Adiposity, fitness, health-related quality of life and the reallocation of time between children's school day activity behaviours: A compositional data analysis

Abstract

Sedentary time (ST), light (LPA), and moderate-to-vigorous physical activity (MVPA) constitute the range of school day activity behaviours. This study investigated whether the composition of school activity behaviours was associated with health indicators, and the predicted changes in health when time was reallocated between activity behaviours. Accelerometers were worn for 7-days between October and December 2010 by 318 UK children aged 10-11, to provide estimates of school day ST, LPA, and MVPA. BMI z-scores and percent waist-to-height ratio were calculated as indicators of adiposity. Cardiorespiratory fitness (CRF) was assessed using the 20-m shuttle run test. The PedsQL™ questionnaire was completed to assess psychosocial and physical health-related quality of life (HRQL). Log-ratio multiple linear regression models predicted health indicators for the mean school day activity composition, and for new compositions where fixed durations of time were reallocated from one activity behaviour to another, while the remaining behaviours were unchanged. The school day activity composition significantly predicted adiposity and CRF (p = 0.04-0.002), but not HRQL. Replacing MVPA with ST or LPA around the mean activity composition predicted higher adiposity and lower CRF. When ST or LPA were substituted with MVPA, the relationships with adiposity and CRF were asymmetrical with favourable, but smaller predicted changes in adiposity and CRF than when MVPA was replaced. Predicted changes in HRQL were negligible. The school day activity composition significantly predicted adiposity and CRF but not HRQL. Reallocating time from ST and LPA to MVPA is advocated through comprehensive school physical activity promotion approaches.

Trial registration: ISRCTN03863885.

Keywords: Accelerometer; CRF, cardiorespiratory fitness; Children; CoDA; HRQL, health-related quality of life; Health; IMD, indices of multiple deprivation; Physical activity; SRT, shuttle run test; Schools; Sedentary behaviour; Time-use epidemiology.

Fig. 1

a–f. Predicted health outcome response surfaces for school day activity compositions. Study took place in the UK in 2010. a. Predicted zBMI (adjusted for SES and sex). b. Predicted %WHtR (adjusted for SES and sex). c. Predicted 20-m SRT laps (adjusted for SES, sex, and zBMI). d. Predicted VO₂ peak (adjusted for SES and sex). e. Predicted psychosocial HRQL (adjusted for SES, sex, and zBMI). f. Predicted physical HRQL (adjusted for SES, sex, and zBMI). Legend. The edges of the triangles are the “time” axes, each grid line represents 10% of the school day (390 min), i.e., 10 = 10% of 390 min, =39 min. The white point represents the mean school-day composition (24.7% LPA; 69% SED, 6.4% MVPA). The black point represents the composition where 10 min (i.e., 2.6% of the school day) have been reallocated from LPA to MVPA, and SED is unchanged. For zBMI the response surface under the white point is green, whereas under the black point it is blue, indicating that zBMI is predicted to decrease with this time reallocation. The colour legend accompanying each ternary surface plot enables interpretation of the white and black points for the other health indicators. Table 4 in the main text includes predicted differences for all 10-minute reallocations around the mean composition (i.e., the white point).