Results from the Lebanese 2022 report card on physical activity for children and youth.

Objective: The Lebanese Active Healthy Kids Work Group (LAHKWG) synthesized literature published on physical activity (PA) indicators among ages 5- to 17- year-olds, using a recommended harmonized process by the Active Healthy Kids Global Alliance (AHKGA), to explore Lebanon's performance since its previous report card publication. Methods: Peer reviewed literature, national surveys, and gray literature published since 2017, on 10 common AHKGA and two LAHKWG recommended indicators were examined. Common indicators included overall PA, organized sport and PA, active play, active transportation, community and environment, sedentary behaviors, physical fitness, family and peers, school, and government. LAHKWG recommended indicators were sleep and weight status. LAHKWG members reviewed 764 records, of which 28 were selected for full review. A grade was assigned for each indicator using AHKGA's grading rubric and established benchmarks on data from nationally representative samples for children and youth. Results: Data from one nationally representative sample were available for ages 13-17 years (i.e., no data <13 years). Five indicators received "Incomplete" (organized sport and PA; active Play; physical fitness; family and peers; community and environment); overall PA received a D-; active transportation and sleep received a D+; school and government received a D; sedentary behaviors received a C; and weight status received a B-. Conclusion: The LAHKWG strongly encourages stakeholders to take concrete actions towards prioritizing PA promotion at a national level especially in the education sector. Offering more quality PA opportunities for Lebanese children and youth will be beneficial for their physical and mental health in any context.

Economic Freedom, Climate Culpability, and Physical Activity Indicators Among Children and Adolescents: Report Card Grades From the Global Matrix 4.0.

BACKGROUND: Macrolevel factors such as economic and climate factors can be associated with physical activity indicators. This study explored patterns and relationships between economic freedom, climate culpability, and Report Card grades on physical activity-related indicators among 57 countries/jurisdictions participating in the Global Matrix 4.0. METHODS: Participating countries/jurisdictions provided Report Card grades on 10 common indicators. Information on economic freedom and climatic factors were gathered from public data sources. Correlations between the key variables were provided by income groups (ie, low- and middle-income countries/jurisdictions and high-income countries/jurisdictions [HIC]). RESULTS: HIC were more economically neoliberal and more responsible for climate change than low- and middle-income countries. Annual temperature and precipitation were negatively correlated with behavioral/individual indicators in low- and middle-income countries but not in HIC. In HIC, correlations between climate culpability and behavioral/individual and economic indicators were more apparent. Overall, poorer grades were observed in highly culpable countries/jurisdictions in the highly free group, while in less/moderately free groups, less culpable countries/jurisdictions showed poorer grades than their counterparts in their respective group by economic freedom. CONCLUSIONS: Global-level physical activity promotion strategies should closely evaluate different areas that need interventions tailored by income groups, with careful considerations for inequities in the global political economy and climate change.

Global Matrix 4.0 Physical Activity Report Card Grades for Children and Adolescents: Results and Analyses From 57 Countries.

BACKGROUND: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children's and adolescents' (5-17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. METHODS: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders' top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. RESULTS: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. CONCLUSIONS: The Global Matrix 4.0 represents the largest compilation of children's and adolescents' PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation.

Physical activity motives have a direct effect on mental health.

Physical activity (PA) motives are associated with both moderate-to-vigorous intensity PA (MVPA) and mental health. Studies examining whether PA motives relate directly to mental health or indirectly through MVPA are lacking. This study examined the direct effect of five PA motives (i.e., enjoyment, competence, fitness, social, appearance) on mental health and their indirect effects through MVPA in adolescents. A total of 424 participants (57.1% females) ages 14-15 years from the longitudinal MATCH study were included. Mediation analyses, based on the counterfactual framework, assessed the natural direct effect of PA motives on mental health, and the natural indirect effects through MVPA. Separate models were conducted for each PA motive. Natural direct effects were observed for enjoyment ( ß Ì‚ [95%CI] = 2.12 [0.34, 3.90]), competence ( ß Ì‚ [95%CI] = 1.58[0.28, 2.88]), fitness ( ß Ì‚ [95%CI] = 1.42[0.04, 2.80]), and social ( ß Ì‚ [95%CI] = 2.32[1.03, 3.60]) motives. No natural direct effects were observed for appearance motives. A natural indirect effect through MVPA was observed for fitness motives, and no other natural indirect effects were found. Interventions and public health strategies in adolescents need to acknowledge the importance of enjoyment, competence social and fitness motives in PA to promote mental health, and integrate specific recommendations on the importance of the reasons why adolescents participate in PA.

Associations between physical activity motives and trends in moderate-to-Vigorous physical activity among adolescents over five years.

This study examined the longitudinal associations between five physical activity (PA) motives and moderate-to-vigorous PA (MVPA) across a 5-year period spanning late childhood to middle adolescence.METHODS: Data (n = 937; 55% girls; mean age = 10.33 years) were drawn from the Monitoring Activities for Teenagers to Comprehend their Habits study. PA motives and MVPA were assessed 15 times over the course of 5 years. Measurement invariance for the Motives for Physical Activity Measure-Revised (MPAM-R) questionnaire was established, and sex-stratified mixed-effects regression models were analysed.MVPA increased until a mean age of 12.18 years for girls and 12.89 years for boys before decreasing through the final assessment. From late childhood to middle adolescence, for boys, enjoyment motives were positively (ß(95% CI) = 6.14(3.86-8.43)), while fitness motives were negatively (ß(95% CI) = -4.80(-8.0, -1.59)) associated with MVPA. Whereas, for girls, competence motives were positively ß(95% CI) = 3.44(1.59-5.28)) associated with MVPABoys may benefit from PA interventions, if these were primarily aimed at increasing ones' enjoyment, whereas developing a girl's competence may provide greater contributions to a girl's future PA behaviours. PA interventions should avoid promoting the desire to be active to improve fitness, particularly among boys.

Investigating physical activity knowledge and beliefs as correlates of behaviour in the general population: a cross-sectional study.

This study examines knowledge of physical activity (PA) guidelines for cancer prevention and beliefs of the role of PA in preventing cancer as correlates of moderate-to-vigorous intensity PA (MVPA) behaviour among adults. Measures assessing socio-demographic characteristics, knowledge of PA guidelines, and PA beliefs and behaviour were completed online by 654 adults (Mage = 36.92 ± 14.61 years) with no history of cancer. Data were analyzed descriptively and using unadjusted and adjusted logistic regression analysis. Approximately half the sample was aware of PA guidelines for cancer prevention (49.24%) and believed that PA was extremely effective in reducing the risk of developing cancer (48.93%). Knowledge of PA guidelines for cancer prevention was associated with a greater likelihood of being active (unadjusted odds ratio [OR]: 1.66, 95% confidence interval [95% CI]: 1.18-2.34; p <.01; adjusted OR: 2.05, 95% CI: 1.36-3.11; p <.001). Beliefs regarding the effectiveness of PA in preventing cancer was not associated with a greater likelihood of being active. There is a lack of awareness of current PA guidelines for cancer prevention. Experimental studies are needed to further explore if increasing adults' knowledge of PA guidelines for cancer prevention can enhance PA levels.

Intensity and frequency of physical activity and high blood pressure in adolescents: A longitudinal study.

Despite limited evidence on the association between physical activity (PA) and blood pressure (BP) in youth, experts recommend that adolescents engage regularly in moderate-to-vigorous PA. We examined the relationships between PA intensity and frequency and the likelihood of having high BP in a population-based cohort of adolescents from Montréal, Canada. PA was self-reported every 3 months from grade 7 to 11, and BP was measured at ages 12.8, 15.2, and 17.0 years on average. We analyzed data from 993 participants (mean [SD] age = 16.0 [1.0], 51.6% female) with BP data at ages 15.2 and/or 17.0 years, using pooled ordinal logistic regression. BP (normal/elevated/hypertensive range) was the outcome, and past-year PA intensity and frequency were potential predictors. Eight percent of participants had elevated BP (120-129/<80), and 3.2% had BP in the hypertensive range (≥130/≥80). Participants engaged in a median (interquartile range) of 7.0 (4.5, 9.3) and 5.5 (2, 10.8) moderate and vigorous PA sessions/week, respectively. After adjusting for age, sex, mother's education, use of alcohol and cigarette consumption, engaging in PA more intense than light during the previous year was associated with a lower odds of having BP in the hypertensive range (ORs [95% CIs] = 0.93 [0.88, 0.97] to 0.97 [0.94, 0.99]). The relationships were not altered by adjusting for BMI. Our findings support recommendations that adolescents engage in at least moderate PA on a regular basis to prevent development of BP in the hypertensive range.

Physical activity mediates the relationship between outdoor time and mental health.

Both spending time outdoors and participating in physical activity improve mental health. Given that the outdoor environment provides an ideal location for physical activity, better understanding of the relationships among time spent outdoors, physical activity and positive mental health is needed to help guide interventions. The aim was to examine if physical activity moderates or mediates the relationship between outdoor time and positive mental health. Two-hundred-forty-two participants (15 ±â€¯1 years old, 59% girls) from New Brunswick, Canada were included in the current analysis. Youth self-reported time spent outdoors and moderate-to-vigorous physical activity (MVPA) three times between October 2016 and June 2017. Data on their mental health were collected in October 2017. Values of outdoor time and MVPA were averaged across the three time points to represent the exposure and mediator variables, respectively. Mental health, dichotomized as flourishing/not flourishing, was the outcome in the mediation analysis. An interaction term tested if the mediation effect depended on outdoor time. Analyses were undertaken in 2019 using the mediation package in R. In univariate analyses, both MVPA (p < 0.001) and outdoor time (p = 0.05) were positive predictors of flourishing mental health. In mediation analyses, a small indirect mediation (OR: 1.02, 95% CI: 1.01-1.04) and no direct (1.00, 0.98-1.05) effect were noted, suggesting that MVPA mediates the effect of outdoor time on positive mental health. This effect did not vary as a function of outdoor time (interaction: 1.00, 0.99-1.01). Physical activity mediates the relationship between outdoor time and positive mental health. Outdoor time could promote positive mental health among youth through increases in physical activity.

Association of Teacher-Level Factors With Implementation of Classroom-Based Physical Activity Breaks.

BACKGROUND: Classroom-based physical activity (CBPA) breaks are a common strategy to increase elementary school children's physical activity (PA) levels. There is limited research examining how teacher-level factors impact teacher implementation of CBPA breaks. In this study, we assessed the relationship of teacher-level factors with teacher use of a CBPA resource. METHODS: We randomized 6 elementary schools in rural Oregon into control (N = 3) or intervention (N = 3) conditions. Each teacher at intervention schools received the CBPA resource. Teachers at control schools received 1 CBPA-Toolkit per grade level to share, and received no training. We surveyed teachers on their use of the toolkit, implementation support and self-efficacy, and value for PA. Logistic regression was used to examine the odds of toolkit use by teacher-level factors. RESULTS: Among survey respondents (N = 83), 57% were self-identified toolkit users and 48% attended a training. Training participation and teacher implementation self-efficacy were associated with greater odds of using the toolkit (odds ratio, OR = 7.76 [95% confidence interval, CI = 1.39-43.19] and OR = 5.54 [95% CI = 1.24-23.87], respectively). CONCLUSION: CBPA tools supported with training aimed at developing teachers' implementation self-efficacy increased the likelihood of teachers employing CBPA tools.

First Physical Activity Report Card for Children and Youth in Lebanon.

Background: Evidence on physical activity (PA) indicators for children and youth at a national level is necessary to improve multilevel support for PA behaviors. Lebanon's first Physical Activity Report Card for children and youth (2018) aimed to fill this gap. Methods: In line with the recommended methods of "Global Matrix 3.0," nationally representative data were retrieved from peer-reviewed manuscripts, national surveys, and government reports. In addition to adopting the 10 indicators of "Global Matrix 3.0," publications that discussed weight status were also retained. A grade was assigned for each indicator using a standard rubric: A = 80% to 100%, B = 60% to 79%, C = 40% to 59%, D = 20% to 39%, F = <20%, and INC = incomplete data. Results: Four indicators (active play, family and peers, community and environment, and physical fitness) received an "INC." Three indicators (overall PA, active transportation, and school) received a "D." Sedentary behaviors received a "C-." Weight status received a "C." Government received a "C+." Organized sport received an "F." Conclusions: PA participation among Lebanese children and youth is low. Stakeholders should aim to improve low PA indicators grades. Gaps in the literature also need to be filled to inform on the status of all indicators.

Report Card Grades on the Physical Activity of Children and Youth From 10 Countries With High Human Development Index: Global Matrix 3.0.

BACKGROUND: The Global Matrix 3.0 brings together the Report Card grades for 10 physical activity indicators for children and youth from 49 countries. This study describes and compares the Global Matrix 3.0 findings among 10 countries with high Human Development Index. METHODS: Report Cards on physical activity indicators were developed by each country following a harmonized process. Countries informed their Report Cards with the best and most recent evidence available. Indicators were graded using a common grading rubric and benchmarks established by the Active Healthy Kids Global Alliance. A database of grades from the countries was compiled, and letter grades were converted to numerical equivalents. Descriptive statistics and scores for groups of indicators were calculated, and correlation analyses were conducted. RESULTS: Grades for the 10 countries clustered around "D" ranging from "F" to "B+." Active Transportation had the highest average grade ("C"), whereas Overall Physical Activity had the lowest average grade ("D-"). Low grades were observed for both behavioral and sources of influence indicators. CONCLUSIONS: In the context of social and economical changes of high- Human Development Index countries, urgent actions to increase physical activity among children and youth are required. Surveillance and monitoring efforts are required to fill research gaps.

Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries.

BACKGROUND: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5-17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. METHODS: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations' human development index (HDI) classification (low or medium, high, and very high HDI). RESULTS: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of "C-," "D+," and "C-" was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. CONCLUSIONS: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.

The impact of life stresses on physical activity participation during adolescence: A 5-year longitudinal study.

Life stresses (LS) could affect levels of physical activity (PA) during adolescence, however research is limited. As different types of PA may have different determinants, the effects of LS on participation in moderate-to-vigorous PA (MVPA) and on organized and unorganized PA (OPA, UPA) were examined in a sample of 937 students (10-11 years-old) followed up over five years. Questionnaires were administered three times per year as part of the Monitoring Activities for Teenagers to Comprehend their Habits (MATCH) study. A total of 16 survey cycles were available for this analysis. At each survey cycle, participants reported exposure to nineteen LS, number of days per week attaining at least 60 min of MVPA, and participation in OPA and in UPA. LS were classified as personal or extrinsic life events, or personal or extrinsic life circumstances. Relationships among the four LS categories and PA outcomes were assessed using gender stratified mixed effects models. Personal circumstances attenuated the increase in MVPA in late childhood, and accentuated the decrease in MVPA in early adolescence (p < 0.001). In contrast, experiencing more extrinsic events attenuated the decrease in the number of reported UPA (p < 0.05). Among girls, experiencing more personal events attenuated the decrease in the number of UPA and OPA by 4.8% and 5.1% respectively. Among boys, experiencing more extrinsic circumstances attenuated the decrease in the number of UPA by 3.4%. The effect of LS on PA differed by gender and by type of PA, highlighting the need for careful tailoring of interventions.

Teacher-Level Factors, Classroom Physical Activity Opportunities, and Children's Physical Activity Levels.

BACKGROUND: Classroom-based physical activity (CBPA) breaks are a cost-effective strategy to promote physical activity (PA) at school. Despite teachers' critical roles in sustained implementation of CBPA breaks, few studies examined the association of teacher-level factors with student PA levels, and none focused on rural schools. METHODS: We monitored children's PA levels over 4 consecutive school days at 6 rural Oregon elementary schools with Walk4Life pedometers. During the same week, teachers recorded all student PA opportunities (recess, PE, and CBPA breaks) and answered a 26-item questionnaire about factors influencing their use of CBPA breaks. Mixed-effects models were used to associate teacher-level factors and PA opportunities with children's moderate to vigorous PA (MVPA; in minutes per day), controlling for child-level covariates. RESULTS: When teachers valued PA, students accumulated more MVPA (1.07 min/d; P < .01) than students of teachers reporting low PA value. Students did more MVPA (1 min/d; P < .001) when teachers agreed the school operating conditions posed barriers to providing PA than when teachers disagreed that barriers existed. PE classes contributed significantly to student's PA levels. CONCLUSION: Provision of PE, increasing teacher value for PA, and further investigation of how teacher-level factors relate to students' MVPA levels during CBPA breaks at rural elementary schools are warranted.