Activity Levels in Mothers and Their Preschool
Children
WHAT’S KNOWN ON THIS SUBJECT: Physical activity is beneficial to health. Parents are crucial in shaping children’s behaviors, with active mothers appearing to have active children. Little is known about this association in preschool-aged children, or about factors influencing activity in mothers of young children.
WHAT THIS STUDY ADDS: Mother-child physical activity levels were positively associated and influenced by temporal and demographic factors. Maternal activity levels were low, and influences differ by activity intensity. Health promotion efforts to increase activity in mothers may also benefit their young children.
abstract
OBJECTIVES: To investigate the association between objectively mea-sured maternal and preschool-aged children’s physical activity, determine how this association differs by demographic and temporal factors, and identify factors associated with maternal activity levels.
METHODS:In the UK Southampton Women’s Survey, physical activity levels of 554 4-year-olds and their mothers were measured concurrently by using accelerometry for#7 days. Two-level mixed-effects linear regression was used to model the association between maternal and children’s minutes spent sedentary, in light (LPA) and moderate-to-vigorous physical activity (MVPA). Linear regression was used to investigate correlates of maternal activity.
RESULTS:Mother-child daily activity levels were positively associated at all activity intensities (sedentary, LPA, and MVPA; allP,.001). The association for sedentary time was stronger for normal-weight children (versus those who were overweight/obese), and those attending preschool part-time (versus full-time). The mother-child association for LPA differed by maternal education and was stronger at the weekend (versus weekdays). The opposite was true for MVPA. Sedentary time and MVPA were most strongly associated in mornings, with LPA most strongly associated in the evenings. Maternal BMI, age leaving school, number and age of children at home, and working hours were independently associated with maternal daily sedentary time and LPA.
CONCLUSIONS:Physical activity levels in mothers and their 4-year-old children are directly associated, with associations at different activity intensities influenced by temporal and demographic factors. Influences on maternal physical activity levels also differ by activity intensity. Providing targeted interventions for mothers of young children may increase both groups’activity.Pediatrics2014;133:e973–e980
AUTHORS:Kathryn R. Hesketh, MPhil,aLaura Goodfellow,
MBBS, MRes,bUlf Ekelund, PhD,c,dAlison M. McMinn, PhD,a,c
Keith M. Godfrey, BM, PhD,b,eHazel M. Inskip, PhD,bCyrus
Cooper, MA, DM,bNicholas C. Harvey, MB, PhD,band Esther
M.F. van Sluijs, PhDa,c
aUK Clinical Research Collaboration Centre of Excellence for Diet
and Activity Research, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom;bMedical Research
Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom;
cMedical Research Council Epidemiology Unit, University of
Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom;
dDepartment of Sport Medicine, Norwegian School of Sport
Sciences, Oslo, Norway; andeNational Institute of Health
Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
KEY WORDS
physical activity, preschool children, mother-child relations
ABBREVIATIONS
CI—confidence interval GMR—geometric mean ratio LPA—light physical activity
MVPA—moderate-to-vigorous physical activity
Ms Hesketh developed the research question, cleaned the physical activity data, conducted the data analyses and interpretation of the results, and re-drafted the manuscript; Dr Goodfellow conducted the initial analyses, drafted the initial manuscript, and critically reviewed the manuscript; Dr Ekelund conceptualized and designed the physical activity data collection, designed the data collection instruments, and reviewed and revised the manuscript; Dr McMinn contributed to the development of the research question, and contributed to data analysis and manuscript drafting; Dr Godfrey was responsible for the overall Southampton Women’s Survey study concept and design, oversaw the collection of data, and reviewed and revised the manuscript; Drs Inskip and Cooper were responsible for the overall Southampton Women’s Survey study concept and design, oversaw the collection of data, and critically reviewed the manuscript; Dr Harvey was responsible for the overall Southampton Women’s Survey study concept and design, oversaw the collection of data, helped conceptualize the research question, and reviewed and revised the manuscript; Dr van Sluijs conceptualized and designed the physical activity data collection, designed the data collection instruments, conceptualized the research question, and reviewed and revised the manuscript; and all authors approved thefinal manuscript as submitted.
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with strong cross-sectional associa-tions seen between physical activity and health outcomes in school-aged chil-dren.1–5 Similar benefits have been
observed in younger children, with active children showing improved so-cial and motor development,6and
de-creased adiposity.7 Yet despite these
benefits, activity levels are known to decrease through childhood into adulthood.8,9 This extends into the
childbearing years, with new parents tending to be less active than their childless counterparts,10,11 and failing
to meet recommended activity guide-lines.12As activity levels frequently fail
to return to pre-parenthood levels,8
and parental activity may influence that of their small children,13,14
un-derstanding this association is impor-tant for health promotion.
Both direct and indirect15 mechanisms
have been proposed for an association between activity of children and their parents, ranging from genetic infl ue-nces,16through the psychosocial impact
parents may have via modeling or sup-port,17,18 to mutual participation.19–21
Review evidence does, however, suggest the association between parental and preschool children’s activity is in-consistent.13,14This is likely due in part to
varying study methods, and in particular the widespread use of self-report mea-sures of physical activity.22,23
Using an objective measure of physical activity (accelerometers20 and
pe-dometers24), studies in older children
report positive associations between children’s and parents’physical activ-ity. In preschool-aged children, several small studies also reported positive associations between child’s and ma-ternal,17 paternal,10,17 and parental
physical activity levels23 by using
ob-jectively measured activity. Few studies have explored how this association differs over the course of the day and
influence activity on weekdays and weekends. Also, with increasing num-bers of children attending out-of-home care,26,27 child care attendance and
temporal factors may be important to consider when promoting activity.
In a large population-based sample, this study explores the association between 4-year-old children’s and their mothers’ objectively measured time-stamped physical activity, and assesses if this association is moderated by demo-graphic and temporal factors. Given the potentially important influence of ma-ternal activity, we also determine fac-tors associated with mothers’activity levels, providing novel information to aid future health promotion efforts.
METHODS Participants
The Southampton Women’s Survey is a population-based prospective cohort study based in Southampton, UK. Full details of participant recruitment and data collection procedures are pre-sented elsewhere.28 Between 1998 and
2002, all female patients aged 20 to 34 years were approached to participate through general practices. Subsequent live births (n= 3159) were followed to examine how a child’s prenatal de-velopment interacts with their postnatal growth, and how both may affect risk factors for future chronic diseases.28All
children turning 4 between March 2006 and June 2009 and their mothers (n= 1065) were invited into a secondary study that included assessment of ha-bitual physical activity. Parental consent was obtained. Ethical approval for the study was granted by the Southampton and Southwest Hampshire Local Re-search Ethics Committee.
Physical Activity Assessment At the age 4 visit, children (n= 594) and their mothers (n= 595) werefitted with
measure free-living physical activity. The Actiheart is a lightweight combined heart-rate monitor and accelerometer, positioned on the chest, previously val-idated in preschool-aged children29and
adults.30The Actiheart was set to record
at 60-second epochs to maximize ca-pacity. Participants wore the monitor continuously for up to 7 days, including during sleep and water-based activities. Monitors and a previously validated maternal questionnaire31 (n = 569)
assessing potential correlates of physi-cal activity were returned by post.
Physical Activity Variables
Only accelerometer data are used for these analyses, as equations to com-bine accelerometer and heart-rate data to estimate free-living physical activity energy expenditure are yet to be de-veloped for the preschool age group. Both child and maternal accelerometer data, derived as cpm, were analyzed using a bespoke program (MAHUffe32).
Actiheart counts were converted to Actigraph counts by using a conversion factor of 5, derived and validated ex-perimentally.33
Data periods of $100 minutes with zero-activity counts were removed,7as
were days with ,600 minutes of re-cording.34All recordings between 11PM
and 6 AM were removed, with those between 9PMand 11PMremoved if they included more than 45 minutes of sedentary time, deemed to reflect the hours children spent sleeping. This method represents a conservative es-timate of sleep time,35while minimizing
Thresholds for light (LPA;$20 cpm) and moderate-to-vigorous (MVPA;$400 cpm) activity were used to determine time spent at each activity intensity for each hour. True sedentary time was calculated by subtracting “active” time ($20 cpm) from total valid reg-istered time. Average daily minutes spent at each activity intensity were also calculated. The Actiheart inten-sity thresholds have been derived ex-perimentally33,36 and equate to 100
counts for LPA and 2000 counts for MVPA in the Actigraph 7164 accel-erometer (Actigraph, Pensacola, FL). These broadly aligned with the re-spective preschool-specific intensity thresholds.37–40
Other Variables
Having appraised the evidence of ac-tivity in young children,14,41and
moth-ers of young children,10,11,42a range of
other variables were used. Hour, time of the day, and week were obtained from the accelerometer output. Days were split into 3 periods: morning (6– 12PM), afternoon (12–5PM), and even-ing (5–11PM). Season was defined as follows: winter, December to February; spring, March to May; summer, June to August; autumn, September to Novem-ber. Child’s age and gender were recorded, and child’s and mother’s height and weight were measured during the visit.43Mother’s and child’s
BMI and child’s BMI z score44 were
calculated. Children and mothers were categorized as underweight, normal weight, or overweight/obese by using the International Obesity Task Force45
and World Health Organization46
clas-sifications, respectively.
Data from the maternal self-report questionnaire were used to derive remaining demographic variables. Age mother left full-time education was classified as follows:#16 years, 17 to 18 years, and .18 years. Day care, nursery, or preschool attendance was
classified as full-time ($30 hours per week) or part-time/other (,30 hours per week). Presence of older or youn-ger siblings was used to quantify chil-dren living in the home: cohort child only, child plus younger siblings, child plus older siblings, child plus older and younger siblings. A dichotomous vari-able was created for the child’s father being present at home (yes/no). The number of hours mothers worked each week was categorized as follows: not in work, part-time (,30 hours), full-time ($30 hours).
Statistical Analysis
Analyses were carried out by using Stata/SE 12 (Stata Corp, College Station, TX). All mother-child dyads with $1 shared valid day of activity were includ-ed. Descriptive characteristics were calculated, and sensitivity analyses conducted to compare those dyads with $1 or $3 days of valid activity data. A significance level of .05 was set a priori.
Using children’s daily activity as the outcome, 2-level random intercept models were used to model the as-sociation between minutes children spent sedentary, in LPA and MVPA, and maternal activity. Hierarchical models allowed for variation in outcome tween days (level 1) and variation be-tween children (level 2).47Correlations
between observations were accounted for by allowing the intercept to vary randomly between children (ie, level 2).
Due to a non-normal distribution, child’s MVPA was log-transformed be-fore analysis. Regression coefficients were subsequently back-transformed and presented as a geometric mean ratio (GMR); any deviation from 1 indi-cates a percentage change in child’s MVPA per unit change in mother’s MVPA relative to the reference category. All models were adjusted for child’s gen-der and weight status, age mother left full-time education, time child spent at
preschool, and time of the week (weekday versus weekend). To test for effect modification, each of these vari-ables was entered separately as an interaction with maternal activity. Fi-nally, the association between mater-nal and child activity segmented across the day (morning, afternoon, evening) was assessed.
To explore the potential correlates of maternal activity, average daily activity (during her child’s waking hours) at each of the 3 intensities was used as the outcome variable in univariable linear regression models. All models were adjusted for child’s activity and plausible predictors of maternal phys-ical activity were added into the mod-els, including maternal age and BMI, age leaving full-time education, chil-dren at home, living with a partner, and hours worked. All variables significantly associated with mother’s activity were carried forward and entered simul-taneously into a multiple regression analysis. Variables not meeting the predefined P, .05 significance level were sequentially removed.
RESULTS
A total of 554 mother-child dyads had valid physical activity data for 1 or more shared days (mean 4.9 days [SD 1.6]). Compared with those not participating in activity assessment, participating mothers were slightly older when their child was born (mean age 30.4 [3.8] vs 31.1 [3.6] years, respectively;P= .004) and better educated (27.5% with higher degree versus 31.3%,P= .014). No dif-ferences in activity levels were ob-served between those children (and therefore mothers) with $1 and $3 days; therefore, all dyads with $1 shared day(s) of valid activity data were included. Descriptive character-istics for mother-child dyads are pre-sented in Table 1, with average activity levels presented in Table 2.
Associations Between Child and Maternal Physical Activity
In adjusted models, there was a positive association between children’s and their mother’s average daily activity at each intensity (Table 3); for each extra minute of maternal activity, children engaged in 0.18 minutes more seden-tary time, 0.14 minutes LPA, and 10% more MVPA. These associations did not differ by child’s gender. There were significant interaction effects for sed-entary time by child’s weight status and attending preschool. The association between LPA and MVPA differed by mother’s age at leaving school. The association for LPA was stronger for mothers who left at 17 to 18 years compared with mothers who left at #16 years. For MVPA, the association was stronger for mothers who left school at #16 years compared with those who left after 18 years. The as-sociation also differed by time of week,
with LPA most strongly associated at the weekend (versus weekdays), whereas the opposite was observed for MVPA. The positive association between maternal and child physical activity remained when activity levels were segmented across the day. The strongest associa-tions were seen in the morning for sed-entary time and MVPA, and in the evenings for LPA (Table 3).
Correlates of Maternal Activity In adjusted analyses, maternal BMI (b= 2.8 minutes [95% confidence interval (CI) 1.3 to 4.3]) and working full-time (44.8 [14.3 to 75.4]) were positively associated with mother’s average sed-entary time, whereas maternal dura-tion of schooling was negatively associated with sedentary time (ie, leaving school at 17–18 years: –26.9 minutes [–47.1 to –6.7];.18 years:
–27.5 minutes [–48.3 to–6.7] compared with leaving at age 16) (Supplemental
working (part-time: –26.9 [–47.1 to
–6.7]; full-time:–39.4 [–68.7 to–10.1]) negatively associated with activity. Having more than 1 younger child at home was positively associated with mothers’average daily LPA (48.7 [25.8 to 71.7]). There were no significant associations with maternal MVPA.
DISCUSSION
Using a large population-based sample, this study showed a direct positive association between the activity levels of mothers and their 4-year-old chil-dren. This association was apparent for overall daily activity levels and activity segmented across the day, controlling for confounders. This suggests mothers and children are active concurrently, but as the association differed by child’s weight status, time spent at preschool, duration of mother’s schooling, and by time of the day and week, that it is moderated by demographic and tem-poral factors. We also established sev-eral correlates associated with both maternal average sedentary time and LPA. Interventions to increase activity in preschool-aged children may therefore consider including an element of ma-ternal co-participation, while also tar-geting specific times throughout the day to achieve maximum gains.
This work supports previous observa-tions in smaller studies (up to 100 dyads), also showing positive associa-tions between objectively measured physical activity in mothers and their preschoolers.12,19,48,49 In a US-based
study, young children were more likely to be active if their mother, father, or both parents were active (versus inactive parents: odds ratios: 2.0, 3.5, and 5.8, respectively).19Here, we found
a stronger association between child’s and mother’s MVPA on weekdays com-pared with weekends, similar to a study in Canadian preschoolers.12
Girls,n(%) 284 (51.3)
Age, y, mean (SD) 4.1 (0.1) 35.2 (3.6)
BMI, mean (SD) 16.0 (1.4) 26.5 (5.6)
Weight status,n(%)
Underweight 35 (6.3)
Normal weight 443 (80.0) 234 (48.2)
Overweight/obese 76 (13.7) 252 (51.8) BMIzscore, mean (SD) 0.16 (1.0)
Children at preschool full-time, mean (SD) 36 (7.4) Age mother left full-time education, y,n(%)
#16 164 (31.8)
17–18 185 (35.9)
.18 167 (32.3)
TABLE 2 Average Daily Activity Levels for Children and Their Mothers
Children Mothers
Registered time, min 847.6 (66.4) 848.2 (68.1) Average activity intensity, cpm 130.4 (45.8)a 60.4 (30.2) Sedentary time, min 282.8 (94.3) 426.5 (119.3) Light physical activity, min 496.1 (88.1)a 402.8 (110.6) Moderate-to-vigorous physical activity, min 68.8 (41.0)a 19.0 (21.5) Percent of days activity guidelines metb 100 22 Percent of participants meeting physical activity guidelinesc 100 53
All values are mean (SD) unless stated. aSignificant difference by genderP,.05.
Our study also showed that the asso-ciation was stronger for LPA on the weekends. Mothers may be more likely to engage in LPA, with fathers partici-pating in higher-intensity activities with their children on weekends.12Due
to the study design, physical activity data were not available for fathers. However, both parents have been shown to influence young children’s activity levels.19,48Moreover, other
house-hold members should be considered, as having older siblings has been shown to be associated with chil-dren’s MVPA in this cohort,50and both
maternal and sibling co-participation may be associated with a positive change in girls’ activity.51 Given that
both parents being active may have a greater effect on their child’s activ-ity than the sum of their individual parts,19 active siblings may further
encourage activity in young children. Health promotion efforts targeting physical activity in young children may therefore consider the inclusion of whole families.
One previous study found a strong correlation between children’s and mothers’objectively measured seden-tary time.49Here, a stronger
associa-tion was seen between activity of mothers and children attending pre-school part-time (versus full-time). To date, most studies have measured children’s activity either during or outside preschool hours.19,48,49 Future
work should determine what effect child care attendance and maternal employment have on children’s activity levels. Indeed, maternal working hours were positively associated with their sedentary time, and negatively associ-ated with LPA. This suggests that mothers who work are more are likely to be more sedentary, but also have less influence on their child’s seden-tary time. As evidence increasingly suggests an association between ma-ternal and child activity, the wider po-tential influence of maternal activity should not be overlooked. Although mothers may provide most informal child care, they may have limited
amounts of time available to engage in activity throughout the working week. Thus, innovative interventions are needed to facilitate greater activity during mother-child time, ultimately benefiting them both.
Few studies have explored factors as-sociated with physical activity levels of mothers of young children. On average, mothers engaged in approximately equal amounts of sedentary and LPA each day, with only 53% of mothers meeting the recommended 30 minutes of MVPA on 1 or more days. Working full-time and having a higher BMI were associated with increased sedentary time and decreased LPA. Living with a partner has previously been shown to be associated with positive health behaviors in adults.42 Living with the
participating child’s father was not associated with maternal activity at any intensity here, although limited heterogeneity in this exposure may in part account for thisfinding. As moth-ers tend to be less active than fathmoth-ers (and men),10 and consume a less
TABLE 3 Associations Between Child and Maternal Physical Activity Levels, and Influence of Temporal and Demographic Factors
Sedentary Time LPA MVPA
Unadjusted Adjusteda Unadjusted Adjusteda Unadjusted Adjusteda
b(95% CI) b(95% CI) GMRb(95% CI)
Average daily activity 0.17 (0.14 to 0.20)** 0.18 (0.13 to 0.22)** 0.18 (0.15 to 0.21)** 0.14 (0.09 to 0.19)** 1.10 (1.08 to 1.12)** 1.10 (1.06 to 1.14)** Interaction terms
Gender 20.01 (–0.08 to 0.05) 0.03 (–0.03 to 0.10) 1.17 (0.93 to 1.07) Weight status
Underweight 20.11 (–0.24 to 0.03) 20.08 (–0.17 to 0.01) 0.96 (0.89 to 1.04) Overweight/obese 20.10 (–0.19 to 0.00)* 20.13 (–0.27 to 0.01) 1.01 (0.91 to 1.13) Full-time preschool
attendance (ref: part-time)
20.16 (–0.28 to–0.03)* 20.11 (–0.23 to 0.02) 0.99 (0.90 to 1.09)
Age mother left full-time education (ref:#16 y)
17–18 y 20.03 (–0.11 to 0.04) 0.09 (0.01 to 0.17)* 1.00 (0.94 to 1.06)
.18 y 20.05 (–0.13 to 0.03) 20.05 (–0.13 to 0.03) 0.95 (0.94 to 0.99)* Time of the week
(ref: weekday)
0.03 (–0.02 to 0.08) 0.05 (0.00 to 0.10)* 0.95 (0.90 to 0.99)*
Association by time of day
Morning (6AM–12 PM) 0.21 (0.19 to 0.24)** 0.21 (0.18 to 0.24)** 0.26 (0.22 to 0.29)** 0.22 (0.19 to 0.26)** 1.17 (1.13 to 1.21)** 1.15 (1.12 to 1.21)** Afternoon (12–5PM) 0.13 (0.09 to 0.16)** 0.12 (0.09 to 0.16)** 0.08 (0.05 to 0.11)** 0.08 (0.05 to 0.11)** 1.14 (1.09 to 1.17)** 1.13 (1.10 to 1.18)** Evening (5–11PM) 0.16 (0.12 to 0.20)** 0.18 (0.14 to 0.22)** 0.34 (0.30 to 0.38)** 0.35 (0.31 to 0.40)** 1.08 (1.02 to 1.14)** 1.07 (1.02 to 1.15)**
b,bregression coefficient (minutes of activity).
aModel adjusted for child gender, weight status, time spent at preschool, age mother left full-time education, and time of the week.
bExponentiatedbor GMR: any deviation from 1 indicates a % change in child’s MVPA per unit change in mother’s MVPA relative to the reference category. *P,.05.
**P,.005.
be at greater risk of negative health outcomes and remain a target for health promotion interventions in their own right.
Mothers with more than 1 child younger than 5 accumulated more LPA than those with 1 child. Active children are likely to require their mothers to be active, just as mothers who engage in activity may also encourage their chil-dren to be active. Contextual in-formation is required to determine if mothers and children are active to-gether. Although the direction of cau-sality remains to be established, this work suggests that health practitioners and pediatricians may wish to consider the influence of maternal activity when discussing ways to promote activity in preschoolers. Even in the absence of mutual participation, a mother may facilitate her child’s activity and act as a positive role model. Moreover, stressing the potential importance of this mother-child relationship could potentially increase activity levels in the less-active of the pair, leading to improved social and health outcomes in both, setting a precedent for positive shared behaviors early in a child’s life.
Using a large population-based sample of more than 500 mother-child dyads, an objective measure of activity, and hourly time-stamped data, this study provides a detailed picture of the association between mothers and preschool-aged children’s physical ac-tivity. Further, it is one of the first to assess factors related to maternal
ac-ity behavior in mothers of young chil-dren. The Actiheart monitor was worn continuously during measurement and is therefore likely to have captured more active time than Actigraph mon-itors, which are removed for water-based activities and sleep. There may have been a slight underestimation of both child and maternal activity after the hours of 9 PM, and by excluding sleep time. However, exploration of hourly activity data showed this was minimal, with children and mothers engaging in little activity and being largely sedentary in the evenings. The use of 60-second epochs, necessary to allow sufficient memory to record for 7 days, may underestimate MVPA,52while
overestimating LPA53in small children.
Despite this, there was a strong asso-ciation between physical activity in mothers and their children at all in-tensities over the course of the day, suggesting that activity in 1 of the pair is likely to influence the other.
Participants were drawn from all so-cioeconomic backgrounds in South-ampton and the surrounding areas. Mothers included here were, however, better educated and older when they gave birth compared with the South-ampton Women’s Survey mothers ini-tially recruited. Fewer children were overweight or obese compared with the national average,54 and
partic-ipants were predominately white Brit-ish, in keeping with the Southampton region (∼82%).55This should not bias
relationships within the data set, but
CONCLUSIONS
We found that objectively measured physical activity levels and sedentary time in 4-year-old British children and their mothers are significantly and di-rectly associated, the strength differing by temporal and demographic factors. Given low levels of activity were seen here in mothers of young children, these results support developing targeted interventions to increase their activity, but also providing additional opportu-nities for mothers to be active with their young children. Pediatricians may be particularly well placed to encourage this mutual participation during well-child visits, promoting increased physical activity in both mothers and their preschool-aged children.
ACKNOWLEDGMENTS
We thank the mothers and children who gave us their time and a team of dedi-cated research nurses and ancillary staff for their assistance. Participants were drawn from a cohort study funded by the Medical Research Council and the Dunhill Medical Trust. In addition, we thank Kate Westgate and Stefanie Mayle from the physical activity technical team at the MRC Epidemiology Unit for their assistance in processing the accelerom-eter data. We thank Stephen Sharp for his statistical advice. Ms Hesketh and Dr Goodfellow made jointfirst author contributions to the manuscript; Drs van Sluijs and Harvey made joint senior author contributions to the manuscript.
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www.pediatrics.org/cgi/doi/10.1542/peds.2013-3153
doi:10.1542/peds.2013-3153
Accepted for publication Jan 17, 2014
Address correspondence to Esther M.F. van Sluijs, PhD, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ. E-mail: esther.vansluijs@mrc-epid.cam.ac.uk
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2014 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE:The authors have indicated they have nofinancial relationships relevant to this article to disclose.
FUNDING:The work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (RES-590-28-0002). This work was also supported by the Medical Research Council (program grant numbers MC_UU_12015/7, MC_UU_12015/3, and MC_UU_12015/4). The work of Drs Cooper, Godfrey, Goodfellow, Harvey and Inskip was supported by funding from the Medical Research Council, British Heart Foundation, the Arthritis Research Campaign, National Osteoporosis Society, International Osteoporosis Foundation, Cohen Trust, the European Union Seventh Framework Programme (FP7/2007-2013) EarlyNutrition project under grant agreement 289346, NIHR Southampton Biomedical Research Centre, and National Institute of Health Research Musculoskeletal Biomedical Research Unit, Oxford.
DOI: 10.1542/peds.2013-3153 originally published online March 24, 2014;
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Pediatrics
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Kathryn R. Hesketh, Laura Goodfellow, Ulf Ekelund, Alison M. McMinn, Keith M.
Activity Levels in Mothers and Their Preschool Children
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