Questionnaires Measuring Physical Activity in Clinical Pediatric Populations: A Systematic Review.

635 Understanding parent perceptions of healthy physical activity for their child with a chronic medical condition

Background: Physical activity (PA) is an important determinant of health throughout the lifespan. Meeting PA guidelines improves health outcomes and prevents or slows the progression of many chronic health conditions. Yet, literature has shown that many Arab Americans do not meet the PA Guidelines. Little is known about determinants of PA in this population. Objective: Guided by the Social Ecological Model, we aimed to 1) describe PA and investigate the relationships between PA and sample characteristics, intrapersonal factors, and interpersonal factors and 2) examine to what extent these factors influence PA in Arab Americans. Methods: A cross-sectional, descriptive-correlational design using a self-administered questionnaire with 140 Arab Americans was used. Spearman's rho correlation was used to assess the associations between PA and sample characteristics, intrapersonal factors, and interpersonal factors. Three simultaneous gamma regression models were used to assess to what extent sample characteristics, intrapersonal, and interpersonal factors jointly influenced PA. Results: A majority (58.6%) of our participants reported a high level of PA. Findings revealed significant positive associations between PA and health status, religiosity, and PA self-efficacy ( r s = 0.21, p = 0.019; r s = 0.19, p = 0.029; r s = 0.28; p = 0.003, respectively). Multiple regression models revealed that being employed (Model 1 Exp( b ) = 1.87, p = 0.030; Model 3 Exp( b ) = 1.77, p = 0.043) and having chronic conditions (Model 1 Exp( b ) = 1.88, p = 0.031; Model 2 Exp( b ) = 1.96, p = 0.034; Model 3 Exp( b ) = 1.91, p = 0.047) were associated with greater PA, when accounting for other sample characteristics, intrapersonal, and interpersonal factors. Conclusion: Clinicians need to recognize the importance of enhancing PA self-efficacy while considering presence of chronic health conditions and employment status when promoting PA in Arab Americans. Future research is needed to explore the relationship between religiosity and PA in this population.

Objective: A systematic review and meta-analysis of randomized controlled trials to determine if motivational interviewing leads to increased physical activity, cardiorespiratory fitness or functional exercise capacity in people with chronic health conditions. Data sources: Seven electronic databases (MEDLINE, PsychINFO, EMBASE, AMED, CINHAL, SPORTDiscus and the Cochrane Central Register of Controlled trials) were searched from inception until January 2014. Trial selection: Two reviewers independently examined publications for inclusion. Trials were included if participants were adults (>18 years), had a chronic health condition, used motivational interviewing as the intervention and examined physical activity, cardiorespiratory fitness or functional exercise capacity. Data extraction: Two reviewers independently extracted data. Risk of bias within trials was assessed using the Physiotherapy Evidence Database Scale. Data synthesis: Meta-analyses were conducted with standardized mean differences and 95% confidence intervals (CIs) were calculated. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence. Results: Eleven publications (of ten trials) were included. There was moderate level evidence that motivational interviewing had a small effect in increasing physical activity levels in people with chronic health conditions relative to comparison groups (standardized mean differences = 0.19, 95% CI 0.06 to 0.32, p = 0.004). Sensitivity analysis based on trials that confirmed treatment fidelity produced a larger effect. No conclusive evidence was observed for cardiorespiratory fitness or functional exercise capacity. Conclusion: The addition of motivational interviewing to usual care may lead to modest improvements in physical activity for people with chronic health conditions.

Status and Potential of Community-Engaged Research to Investigate Physical Activity Interventions for Children with Autism Spectrum Disorder in Chinese-American Communities

In children with a chronic condition, physical activity (PA) and physical fitness is reduced compared to healthy controls. As a consequence, children with a chronic condition are restricted in their social participation. Low PA and low physical fitness increase the risk of cardiovascular disease, obesity and diabetes. It is assumed that children with a chronic condition experience the same health benefits from PA as healthy children, which is why there is a strong shift towards stimulating physical activity in children with a chronic condition. Despite stimulating PA in children with Juvenile Idiopathic Arthritis (JIA), these children are less active and spent more time on sedentary activities compared to healthy controls. Children after a liver transplantation are on the same activity and fitness level as norm values. Unfortunately, both patient groups did not reach the recommendations (i.e. one hour of moderate to vigorous PA seven days each week). For children with a chronic condition, it is sometimes difficult to participate in regular sport programmes. Stimulating PA for health benefits is a challenge, additionally intensity and activity duration are difficult to measure objectively. One must take into account that physical activities require the appropriate motor skills for children to participate. A home-based exercise training program in children with Juvenile Dermatomyositis as well as an internet-based cognitive behavioural treatment program Rheumates@Work in children with JIA are safe, showing high adherence, but have no positive effect on increasing PA. Combining both programs might improve PA, but evaluation of such a program is needed.

Primary Subject area Mental Health Background Chronic childhood health conditions are known to have an impact on the well-being of family members. Parental caregivers face well-defined adverse health outcomes, though less is known about the health impacts on siblings. Objectives To assess clinical health outcomes in siblings of children with chronic health condition(s) compared to siblings of healthy children or normative data. Design/Methods We searched Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL through June 4, 2020. We included English-language studies that: (1) reported clinically diagnosable mental or physical health outcomes of siblings of children (0-18 years old) diagnosed with any childhood chronic health condition; (2) included a comparison group; and (3) used an experimental or observational study design. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results We included 28 studies of the 9053 screened, comprising 10 cohort studies and 18 cross-sectional studies. Studies from 11 different countries reported most commonly on siblings of children with disabilities (12 studies), cancer (8 studies), or psychiatric disorders (4 studies). Siblings of children with chronic conditions had greater depression rating scale scores than their comparison groups (standardized mean difference 0.49; 95% CI 0.33-0.65; P < .001 [5 studies]) (Fig. 1), whereas anxiety scores did not differ significantly (standardized mean difference 0.24; 95% CI -0.03-0.52; P = .08 [6 studies]) (Fig. 2). Studies that reported on prevalence of psychiatric diagnoses, rather than rating scale scores, had mixed results, either indicating increased risk (3 studies) or no increased risk (4 studies) among exposed siblings. We did not meta-analyze effects for mortality (3 studies) or physical health outcomes (dental caries [1 study], traumatic brain injury [1 study], sexually transmitted infection [1 study], overweightness/obesity [1 study]) given the limited number of studies and between-study heterogeneity. Included studies were rated as high quality (12 studies) or of moderate quality (16 studies). Conclusion Siblings of children with chronic health conditions may be at an increased risk of depression. Our findings suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.

BackgroundAdults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses.ObjectiveThe primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions.MethodsRandomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled.ResultsA total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95% CI 18.60-58.47), quality of life (SMD=0.36, 95% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support.ConclusionsThe use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change.Trial RegistrationPROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283168

Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative assessment via meta-analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. A total of 1053 childcare services participated across all trials. Of the 10 trials, eight examined implementation strategies versus a usual practice control and two compared alternative implementation strategies. There was considerable study heterogeneity. We judged all studies as having high risk of bias for at least one domain.It is uncertain whether the strategies tested improved the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention. No intervention improved the implementation of all policies and practices targeted by the implementation strategies relative to a comparison group. Of the eight trials that compared an implementation strategy to usual practice or a no intervention control, however, seven reported improvements in the implementation of at least one of the targeted policies or practices relative to control. For these trials the effect on the primary implementation outcome was as follows: among the three trials that reported score-based measures of implementation the scores ranged from 1 to 5.1; across four trials reporting the proportion of staff or services implementing a specific policy or practice this ranged from 0% to 9.5%; and in three trials reporting the time (per day or week) staff or services spent implementing a policy or practice this ranged from 4.3 minutes to 7.7 minutes. The review findings also indicate that is it uncertain whether such interventions improve childcare service staff knowledge or attitudes (two trials), child physical activity (two trials), child weight status (two trials) or child diet (one trial). None of the included trials reported on the cost or cost-effectiveness of the intervention. One trial assessed the adverse effects of a physical activity intervention and found no difference in rates of child injury between groups. For all review outcomes, we rated the quality of the evidence as very low. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used in this review. Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practices, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. Further research in the field is required.

Maternal Reports of Raising Children With Chronic Illnesses:The Prevalence of Positive Thinking

In 2020, approximately 47.1 million US adults were current smokers, with smoke exposure negatively affecting lung function and cardiovascular capacity, thereby making physical activity (PA) more challenging and less enjoyable and contributing to negative mental health effects. PURPOSE: This study explored the role of PA in protecting against sleep disorders and depressive symptoms among U.S. adults, focusing on variations across smoking statuses (active smokers, secondhand smokers, and non-smokers) using serum cotinine levels as nicotine exposure markers. METHODS: Data were analyzed from the 2017-2020 National Health and Nutrition Examination Survey. Sleep disorders and depressive symptoms were assessed across six groups combined with PA guideline adherence and smoking status. The PA guidelines adherence was classified into two groups (meet PA guidelines and did not meet guidelines), and smoke exposure was categorized into three groups (non-smokers: <0.05 ng/mL, secondhand smokers: 0.05-15 ng/mL, and active smokers: >15 ng/mL). Socioeconomic status, anthropometric information, chronic conditions, and alcohol consumption related to smoking were included as covariates. Survey logistic regression was used to explore the relationships for sleep disorders and depressive symptoms, using non-smokers who met PA guidelines as the reference group. Analyses were also stratified by age groups (21-39 years, 40-59 years, 60+ years). RESULTS: Active smokers not meeting PA guidelines had significantly higher odds of depressive symptoms (OR = 4.48, p < 0.01) compared to non-smokers meeting PA guidelines. Among young adults, active smokers adhering to PA guidelines had increased odds of sleep disorders (OR = 2.86, p < 0.01). Middle-aged adults showed higher odds for sleep disorders (OR = 2.18, p < 0.01) and depressive symptoms (OR = 13.74, p < 0.05) when not meeting PA guidelines. For older adults, the odds of depressive symptoms were also elevated compared to non-smokers with met PA guidelines (OR = 3.46, p < 0.05). CONCLUSIONS: Public health strategies should prioritize increasing PA levels, especially among smokers, to mitigate mental health risks. Meeting PA guidelines continues to show positive health benefits even among individuals who smoke.

The school effect on children's school time physical activity: The PEACH Project

eHealth tools such as patient portals and personal health records, also known as patient-centered digital health records, can engage and empower individuals with chronic health conditions. Patients who are highly engaged in their care have improved disease knowledge, self-management skills, and clinical outcomes. We aimed to systematically review the effects of patient-centered digital health records on clinical and patient-reported outcomes, health care utilization, and satisfaction among patients with chronic conditions and to assess the feasibility and acceptability of their use. We searched MEDLINE, Cochrane, CINAHL, Embase, and PsycINFO databases between January 2000 and December 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible studies were those evaluating digital health records intended for nonhospitalized adult or pediatric patients with a chronic condition. Patients with a high disease burden were a subgroup of interest. Primary outcomes included clinical and patient-reported health outcomes and health care utilization. Secondary outcomes included satisfaction, feasibility, and acceptability. Joanna Briggs Institute critical appraisal tools were used for quality assessment. Two reviewers screened titles, abstracts, and full texts. Associations between health record use and outcomes were categorized as beneficial, neutral or clinically nonrelevant, or undesired. Of the 7716 unique publications examined, 81 (1%) met the eligibility criteria, with a total of 1,639,556 participants across all studies. The most commonly studied diseases included diabetes mellitus (37/81, 46%), cardiopulmonary conditions (21/81, 26%), and hematology-oncology conditions (14/81, 17%). One-third (24/81, 30%) of the studies were randomized controlled trials. Of the 81 studies that met the eligibility criteria, 16 (20%) were of high methodological quality. Reported outcomes varied across studies. The benefits of patient-centered digital health records were most frequently reported in the category health care utilization on the "use of recommended care services" (10/13, 77%), on the patient-reported outcomes "disease knowledge" (7/10, 70%), "patient engagement" (13/28, 56%), "treatment adherence" (10/18, 56%), and "self-management and self-efficacy" (10/19, 53%), and on the clinical outcome "laboratory parameters," including HbA1c and low-density lipoprotein (LDL; 16/33, 48%). Beneficial effects on "health-related quality of life" were seen in only 27% (4/15) of studies. Patient satisfaction (28/30, 93%), feasibility (15/19, 97%), and acceptability (23/26, 88%) were positively evaluated. More beneficial effects were reported for digital health records that predominantly focus on active features. Beneficial effects were less frequently observed among patients with a high disease burden and among high-quality studies. No unfavorable effects were observed. The use of patient-centered digital health records in nonhospitalized individuals with chronic health conditions is potentially associated with considerable beneficial effects on health care utilization, treatment adherence, and self-management or self-efficacy. However, for firm conclusions, more studies of high methodological quality are required. PROSPERO (International Prospective Register of Systematic Reviews) CRD42020213285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213285.

To test the 6-month efficacy of an inclusive non-diagnosis-specific, 7-session parent education curriculum on five pre-specified outcomes. A randomized clinical trial with 100 parents having children 2-11 years with a variety of chronic conditions was conducted. The 7-session curriculum, Building on Family Strengths (BFS), was created by an interdisciplinary pediatric team as a derivative of a successful adult chronic disease self-Management program distributed by Stanford University Patient and Education Research Center. Despite no differences at baseline, intervention participants had higher scores on self-efficacy to manage the child's condition (p = 0.049), coping with childhood chronic illness (p < 0.001), parent-child shared management of the condition (p = 0.097), family quality of life (p = 0.010), and, lower scores on a measure of depressive symptoms (p = 0.046) at the 6-month end-point. Average effect-sizes were modest across outcomes (7-11% improvement) with intervention participants having baseline scores in the least favorable quartile improving the most (12-41%). This research provides evidence that the BFS curriculum can yield significant improvements across five important outcomes for parents of children with various chronic conditions. Parent education programs should be offered especially to parents of children with chronic health conditions, regardless of the type of condition, who lack adequate support. These programs can help parents cope with and manage their children's chronic conditions more effectively.

Physical activity in young children

Introduction Adolescence is a transformative phase of life, defined broadly as a period spanning from 10 to 19 or 21 years of age. This age group occupies a distinct biopsychosocial developmental stage, and living with chronic health conditions (CHCs) increases the burden of navigating both developmental and condition-related challenges. Globally, it is estimated that 15–20% of children and adolescents have CHCs that impact their lifelong experience. Previous research has highlighted concerns about whether adolescents have sufficient information about their prescribed medicines, which may impact their self-management. To date, no previous review has specifically focused on the medicine information needs of adolescents with CHCs. Aim This review aimed to synthesise the existing evidence on the medicine information needs of adolescents with CHCs and how these have been reported to impact their self-management. Methods The review was undertaken in accordance with the PRISMA 2020 guidelines, employing a comprehensive search strategy. Six electronic databases were searched (Medline, EMBASE, EMCare, CINAHL, PsycINFO, and Epistemonikos) from inception to October 2024. Studies were eligible for inclusion if they reported on the medicine information needs of adolescents aged 10–21 years with CHCs who were on regular medication. Qualitative, quantitative, and mixed-methods designs were included, with no restrictions on language. Exclusions were studies outside this age range, without CHCs or medicine, and non-empirical papers. Two independent reviewers conducted screening using the Rayyan web tool, followed by data extraction and quality assessment with the Mixed Methods Appraisal Tool.[1] Thematic synthesis was conducted using an inductive approach, then informed by a deductive approach using the Individual and Family Self-Management Theory framework.[2] Results Of 5000 records screened, fifteen studies were included (eleven quantitative, four qualitative). In total, 1339 adolescents with different types of CHCs were represented. The included studies were heterogeneous in design, setting, participants, and how results were reported. Themes identified included what information adolescents want, who they perceive needs information related to their medicines, and where they prefer to obtain this information. Across studies, adolescents living with CHCs expressed a need for information about their medicines. The most reported information needed was related to potential side effects, followed by treatment options, benefits, and the use and administration of medicines. Adolescents’ medicine information needs were also influenced by their developmental stage, sex/gender, the complexity of their chronic condition, and the period since diagnosis. However, no study to date has primarily focused on identifying the medicine information needs of adolescents with CHCs from their own perspectives. Conclusion This review synthesises existing evidence on adolescents’ medicine information needs, highlighting key concerns reported in the literature. The findings highlight the need for clinicians and healthcare systems to provide adolescents with information about medicines, particularly about potential side effects and treatment options. Strategies are needed to guide how medicine information is provided to adolescents with CHCs, taking into account their developmental stage and the nature of their condition. Strengths of this review included the comprehensive search strategy and adherence to PRISMA 2020; Heterogeneity across studies limits the comparability and synthesis of findings.