howchanges related to lifestyle, particularly diet, haveoccurred in parallel with the increasing prevalence ofobesity and chronic disease. 7-9) The nutritionaltransition is characterized by a shift away fromtraditional diets (based on indigenous staple grains,
local legumes, fruits and vegetables, and limited foodsof animal origin) in favor of a more “industrialized”
diet (comprised of more animal-based food products
and processed food high in saturated fats and sugar).
At the global level, these changes have beenaccompanied by a rising prevalence of obesity and arecontributing to shifting morbidity and mortality
profiles around the world.10,11)
The physical activity transition is aligned with thedemographic and economic shifts that drive theoverall epidemiological transition; however, it posits
that changes in physical activity patterns and levels
that accompany economic and demographic shifts
could be contributing to the observed changes inobesity, and in morbidity and mortality rates. 4) Given
that physical activity is negatively related topremature mortality,12) the adoption of a lifestylecharacterized by lower levels of physical activity
would be expected to attenuate the expected gains in

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life expectancy associated with the epidemiologicaltransition.13)
Two recent studies provide evidence of elements of
the on-going physical activity transition in Africa.
Using a nationally representative sample of 3323
adults from urban and rural regions of Mozambique,
Padrao et al.14) demonstrated that vigorous physicalactivity was less common among urban and better
educated adults, indicated that shifts in physicalactivity levels were occurring when moving from arural to an urban lifestyle. Similarly, Onywera et al. 15)
showed using pedometers that children from urban
Kenya took significantly fewer steps per day thanchildren living in rural Kenya. Further, Kenyan
children from urban areas watched more television
than children from rural areas. 15) These studies
highlight urban-rural differences in physical activity
in individual countries undergoing economic anddemographic transitions, and provide insights into
potential longer term trends that may occur withfurther demographic shifts in the population.

2014 Global Summit on the Physical Activityof Children
The Global Summit on the Physical Activity ofChildren was held in Toronto, Canada in May, 2014.
This event was attended by over 750 delegates from32 countries across 5 continents. This summit brought
together leading researchers and experts from aroundthe world to share evidence and best practices to drive
coordinated action and initiatives to stem the growing
global childhood physical inactivity crisis. A highlightof the summit was the release of 15 report cards on theTable 1 Indicators Used in 15 National Report Cards
on Physical Activity in Children and Youth.
12

Overall Physical Activity
Organized Sport Participation

3

Active Play

4

Active Transportation

5

Sedentary Behaviour

6Family and Peers

7 School
8972

Community and the Built Environment
Government Strategies and Investments

Res Exerc Epidemiol 2014; 16(2): 71-5.

“D-” in Australia, Canada, Ireland and the UnitedStates to “B” in Mozambique and New Zealand. The
traditional letter grades in the global matrix 16) wereconverted to a numerical score (F = 1, D = 2, C = 3, B= 4, A = 5) and data on the Gross Domestic Product(DGP; per capita) of each country were obtained fromthe World Bank17) as an indicator of country-levelsocio-economic development. Figure 1A presents therelationship between the country-level GDP andoverall physical activity grades across the 15 countries(r = - 0.54), and Figure 1B presents the association
between GDP and the grades for “community andbuilt environment” (r = 0.92). Finally, the association
between the overall physical activity grade and thecommunity and built environment grade is presented
in Figure 2 (r = - 0.69).
Taken together, the results from the global matrix
analysis suggest that countries with higher socioeconomic status have better infrastructure developed
for physical activity, but at the same time they havelower grades for overall physical activity. The inverse
relationship between grades for overall physicalactivity and the community and built environment
indicate that simply building better infrastructure forphysical activity does not necessarily translate intohigher physical activity levels. Indeed, the results
suggest that in a global context, built environment
interventions may not prove fruitful at increasing

physical activity of children and youth. The countries
that issued report cards included Australia, Canada,Colombia, England, Finland, Ghana, Ireland, Kenya,
Mexico, Mozambique, New Zealand, Nigeria,
Scotland, South Africa, and the United States. Thesereport cards used a common rubric and grading system
to provide grades across several indicators of physicalactivity in children and youth that contributed to a
global “matrix” of grades. 16) The nine commonindicators that were graded across the 15 countries areprovided in Table 1. The list of indicators wasdeveloped to capture information about levels ofphysical activity and sedentary behaviour, as well as
facilitators and barriers to physical activity.
The grades for overall physical activity ranged fromA)

4.5

Overall Physical Activity Grade

New Zealand (B)3.5

Mexico (C+)
Nigeria (C)3Kenya (C)2.5
2r = - 0.54

Mozambique (B)4England (C-)

Ghana (D)Colombia (D)South Africa (D)Finland (D)1.5
Scotland (F)1United States (D-)
Ireland (D-) Canada (D-) Australia (D-)

0.5
0
$0

$20,000$40,000$60,000$80,000

Gross Domestic Product ($ per capita)

5CanadaCanada (B+)

r = 0.92

4.5

Scotland (B)4England (B)

3.5

4.5

Australia (A-)

Community and Built Environment Grade

Community and Built Environment GradeB)

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Ireland (B)Finland (B)United States (B-)

3
New Zealand (C)2.5
2Ghana (D)South Africa (D)

1.5
Mexico (F)1Mozambique (F)Colombia (INC)
Kenya (INC)
Nigeria (INC)

0.5

0$0

$20,000$40,000$60,000$80,000

r = - 0.69

Australia

4

ScotlandIreland Finland England
England3.5

United States
3

New Zealand
2.5

Ghana

2

South Africa
1.5

MexicoMozambique

1
0.5
0.5

1

1.5

2

2.5

33.5

44.5

Overall Physical Activity Grade

Gross Domestic Product ($ per capita)

Figure 2 Association between grades for overall physicalactivity levels and community and built environment.
Grades were obtained from the global matrix of reportcards.16) Note that Colombia, Kenya and Nigeria are notshown due to incomplete grades for community and thebuilt environment.

Figure 1 Associations between Gross Domestic Product(GDP) and grades for indicators of A) overall physicalactivity levels, and B) community and built environment.
Grades were obtained from the global matrix of reportcards.16) INC = incomplete grade.

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Res Exerc Epidemiol 2014; 16(2): 71-5.

physical activity levels in children and youth. In
fact, the absence of “official” physical activity
infrastructure may actually promote physical activity
through active transportation, active play, and othermeans.
The global matrix of physical activity report card
grades allows for an examination of trends acrosscountries at different stages of epidemiologic transition, and provides insights into possible intervention
options for physical activity in different cultural andenvironmental contexts. This exercise also highlights
the complexity of the problem of physical inactivity inchildren and youth, and the necessity to understandthe context-specific role of physical activity in theoverall spectrum of movement performed by children
and youth throughout the day.

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of ISCOLE is the collection of 24-hour accelerometry
data over 7 days on all participants, which allows forthe objective quantification of sedentary behaviour,
different intensities of physical activity (light,moderate, vigorous), and sleep duration.
ISCOLE represents a multi-national collaboration
among all world regions, and represents a global effort
to increase research understanding, capacity andinfrastructure in childhood physical activity andobesity. To date, more than 240 people have worked
on ISCOLE in some capacity, including junior andsenior scientists, post-doctoral fellows, students andstaff. Each study site had a local principal investigator
who collaborated on the development of the study
protocol, and who ensured that the standardized
protocol was implemented correctly with their local
research team who conducted the research. It isanticipated that ISCOLE will provide a robust
examination of the correlates of body weight andobesity in children, focusing on both sides of theenergy balance equation. The results will also provide
important new information that will inform thedevelopment of lifestyle, environmental, and policy
interventions to address childhood obesity that can beculturally adapted for implementation around theworld.

The International Study of Childhood Obesity,
Lifestyle and the Environment
The International Study of Childhood Obesity,
Lifestyle and the Environment (ISCOLE) is a crosssectional, multi-national study conducted at sites in 12countries from all major world regions, including
Australia, Brazil, Canada, China, Colombia, Finland,India, Kenya, Portugal, South Africa, United Kingdomand United States.18) These countries represent a rangeof economic development (low to high income) andhuman development index (0.509 (low) in Kenya to0.929 (high) in Australia). The primary aim ofISCOLE is to determine the relationships between
lifestyle behaviours and obesity in a multi-national
study of children, and to investigate the influence of
higher-order characteristics such as behaviouralsettings, and the physical, social and policy
environments, on the observed relationships within
and between countries.
At all sites, participants were recruited via schools,and data were collected at the individual level, family
and neighbourhood level, and the school environment
level.18) The standardization of the ISCOLE protocol
across sites, a rigorous system of training andcertification of study personnel, the use of a
web-based data entry system, and centralized data
management and analysis at the coordinating center
ensured the quality of data collected. A unique featureConclusions
There is a need to develop sustainable interventions
for the promotion of physical activity in children andyouth. These interventions need to be culturally
adapted for implementation in different countries andsettings, which will require a better understanding of
the correlates and determinant of physical activity
across low, middle and high income countries.
Initiatives such as the global matrix of report cards forphysical activity in children and youth 16) and studies
like ISCOLE18) are providing a framework to increase
global research capacity in physical activity researchin children and youth.

Acknowledgements
A version of this paper was presented as a keynote
lecture at the 2014 Global Summit on the Physical
Activity of Children in Toronto, Canada, May, 2014.

74

Res Exerc Epidemiol 2014; 16(2): 71-5.

The International Study of Childhood Obesity,
Lifestyle and the Environment is funded by The
Coca-Cola Company.

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in the developing world. J Nutr. 2001; 131(3):871S-3S.
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2004; 28 Suppl. 3: S2-9.
12） Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory
Committee Report, 2008. Washington, DC: U.S.
Department of Health and Human Services,
2008.
13） Lee IM, Shiroma EJ, Lobelo F, et al. Effect ofphysical inactivity on major non-communicablediseases worldwide: an analysis of burden of
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14） Padrao P, Damasceno A, Silva-Matos C, et al.
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Urban/rural differences during epidemiologicaltransition. Prev Med. 2012; 55(5): 444-9.
15） Onywera VO, Adamo KB, Sheel AW, et al.
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16） Tremblay MS, Gray CE, Akinroye K, et al.
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17） World Bank. World Development Indicators
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The International Study of Childhood Obesity,
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