Relationships between outdoor time, physical activity, sedentary time, and body mass index in children: a 12-country study

Richard Larouche, Tiago V. Barreira, Gang Hu, José Maia, Olga L. Sarmiento, Peter T. Katzmarzyk, Emily F. Mire, Jean Philippe Chaput, Estelle V. Lambert, Tim Olds, Martyn Standage, Kevin Belanger, Mikael Fogelholm, Carol Maher, Vincent Onywera, Catrine Tudor-Locke, Mark S. Tremblay, Timothy S. Church, Denise G. Lambert, Stephanie BroylesBen Butitta, Catherine Champagne, Shannon Cocreham, Kara Dentro, Katy Drazba, Deirdre Harrington, William Johnson, Dione Milauskas, Allison Tohme, Ruben Rodarte, Bobby Amoroso, John Luopa, Rebecca Neiberg, Scott Rushing, Timothy Olds, Lucy Lewis, Katia Ferrar, Effie Georgiadis, Rebecca Stanley, Victor Keihan Rodrigues Matsudo, Sandra Matsudo, Timoteo Araujo, Luis Carlos De Oliveira, Leandro Rezende, Luis Fabiano, Diogo Bezerra, Gerson Ferrari, Priscilla Bélanger, Mike Borghese, Yue Wang

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Purpose: This study investigated the relationship between outdoor time and physical activity (PA), sedentary time (SED), and body mass index z scores among children from 12 lower-middle-income, upper-middle-income, and high-income countries. Methods: In total, 6478 children (54.4% girls) aged 9-11 years participated. Outdoor time was self-reported, PA and SED were assessed with ActiGraph GT3X+ accelerometers, and height and weight were measured. Data on parental education, neighborhood collective efficacy, and accessibility to neighborhood recreation facilities were collected from parent questionnaires. Country latitude and climate statistics were collected through national weather data sources. Gender-stratified multilevel models with parental education, climate, and neighborhood variables as covariates were used to examine the relationship between outdoor time, accelerometry measures, and body mass index z scores. Results: Each additional hour per day spent outdoors was associated with higher moderate-to vigorous-intensity PA (boys: +2.8 min/d; girls: +1.4 min/d), higher light-intensity PA (boys: +2.0 min/d; girls: +2.3 min/d), and lower SED (boys: -6.3 min/d; girls: -5.1 min/d). Effect sizes were generally weaker in lower-middle-income countries. Outdoor time was not associated with body mass index z scores. Conclusions: Outdoor time was associated with higher PA and lower SED independent of climate, parental education, and neighborhood variables, but effect sizes were small. However, more research is needed in low-and middle-income countries.

Original languageEnglish
Pages (from-to)118-129
Number of pages12
JournalPediatric Exercise Science
Issue number1
Early online date1 Oct 2018
Publication statusPublished - 1 Feb 2019


  • epidemiology
  • exercise
  • Health Promotion
  • motor behavior


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