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Item Top 10 International Priorities for Physical Fitness Research and Surveillance Among Children and Adolescents: A Twin-Panel Delphi Study(Springer, 2022) Onywera, Vincent O; Lang, Justin J; Olds, TimBackground The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts. Objective This study aimed to produce a list of the top 10 international priorities for research and surveillance on physical fitness among children and adolescents. Methods Using a twin-panel Delphi method, two independent panels consisting of 46 international experts were identified (panel 1 = 28, panel 2 = 18). The panel participants were asked to list up to five priorities for research or surveillance (round 1), and then rated the items from their own panel on a 5-point Likert scale of importance (round 2). In round 3, experts were asked to rate the priorities identified by the other panel. Results There was strong between-panel agreement (panel 1: rs = 0.76, p < 0.01; panel 2: rs = 0.77, p < 0.01) in the priorities identified. The list of the final top 10 priorities included (i) “conduct longitudinal studies to assess changes in fitness and associations with health”. This was followed by (ii) “use fitness surveillance to inform decision making”, and (iii) “implement regular and consistent international/national fitness surveys using common measures”. Conclusions The priorities identified in this study provide guidance for future international collaborations and research efforts on the physical fitness of children and adolescents over the next decade and beyond.Item Physical activity and active transportation behaviour among rural, peri-urban and urban children in Kenya, Mozambique and Nigeria: The PAAT Study(PLOS, 2022) Onywera, Vincent O; Wachira, Lucy-Joy; Hayker, Sylvester O.; Larouche, Richard; Oyeyemi, Adewale LAbstract Background Physical activity (PA) is associated with numerous health benefits among children and youth. However, few studies have examined how active transportation (AT) and device-based measures of PA vary within and between countries in sub-Saharan Africa. Purpose This cross-sectional study sought to investigate the prevalence and correlates of AT and device-measured PA among children living in urban, peri-urban and rural areas in three African countries representing Eastern, Western and Southern regions of Africa. Methods 3,205 participants (53.3% girls; 46.7% boys) aged 10–12 years were recruited in Kenya, Nigeria and Mozambique. Data were collected using a child questionnaire, a parent/guardian questionnaire and PiezoRx® pedometers. ANCOVA and binary logistic regression analyses were used to examine the correlates of AT and PA while controlling for gender, age, parent education and vehicle ownership. Results Participants accumulated an average of 45.6±23.5 min/day of moderate-to-vigorous physical activity (MVPA) and 11,215±4,273 steps/day. Kenyan and Mozambican children were significantly more active than their Nigerian counterparts (p<0.001). Only 23% met the MVPA guidelines of 60 min/day. 65.1% of participants engaged in AT to school (and 67.8% for the trip back home) with no gender differences. Living in a rural area, lower parent education, lower vehicle ownership and higher motorcycle ownership were associated with higher odds of AT. Other correlates of AT were country specific. Girls accumulated less daily MVPA than boys in all countries. MVPA was positively associated with living in less urbanized areas in Nigeria and Mozambique. In Kenya, lower parental education and AT were associated with higher MVPA. Nigerian children’s daily MVPA decreased with age and the number of parent-perceived barriers to AT. Conclusions Majority of children engaged in AT, but still failed to meet MVPA recommendations. Most correlates of AT and PA were country-specific, suggesting that strategies to encourage both behaviors should be informed by local evidence.Item Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings from the Global Observatory for Physical Activity—GoPA! 2015 and 2020 Surveys(Human Kinetics, 2022) Onywera, Vincent O; Pratt, Michael; Dionyssiotis, Yannis; Wendel-Vos, Wanda; Puloka, Viliami KulikefuBackground: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world’s population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world’s population live in countries where PA promotion capacity should be significantly improved. Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.Item Why are COVID-19 effects less severe in Sub-Saharan Africa? Moving more and sitting less may be a primary reason(Elsevier, 2022) Onywera, Vincent O; Wachira, Lucy-Joy; Arena, Ross; Sallis, James F.; Oyeyemi, Adewale L.The world is entering a new phase of the coronavirus disease 2019 (COVID-19) health crisis with the lifting of social and physical distancing as well as lockdown restrictions to control the pandemic. Scientific evidence obtained during the COVID-19 pandemic to this point have brought clear themes to the forefront. One important theme pertains to who is at a higher risk for poorer outcomes if infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clearly, indi viduals with risk factors for chronic disease and one or more chronic disease diagnoses are at significantly higher risk for poor outcomes with SARS-CoV-2 infection.1,2 Moreover, unhealthy lifestyle behaviors (i.e., physical inactivity, poor nutrition, smoking and excess body mass) are the leading cause for the high incidence and prevalence of chronic disease the world was facing well before the COVID-19 pandemic.3 In fact, physical inactivity and chronic diseases were both characterized as pandemics prior to COVID-19Item Association between breakfast frequency and physical activity and sedentary time: a cross-sectional study in children from 12 countries(Springer Nature, 2019) Onywera, Vincent O; Zakrzewski-Fruer, Julia K.; Gillison, Fiona B.; Katzmarzyk, Peter T; Mire, Emily F.Background Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. Methods This multinational, cross-sectional study included 6228 children aged 9–11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. Results Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. Conclusions In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance.Item The “New York City Marathon”: participation and performance trends of 1.2M runners during half-century(Taylor and Francis, 2019) Onywera, Vincent O; Onywera, Vincent O; Nikolaidis, Pantelis T.; Villiger, Elias; Knechtle, BeatThe aim of the present study was to examine trends in participation, performance, age and nationality during a ~ 50-years period in the largest dataset ever studied in the “New York City Marathon”. We analyzed 1,174,331 finishers (women, n= 349,145, age 39.7 ± 8.7 years; men, n= 825,186, 41.7 ± 9.2 years). The overall participation increased across calendar years for all nationalities, and this increase was more pronounced in women, which resulted in a decreasing men-to-women ratio. Men were faster and older than women. Ethiopians and Kenyans were the fastest and youngest in women and men, respectively. Japanese were the slowest and Germans were the oldest in both sexes. Race time increased across years. Coaches and fitness trainers should be aware of these trends and should emphasize the development of training programs for older and slower runnersItem Epidemiological Transition in Physical Activity and Sedentary Time in Children(Human Kinetics, 2019) Onywera, Vincent O; Barreira, Tiago V.; Broyles, Stephanie T.; Tudor-Locke, Catrine; Chaput, Jean-Philippe; Standage, MartynTo determine if children’s moderate to vigorous physical activity (MVPA) and sedentary time varied across levels of household income in countries at different levels of Human Development Index (HDI), consistent with the theory of epidemiological transition. Methods: Data from 6548 children (55% girls) aged 9–11 years from 12 countries at different HDI levels are used in this analysis to assess MVPA and sedentary time (measured using ActiGraph accelerometers) across levels of household income. Least-square means are estimated separately for boys and girls at the estimated 10th, 50th, and 90th percentiles of HDI for the sample. Results: For boys, time in MVPA is negatively associated with income at the 10th and 50th percentiles of HDI (both P < .002). For girls, time in MVPA is negatively associated with income at the 10th and 50th percentiles of HDI (all P < .01) and positively related with income at the 90th percentile (P = .04). Sedentary time is positively associated with income at the 10th percentile of HDI for boys (P = .03), but not for girls. Conclusions: Results support the possibility of an epidemiological transition in physical activity, with lower levels of MVPA observed at opposite levels of income depending on the HDI percentile. This phenomenon was not observed for sedentary timeItem Association between dietary behaviours and weight status of school children: results from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) -Kenya(2020) Onywera, Vincent O; Wachira, Lucy-Joy; Muthuri, Stella; Ocholla, Sophie; Tremblay, MarkABSTRACT Background: Sub-Saharan African countries are undergoing rapid urbanization resulting in vast changes in dietary habits. Dietary practices involving excess energy intake have been associated with overweight/obesity. We assessed the dietary behavior of children and their relationships with weight status. Methods: Data was collected in Kenya, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). The study recruited 563 children aged 9–11 years from 29 schools in Nairobi. A seven-day food frequency questionnaire was used to assess dietary intake. Dietary behaviors such as consumption of breakfast, school lunch, meals prepared/eaten away from home, emotional eating and snacking while watching television were also assessed. Body mass index (BMI-for-age and sex) was used as the indicator of weight status. Results: Of the sample, 53.5% were girls; 20.8% were classified as overweight/ obese; 72.9% ate meals out of home regularly; 55.2% ate lunch provided by the school; and only 76% had breakfast on all weekdays. Eating more when happy, eating fried foods while watching television, and consumption of vegetables were positively associated with BMI. Majority of overweight children were female (56.6%) and the type of school attended predicted BMI, F(6, 536) = 18.371, p < 0.0001, R2 = 0.171. BMI was negatively associated with consumption of cakes/pastries (χ2 = 14.7, V = 0.165, p = 0.023), potato crisps (χ2 = 21.6, V = 0.197, p = 0.003), and fast foods (χ2 = 13.5, p = 0.036). ANOVA results revealed no significant differences in the consumption of foods with BMI except for vegetables (p = 0.003). Conclusions: Children have healthy diets rich in fruits and vegetables and low in energy-dense foods. Also, less healthy diets were observed in children with CONTACT Lucy-Joy Wachira wachira.lucy@ku.ac.ke Department of Physical Education, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya CHILD AND ADOLESCENT OBESITY 2021, VOL. 4, NO. 1, 1–22 https://doi.org/10.1080/2574254X.2020.1842014© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lower BMI. There is need for interventions targeting the overweight/obese children, particularly those of higher SES.Item Development and convergent validity of new self-administered questionnaires of active transportation in three African countries: Kenya, Mozambique and Nigeria.(BMC Public Health, 2018) Onywera, Vincent O; Larouche, Richard; Oyeyemi, Adewale L.; Prista, Antonio; Akinroye, Kingsley K.Background There is currently a rapid physical activity transition taking place in developing countries that includes a decrease in active transportation. Building on findings from an earlier systematic review, this paper describes the development and convergent validity of self-administered child and parent questionnaires assessing active transportation of children in three African countries: Kenya, Mozambique and Nigeria. Methods A pilot study was conducted to examine the convergent validity of the developed questionnaires by comparing responses between children and their parents (N = 121; n = 43 for Mozambique, n = 24 for Kenya and n = 54 for Nigeria). After modification, the questionnaires were then administered to a larger convenient sample of both children and parents from Kenya (n = 1123), Mozambique (n = 1097) and Nigeria (n = 831) which defined the main study. The questionnaires assessed active transportation to/from 8 categories of destinations including school, friends’ and relatives’ home/houses, parks and playgrounds among others. Twenty items were used to assess child - and parent-perceived barriers to active transportation, and the parent questionnaire inquired about parent education and availability of cars, motorcycles, and bicycles. Spearman’s rho was used to compare children’s mode of travel in the pilot study while the prevalence-adjusted bias-adjusted kappa (PABAK) coefficient was used to compare convergent validity between children’s and parents responses on active transportation in the main study. Results Findings of the main study show that convergent validity for active transportation to and from each destination in the combined sample ranged from 0.472 (from school) to 0.998 (to other places). Convergent validity for challenges/barriers to active transportation to school ranged from fair (0.30 - The route does not have good lighting) to substantial (0.77 - My child has a disability). It varied between countries from fair (n = 11-items) to moderate (n = 9-items) agreement in Kenya and from poor (n = 2-items) to fair (n = 16-items) agreement in Nigeria. Data from Mozambique was however missing and therefore could be included. Conclusions The questionnaires provided valid information on the number of trips to/from various destinations and show acceptable and modest convergent validity for measuring barriers to active transport in a sample of children from three African countries. These questionnaires may be suitable for future research on active transport among school children in Sub-Saharan African countries.Item Screen-based sedentary behavior and adiposity among school children: Results from International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) - Kenya(PLOS, 2018) Onywera, Vincent O; Wachira, Lucy-Joy M; Ocholla, Sophie A; Tremblay, Mark SBackground High levels of sedentary behaviours have been independently associated with several negative health indicators, including obesity. Screen time (ST) is often used as a contributing measure of sedentary time. It is recommended that children spend no more than 2 hours on recreational sedentary screen-based activities daily. We describe screen-based sedentary time of urban school children and examine the associations between body mass index (BMI) and percent Body Fat (%BF) with ST levels. Methods Data were collected from 563 children aged 9 to 11 years attending 29 non-boarding primary schools in Nairobi, Kenya, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Data were analysed to test for associations between ST and sex, type of school attended (public verses private), Socioeconomic status, adiposity, and access to electronic devices. We also assessed participants’ ST on school and weekend days. Results Of the participants recruited, 15.5% had high ST levels, 67.9% spent no more than 2 hours in recreational screen activities on school days while 74.2% did not meet the guidelines on weekend days. Participants sex was associated with daily ST (t = 3.5, p<0.001), ST on the weekend (t = 3.9, p <0.001) and total ST per week (t = 3.5, p<0.001) with males having higher ST than females. ST was associated with type of school for daily ST (t = 3.6, p <0.001), ST on the weekend (t = 4.5, p<0.001) and total ST per week (t = 3.6, p<0.001) where private schools pupils had higher ST. ST was not associated with BMI. ST was not associated with %BF except on weekend days (p = 0.038) where those classified as overfat/obese (fat) had higher ST. Conclusions A large proportion of children spend more time than recommended on screen activities particularly on weekend days. Strategies to improve healthy living should focus on the reduction of sedentary ST for school-aged children.