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Papers by Dylan Cliff

A systematic review to update the Australian physical activity guidelines for A systematic review... more A systematic review to update the Australian physical activity guidelines for A systematic review to update the Australian physical activity guidelines for children and young people children and young people

The British journal of nutrition, Jan 16, 2016

The aim of this study was to demonstrate the use of testing for equivalence in combination with t... more The aim of this study was to demonstrate the use of testing for equivalence in combination with the Bland and Altman method when assessing agreement between two dietary methods. A sample data set, with eighty subjects simulated from previously published studies, was used to compare a FFQ with three 24 h recalls (24HR) for assessing dietary I intake. The mean I intake using the FFQ was 126·51 (sd 54·06) µg and using the three 24HR was 124·23 (sd 48·62) µg. The bias was -2·28 (sd 43·93) µg with a 90 % CI 10·46, 5·89 µg. The limits of agreement (LOA) were -88·38, 83·82 µg. Four equivalence regions were compared. Using the conventional 10 % equivalence range, the methods are shown to be equivalent both by using the CI (-12·4, 12·4 µg) and the two one-sided tests approach (lower t=-2·99 (79 df), P=0·002; upper t=2·06 (79 df), P=0·021). However, we make a case that clinical decision making should be used to set the equivalence limits, and for nutrients where there are potential issues wit...

Educational Psychology Review, 2015

Research suggests that integrating human movement into a cognitive learning task can be effective... more Research suggests that integrating human movement into a cognitive learning task can be effective for learning due to its cognitive and physiological effects. In this study, the learning effects of enacting words through whole-body movements (i.e., physical exercise) and part-body movements (i.e., gestures) were investigated in a foreign language vocabulary task. Participants were 111 preschool children of 15 childcare centers, who were randomly assigned to one of four conditions. Participants had to learn 14 Italian words in a 4-week teaching program. They were tested on their memory for the words during, directly after, and 6 weeks after the program. In the integrated physical exercise condition, children enacted the actions indicated by the words to be learned in physical exercises. In the non-integrated physical exercise condition children performed physical exercises at the same intensity, but unrelated to the learning task. In the gesturing condition, children enacted the actions indicated by the words to be learned by gesturing while remaining seated. In the conventional condition, children verbally repeated the words while remaining seated. Results confirmed the main hypothesis, indicating that children in the integrated physical exercise condition achieved the highest learning outcomes. Implications of integrated physical exercise programs for preschool children's cognition and health are discussed.

Sports Medicine, 2016

Gross motor competence confers health benefits, but levels in children and adolescents are low. W... more Gross motor competence confers health benefits, but levels in children and adolescents are low. While interventions can improve gross motor competence, it remains unclear which correlates should be targeted to ensure interventions are most effective, and for whom targeted and tailored interventions should be developed. The aim of this systematic review was to identify the potential correlates of gross motor competence in typically developing children and adolescents (aged 3-18 years) using an ecological approach. Motor competence was defined as gross motor skill competency, encompassing fundamental movement skills and motor coordination, but excluding motor fitness. Studies needed to assess a summary score of at least one aspect of motor competence (i.e., object control, locomotor, stability, or motor coordination). A structured electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Six electronic databases (CINAHL Complete, ERIC, MEDLINE Complete, PsycINFO(®), Scopus and SPORTDiscus with Full Text) were searched from 1994 to 5 August 2014. Meta-analyses were conducted to determine the relationship between potential correlates and motor competency if at least three individual studies investigated the same correlate and also reported standardized regression coefficients. A total of 59 studies were identified from 22 different countries, published between 1995 and 2014. Studies reflected the full range of age groups. The most examined correlates were biological and demographic factors. Age (increasing) was a correlate of children's motor competence. Weight status (healthy), sex (male) and socioeconomic background (higher) were consistent correlates for certain aspects of motor competence only. Physical activity and sport participation constituted the majority of investigations in the behavioral attributes and skills category. Whilst we found physical activity to be a positive correlate of skill composite and motor coordination, we also found indeterminate evidence for physical activity being a correlate of object control or locomotor skill competence. Few studies investigated cognitive, emotional and psychological factors, cultural and social factors or physical environment factors as correlates of motor competence. This systematic review is the first that has investigated correlates of gross motor competence in children and adolescents. A strength is that we categorized correlates according to the specific ways motor competence has been defined and operationalized (object control, motor coordination, etc.), which enables us to have an understanding of what correlates assist what types of motor competence. Indeed our findings do suggest that evidence for some correlates differs according to how motor competence is operationalized.

Cliff, Dylan P., Promoting physical activity among overweight and obese children: a randomised co... more Cliff, Dylan P., Promoting physical activity among overweight and obese children: a randomised controlled trial comparing a physical activity program, a dietary program and a combined physical activity plus dietary program, Doctor of Philosophy thesis, Faculty of Education, University of Wollongong, 2008. The Faculty of Education 2008 ii CERTIFICATION I, Dylan Cliff, declare that this thesis, submitted in fulfilment of the requirements for the award of Doctor of Philosophy, in the Faculty of Education, University of Wollongong, is wholly my own work unless otherwise referenced or acknowledged. The document has not been submitted for qualification at any other academic institution. Signed ____________________________ Dylan Cliff Date: iii ABSTRACT Childhood overweight and obesity is prevalent in both developed and developing countries world-wide, and urgent and effective response is required. To date, methodological limitations in paediatric obesity treatment trials have precluded recommendations advocating specific treatment strategies. Physical inactivity is implicated in the aetiology of obesity, however, published experimental trials evaluating interventions designed to promote physical activity in overweight and obese children have been compromised by the same methodological limitations as many paediatric obesity treatment trials. The aim of this study was to compare the efficacy of the following interventions for the promotion of habitual physical activity, fundamental movement skill proficiency and perceived competence and for reducing adiposity in overweight and obese children: a child-centred physical activity skill-development program (PA), a parent-centred dietary modification program (DIET) and a childcentred physical activity skill-development program plus a parent-centred dietary modification program (PA+DIET).

Pediatric exercise science, Jan 25, 2015

Single sex after-school physical activity programs show potential to prevent unhealthy weight gai... more Single sex after-school physical activity programs show potential to prevent unhealthy weight gain. The aim of this study was to assess the acceptability and potential efficacy of single-sex after-school physical activity programs for overweight and at-risk children from low-income communities. 7-month, 2-arm parallel-group, RCT, conducted at an elementary school in a disadvantaged area in Wollongong, Australia (March-November 2010). 20 boys and 17 girls were randomized to intervention (PA) or active comparison groups (HL). Primary outcomes included implementation, acceptability, percentage body fat and BMI z-score. The PA programs were acceptable with high implementation and enjoyment rates. At 7 months postintervention girls in the PA group displayed greater changes in percentage body fat (adjust diff. = -1.70, [95% CI -3.25, -0.14]; d = -0.83) and BMI z-score (-0.19 [-0.36, -0.03]; d= -1.00). At 7 months boys in the PA group showed greater changes in waist circumference (-3.87 cm...

Journal of Science and Medicine in Sport, 2015

Objectives: To assess the effect of a school playground intervention on the physical activity lev... more Objectives: To assess the effect of a school playground intervention on the physical activity levels of primary/elementary aged children.

Childhood overweight and obesity is prevalent in both developed and developing countries world-wi... more Childhood overweight and obesity is prevalent in both developed and developing countries world-wide, and urgent and effective response is required. To date, methodological limitations in paediatric obesity treatment trials have precluded recommendations advocating specific treatment strategies. Physical inactivity is implicated in the aetiology of obesity, however, published experimental trials evaluating interventions designed to promote physical activity in overweight and obese

The Journal of Pediatrics, 2015

To identify distinct trajectories of health-related quality of life (HRQOL) during childhood, alo... more To identify distinct trajectories of health-related quality of life (HRQOL) during childhood, along with their predictors. A nationally representative sample of 2700 children aged 4-5 years at baseline was followed up every 24 months through to age 12-13 years. Parents reported the children's HRQOL and data on potential predictors at each wave (5 in total) as part of the Longitudinal Study of Australian Children. Growth mixture modeling identified 5 distinct trajectories of HRQOL during childhood. Eighty-five percent of children had consistently high levels of HRQOL from age 4-5 years to 12-13 years (healthy); 8% of children had a significant and continuous decrease in HRQOL over time (high risk); and a further 5.3% of children had decreases in HRQOL from age 4-5 years to 8-9 years, followed by increases through to 12-13 years (rebound). Finally, a small percentage (1.6%) of children had extremely low levels of HRQOL at age 4-5 years that increased over time (recovery). Maternal smoking, lower household income, living in a non-English speaking household, and nonparticipation in organized sports were predictive of poorer HRQOL trajectories when compared with children in the healthy trajectory. There are distinct trajectories of HRQOL during childhood. Most children (85%) have a healthy, stable pattern, but the remaining children have trajectories indicative of poor HRQOL. Participation in sports, maternal smoking, lower family income, and language spoken at home distinguish among these trajectories. Of these, participation in organized sports has received relatively little attention as a preventative health priority.

International Journal of Pediatric Obesity, 2010

To examine the relationship between weight status and child, parent and community characteristics... more To examine the relationship between weight status and child, parent and community characteristics among young boys and girls. Cross-sectional data were collected from 1 299 5-7-year-old children and their parents from 20 government primary schools in New South Wales, Australia. Measures included parental report of time spent in physical and sedentary activities, time spent with parents, parental working hours, parental perceptions of their child's physical competence and children's actual physical competence. Overweight boys spent more time watching television (p = 0.001 for weekday) and in quiet play (p = 0.007 for weekdays and p = 0.006 for weekends) and less time away from their parents (p = 0.01) than their lean counterparts. Parents of overweight boys perceived them to be less competent in the skill of running than parents of non-overweight boys (p = 0.001). Overweight girls spent more time watching television on weekends compared with their non-overweight peers (p = 0.008), and were less proficient in overall actual competence (p = 0.008), particularly overall locomotor skill proficiency (p = 0.001). Several modifiable relationships between weight status and child, parental and community characteristics were identified. Importantly these relationships differed between boys and girls. We suggest that early school years may be an appropriate time to intervene through targeting the identified characteristics.

International Journal of Pediatric Obesity, 2011

Medicine and science in sports and exercise, 2015

This study aimed to establish whether the peak plantar pressures generated by overweight and obes... more This study aimed to establish whether the peak plantar pressures generated by overweight and obese school-age children during walking were associated with their objectively measured physical activity. Physical activity levels of a subset of 73 overweight/obese children from a randomized controlled trial (mean ± SD: age, 8.3 ± 1.1 yr; 47 girls; body mass index z-score, 2.7 ± 0.7) were objectively measured using accelerometers. Plantar pressure distributions were also quantified as the participants walked over a pressure platform. Pearson product moment correlation coefficients were calculated to determine the strength of the relations between the peak plantar pressures generated during walking and the physical activity levels for overweight/obese children. Peak pressures generated beneath the forefoot during walking were inversely correlated with time spent in different intensity levels of physical activity. Moderate-intensity (r = -0.321, P = 0.007), vigorous-intensity (r = -0.326, ...

Journal of science and medicine in sport / Sports Medicine Australia, Jan 24, 2014

Recent research has shown that machine learning techniques can accurately predict activity classe... more Recent research has shown that machine learning techniques can accurately predict activity classes from accelerometer data in adolescents and adults. The purpose of this study is to develop and test machine learning models for predicting activity type in preschool-aged children. Participants completed 12 standardised activity trials (TV, reading, tablet game, quiet play, art, treasure hunt, cleaning up, active game, obstacle course, bicycle riding) over two laboratory visits. Eleven children aged 3-6 years (mean age=4.8±0.87; 55% girls) completed the activity trials while wearing an ActiGraph GT3X+ accelerometer on the right hip. Activities were categorised into five activity classes: sedentary activities, light activities, moderate to vigorous activities, walking, and running. A standard feed-forward Artificial Neural Network and a Deep Learning Ensemble Network were trained on features in the accelerometer data used in previous investigations (10th, 25th, 50th, 75th and 90th perce...

A systematic review to update the Australian physical activity guidelines for A systematic review... more A systematic review to update the Australian physical activity guidelines for A systematic review to update the Australian physical activity guidelines for children and young people children and young people

The British journal of nutrition, Jan 16, 2016

The aim of this study was to demonstrate the use of testing for equivalence in combination with t... more The aim of this study was to demonstrate the use of testing for equivalence in combination with the Bland and Altman method when assessing agreement between two dietary methods. A sample data set, with eighty subjects simulated from previously published studies, was used to compare a FFQ with three 24 h recalls (24HR) for assessing dietary I intake. The mean I intake using the FFQ was 126·51 (sd 54·06) µg and using the three 24HR was 124·23 (sd 48·62) µg. The bias was -2·28 (sd 43·93) µg with a 90 % CI 10·46, 5·89 µg. The limits of agreement (LOA) were -88·38, 83·82 µg. Four equivalence regions were compared. Using the conventional 10 % equivalence range, the methods are shown to be equivalent both by using the CI (-12·4, 12·4 µg) and the two one-sided tests approach (lower t=-2·99 (79 df), P=0·002; upper t=2·06 (79 df), P=0·021). However, we make a case that clinical decision making should be used to set the equivalence limits, and for nutrients where there are potential issues wit...

Educational Psychology Review, 2015

Research suggests that integrating human movement into a cognitive learning task can be effective... more Research suggests that integrating human movement into a cognitive learning task can be effective for learning due to its cognitive and physiological effects. In this study, the learning effects of enacting words through whole-body movements (i.e., physical exercise) and part-body movements (i.e., gestures) were investigated in a foreign language vocabulary task. Participants were 111 preschool children of 15 childcare centers, who were randomly assigned to one of four conditions. Participants had to learn 14 Italian words in a 4-week teaching program. They were tested on their memory for the words during, directly after, and 6 weeks after the program. In the integrated physical exercise condition, children enacted the actions indicated by the words to be learned in physical exercises. In the non-integrated physical exercise condition children performed physical exercises at the same intensity, but unrelated to the learning task. In the gesturing condition, children enacted the actions indicated by the words to be learned by gesturing while remaining seated. In the conventional condition, children verbally repeated the words while remaining seated. Results confirmed the main hypothesis, indicating that children in the integrated physical exercise condition achieved the highest learning outcomes. Implications of integrated physical exercise programs for preschool children's cognition and health are discussed.

Sports Medicine, 2016

Gross motor competence confers health benefits, but levels in children and adolescents are low. W... more Gross motor competence confers health benefits, but levels in children and adolescents are low. While interventions can improve gross motor competence, it remains unclear which correlates should be targeted to ensure interventions are most effective, and for whom targeted and tailored interventions should be developed. The aim of this systematic review was to identify the potential correlates of gross motor competence in typically developing children and adolescents (aged 3-18 years) using an ecological approach. Motor competence was defined as gross motor skill competency, encompassing fundamental movement skills and motor coordination, but excluding motor fitness. Studies needed to assess a summary score of at least one aspect of motor competence (i.e., object control, locomotor, stability, or motor coordination). A structured electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Six electronic databases (CINAHL Complete, ERIC, MEDLINE Complete, PsycINFO(®), Scopus and SPORTDiscus with Full Text) were searched from 1994 to 5 August 2014. Meta-analyses were conducted to determine the relationship between potential correlates and motor competency if at least three individual studies investigated the same correlate and also reported standardized regression coefficients. A total of 59 studies were identified from 22 different countries, published between 1995 and 2014. Studies reflected the full range of age groups. The most examined correlates were biological and demographic factors. Age (increasing) was a correlate of children's motor competence. Weight status (healthy), sex (male) and socioeconomic background (higher) were consistent correlates for certain aspects of motor competence only. Physical activity and sport participation constituted the majority of investigations in the behavioral attributes and skills category. Whilst we found physical activity to be a positive correlate of skill composite and motor coordination, we also found indeterminate evidence for physical activity being a correlate of object control or locomotor skill competence. Few studies investigated cognitive, emotional and psychological factors, cultural and social factors or physical environment factors as correlates of motor competence. This systematic review is the first that has investigated correlates of gross motor competence in children and adolescents. A strength is that we categorized correlates according to the specific ways motor competence has been defined and operationalized (object control, motor coordination, etc.), which enables us to have an understanding of what correlates assist what types of motor competence. Indeed our findings do suggest that evidence for some correlates differs according to how motor competence is operationalized.

Cliff, Dylan P., Promoting physical activity among overweight and obese children: a randomised co... more Cliff, Dylan P., Promoting physical activity among overweight and obese children: a randomised controlled trial comparing a physical activity program, a dietary program and a combined physical activity plus dietary program, Doctor of Philosophy thesis, Faculty of Education, University of Wollongong, 2008. The Faculty of Education 2008 ii CERTIFICATION I, Dylan Cliff, declare that this thesis, submitted in fulfilment of the requirements for the award of Doctor of Philosophy, in the Faculty of Education, University of Wollongong, is wholly my own work unless otherwise referenced or acknowledged. The document has not been submitted for qualification at any other academic institution. Signed ____________________________ Dylan Cliff Date: iii ABSTRACT Childhood overweight and obesity is prevalent in both developed and developing countries world-wide, and urgent and effective response is required. To date, methodological limitations in paediatric obesity treatment trials have precluded recommendations advocating specific treatment strategies. Physical inactivity is implicated in the aetiology of obesity, however, published experimental trials evaluating interventions designed to promote physical activity in overweight and obese children have been compromised by the same methodological limitations as many paediatric obesity treatment trials. The aim of this study was to compare the efficacy of the following interventions for the promotion of habitual physical activity, fundamental movement skill proficiency and perceived competence and for reducing adiposity in overweight and obese children: a child-centred physical activity skill-development program (PA), a parent-centred dietary modification program (DIET) and a childcentred physical activity skill-development program plus a parent-centred dietary modification program (PA+DIET).

Pediatric exercise science, Jan 25, 2015

Single sex after-school physical activity programs show potential to prevent unhealthy weight gai... more Single sex after-school physical activity programs show potential to prevent unhealthy weight gain. The aim of this study was to assess the acceptability and potential efficacy of single-sex after-school physical activity programs for overweight and at-risk children from low-income communities. 7-month, 2-arm parallel-group, RCT, conducted at an elementary school in a disadvantaged area in Wollongong, Australia (March-November 2010). 20 boys and 17 girls were randomized to intervention (PA) or active comparison groups (HL). Primary outcomes included implementation, acceptability, percentage body fat and BMI z-score. The PA programs were acceptable with high implementation and enjoyment rates. At 7 months postintervention girls in the PA group displayed greater changes in percentage body fat (adjust diff. = -1.70, [95% CI -3.25, -0.14]; d = -0.83) and BMI z-score (-0.19 [-0.36, -0.03]; d= -1.00). At 7 months boys in the PA group showed greater changes in waist circumference (-3.87 cm...

Journal of Science and Medicine in Sport, 2015

Objectives: To assess the effect of a school playground intervention on the physical activity lev... more Objectives: To assess the effect of a school playground intervention on the physical activity levels of primary/elementary aged children.

Childhood overweight and obesity is prevalent in both developed and developing countries world-wi... more Childhood overweight and obesity is prevalent in both developed and developing countries world-wide, and urgent and effective response is required. To date, methodological limitations in paediatric obesity treatment trials have precluded recommendations advocating specific treatment strategies. Physical inactivity is implicated in the aetiology of obesity, however, published experimental trials evaluating interventions designed to promote physical activity in overweight and obese

The Journal of Pediatrics, 2015

To identify distinct trajectories of health-related quality of life (HRQOL) during childhood, alo... more To identify distinct trajectories of health-related quality of life (HRQOL) during childhood, along with their predictors. A nationally representative sample of 2700 children aged 4-5 years at baseline was followed up every 24 months through to age 12-13 years. Parents reported the children's HRQOL and data on potential predictors at each wave (5 in total) as part of the Longitudinal Study of Australian Children. Growth mixture modeling identified 5 distinct trajectories of HRQOL during childhood. Eighty-five percent of children had consistently high levels of HRQOL from age 4-5 years to 12-13 years (healthy); 8% of children had a significant and continuous decrease in HRQOL over time (high risk); and a further 5.3% of children had decreases in HRQOL from age 4-5 years to 8-9 years, followed by increases through to 12-13 years (rebound). Finally, a small percentage (1.6%) of children had extremely low levels of HRQOL at age 4-5 years that increased over time (recovery). Maternal smoking, lower household income, living in a non-English speaking household, and nonparticipation in organized sports were predictive of poorer HRQOL trajectories when compared with children in the healthy trajectory. There are distinct trajectories of HRQOL during childhood. Most children (85%) have a healthy, stable pattern, but the remaining children have trajectories indicative of poor HRQOL. Participation in sports, maternal smoking, lower family income, and language spoken at home distinguish among these trajectories. Of these, participation in organized sports has received relatively little attention as a preventative health priority.

International Journal of Pediatric Obesity, 2010

To examine the relationship between weight status and child, parent and community characteristics... more To examine the relationship between weight status and child, parent and community characteristics among young boys and girls. Cross-sectional data were collected from 1 299 5-7-year-old children and their parents from 20 government primary schools in New South Wales, Australia. Measures included parental report of time spent in physical and sedentary activities, time spent with parents, parental working hours, parental perceptions of their child's physical competence and children's actual physical competence. Overweight boys spent more time watching television (p = 0.001 for weekday) and in quiet play (p = 0.007 for weekdays and p = 0.006 for weekends) and less time away from their parents (p = 0.01) than their lean counterparts. Parents of overweight boys perceived them to be less competent in the skill of running than parents of non-overweight boys (p = 0.001). Overweight girls spent more time watching television on weekends compared with their non-overweight peers (p = 0.008), and were less proficient in overall actual competence (p = 0.008), particularly overall locomotor skill proficiency (p = 0.001). Several modifiable relationships between weight status and child, parental and community characteristics were identified. Importantly these relationships differed between boys and girls. We suggest that early school years may be an appropriate time to intervene through targeting the identified characteristics.

International Journal of Pediatric Obesity, 2011

Medicine and science in sports and exercise, 2015

This study aimed to establish whether the peak plantar pressures generated by overweight and obes... more This study aimed to establish whether the peak plantar pressures generated by overweight and obese school-age children during walking were associated with their objectively measured physical activity. Physical activity levels of a subset of 73 overweight/obese children from a randomized controlled trial (mean ± SD: age, 8.3 ± 1.1 yr; 47 girls; body mass index z-score, 2.7 ± 0.7) were objectively measured using accelerometers. Plantar pressure distributions were also quantified as the participants walked over a pressure platform. Pearson product moment correlation coefficients were calculated to determine the strength of the relations between the peak plantar pressures generated during walking and the physical activity levels for overweight/obese children. Peak pressures generated beneath the forefoot during walking were inversely correlated with time spent in different intensity levels of physical activity. Moderate-intensity (r = -0.321, P = 0.007), vigorous-intensity (r = -0.326, ...

Journal of science and medicine in sport / Sports Medicine Australia, Jan 24, 2014

Recent research has shown that machine learning techniques can accurately predict activity classe... more Recent research has shown that machine learning techniques can accurately predict activity classes from accelerometer data in adolescents and adults. The purpose of this study is to develop and test machine learning models for predicting activity type in preschool-aged children. Participants completed 12 standardised activity trials (TV, reading, tablet game, quiet play, art, treasure hunt, cleaning up, active game, obstacle course, bicycle riding) over two laboratory visits. Eleven children aged 3-6 years (mean age=4.8±0.87; 55% girls) completed the activity trials while wearing an ActiGraph GT3X+ accelerometer on the right hip. Activities were categorised into five activity classes: sedentary activities, light activities, moderate to vigorous activities, walking, and running. A standard feed-forward Artificial Neural Network and a Deep Learning Ensemble Network were trained on features in the accelerometer data used in previous investigations (10th, 25th, 50th, 75th and 90th perce...