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In This Article

  • Summary
  • Abstract
  • Introduction
  • Protocol
  • Results
  • Discussion
  • Disclosures
  • Acknowledgements
  • Materials
  • References
  • Reprints and Permissions

Summary

This study proposes an accelerometer-based method to objectively measure physical activity (PA) and leisure time physical activity (LTPA) in Chinese children accepting table tennis training in clubs.

Abstract

An increasing body of evidence now shows that the majority of children in China experience lower levels of physical activity (PA) than the recommended guideline. Table tennis is a compound and technically difficult game that is popular in China; undertaking table tennis training in clubs can help children to elevate their levels of PA. Given that children cannot complete self-evaluated questionnaires themselves and caregiver-based observations are not suitable for children, we hypothesized that an actigraphy-based method can be an objective method to measure PA. In the present study, we describe a procedure that can be used to evaluate PA levels using an actigraphic device and software. Furthermore, since hip-worn devices are known to reduce compliance, we attempted to assess the agreement between hip-worn and wrist-worn device data. Collectively, our results indicate that these devices are suitable for measuring PA and leisure time physical activity (LTPA) levels. Together with subjective questionnaires, both hip-worn and wrist-worn devices are highly suitable for evaluating PA in Chinese children undergoing table tennis training in clubs.

Introduction

Physical activity (PA) is very important in childhood and is positively associated with physical and mental health. It is well documented that PA is associated with beneficial effects in school-going children with regards to obesity, bone health, mental wellbeing, cognitive function, and academic achievements1,2,3. However, most children in China still experience lower levels of PA than recommended for their age4; furthermore, sedentary time is known to increase with age. According to the National Physical Fitness and Health Surveillance Study for Students in China, the number of students with obesity has remained significantly high over the first two decades of the 21st century5.

International PA guidelines for children and adolescents recommend at least 60 min of moderate-to-vigorous physical activity (MVPA) per day and vigorous physical activity (VPA) on 3 days/week6 in order to achieve health benefits. Similarly, the latest version of the Physical Activity Guidelines for Chinese (2021)7 highlights that accumulated sedentary behavioral time should not last for more than 60 min, based on international PA guidelines. Participation in sports clubs or school activities is a highly beneficial way by which children can meet PA guidelines8. Table tennis is a compound and technically difficult game that is popular in China. Recent studies have confirmed that regular table tennis training has a positive effect on the health-related physical fitness of children and adolescents9,10. As such, table tennis club/school-based training is a very suitable method for children to increase their levels of PA11.

It is important to consider several issues that might impede the fulfillment of the recommendations made by international PA guidelines. For example, most surveys of PA in children are based on parent-reported questionnaires12; there is a significant lack of data acquired by objective methods in China. Furthermore, the activity patterns of children are characterized by relatively short bouts of spontaneous, but intense PA13,14. This type of pattern is difficult to summarize and report by observation alone; additionally, questionnaires or parental reports are prone to error15. Secondly, children spend a significant amount of leisure time at home, for example, during the evenings and weekends, and tend to accumulate a substantial part of their daily PA in a home-based setting. It is difficult to collect or estimate leisure time physical activity (LTPA) in children outside of school hours. LTPA is essential for health and is one of the most important components of total PA16. Thirdly, the PA of children may be influenced by gender differences and parental life style8. Collectively, this information highlights the need to acquire accurate measurements of PA to evaluate overall health, its social impact, and its use in policy making. If the activity levels of specific subpopulations (e.g., children undergoing table tennis training) are not correctly estimated, it is possible that the data may even misdirect policies and public health priorities12.

As the most widely used objective measurement for PA patterns in youths, accelerometers have been recognized as the gold standard for measuring PA in children17,18,19,20. With technological improvements, actigraphic devices have progressed into cost-effective capacitive sensors. In most cases, these devices need to be attached to the right hip21, an issue that might be a potential risk factor and lowers compliance22. Over recent years, several research studies have indicated that PA data derived from devices worn at other anatomical locations can be comparable when set-up appropriately23,24.

In the present study, we aimed to develop a wrist-worn actigraphy accelerometer-based method to assess PA in children undergoing table tennis training.

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Protocol

This study was approved by the Academic Ethics Committee of Inner Mongolia Medical University in Hohhot, China. The parents of all children included in this study provided signed and informed consent. In the study, we used the Actigraph GT3X+ device which is referred to as an accelerometer hereafter.

1. General aspects of method development

  1. Obtain accelerometers to evaluate PA. The accelerometer is a small (3.3 cm x 4.6 cm x 1.5 cm, 19 g), watch-like unobtrusive device that measures acceleration in three axes: vertical, antero-posterior, and medio-lateral.
  2. Connect the device to a laptop PC with USB cable. Use an exclusive software for data recording, processing, and analyzing.
  3. Select participants according to the following inclusion/exclusion criteria.
    1. Include 20 children between 7-12 years of age who accept table tennis training as the Sports group. Include children who attend the table tennis club regularly, with three-to-five weekly training session,s with each training session lasting 2 h. Include children living majorly in a house or rented flat with their parents with a short home-to-club distance.
    2. Select 20 children from the same class as the Sports group as an age and gender matched Control group. Children of the Control group don't attend any sports club.
  4. Exclude participants whose parents do not know their children's PA information at school and home.
  5. Exclude participants who were diagnosed to have any neurodevelopment disorder such as Attention Deficit and Hyperactivity Disorder (ADHD), autism, Developmental Coordination Disorder (DCD), etc.

2. Initialization of data collection using the accelerometer

  1. Download and run the software for the device.
  2. Type in the duration for collecting data by clicking the button Select Start Time and entering the date (e.g., 2022/2/9) and time (e.g., 13:00).
  3. Click the button Enter Subject Info to enter the next step about demographic information setting. Type in the demographic information of the participant, including name, gender, height, weight, date of birth, ethnic, side (right), limb (waist), and dominance (dominant).
    NOTE: For the left-handed participants, in step 2.4 select the opposite side.
  4. Initialize the data collection by clicking Initialize 1 device. Make sure that the battery is charged to more than 80%, otherwise the initialization will fail. Initialize to record raw accelerations at a frequency of 30 Hz.
  5. Instruct the participants to wear the accelerometer on the right hip with an elastic waistband. Ensure that the accelerometer is positioned on the right mid-axilla line at the level of the iliac crest.
  6. Repeat step 2.2. Set the same start date (e.g., 2022/2/9) and time (e.g., 13:00), to ensure that the data from both devices is collected at the same time.
  7. Repeat 2.4 with the following modifications: side (left), limb (wrist), dominance (non-dominant).
    NOTE: For the left-handed participants, in step 2.8 select the opposite side.
  8. Instruct the participants to wear the accelerometer on the wrist of the non-dominant hand on a watch belt.
  9. Remind the participants to wear the devices all day long, except while bathing, swimming, and showering.
    NOTE: The duration of data collection should not be shorter than 7 days. (e.g., from 13:00, 2022/2/9 to 12:59, 2022/2/16).
  10. For the raw data collected, get the data confirmed by a physician, institutional researcher, or professional coach, according to the VM chart and counts (Figure 1).
  11. Delete any extreme data that is unexplained (e.g., from 21:41, 2022/2/12 to 22:07, 2022/2/12, the data was zero, and cannot be explained). Delete such data from the collected raw data.

3. Data collection from diary entries

  1. Ask the participants to wear the device all day long. Ask the trainers to maintain a diary of table tennis training, including the exact time schedule. For the children of the Control group, no diary of training is needed.
  2. Make sure that the participants performed their daily routines during data collection.
  3. Ask the parents to maintain a diary of leisure time at home. Instruct the parents to collect the data of sleep, the time to bed, and the time of waking up in the diary.

4. Accelerometer data output

  1. Take off the device from the right hip and connect it to a laptop/PC with a USB cable. Run the software of the device.
  2. Download the accelerometer data of the participant, by clicking Download. Analyze raw accelerometer data in 60 s epochs.
  3. Take off the device from the non-dominant hand and connect it to a laptop/PC with a USB cable. Repeat step 4.2.
  4. Raw acceleration outcome variables for the accelerometer are based on vector magnitude (VM) counts. Confirm the accelerometer data of LTPA according to the diary of training, leisure time, and sleep.

5. Scoring the data

  1. Open the scoring page of the software (Figure 2).
  2. Select Algorithms > Cut Points and MVPA > Puyau Children (2002) on the left of the page.
    NOTE: Other algorithms for the cut points of PA can be selected if necessary.
  3. Click Calculate and then Export, and the scoring output will be displayed automatically, including SBs (sedentary behaviors), LPAs (light physical activities), MPAs (moderate physical activities), and MVPAs (moderate-to-vigorous physical activities).
  4. Obtain everyday-LTPA by adding diary timing and defining leisure time (e.g., the leisure time of 2022/2/9 is from 19:00, 2022/2/9 to 21:00 2022/2/6, according to the diary). Then, define the mean VM counts during this time as 715.75, and the LTPA for this epoch as 715.75.
  5. Average all the everyday-LTPAs, to get the LTPA for the participant.

6. Statistical analysis

  1. Use Student's t-test to measure group differences with a P value less than 0.05 considered statistically significant. Use a commercially available statistical software package to conduct all statistics.
  2. Use the Bland-Altman procedures to assess agreement for each PA, including MPA, VPA, and MVPA, between hip-worn and wrist-worn devices based on raw data and counts. Calculate the mean difference between the two methods of measurement and 95% limit of agreement for the mean difference calculated.

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Results

Demographic data are shown in Table 1, including gender, age, height, weight, ethnicity, and dominant hand. As shown in Table 1, there were no significant differences between the groups with regards to gender, age, height, weight, and dominant hand. Furthermore, participants from the Sports group did not exhibit any significantly different parameters in terms of sedentary behaviors (SB; 441.05 ± 31.80 vs 442.25 ± 30.74, P = 0.904), LPA (213.10 ± 15.00 vs ...

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Discussion

As shown in Table 1, children in the Sports group exhibited a significantly higher VPA and MVPA (64.20 ± 2.33 vs 57.85 ± 3.36, P < 0.001) relative to those in the Control group. According to the findings of previous reports in both adolescents25 and young adults26, accelerometer devices represent an accurate method for the estimation of PA, relative to subjective surveys.

Bland-Altman plots demonstrated tha...

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Disclosures

The authors have nothing to disclose.

Acknowledgements

We thank Ms Shuo Tian for the digital technology support. This study was supported by the Wu Jieping Foundation (Grant No. 320.6750.18456).

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Materials

NameCompanyCatalog NumberComments
Actigraph ActiGraph Corp GT3X+device
ActiLifeActiGraph Corp v6.13.3software
SPSS 22.0 softwarestatistical analysis software

References

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Physical Activity MeasurementChildrenTable Tennis TrainingAccelerometersActigraphic DeviceWrist wornHip wornNeuro development DisorderData CollectionDemographic InformationParticipant MonitoringRaw AccelerationsComplianceData ConfirmationTraining ScheduleLeisure Time Tracking

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