Psychosocial correlates of physical activity in adolescents with haemophilia

Summary. Boys with haemophilia are now encouraged to exercise and take part in physical activities, but actual measures of time spent in active participation is lacking. The aim of this study was to obtain an objective measure of daily physical activity in boys with haemophilia as compared with healthy controls. The study also aimed to ascertain the social and cognitive factors associated with exercise in this population. Seventeen patients (aged 11–18 years) with haemophilia were studied and compared with 44 healthy controls (aged 10–16.5 years). Physical activity was measured by accelerometry. Psychosocial correlates were assessed using validated questionnaires. Measured physical activity levels in subjects with haemophilia were slightly higher than for the control group. Both groups spent 70% of the day inactive, with similar proportions of time in moderate and vigorous activity. Subjects with haemophilia had a favourable self‐image and similar levels of anxiety as peers without a bleeding disorder. Self‐efficacy scores were lower than for controls suggesting increased sensitivity to barriers and lack of acceptance of alternatives. Health beliefs did not influence physical activity, but a negative correlation of time spent in high or vigorous activity with scores for support‐seeking was observed. The data demonstrate that in the appropriate social environment and with medical support, patients with haemophilia may be as physically active as their peers without a bleeding disorder. Further investigation into the psychosocial barriers of physical activity in patients with haemophilia is needed to more effectively encourage healthy behaviours.     

Associations between sedentary behaviour and physical activity in children and adolescents: a meta‐analysis

Physical activity and sedentary behaviour are associated with metabolic and mental health during childhood and adolescence. Understanding the inter‐relationships between these behaviours will help to inform intervention design. This systematic review and meta‐analysis synthesized evidence from observational studies describing the association between sedentary behaviour and physical activity in young people (<18 years). English‐language publications up to August 2013 were located through electronic and manual searches. Included studies presented statistical associations between at least one measure of sedentary behaviour and one measure of physical activity. One hundred sixty‐three papers were included in the meta‐analysis, from which data on 254 independent samples was extracted. In the summary meta‐analytic model (k = 230), a small, but significant, negative association between sedentary behaviour and physical activity was observed (r = ?0.108, 95% confidence interval [CI] = ?0.128, ?0.087). In moderator analyses, studies that recruited smaller samples (n < 100, r = ?0.193, 95% CI = ?0.276, ?0.109) employed objective methods of measurement (objectively measured physical activity; r = ?0.233, 95% CI = ?0.330, ?0.137) or were assessed to be of higher methodological quality (r = ?0.176, 95% CI = ?0.215, ?0.138) reported stronger associations, although effect sizes remained small. The association between sedentary behaviour and physical activity in young people is negative, but small, suggesting that these behaviours do not directly displace one another.     

Habitual physical activity in Dutch children and adolescents with haemophilia

Summary. For patients with haemophilia, a physically active lifestyle is important to maintain musculoskeletal health and to prevent chronic diseases, such as cardiovascular disease. Therefore, we studied physical activity levels, in Dutch children and adolescents with haemophilia as well as its association with aerobic fitness and joint health. Forty‐seven boys with haemophilia (aged 8–18) participated. Physical activity was measured using the Modifiable Activity Questionnaire (MAQ) and was compared with the general population. Aerobic fitness was determined using peak oxygen uptake (VO_2peak). Joint health was measured using the Haemophilia Joint Health Score (HJHS). Associations between physical activity, joint health and aerobic fitness were evaluated by correlation analysis. Subjects were 12.5 (SD 2.9) years old, had a Body Mass Index (BMI) of 19.5 (SD 3.1; z‐score 0.5) and a median HJHS score of 0 (range 0–6). Cycling, physical education and swimming were most frequently reported (86%, 69% and 50% respectively). Children with severe haemophilia participated significantly less in competitive soccer and more in swimming than children with non‐severe haemophilia. Physical activity levels were similar across haemophilia severities and comparable to the general population. VO_2peak kg^?1 was slightly lower than healthy boys (42.9 ± 8.6 vs. 46.9 ± 1.9 mL kg^?1 min^?1; P = 0.03). Joint health, aerobic fitness and physical activity showed no correlation. Dutch children with haemophilia engaged in a wide range of activities of different intensities and showed comparable levels of physical activity to the general population. Aerobic fitness was well preserved and showed no associations with physical activity levels or joint health.     

Relationships among obesity,physical activity and sedentary behavior in young adolescents with and without lifetime asthma

Objective: To examine the inter-relationships among body mass index (BMI), physical activity, sedentary behavior and gender in urban, low-income, primarily African American young adolescents with or without lifetime asthma. Methods: Data were collected in 2002–2004 from 626 12-year old adolescents who were children of women who participated in the New Mother’s Study in Memphis, TN (1990–1991). Adolescents with and without asthma were compared on BMI, physical activity and sedentary behavior. Multiple linear regression models were used to examine the association of asthma, gender and BMI with physical activity and sedentary behavior. Results: Complete data were available for 545 adolescents. Eleven percent of adolescents had lifetime asthma. Asthma and gender were associated with high-intensity physical activity (p?<?0.001). Adolescents with asthma participated in less physical activity and girls participated less than boys. Gender was associated with sedentary behavior (p?<?0.001): boys used personal computer (pc)/video after school more than girls. Girls with asthma had a higher BMI than girls without asthma (p?=?0.027). Boys with asthma were less physically active than boys without asthma (p?<?0.05). Conclusions: Adolescents with asthma are less physically active than those without asthma and girls are less active than boys. Clinicians who provide care for adolescents with asthma are encouraged to assess physical activity/sedentary behavior and provide guidance that promotes active lifestyles. A longitudinal study is needed to shed light on the unique contribution of asthma separated from the effects of overweight/obesity on physical activity and sedentary behaviors.     

A qualitative study identifying the knowledge, attitudes and behaviours of young men with mild haemophilia

The Canadian Physiotherapists in Hemophilia Care (CPHC) sought to learn about attitudes and behaviours of young male adults with mild haemophilia towards their condition and care. Semi-structured in-person or telephone interviews were conducted with 18 young men from and across Canada. This report summarizes the participants' attitudes towards their haemophilia, previous injuries, perceived barriers to seeking treatment, as well as their decision-making process when self-assessing injury. The interviews demonstrated that communication between the young adults and the health care team was not optimal, with common reference to the ineffectiveness of lecture style education. Gaps in knowledge also emerged regarding bleed identification and management.     

Patterns of physical activity in children with haemophilia

The current widespread use of prophylaxis in developed countries has enabled greater participation in physical activity. However, there are no data available on leisure‐time physical activity in Australian children with haemophilia. The data reported here were obtained from a case‐crossover study nested in a prospective cohort study of 104 boys with moderate and severe haemophilia followed for one year. Each child's physical activity was assessed using a modifiable physical activity questionnaire (Kriska's MAQ) administered at baseline, and a one‐week prospective activity diary at a randomly determined time. Children were aged 4–18 years. The median time spent in sport or leisure‐time physical activity in the preceding year was 7.9 h/week (IQR 4.6 to 12.9). The median time spent in vigorous physical activity was 3.8 h/week (IQR 1.6 to 6.4) and in moderate and vigorous physical activity 6.4 h/week (IQR 3.7 to 10.0). The median small‐screen time was 2.5 h/day (IQR 0.5 to 2.5). Forty‐five per cent of all children and 61% of children over the age of 10 years played at least one competitive sport. Averaged across one week, 43% of all children met the Australian government physical activity guidelines for children and 36% met the guidelines for small‐screen time. This study provides the first data regarding leisure‐time physical activity in children with haemophilia living in Australia. The majority of Australian children with haemophilia are not meeting the national physical activity and small‐screen time guidelines.     

Correlates of physical activity and sedentary behavior in adults living with overweight and obesity: A systematic review

Overweight and obesity are consistently associated with lower physical activity (PA) levels and greater sedentary behavior (SB) in population studies. To date, no review has evaluated the factors associated with these behaviors in the specific population who have developed obesity/overweight. The aim of this systematic review was to identify the correlates/determinants of SB and PA in adults with overweight and obesity. Five databases were searched for studies, which reported factors or outcomes relating to PA or SB in adults living with overweight/obesity, published from 1980 to 2021. The factors were categorized using a socioecological model, strength, and direction of association. Of 34,058 articles retrieved, 45 studies were included, and 155 factors were identified. Self-efficacy, intrinsic motivation, exercise enjoyment, self-perceived good health, and social support were consistently associated with higher levels of PA. Consistent negative correlations were married females, increased BMI, obesity severity, pain, number of comorbidities, lack of time, energy, and willpower, and hilly terrain. Few studies (n = 12) examined SB, and no evidence for consistent associations were found. This review identified several correlates specific to PA in this population. Further studies are required to identify directionality and distal correlates for PA and all correlate levels of SB.     

The school environment and adolescent physical activity and sedentary behaviour: a mixed‐studies systematic review

There is increasing academic and policy interest in interventions aiming to promote young people's health by ensuring that the school environment supports healthy behaviours. The purpose of this review was to summarize the current evidence on school‐based policy, physical and social‐environmental influences on adolescent physical activity and sedentary behaviour. Electronic databases were searched to identify studies that (1) involved healthy adolescents (11–18 years old), (2) investigated school‐environmental influences and (3) reported a physical activity and/or sedentary behaviour outcome or theme. Findings were synthesized using a non‐quantitative synthesis and thematic analysis. Ninety‐three papers of mixed methodological quality were included. A range of school‐based policy (e.g. break time length), physical (e.g. facilities) and social‐environmental (e.g. teacher behaviours) factors were associated with adolescent physical activity, with limited research on sedentary behaviour. The mixed‐studies synthesis revealed the importance of specific activity settings (type and location) and intramural sport opportunities for all students. Important physical education‐related factors were a mastery‐oriented motivational climate and autonomy supportive teaching behaviours. Qualitative evidence highlighted the influence of the wider school climate and shed light on complexities of the associations observed in the quantitative literature. This review identifies future research needs and discusses potential intervention approaches to be considered.     

A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta‐analysis of controlled trials

The objective of this study was to systematically review the literature and compare the effectiveness of controlled interventions with a focus on physical activity (PA) and/or sedentary behaviours (SBs) for reducing sedentary time in adults. Six electronic databases were searched to identify all studies that examined the effects of interventions that targeted PA and/or SBs and that reported on changes in SBs (sedentary, sitting or television time). A qualitative synthesis was performed for all studies, and meta‐analyses conducted among studies with mean differences (min/d) of sedentary time. PROSPERO: CRD42014006535. Sixty‐five controlled studies met inclusion criteria; 33 were used in the meta‐analyses. Interventions with a focus on PA or that included a PA and SB component produced less consistent findings and generally resulted in modest reductions in sedentary time (PA: standardized mean differences [SMD] = ?0.22 [95% confidence interval {CI}: ?0.35, ?0.10], PA + SB: SMD = ?0.37 [95% CI: ?0.69, ?0.05]). Moderate quality evidence from the randomized controlled trial meta‐analysis coupled with the qualitative synthesis provides consistent evidence that large and clinically meaningful reductions in sedentary time can be expected from interventions with a focus on reducing SBs (SMD = ?1.28 [95% CI: ?1.68, ?0.87] ). There is evidence to support the need for interventions to include a component focused on reducing SBs in order to generate clinically meaningful reductions in sedentary time.     

Do interventions to limit sedentary behaviours change behaviour and reduce childhood obesity? A critical review of the literature

We sought to determine whether interventions that emphasize decreasing sedentary behaviours in children and adolescents result in behaviour change and weight control. A comprehensive literature search was conducted to identify all comparative studies of interventions to reduce sedentary behaviour among children, alone or in combination with other health messages. Two investigators evaluated articles for eligibility and validity. As methods, settings and interventions differ across studies, results were synthesized narratively. Twelve studies met the inclusion criteria and provided relevant data. Six targeted clinic-based populations that were overweight or at risk of overweight, and six were population-based prevention studies. Approaches varied, but all reduced sedentary behaviour and improved weight indices. An emphasis on decreasing sedentary behaviours is an effective intervention to decrease sedentary behaviours and control weight in children and adolescents.     

Relationship between physical activity,screen-related sedentary behaviors and anxiety among adolescents in less developed areas of China

This study aimed to explore the association between physical activity, screen-related sedentary behaviors, and anxiety. The current study used latent profile analysis (LPA) to identify homogenous subtypes of anxiety among adolescents in less-developed areas of China. Data were aggregated from 6 schools in the less-developed areas of China in September 2018. In total, 900 students were evaluated using the 100-item Mental Health Test (MHT) and Youth Risk Behavior Surveillance System (YRBSS) questionnaire. The LPA was conducted to explore the potential classification of anxiety, which makes full use of all the sample data and explore heterogeneous classifications within groups. Logistic regression was used for the multifactor analysis. A P value <.05 was considered statistically significant. The entropy value suggested that the model with 3 latent profile was the best choice. There were 223 adolescents in the severe anxiety group, accounting for 24.78%. Logistics regression analysis of anxiety revealed that the risk of severe anxiety in boys was lower (odds ratio [OR] = 0.317, P < .001) than in girls. Students had a significantly lower probability of suffering from severe anxiety in using cellphones or computers ≤ 2 hours/day than those used cellphones or computers＞2 hours/day (OR = 0.391, P = .004). Decreasing screen-related sedentary behaviors should be a target of community and school-based interventions, because high screen-related sedentary behaviors were associated with higher odds of anxiety among adolescents in less developed area of China.     

The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity

Most health care professionals involved in the management of people with haemophilia (PWH) believe that exercise is beneficial and its practice is widely encouraged. This article aims to demonstrate that appropriate exercise (adapted to the special needs of the individual PWH) may be beneficial for all PWH through improved physical, psychosocial and medical status. Based on evidence gathered from the literature, many PWH, particularly those using long‐term prophylaxis or exhibiting a mild/moderate bleeding phenotype, are as active as their healthy peers. PWH experience the same benefits of exercise as the general population, being physically healthier than if sedentary and enjoying a higher quality of life (QoL) through social inclusion and higher self‐esteem. PWH can also gain physically from increased muscle strength, joint health, balance and flexibility achieved through physiotherapy, physical activity, exercise and sport. Conversely, very little data exist on activity levels of PWH in countries with limited resources. However, regarding specific exercise recommendations in PWH, there is a lack of randomized clinical trials, and consequently formal, evidence‐based guidelines have not been produced. Based on published evidence from this review of the literature, together with the clinical experience of the authors, a series of recommendations for the safe participation of PWH in regular physical activities, exercises and sport are now proposed. In summary, we believe that appropriately modified programmes can potentially allow all PWH to experience the physical and psychosocial benefits of being physically active which may ultimately lead to an improved QoL.     

Self‐report use‐of‐time tools for the assessment of physical activity and sedentary behaviour in young people: systematic review

Regular physical activity and limiting extended periods of sitting are two behaviours critical for the prevention of obesity in young people. The purpose of the systematic review was to synthesize the psychometric evidence for self‐report use‐of‐time tools that assess these behaviours. Articles were retrieved that reported reliability and/or validity for use‐of‐time tools in participants aged 18 years or under. Outcome variables were physical activity, sedentary behaviour and energy expenditure. Study quality was appraised, and the results summarized narratively. Sixteen studies and six different tools were identified. The tools were the Previous Day Physical Activity Recall, the Three‐Day Physical Activity Recall, the Physical Activity Interview, the Computerized Activity Recall, the Activitygram, and the Multimedia Activity Recall for Children and Adolescents. Overall, tools indicated moderate validity compared with objective and criterion comparison methods. Generally, validity correlation coefficients were in the range of 0.30–0.40. Correlation coefficients for test–retest reliability ranged widely from 0.24 to 0.98. Conclusion: Use‐of‐time tools have indicated moderate reliability and validity for the assessment of physical activity and energy expenditure. Future research should focus on using criterion methods and on validating specifically for sedentary behaviour outcomes. Implementation of these tools for population surveillance should be considered.     

Enhancing lifestyle for individuals with haemophilia through physical activity and exercise: the role of physiotherapy

Summary.  For individuals with haemophilia, the benefits of many forms of physical activity outweigh their risks. Although activities with significant trauma risk should be avoided, persons who have haemophilia can participate in, enjoy and even excel in a variety of physical activities and sports. Both the National Hemophilia Foundation and the World Foundation of Hemophilia have produced documents to guide individuals with haemophilia and their healthcare professionals, coaches and parents in developing physical activity programmes and participation in sports. Physical activity guidelines for promoting health benefits exist worldwide and can be incorporated into individualized exercise programmes to ensure that a person with haemophilia is not only choosing appropriate activities, but also improving overall health and preparing the body to manage haemophilia better. Physiotherapy treatment is paramount in helping individuals prevent, manage and optimally recover from bleeds. Furthermore, the physical therapist, along with the haemophilia care team, can assist in preparing an individual to begin or progress to a physical activity programme that enhances fitness level, body composition and overall well-being. This article presents the unique role of the physiotherapist in facilitating safe participation in quality physical activity in the context of risks, benefits and activity recommendations. Participation in physical activity from an early age is ideal to facilitate the development of body awareness and capability and to foster the adoption of a physically active lifestyle; however, it is never too late to start. Consistent participation in quality physical activity beginning at any age is central to managing haemophilia and, equally important, to achieving overall health and well-being.     

Participation in sports and physical activity of haemophilia patients

Modern therapy options offer haemophiliacs more and more possibilities for an active participation in sports. The purpose of the present study was to investigate the attitude of these patients towards sports, their participation in school and leisure time sports activities, and differences between juveniles and adults. We investigated 44 children and adolescents (aged from 4 to 16 years) and 27 adults (aged from 18 to 72 years) with haemophilia by means of a questionnaire. 79.6% of the juvenile patients participated always or almost always in school sports, while this percentage was significantly (P < 0.05) lower in the former school time of the adults (37%). Sports play an important or very important role in leisure time activities for 75% of the adolescent and 55.5% of the adult haemophiliacs (P < 0.05). Bleeding complications occurred in 17.6% of all patients; there was no correlation with any particular type of sports. There were only slight differences between both groups, regarding their motivation to participate in sports activities. The main reasons involved social aspects and having fun. The results show that the modern therapy of haemophilia probably leads to a more positive attitude towards sports and to a wider spectrum of practised sports. This, however, may be associated with an increasing potential of health risks, which require a high level of sports medical care.