title: Prevalence and correlates of achieving recommended physical activity levels among children living in rural South Asia-A multi-centre study.
abstract: We report the prevalence of recommended physical activity levels (RPALs) and examine the correlates of achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes.
  
  
  
  This analysis on rural South Asian children aged 5-14 years (n = 564) is a part of the Chronic Disease Risk Factor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Data on socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administered questionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used to examine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) were associated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were used to investigate associations between RPALs and anthropometrics (BMI- and waist z-scores).
  
  
  
  The majority of children (71.8 %) belonged to households where a parent had at least a secondary education. Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had ≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10-14 years, OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel actively to school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children in Matlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3; 95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5-9 years, OR = 1.6; 95 % CI: 1.1, 2.4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education (OR = 2.1; 95 % CI: 1.1, 4.1). In multivariate analyses, sedentary activity ≤ 2 h/day was associated with lower BMI-z-scores (β = -0.3; 95 % CI: -0.5, -0.08) and lower waist-z-scores (β = -1.1; 95 % CI: -2.2, -0.07).
  
  
  
  Only one quarter of children in these rural areas achieved RPAL in active travel, leisure and sedentary activity. Improved understanding of RPAL in rural South Asian children is important due to rapid socio-economic transition.
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 4th Floor, Plot.No.47, Sector 44, Gurgaon, 122002, Haryana, India. g.krithiga@phfi.org.
authors.forename: Krithiga
authors.initials: K
authors.lastname: Shridhar
authors.affiliation: Department of Primary Care and Public Health, Imperial College, Reynolds Building, Charing Cross Campus, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.affiliation: Department of Primary Care and Public Health, Imperial College, Reynolds Building, Charing Cross Campus, London, UK.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Laverty
authors.affiliation: Centre for Global Health Research, Li KaShing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Dewan
authors.initials: D
authors.lastname: Alam
authors.affiliation: Goa Medical College, Sangath, Bardez, Goa, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Dias
authors.affiliation: Voluntary Health Services, Chennai, India.
authors.forename: Joseph
authors.initials: J
authors.lastname: Williams
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 4th Floor, Plot.No.47, Sector 44, Gurgaon, 122002, Haryana, India.
authors.forename: Preet K
authors.initials: PK
authors.lastname: Dhillon
mesh_terms: D000293:Adolescent; D001208:Asia; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004032:Diet; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007194:India; D007899:Leisure Activities; D008019:Life Style; D016015:Logistic Models; D008297:Male; D010290:Parents; D015995:Prevalence; D012424:Rural Population; D012574:Schools; D057185:Sedentary Behavior; D012959:Socioeconomic Factors; D014186:Transportation
keywords: Active travel; Anthropometrics; BMI-z- score; Children; LMIC; Physical activity; Sedentary activity; South Asia; Waist- z- score