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Preschool Physical Activity and Functional Constipation: The Generation R Study

Driessen, Lisa M.*; Jong, Jessica C. Kiefte-de*; Wijtzes, Anne; de Vries, Sanne I.§; Jaddoe, Vincent W.V.; Hofman, Albert; Raat, Hein; Moll, Henriette A.*

Journal of Pediatric Gastroenterology and Nutrition: December 2013 - Volume 57 - Issue 6 - p 768–774
doi: 10.1097/MPG.0b013e3182a313fc
Original Articles: Gastroenterology

Objectives: Decreased physical activity levels in children may partly explain the rising prevalence of functional constipation in childhood. The aim of the present study, therefore, was to examine the association between physical activity and functional constipation during the preschool period.

Methods: This study was embedded in the Generation R study, a large prospective birth-cohort study in Rotterdam, The Netherlands. Physical activity was measured by an Actigraph accelerometer in 347 children (182 boys, 165 girls; mean age 25.1 months) and data were expressed as counts per minute. Data were categorized into light activity (302–614 counts/15 seconds), moderate activity (615–1230 counts/15 seconds), and vigorous activity (≥1231 counts/15 seconds). Functional constipation in the third and fourth year of life was defined according to the Rome II criteria.

Results: Children spending time in the highest tertile of light (adjusted odds ratio [OR] 0.34; 95% confidence interval [CI] 0.13–0.87), moderate (adjusted OR 0.37; 95% CI 0.14–0.97), and total activity (adjusted OR 0.37; 95% CI 0.15–0.92) at the age of 2 years had significantly less functional constipation in the fourth year of life. For functional constipation in the third year of life, the results were in similar direction but not statistically significant. Additionally, children with physical activity of more than the WHO recommendation of 60 min/day had significantly less functional constipation in the fourth year of life (adjusted OR 0.48; 95% CI 0.24–0.97).

Conclusions: Physical activity is associated with a decreased risk of functional constipation in the preschool period, but this may be time dependent.

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*Department of Pediatrics

Department of Public Health

Department of Epidemiology, Erasmus Medical Center, Rotterdam

§Department of Healthy Living, Expertise Centre Life Style TNO, Leiden (SIdV), The Netherlands.

Address correspondence and reprint requests to Prof Henriëtte A. Moll, MD, PhD, Department of Pediatrics, Erasmus Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands (e-mail:

Received 29 November, 2012

Accepted 30 June, 2013

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

L.M.D., J.C.K., A.W., and V.W.V.J. are members of the Generation R Study Group.

This phase of the Generation R Study was supported by the Erasmus Medical Center, the Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development (Zon Mw) and Europe Container terminals B.V. The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service–Rotterdam Metropolitan Area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,