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Inuence of Activity Patterns in Fitness During Youth

Authors Aliations

L. Aires1, G. Silva1, C. Martins1, M. P. Santos1, J. C.Ribeiro1, J. Mota2


1 2

Faculty of Sports Research Centre in Physical Activity, Health and Leisure, University of Porto, Portugal FADEUP, CIAFEL, Porto, Portugal

The aim of this study was to analyze longitudinal associations between cardiorespiratory tness, physical activity and body mass index in a 4-year longitudinal study. 170 students (97 girls and 73 boys) aged at baseline from 11 to 17 years were followed. Students performed 20-m-SR; physical activity patterns and parents education were evaluated using a standard questionnaire. Body mass index was categorized according to established cut points. In a multilevel analysis using MLwIN, 2 level structures were dened: rst for individuals and second for time observations. In a longitudinal 2 level analysis, cardiorespiratory tness was

Introduction
accepted after revision October 31, 2011 Bibliography DOI http://dx.doi.org/ 10.1055/s-0031-1297955 Published online: February 29, 2012 Int J Sports Med 2012; 33: 325329 Georg Thieme Verlag KG Stuttgart New York ISSN 0172-4622 Correspondence Prof. Luisa Aires Faculty of Sports University of Porto Research Centre in Physical Activity Health and Leisure Rua Plcido Costa, 91 4200-250 Porto Portugal Tel.: +351/225/074 700 Fax: +351/225/500 689 luisa.aires@gmail.com

It is well known that physical activity (PA) and cardiorespiratory tness (CRF) may inuence health status during childhood and adolescence, protecting youth from excessive weight gain as well as other metabolic diseases [20]. Moreover, a decline of CRF in children and adolescents may be enhanced by increases in adiposity [22]. PA has been promoted as a lifelong positive health behaviour and CRF is proposed as a major marker of health status at any age [16]. However, childrens PA and CRF are declining globally [24] probably as a consequence of youths preference for sedentary activities [15, 19]. In general, PA in youth can be divided into 2 categories: non-organized activities such as playing with friends in leisure time and organized activity such as participation on a sports team. A 15-year longitudinal study covering adolescence and young adulthood showed a gradual decline in the total weekly time and energy expenditure spent on physical activities. In the course of time organized sports activities became a relatively more important component of the total weekly activity time in both genders predominantly caused by a drop in

non-organized sports activities [26]. Organized PA participation such as team sports might be an important source of intensive and regular exercise, increasing habitual PA and consequently leading to improved cardiovascular function and physical tness over time [23]. Some authors suggested that increasing overall PA through dierent behaviour could contribute to preventing the decline of CRF [5]. However, other authors gave emphasis to the sustained high intensity levels [3]. Although a large number of health promotion programs aim to change activity patterns, few longitudinal data are available about PA pattern and its eects on CRF level, especially in children. Therefore, the aim of this longitudinal study was to nd out how the variance of BMI, overall PA and dierent domains of PA could explain the variance of CRF over 4 years of observation throughout adolescence.

Material and Methods Sample


This is a school-based longitudinal study carried out in a secondary school in Valongo (Porto

Aires L et al. Inuence of Activity Patterns Int J Sports Med 2012; 33: 325329

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Key words longitudinal study physical activity cardiorespiratory tness body mass index adolescence

Abstract

negatively associated with body mass index for girls and boys, respectively (p < 0.05; R2 = 0.63; 0.62), especially with obesity category (p < 0.01; R2 = 0.58; 0.60). In girls, independent associations were observed between CRF and PA categories regarding participation almost every day in organized (p < 0.05; R2 = 0.50) and non-organized sports outside school (p < 0.05; R2 = 0.52) and participation in sports competitions (p < 0.05; R2 = 0.51). In boys, associations were found only with participation in sports competitions (p < 0.05; R2 = 0.50). The results highlight the importance of youth participation in organized activities and competitive sports over time to achieve health-related tness benets.

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District) comprising all the students from the 7th up to the 12th year. Over a period of 4 academic years, 2005 (TP0), 2006 (TP1), 2007 (TP2), and 2008 (TP3), 97 girls and 73 boys with mean ages of 13.28 1.26 (TP0), 14.25 1.28 (TP1), 15.24 1.28 (TP2) and 16.24 1.28 (TP3) were followed. 2 weeks before the annual measurements took place a letter was sent to the students families informing them about this. Written given consent was required. The experimental protocol was approved by the Review Committee of the Scientic Board of the Faculty of Sport of the University of Porto as well as by the Foundation of Science and Technology and performed in accordance with the ethical standards required elsewhere [8].

an inability to keep the required pace. All participants were familiar with the test, since the Fitnessgram test battery is included in the Portuguese Physical Education curriculum. Therefore, most of the students perform the 20 m-SR test 3 times a year. The result was recorded as laps taken to complete the 20 m-SR. Further, the participants received verbal encouragement from the investigators in order to achieve maximum performance. Exhaustion was conrmed when subjects desired to stop or demonstrated an inability to maintain the required running pace despite strong verbal encouragement. A sub-sample of 48 participants had also been tested using the 20 m-SR test and achieved the pre-determined exhaustion criteria. These data are presented elsewhere [21].

Anthropometric measurements
Height was measured using a Holtain stadiometer. Values of height were recorded in meters to the nearest centimeters. Body mass was measured to the nearest 0.1 kg with an electronic weight scale (Tanita Inner Scan BC 532) with subjects in t-shirts and shorts. BMI was calculated from the ratio weight/height2 (Kg/m2) categorized as normal weight, overweight or obese using age and sex specic cut points [4].

Physical activity
PA was assessed by a questionnaire [9] previously determined to have good reliability with strong intra-class correlation coecients (ICC: 0.920.96) [12, 18]. The questionnaire had 5 questions with 4 or 5 answer choices (4 or 5-point scale): 1 Do you take part in organized sport outside school? (Never; Less than once a week; At least once a week; Almost every day) 2 Do you take part in non-organized sport outside school? (Never; Less than once a week; At least once a week; Almost every day) 3 How many times per week do you take part in sport or PA for at least 20 min outside school? (Never; Less than once a week; Between once a week and once a month; 2 or 3 times a week; 4 times a week or more) 4 How many hours per week do you usually take part in PA so much that you get out of breath or sweat outside school? (Never; 30 min to 1 h; 23 h; 46 h; 7 h or more) 5 Do you take part in sports competition? (Never; No, but I already had; Yes, at school; Yes, in a club). A PA index (PAI) was obtained according to the total sum of the points (maximum 22) with increasing ranks from the sedentary to vigorously activity levels.

Maturational stage
Children and youths were grouped according to maturation stages determined by Tanners criteria. To determine maturational stage (ranging from stage 1 to 5), each subject was asked to self-assess his/her stage of secondary sex characteristics. Stage of breast development in females and pubic hair in males were evaluated which had previously been validated in a similar sample [13].

Cardiorespiratory tness
Cardiorespiratory tness was evaluated using the 20 m-Shuttle Run (20 m-SR) from Fitnessgram battery test [27]. This is a widely validated instrument to assess CRF [21]. Briey, the test consists in running back and forth between 2 lines 20 m apart, with running speed determined by audio signals from a pre-recorded music CD. The running speed increases at the end of each 1-min stage. The running speed is 8.0 km.h-1 for the rst stage, 9.0 km.h1 for the second stage, and thereafter increases by 0.5 km.h-1 each minute. The test ends when the subjects twice fail to reach the lines at the time indicated by the audio signals, demonstrating

Parents education level


Parents educational level categories were based on the Portuguese Educational system: (1) 9 years education or less subsecondary level; (2) 1012 years education secondary level and (3) College/Master/Doctoral degree higher education level). These 3 levels were named as low, middle and high level of education. Similar procedures have previously been applied in the Portuguese context [14].

Table 1 Participants characteristics. TP0 N age weight (kg) height (m) pai bmi (kg.m-2) 20 m-SR (n laps) age weight (kg) height (m) pai bmi (kg.m-2) 20 m-SR (n laps) 94 80 80 68 80 94 73 57 57 52 57 73 Mean 13.31 53.02 c,d 1.60 b.c,d 11.72 20.93 c,d 24.97 b.c,d 13.25 54.54 b.c,d 1.62 b.c,d 13.67 20.52 b.c,d 36.58 b.c,d SD 1.22 13.39 0.07 4.01 4.52 13.27 1.32 13.47 0.11 4.13 3.77 17.34 Mean 14.26 55.26 c,d 1.62 c,d 11.25 21.23 c,d 32.6 a 14.22 a 60.79 1.67 c,d 13.85 21.53 c,d 48.39c,d TP1 SD 1.23 11.68 0.07 3.86 4.09 13.27 1.33 14.47 0.09 4.16 3.96 18.24 Mean 15.26 57.66a 1.63 11.40 21.98 34.09 15.19 65.59 1.72d 14.19 22.02 58.58 TP2 SD 1.26 11.23 0.06 3.76 4.14 13.8 1.33 14.04 0.07 4.28 3.96 20.04 Mean 16.26 58.55a 1.63 11.28 22.20 35.18 16.16 65.48 1.73 12.85 21.84 62.97 TP3 SD 1.26 11.82 0.07 3.9 4.53 13.29 1.33 13.73 0.07 4.76 4.04 19.27

girls

boys

Repeated measures analysis of variance used to test for mean dierences between the 4 time points; Adjustment for multiple comparisons with Bonferroni; the mean dierence is signicant at the 0.05 level; PAI (Physical Activity Index)
a

Signicantly dierent from TP0; b Signicantly dierent from TP1; c Signicantly dierent from TP2; d Signicantly dierent from TP3

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Table 2 Unstandardized regression coecients () and 95 % condence intervals (95 % CI) for each Physical Activity category for girls. Model 1 SE 95 % CI for SE 0.28 2.86 3.45 0.25 4.04 2.01 2.98 2.81 2.16 3.15 3.02 2.54 2.59 4.01 BMI a 0.38 0.21 ( 079; 0.02) 0.93 overweight 5.64 2.05 ( 9.65; 1.63)* 5.62 obesity 12.44 3.30 ( 18.90; 5.97)** 15.67 PAI 0.29 0.19 (1.18; 0.66) 0.85 1 Do you take part in organized sport outside school? 0.22 less than once a week 1.59 2.75; 5.94) 4.45 at least once a week 2.15 1.50 ( 0.78; 5.08) 3.97 almost every day 2.42 2.06 ( 1.62; 6.47) 10.32 2 Do you take part in non-organized sport outside school? 1.94 less than once a week 3.46 ( 0.34; 7.25) 5.15 at least once a week 2.89 1.41 (0.13; 5.66)* 1.36 almost every day 2.14 2.11 ( 1.99; 6.27) 9.72 3 How many times/week do you take part in sport or physical activity for at least 20 min outside school? 2.25 4.16 less than once a month 5.63 (1.21; 10.04)* between once a week and once a month 4.46 1.95 (0.64; 8.28)* 4.16 2 or 3 times a week 4 times a week or more 2.07 2.75 1.93 2.8 ( 1.71; 5.85) ( 2.70; 8.20) 5.89 14.22 Model 2 95 % CI for ( 1.48; 0.37)* ( 11.22; 0.01) ( 22.42; 8.92)** (0.37; 1.33)* ( 3.47; 12.36) (0.02; 16.15) (4.48; 11.76)* ( 0.36; 10.67) ( 2.88; 5.60) (3.54; 15.90)* ( 1.75; 10.08)* ( 0.83; 9.14) ( 0.81; 10.96) (6.36; 22.07)

Reference category for BMI Normal weight and for PA Never; Model 1 Raw model (1 degree of freedom); Model 2 Adjusted model for age, maturation, parents education and BMI (5 degrees of freedom)
a

Model 2 Adjusted model for age, maturation and parents education (4 degrees of freedom)

*p < 0.05; ** p < 0.001

Statistical procedures
Descriptive statistics were used to characterize the sample (mean and standard deviation), and general linear model (repeated measures) to analyze dierences between baseline (Time Point 0; TP0) and the last year of evaluation (TP3). Multilevel analyses were performed with MLwIN (version 2.16) [25]. This method was chosen because the number of observations per individual may vary and multilevel analysis does not use strict conditions concerning the type of missing, as it assumes missing at random. Multilevel analysis was used to determine the eect of BMI and PA in CRF (number of laps) over time. 2 level structures were used: rst level for individuals and second level for time. The model is given with the intercept b0 (estimation of the intercept) and b1 the regression coecient for time (estimation of the slope). For each variable (BMI, PAI and PA categories) 2 models were analyzed. The rst one was a raw model and the second model was adjusted for maturation, parents education, and BMI. Condence intervals and Wald tests were calculated and signicances were found according to the degrees of freedom. Repeated measures were performed with SPSS (version 18). The signicance level was 5 %.

Results
Participants characteristics (Mean and SD) are presented in
Table 1 according to gender in TP0, TP1, TP2 and TP3. Repeated

measures showed signicant dierences between each time point. Both genders presented higher body mass, height, BMI and higher scores in 20 m-SR between TP0, TP1 and TP3 (p < 0.05) but not between TP2 and TP3. No signicant dierences were found for PAI over the 4 years. Table 2, 3 show the longitudinal relationship between CRF, BMI and PA according to gender. For girls and boys, respectively, CRF showed a negative association with BMI (p < 0.05; R2 = 0.63; p < 0.05; 0.62). Signicance remained for obesity when BMI was categorized in raw (p < 0.001; R2 = 0.46; p < 0.001; R2 = 0.36) and in adjusted models (p < 0.001; R2 = 0.58; p < 0.001; R2 = 0.60). Positive associations were also observed between CRF and PAI in raw model for boys (p < 0.001; R2 = ; 0.34) and in adjusted models for girls and boys (p < 0.05; R2 = 0.53; p < 0.05; R2 = 0.49). When each question from the PA questionnaire was analyzed (adjusted models), positive associations were found in questions 1, 2 and 5 for girls, and in question 5 for boys. Specically, for girls taking part in organized (p < 0.05; R2 = 0.50) or non-organized sports outside school almost every day (p < 0.05; R2 = 0.52) and being engaged in sports competitions (p < 0.05; R2 = 0.51) better performances in CRF were observed. Boys being engaged in sports competitions currently or in the past (p < 0.05; R2 = 0.50) showed a higher CRF comparied to those who never took part in sports activities outside school.

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4 How many hours per week do you usually take part in physical activity so much that you get out of breath or sweat outside school? 1.05 1.53 ( 4.05; 1.94)* ( 4.87; 7.32) 30 min to 1 hour 0.49 2.24 23 h 0.42 1.76 ( 3.86; 3.02)* 0.004 2.29 ( 4.49; 6.52) 46 h 1.00 3.94 ( 8.72; 6.71) 0.82 8.43 ( 15.61; 22.33) 7 h or more 5.35 9.52 ( 13.31; 24.01) 0.49 2.24 ( 4.87; 3.90) 5 Do you take part in competitive sport? 6.39 1.73 (3.01; 9.77)* ( 1.19; 7.77) no, but I did before 3.29 2.28 yes, at school level 3.90 1.93 (0.12; 7.68)* 2.71 2.52 ( 2.24; 7.66) yes, in a sports club 7.34 2.69 (2.06; 12.62)* 15.07 3.43 (8.35; 21.79)*

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Table 3 Unstandardized regression coecients () and 95 % condence intervals (95 % CI) for each Physical Activity category for boys. Model 1
a

Model 2 95 % CI for SE 95 % CI for

SE

Reference category for BMI Normal weight and for PA Never; Model 1 Raw model (1 degree of freedom); Model 2 Adjusted model for age, maturation, parents education and BMI (5 degrees of freedom)
a

Model 2 Adjusted model for age, maturation, SES (4 degrees of freedom)

*p < 0.05; **p < 0.001

Discussion
This longitudinal study explored the association between CRF, BMI and PA patterns over 4 years of evaluation. Although there were positive associations of PAI with CRF both in boys and girls, our ndings showed that after adjustments for BMI, in girls sustained high frequency of PA through organized or non-organized sports outside school and taking part in competitive sports was independently associated with CRF, whereas in boys signicant associations were found only for competitive sports. This multilevel model showed that the variance of BMI and PA categories explained 5063 % of the variance in CRF. Our results are consistent with other authors who stress the importance of exercise intensity [7, 10, 20]. The observation that these associations are more restricted in boys may be due to the higher PA and CRF values at baseline observed in boys, and consequently only PA at a higher relative intensity is supposed to have an eect on the tness level [1]. This dierence was also reported in previous studies, where sex- and intensity-specic PA thresholds discriminate between adolescents with higher CRF levels [11]. Conversely, other authors also found positive and signicant associations between objectively measured light and moderate PA and CRF [6, 11]. However, it must be noted that in the previous study moderate PA showed weaker association with CRF than vigorous PA, which concurs with our results. Considering the concomitant inuences of both PA and body fatness on CRF [10], it is important to emphasize the associations
Aires L et al. Inuence of Activity Patterns Int J Sports Med 2012; 33: 325329

found after adjustments for BMI. These ndings suggest that independent inuence of PA domains, characterized by dierent parameters such as intensity, volume or frequency, might be related to dierent physiological doseresponse. Indeed, it is not surprising that those who took part in competitive sports presented better performances in CRF. High-intensity exercise levels normally characterize training condition. On average, youth sport can contribute to higher percentage of total minutes of moderate to vigorous PA, whereas leisure time activity and PE may be less relevant given the limitations of most schools regarding the number of students per class, their heterogeneity and space available [28]. The Portuguese Ministry of Education provides School Sports Clubs with free access and voluntary participation. It is an important source of PA and tness training and it signicantly inuences the health status in youths and plays a prominent role in promoting PA in this population [2, 17]. There are limitations to our study such as the relatively small sample size and the absence of objective measures to analyze PA. Although questionnaires are a valid tool to assess PA patterns, some youngsters have diculties to recall, quantify and categorize this type of information about their behaviour. Moreover, the use of accelerometers would capture additional objective information about the intensity and volume of PA. The lack of a direct determination of the maximal oxygen uptake can also be considered a limitation. However, the 20 m-SR test is a standardized, reliable, and valid tool for assessing CRF in the eld, considering the intention of the study. The strength of this study was

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0.58 0.415 ( 1.39; 0.231) 1.47 0.42 ( 2.31: 0.63) * BMI overweight 14.16 3.614 ( 21.25; 7.081)** 10.48 3.88 ( 18.10; 2.87) obesity 26.36 5.243 ( 36.63; 16.080)** 24.17 5.38 ( 34.73; 13.62)** PAI 0.83 0.338 0.16;1.488** 1.25 0.35 (0.57; 1.926)* 1 Do you take part in organized sport outside school? 4.51 5.043 5.28 5.38 ( 5.26; 15.82) less than once a week ( 5.37; 14.396) at least once a week 5.95 3.501 ( 0.92; 12.807) 11.29 3.84 (3.77; 18.81) almost every day 8.83 3.545 (1.89; 15.781)* 9.46 3.59 (2.43; 16.48) 2 Do you take part in non-organized sport outside school? 10.77 4.03 4.61 (0.65; 18.73) less than once a week (2.86; 18.673)* 9.69 at least once a week 5.86 3.28 ( 0.56; 12.291) 6.28 3.30 ( 0.18; 12.74) almost every day 8.28 3.52 (1.39; 15.170)* 3.68 3.66 ( 3.48; 10.85) 3 How many times/week do you take part in sport or physical activity for at least 20 min outside school? 4.79 6.28 6.33 ( 11.01; 13.81) less than once a month ( 7.51; 17.09) 1.40 between once a week and once a month 5.93 5.50 ( 4.86; 16.72) 2.31 6.01 ( 9.46; 14.08) 2 or 3 times a week 6.84 4.89 ( 2.74; 16.41) 4.56 5.28 ( 5.79; 14.92) 4 times a week or more 12.91 5.33 (2.46; 23.35)* 11.60 6.11 ( 0.38; 23.58) 4 How many hours per week do you usually take part in physical activity so much that you get out of breath or sweat outside school? 1.44 4.08 3.90 ( 8.51; 6.78) 30 min to 1 h ( 9.44; 6.55) 0.85 23 h 2.74 3.99 ( 5.09; 10.56) 3.70 2.06 ( 0.34; 7.75) 46 h 2.82 4.89 ( 6.76; 12.40) 9.14 5.288 ( 1.23; 19.50) 7 h or more 7.33 8.76 ( 9.83; 24.50) 15.38 7.57 (0.54; 30.21) 5 Do you take part in competitive sport? 7.44 4.12 4.16 (5.95; 22.26)* no, but I did before ( 0.63; 15.50) 14.10 yes, at school level 6.75 4.95 ( 2.94; 16.45) 12.02 5.06 (2.11; 21.93) yes, in a sports club 12.40 4.33 (3.91; 20.90)** 15.55 4.042 (7.63; 23.47)*

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its longitudinal design with repeated measures. Based on our ndings and other research evidence, we encourage the inclusion of CRF testing in health monitoring systems. Appropriate tness tests can provide relevant indicators for PE teachers, as they are also related to dierent levels of healthy lifestyles of children and adolescents. In conclusion, although more research is needed to further elucidate the complex interrelationships between CRF, BMI and PA patterns in youths, the ndings from our study emphasize the importance of youth participation in organized sport competition as an asset for a healthy lifestyle. Thus, interventions should target these factors through a variety of strategies including environment and policy reinforce to promote competitive sports in and outside school.

Acknowledgements
This study was supported in part by The Foundation of Science and Technology (FCT) with a research project [reference PTDC/ DES/72424/2006 (FCOMP-01-0124-FEDER-007183)].

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