Effects of controlled school-based multi-component model of nutrition and lifestyle interventions on behavior modification, anthropometry and metabolic risk profile of urban Asian Indian adolescents in North India. Development and exploratory cluster-randomised opportunistic trial of a theory-based intervention to enhance physical activity among adolescents. Improvements in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: the PATH program. Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children. Effects of manual resistance training on fitness in adolescents. A longitudinal study of the impact of a school heart health curriculum. Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children: switch-play. A controlled trial of health promotion programs in 11-year-olds using physical activity "enrichment" for higher risk children. Eight months of regular in-school jumping improves indices of bone strength in adolescent boys and Girls: the POWER PE study. Using heart-rate feedback to increase physical activity in children. Results of the "Active by Choice Today" (ACT) randomized trial for increasing physical activity in low-income and minority adolescents. Effect of increased exercise in school children on physical fitness and endothelial progenitor cells: a prospective randomized trial. Increasing physical activity and decreasing sedentary activity in adolescent girls--the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study. Effects of integrating pedometers, parental materials, and E-mail support within an extracurricular school sport intervention. Changes in BMI and blood pressure after a school based intervention: the CHILDREN study. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. Ten months of exercise improves general and visceral adiposity, bone, and fitness in black girls. Design, implementation, and quality control in the Pathways American-Indian multicenter trial. Report on childhood obesity in China (8): effects and sustainability of physical activity intervention on body composition of Chinese youth. Modification of risk factors for coronary heart disease. Five-year results of a school-based intervention trial. Evaluation of a multiple ecological level child obesity prevention program: Switch what you Do, View, and Chew. Supplemental fitness activities and fitness in urban elementary school classrooms. 'Ready. Set. ACTION!' A theater-based obesity prevention program for children: a feasibility study. Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior. Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial. Randomised controlled trial adapting US school obesity prevention to England. Cardiovascular risk factor prevention in black schoolchildren: two-year results of the "Know Your Body" program. Self-efficacy partially mediates the effect of a school-based physical-activity intervention among adolescent girls. Cost-effectiveness of a school-based obesity prevention program. Evaluation of a 2-year physical activity and healthy eating intervention in middle school children. Increasing children's physical activity levels during recess periods in elementary schools: the effects of providing game equipment. Effectiveness of a computer tailored physical activity intervention in adolescents compared to a generic advice. Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. Wise Mind project: a school-based environmental approach for preventing weight gain in children. Successful overweight prevention in adolescents by increasing physical activity: a 4-year randomized controlled intervention. Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension. Reducing children's television viewing to prevent obesity: a randomized controlled trial. Effects of a life skills intervention for increasing physical activity in adolescent girls. New moves-preventing weight-related problems in adolescent girls a group-randomized study. Promoting healthy lifestyles among adolescent boys: the Fitness Improvement and Lifestyle Awareness Program RCT. Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls. Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: a randomized controlled trial.
To study the effectiveness of a multi-component intervention model of nutrition and lifestyle education on behavior modification, anthropometry and metabolic risk profile of urban Asian-Indian adolescents in North India.
                Two schools matched for student strength and middle socioeconomic strata were randomly allocated to intervention and control group. Changes in nutrition-related knowledge, attitude, lifestyle practices, food frequency and body image of eleventh-grade students (15-17 years) in both schools were tested using a validated questionnaire. Anthropometric and biochemical measurements were made using standard methods. Segmental body composition analysis was carried out using an 8-electrode multifrequency bioelectrical impedance method of body fat estimation.
                At 6 months follow-up, significant improvement in several domains of knowledge was observed in intervention children (n=99; males=60; females=39) as compared with control school children (n=102; males=61; females=41). In the intervention group, significantly lower proportion of children consumed aerated drinks (15.1%; P<0.001) and energy-dense unhealthy foods (8.9%; P=0.03), whereas significantly higher proportion brought tiffin (packed lunch) to school (14.9%; P=0.004) and brought a fruit in their tiffin (30.7%; P<0.001) as compared with the control group. Significant decrease in mean waist circumference (P=0.02, 95% confidence interval (CI)=-2.43,-0.17), sagittal abdominal diameter (P<0.001, 95% CI=-0.82,-0.09), waist-to-hip ratio (P=0.02, 95% CI=-0.03,-0.004) and fasting blood glucose (P=0.05, 95% CI=-0.09, 5.00) was seen in intervention as compared with control school children.
                Multi-component model of nutrition and lifestyle education was successful in improving the nutrition-related knowledge, eating habits and lifestyle practices, and resulted in beneficial changes in anthropometric and biochemical profiles of the Asian Indian adolescents. This model should be applied on countrywide basis to prevent obesity and diabetes. This article reports the development and exploratory testing of a school-based intervention programme designed to enhance levels of physical activity in adolescents. The intervention is based on social cognitive theory (SCT), self-regulation theory (SRT) and planning as evidence-based mediators of physical activity changes. Two classes, paired on socio-economic variables, were selected from each of eight Portuguese schools and randomly assigned to an intervention or control group (N = 291). Primary outcome was 'moderate to vigorous physical activity' (International Physical Activity Questionnaire) measured pre and post intervention and at three and nine months follow-up. SCT, SRT and planning variables were secondary outcomes measured pre and post intervention. At post test, participants in the intervention group reported 18 min per week more physical activity (PA), adjusted for pre-intervention, age and sex, than those in the control group (95% confidence interval -10 to 46; p = 0.249). This difference increased to 33 min (95% CI-4 to 71; p = 0.082) at three months and to 57 min (95% CI 13 to 101, p = 0.008) at nine month follow-up. Moreover, the intervention resulted in changes of some of the theoretical target variables, including outcome expectancies and coping planning. However, no evidence was found for the changes in theoretical moderators to mediate the intervention effects on behaviour. Implications for theory and for future research are discussed. We sought to assess the effects of a school-based intervention program on cardiovascular disease risk factors in urban girls.
                We compared heart health knowledge, health behaviors, cardiovascular risk factors, and physical fitness among a group of 442 multiethnic teenaged girls (310 experimental participants vs 132 control participants). Testing was conducted before and after a 12-week program of vigorous exercises integrated with lectures and discussions on diet, exercise, stress, and smoking.
                Significant differences in body fat, systolic and diastolic blood pressure, heart health knowledge, and whether breakfast was eaten were observed between experimental participants and control participants.
                An integrated program of exercise and heart health-related lectures and discussions had a beneficial effect on health knowledge, health behaviors, and onset of risk factors for coronary artery disease among urban girls. Our primary objective was to determine whether a novel 'active school' model--Action Schools! BC--improved the cardiovascular disease (CVD) risk profile in elementary-school children. Our secondary objective was to determine the percentage of children with elevated CVD risk factors.
                We undertook a cluster-randomized controlled school-based trial with 8 elementary schools across 1 school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268, age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools) or intervention (INT, 6 schools) groups. We assessed change between groups in cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index (BMI, wt/ht(2)). We evaluated total cholesterol (TC), total:high-density cholesterol (TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and fibrinogen on a subset of volunteers (n=77).
                INT children had a 20% greater increase in fitness and a 5.7% smaller increase in BP compared with children attending UP schools (P<0.05). Forty five percent of children had at least one elevated risk factor (fitness, BP or BMI) at baseline. There were no significant differences between groups for change in BMI or in any of the blood variables.
                Action Schools! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children. Our multi-component intervention exposed children to fitness enhancing physical activity. It may be important for education stakeholders to adequately resource the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis. Manual resistance training (MRT), an alternative to traditional resistance training, requires minimal equipment and may be effective when applied in school-based physical education (PE) classes. The purpose of this study was to document the physical changes in adolescents (n = 222) using MRT in school-based PE settings. Six fitness tests from the Fitnessgram assessment tool were selected to assess students' cardiovascular and muscular fitness, and skinfold tests were used to assess body composition. One control and 2 experimental groups were defined. The control group of students (n = 129) attended regular PE classes. One experimental group (n = 63) attended PE that was complemented by the MRT system. A second experimental group (n = 30) attended PE complemented by MRT and cardiovascular endurance training. With use of the selected Fitnessgram tests, post-test measurements were performed after 9 and 18 weeks of PE. At baseline, there were no significant differences among the 3 groups for most measures. Compared with baseline, the experimental groups improved significantly in all 6 fitness measures and showed more improvements than the control group in most fitness measures both at 9 and 18 weeks. None of the groups showed significant improvement in body composition. The results documented that an MRT-complemented PE program was effective in improving adolescents' muscular fitness. An 18-week combined MRT and cardiovascular endurance training program effectively improved cardiovascular and muscular fitness but was ineffective in improving adolescent body composition. An MRT-based exercise session requires minimal equipment and set-up and can be performed in a short period of time, and therefore it is suitable for application in regular PE settings. This paper presents the findings of a study testing the impact of the Chicago Heart Health Curriculum on the behavior and attitudes towards cardiovascular disease prevention of 325 sixth graders residing in rural, suburban and residential suburban, northeast Ohio regions. Using a pre-test/post-test control group experimental design, data were gathered with a Student Health Questionnaire testing self-reported attitudes and behaviors regarding heart disease factors, at three points in time: 1) Pre-test: before implementation of the Heart Health Curriculum; 2) Post-test: immediately following implementation; and 3) Follow-up: one year later. Using an analysis of variance procedure, treatment effects were evidenced for only one of the outcome variables, Heart Health Knowledge (F = 26.80, df = 2/638, p less than .00005). Results revealed that while the Chicago Heart Health Curriculum contributed to an increase in cardiovascular knowledge among the sixth graders tested, it did not affect attitudinal/behavioral preference change among the students. To evaluate the effectiveness of an intervention to prevent excess weight gain, reduce time spent in screen behaviours, promote participation in and enjoyment of physical activity (PA), and improve fundamental movement skills among children.
                In 2002, 311 children (78% response; 49% boys), average age 10 years 8 months, were recruited from three government schools in low socioeconomic areas of Melbourne, Australia.
                Group-randomized controlled trial. Children were randomized by class to one of the four conditions: a behavioural modification group (BM; n=66); a fundamental movement skills group (FMS; n=74); a combined BM/FMS group (BM/FMS; n=93); and a control (usual curriculum) group (n=62). Data were collected at baseline, post intervention, 6- and 12-month follow-up periods.
                BMI data were available for 295 children at baseline and 268 at 12-month follow-up. After adjusting for food intake and PA, there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls (-1.88 kg m(-2), P<0.01), which was maintained at 6- and 12-month follow-up periods (-1.53 kg m(-2), P<0.05). Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention (adjusted odds ratio (AOR)=0.36, P<0.05); also maintained at 12-month follow-up (AOR=0.38, P<0.05). Compared with controls, FMS group children recorded higher levels and greater enjoyment of PA; and BM children recorded higher levels of PA and TV viewing across all four time points. Gender moderated the intervention effects for participation in and enjoyment of PA, and fundamental movement skills.
                This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA. Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required. To evaluate the short and long term benefits of a school and home based physical activity "enrichment" program for children at higher risk of cardiovascular disease as identified by cluster analysis.
                During two 10-week school terms, 800 11-year-olds took part in a randomized controlled trial with the standard physical activity and nutrition program in six schools, the standard program in a further seven schools but with the addition of physical activity enrichment for higher risk children in those schools, and no program in five control schools. Cluster analysis identifying the 29% or so highest risk children used systolic blood pressure, percent body fat, physical fitness, and blood cholesterol.
                Fitness improved significantly in program schools, particularly with enrichment in higher risk boys. Substantial improvements persisted 6 months later in girls from program schools. At "Enrichment" schools, cholesterol showed significant benefits in higher risk girls and, 6 months later, in both boys and higher risk girls. Sodium intake and, in girls, subscapular skinfolds were lower in "Enrichment" schools when the program ended, but not 6 months later.
                Two-semester health programs with physical activity enrichment for higher risk children can produce benefits sustained for at least 6 months. Improvements extend to lower risk children exposed indirectly to the enrichment. Attenuation of effects on diet and body composition in the longer-term suggest the need for on-going programs. The POWER PE study was an 8-mo, randomized, controlled, school-based exercise intervention designed to apply known principles of effective bone loading to practical opportunities to improve life-long musculoskeletal outcomes. A total of 99 adolescents (46 boys and 53 girls) with a mean age of 13.8 +/- 0.4 yr (peri- to postpubertal) volunteered to participate. Intervention subjects performed 10 min of jumping activity in place of regular physical education (PE) warm up. Control subjects performed usual PE warm-up activities. Bone mass (DXA and QUS) was assessed at baseline and follow-up along with anthropometry, maturity, muscle power, and estimates of physical activity and dietary calcium. Geometric properties (such as femoral neck [FN] moment of inertia) were calculated from DXA measures. Boys in the intervention group experienced improvements in calcaneal broadband ultrasound attenuation (BUA) (+5.0%) and fat mass (-10.5%), whereas controls did not (+1.4% and -0.8%, respectively). Girls in the intervention group improved FN BMC (+13.9%) and lumbar spine (LS) BMAD (+5.2%) more than controls (+4.9% and +1.5%, respectively). Between-group comparisons of change showed intervention effects only for whole body (WB) BMC (+10.6% versus +6.3%) for boys. Boys in the intervention group gained more lean tissue mass, trochanter (TR) BMC, LS BMC, and WB BMC and lost more fat mass than girls in the intervention group (p < 0.05). Ten minutes of jumping activity twice a week for 8 mo during adolescence seems to improve bone accrual in a sex-specific manner. Boys increased WB bone mass and BUA, and reduced fat mass, whereas girls improved bone mass at the hip and spine. The objective of this study was to test whether heart-rate feedback prompts increased physical activity (PA) in primary school students.
                A controlled trial with 210 9-11 year olds from subsidized Hong Kong Government primary schools was completed in December 2006. Schools were randomly assigned to one of three groups: Control (CG); Educational program (EG); No-educational program (NEG).
                In a short-term school-based intervention, heart-rate feedback was given either in combination with an educational program (EG) or in isolation (NEG). Long-term retention was assessed in comparison to the control group after 6 months follow-up.
                Physical activity and changes in attraction to PA.
                In the short-term, heart-rate monitor feedback increased total daily PA by an average of 24% (p<0.001) and vigorous PA by 0.6% (p<0.05). No change was found for moderate PA. Increases occurred regardless of involvement in the educational program, and in the absence of any change in attitudes towards PA. No long-term retention was apparent.
                The findings from the study suggest that feedback from heart-rate monitors encourages low intensity PA, but when removed increases do not persist. This study reports the results of the "Active by Choice Today" (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents.
                The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduce lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program.
                The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention.
                At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention.
                Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA. The aim of this prospective, randomized study was to examine whether additional school exercise lessons would result in improved peak oxygen uptake (primary end point) and body mass index-standard deviation score, motor and coordinative abilities, circulating progenitor cells, and high-density lipoprotein cholesterol (major secondary end points).
                Seven sixth-grade classes (182 children, aged 11.1+/-0.7 years) were randomized to an intervention group (4 classes with 109 students) with daily school exercise lessons for 1 year and a control group (3 classes with 73 students) with regular school sports twice weekly. The significant effects of intervention estimated from ANCOVA adjusted for intraclass correlation were the following: increase of peak o(2) (3.7 mL/kg per minute; 95% confidence interval, 0.3 to 7.2) and increase of circulating progenitor cells evaluated by flow cytometry (97 cells per 1 x 10(6) leukocytes; 95% confidence interval, 13 to 181). No significant difference was seen for body mass index-standard deviation score (-0.08; 95% confidence interval, -0.28 to 0.13); however, there was a trend to reduction of the prevalence of overweight and obese children in the intervention group (from 12.8% to 7.3%). No treatment effect was seen for motor and coordinative abilities (4; 95% confidence interval, -1 to 8) and high-density lipoprotein cholesterol (0.03 mmol/L; 95% confidence interval, -0.08 to 0.14).
                Regular physical activity by means of daily school exercise lessons has a significant positive effect on physical fitness (o(2)max). Furthermore, the number of circulating progenitor cells can be increased, and there is a positive trend in body mass index-standard deviation score reduction and motor ability improvement. Therefore, we conclude that primary prevention by means of increasing physical activity should start in childhood.
                URL: http://www.clinicaltrials.gov. Identifier: NCT00176371. Lack of regular physical activity and consequent sub-optimal bone mass acquisition in youth has been implicated as a primary cause of adult-onset osteoporosis. IMPACT was a behavioral theory-based 1 1/2 year randomized controlled field study aimed at increasing bone accretion in middle school girls. The objective of this study was to determine the intervention effects of the IMPACT program upon key physical and sedentary activity endpoints among schools that participated in the IMPACT study. Endpoints examined included weight bearing physical activity (WBPA); moderate to vigorous physical activity (MVPA); vigorous physical activity (VPA); MET (metabolic equivalent) - weighted WBPA and MVPA; sedentary activity; before/after-school physical activity; and weekend physical activity.
                Primary data analysis using a pretest-posttest control group design was conducted utilizing mixed model analysis of covariance. Data gathered from the IMPACT cohort from 2000-2002 were analyzed to determine baseline versus follow-up differences in activity endpoints. Confounders investigated included ethnicity, body mass index, menarcheal status, participation in 7th grade PE/athletics, friend/familial support and neighborhood safety.
                Follow-up means were higher for participating intervention schools relative to control schools for all physical activity variables but were statistically significant only for the following variables: daily minutes of vigorous physical activity (mean difference between Intervention (I) and Control (C) = 6.00 upward arrow minutes, 95% CI = 5.82-6.18, p = 0.05), daily after school activity minutes (mean difference between I and C = 8.95 upward arrow minutes, 95% CI = 8.69-9.21, p = 0.04), and daily weekend activity minutes (mean difference between I and C = 19.00 upward arrow minutes, 95% CI = 18.40-19.60, p = 0.05). The intervention significantly reduced duration of student daily TV/Video watching (mean difference between I and C = 12.11 downward arrow minutes, 95% CI = 11.74-12.48, p = 0.05) and total daily sedentary activity minutes (mean difference between I and C = 16.99 downward arrow minutes, 95% CI = 16.49-17.50, p = 0.04).
                A well designed and implemented school based health and physical activity intervention can result in a positive influence upon increasing physical activity levels and decreasing sedentary activity. Future interventions should consider a more structured intervention component to obtain significant changes in WBPA. The objective of this study was to evaluate the impact of a school-based intervention (Program X) incorporating pedometers and e-mail support on physical activity, sedentary behavior, and healthy eating in adolescents.
                A randomized control trial was used to evaluate the impact of the Program X intervention. Six schools (N = 124 participants; mean age 14.1 +/- .8 years) were randomized to intervention or control conditions for the 6-month study period. Objectively recorded physical activity (mean steps/day), self-reported sedentary behavior, and dietary habits were measured at baseline and at 6-month follow-up and intervention effects were assessed using repeated-measures analysis of variance and chi(2) tests.
                Participants in the intervention group increased their step counts by 956 +/- 4107 steps/day (boys) and 999 +/- 1999 (girls). Repeated-measures analysis of variance revealed significant group-by-time interactions for boys (F = 7.4, p = .01, d = .80) and girls (F = 29.6, p <.001, d = 1.27) for mean steps/day. The intervention significantly decreased the number of energy-dense/low-nutrient snacks consumed by boys (chi(2) = 4.0, p = .043) and increased the number of fruit serves among girls (chi(2) = 4.8, p = .028). The intervention did not have a statistically significant effect on sedentary behavior.
                A school-based intervention incorporating physical activity monitoring using pedometers and e-mail support was successful in promoting physical activity and selected healthy eating behaviors in adolescent boys and girls. Identification of the behavioural, normative and control beliefs influencing children's behaviour is an important prerequisite in designing effective interventions. The current study aims to evaluate the effectiveness of an intervention program, based on the Theory of Planned Behaviour (TPB), on obesity indices and blood pressure (BP) in Ioannina, Greece.
                Participants were 646 fifth grade pupils (360 girls and 286 boys). The intervention group (IG) consisted of 321 children in 13 randomly selected schools while the rest (n = 325 children) served as the control group (CG). Based on the outcome of the TPB questionnaire, the intervention focused on overcoming the barriers in accessing physical activity areas, increasing the availability of fruits and vegetables and increasing parental support. General linear mixed model and mediating variable analysis were used to evaluate the differences between the two groups and to test whether changes in certain dietary, physical activity and anthropometrical indices mediated the effect of the intervention on BP.
                IG had higher consumption of fruits and lower consumption of fats/oils and sweets/beverages compared with the CG. Intervention's effect on BMI could be explained by the changes in fruit and fats/oils intake whereas the reduction of systolic and diastolic BP could be explained by the reduction of BMI.
                The findings indicate favourable changes in BP and obesity indices after the implementation of a 1-year school-based intervention program based on the TPB. These results highlight the importance of developing a social and physical environment that promotes balanced eating behaviours and extra-curricular access to physical activity venues. To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren.
                Cluster randomised controlled trial.
                28 classes from 15 elementary schools in Switzerland randomly selected and assigned in a 4:3 ratio to an intervention (n=16) or control arm (n=12) after stratification for grade (first and fifth grade), from August 2005 to June 2006.
                540 children, of whom 502 consented and presented at baseline.
                Children in the intervention arm (n=297) received a multi-component physical activity programme that included structuring the three existing physical education lessons each week and adding two additional lessons a week, daily short activity breaks, and physical activity homework. Children (n=205) and parents in the control group were not informed of an intervention group. For most outcome measures, the assessors were blinded.
                Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). Secondary outcome measures included body mass index and cardiovascular risk score (average z score of waist circumference, mean blood pressure, blood glucose, inverted high density lipoprotein cholesterol, and triglycerides).
                498 children completed the baseline and follow-up assessments (mean age 6.9 (SD 0.3) years for first grade, 11.1 (0.5) years for fifth grade). After adjustment for grade, sex, baseline values, and clustering within classes, children in the intervention arm compared with controls showed more negative changes in the z score of the sum of four skinfolds (-0.12, 95 % confidence interval -0.21 to -0.03; P=0.009). Likewise, their z scores for aerobic fitness increased more favourably (0.17, 0.01 to 0.32; P=0.04), as did those for moderate-vigorous physical activity in school (1.19, 0.78 to 1.60; P<0.001), all day moderate-vigorous physical activity (0.44, 0.05 to 0.82; P=0.03), and total physical activity in school (0.92, 0.35 to 1.50; P=0.003). Z scores for overall daily physical activity (0.21, -0.21 to 0.63) and physical quality of life (0.42, -1.23 to 2.06) as well as psychological quality of life (0.59, -0.85 to 2.03) did not change significantly.
                A school based multi-component physical activity intervention including compulsory elements improved physical activity and fitness and reduced adiposity in children. Trial registration Current Controlled Trials ISRCTN15360785. The goal of this study was to evaluate the impact of a 10-month after-school physical activity (PA) program on body composition and cardiovascular (CV) fitness in young black girls.
                Subjects were 8- to 12-year-olds recruited from elementary schools. Body composition was measured using anthropometrics {waist circumference and BMI, DXA [percentage body fat (%BF)] and bone mineral density (BMD)}, and magnetic resonance imaging [visceral adipose tissue (VAT)]. CV fitness was measured using a graded treadmill test. The intervention consisted of 30 minutes homework/healthy snack time and 80 minutes PA (i.e., 25 minutes skills instruction, 35 minutes aerobic PA, and 20 minutes strengthening/stretching). Analyses were adjusted for age, baseline value of the dependent variable, and sexual maturation (pediatrician observation).
                Mean attendance was 54%. Compared with the control group, the intervention group had a relative decrease in %BF (p < 0.0001), BMI (p < 0.01), and VAT (p < 0.01) and a relative increase in BMD (p < 0.0001) and CV fitness (p < 0.05). Higher attendance was associated with greater increases in BMD (p < 0.05) and greater decreases in %BF (p < 0.01) and BMI (p < 0.05). Higher heart rate during PA was associated with greater increases in BMD (p < 0.05) and greater decreases in %BF (p < 0.005).
                An after-school PA program can lead to beneficial changes in body composition and CV fitness in young black girls. It is noteworthy that the control and intervention groups differed in change in VAT but not waist circumference. This suggests that changes in central adiposity can occur in response to PA, even in young children, but that waist circumference may not be a good indicator of central adiposity. Pathways was the first multicenter American-Indian school-based study to test the effectiveness of an obesity prevention program promoting healthy eating and physical activity.
                Pathways employed a nested cohort design in which 41 schools were randomized to intervention or control conditions and students within these schools were followed as a cohort (1,704 third graders at baseline). The study's primary endpoint was percent body fat. Secondary endpoints were levels of fat in school lunches; time spent in physical activity; and knowledge, attitudes, and behaviors regarding diet and exercise. Quality control (QC) included design of data management systems which provided standardization and quality assurance of data collection and processing. Data QC procedures at study centers included manuals of operation, training and certification, and monitoring of performance. Process evaluation was conducted to monitor dose and fidelity of the interventions. Registration and tracking systems were used for students and schools.
                No difference in mean percent body fat at fifth grade was found between the intervention and control schools. Percent of calories from fat and saturated fat in school lunches was significantly reduced in the intervention schools as was total energy intake from 24-hour recalls. Significant increases in self-reported physical activity levels and knowledge of healthy behaviors were found for the intervention school students.
                The Pathways study results provide evidence demonstrating the role schools can play in public health promotion. Its study design and QC systems and procedures provide useful models for other similar school based multi- or single-site studies. To determine whether a large-scale physical activity intervention could affect body composition in primary school students in Beijing, China.
                The study design was one-year cluster randomized controlled trial of physical activity intervention (20 min of daily exercise in the classroom) with an additional year of follow-up among 4 700 students aged 8-11 years at baseline.
                After the one-year intervention, BMI increased by 0.56 kg/m(2) (SD 1.15) in the intervention group and by 0.72 kg/m(2) (SD 1.20) in the control group, with a mean difference of -0.15 kg/m(2) (95% CI: -0.28 to -0.02). BMI z score decreased by -0.05 (SD 0.44) in the intervention group, but increased by 0.01 (SD 0.46) in the control group, with a mean difference of -0.07 (-0.13 to -0.01). After another year of follow up, compared to the control group, children in the intervention group had significantly lower BMI (-0.13, -0.25 to -0.01), BMI z score (-0.05, -0.10 to -0.01), fat mass (-0.27 kg, -0.53 to -0.02) and percent body fat (-0.53, -1.00 to -0.05). The intervention had a more pronounced effect on weight, height, BMI, BMI z score, and body composition among obese children than among normal weight or overweight children. Compared to the control group, the intervention group had a significantly higher percentage of children who maintained or reduced their BMI z score at year 1 (P=0.008) and year 2 (P=0.04).
                These findings suggest that 20 min of daily moderate to vigorous physical activity during the school year is a feasible and effective way to prevent excessive gain of body weight, BMI, and body fatness in primary school students.
                Copyright © 2010 The Editorial Board of Biomedical and Environmental Sciences. Published by Elsevier B.V. All rights reserved. We conducted a study of the effectiveness of an educational intervention designed to modify risk factors associated with coronary heart disease among 3388 children in 37 schools in two demographically dissimilar areas (the Bronx and Westchester County) in and around New York City. Schools within each area were randomly assigned to either intervention or nonintervention groups. In schools targeted for intervention, children in the fourth through eighth grades were taught a teacher-delivered curriculum focusing on diet, physical activity, and cigarette smoking. Risk-factor levels were measured in all schools at base line and at four follow-up points. A total of 1769 of the children qualified for analysis of the intervention effect. After five years, the net mean change in plasma levels of total cholesterol was -1.7 mg per deciliter per year (-0.04 mmol per liter) (95 percent confidence interval, -2.7 to -0.7 mg per deciliter [-0.07 to -0.02 mmol per liter]) in the Westchester County schools, or -8.5 mg per deciliter (-0.22 mmol per liter) (5.1 percent) over a period of five years. In the schools in the Bronx, the net mean change was -1.0 mg per deciliter per year (-0.03 mmol per liter) (95 percent confidence interval, -2.3 to +0.3 mg per deciliter [-0.06 to +0.01 mmol per -2.3 to +0.3 mg per deciliter [-0.06 to +0.01 mmol per liter]), or -5.0 mg per deciliter (-0.13 mmol per liter) (2.9 percent) over a period of five years. Favorable trends in dietary intake and health knowledge were also observed, whereas the other targeted risk factors were not significantly altered. If these findings can be replicated, this will suggest that educational programs to modify coronary risk factors are feasible and may have a favorable (albeit small) effect on blood levels of cholesterol in children. Schools are the most frequent target for intervention programs aimed at preventing child obesity; however, the overall effectiveness of these programs has been limited. It has therefore been recommended that interventions target multiple ecological levels (community, family, school and individual) to have greater success in changing risk behaviors for obesity. This study examined the immediate and short-term, sustained effects of the Switch program, which targeted three behaviors (decreasing children's screen time, increasing fruit and vegetable consumption, and increasing physical activity) at three ecological levels (the family, school, and community).
                Participants were 1,323 children and their parents from 10 schools in two states. Schools were matched and randomly assigned to treatment and control. Measures of the key behaviors and body mass index were collected at baseline, immediately post-intervention, and 6 months post-intervention.
                The effect sizes of the differences between treatment and control groups ranged between small (Cohen's d = 0.15 for body mass index at 6 months post-intervention) to large (1.38; parent report of screen time at 6 months post-intervention), controlling for baseline levels. There was a significant difference in parent-reported screen time at post-intervention in the experimental group, and this effect was maintained at 6 months post-intervention (a difference of about 2 hours/week). The experimental group also showed a significant increase in parent-reported fruit and vegetable consumption while child-reported fruit and vegetable consumption was marginally significant. At the 6-month follow-up, parent-reported screen time was significantly lower, and parent and child-reported fruit and vegetable consumption was significantly increased. There were no significant effects on pedometer measures of physical activity or body mass index in the experimental group. The intervention effects were moderated by child sex (for fruit and vegetable consumption, physical activity, and weight status), family involvement (for fruit and vegetable consumption), and child body mass index (for screen time). The perception of change among the experimental group was generally positive with 23% to 62% indicating positive changes in behaviors.
                The results indicate that the Switch program yielded small-to-modest treatment effects for promoting children's fruit and vegetable consumption and minimizing screen time. The Switch program offers promise for use in youth obesity prevention. The physical activity levels of US children are declining. Opportunities for physical activity within city schools are constrained by time and space limits. This study determined whether a supplemental program of physical activity would significantly alter the fitness levels of low-income, minority, urban elementary schoolchildren.
                Ninety-nine students from two Cleveland Public Schools served as subjects. One school received a 15-week intervention program where teams of two medical students met with urban elementary schoolchildren three times a week for physical activity sessions. The other school served as a control and received no supplemental activity other than a regularly scheduled physical education class held once a week. We obtained field measurements of skinfold thickness, heart rate response to submaximal exercise, and sit and reach flexibility.
                The supplemental activity group showed significant improvements in flexibility, body composition, and heart rate response to submaximal exercise.
                This investigation indicates that a program of fitness activities conducted within the classroom can significantly improve levels of fitness in urban elementary schoolchildren. This study examined the feasibility of implementing an innovative theater-based after-school program, 'Ready. Set. ACTION!', to reach ethnically diverse and low-income children and their parents with obesity prevention messages. The study population included 96 children and 61 parents. Children were in fourth to sixth grade and 41% were overweight at baseline. Program impact was evaluated with a pre/post-randomized controlled study design, but a major focus was placed on the process evaluation conducted in the intervention schools. Intervention children and parents reported high program satisfaction and that they had made changes or intended to make positive changes in their behaviors due to program participation. However, few meaningful differences between the intervention and control conditions were found at follow-up. Thus, the combined process and impact evaluation results suggest that the intervention was effective in leading to increased awareness of the need for behavioral change, but was not powerful enough on its own to lead to behavioral change. From this feasibility study, we concluded that Ready. Set. ACTION! offers promise as a creative intervention strategy. The next research step may be to incorporate theater-based programs into more comprehensive school-based interventions, with both educational and environmental components, and evaluate program impact. To determine whether a multicomponent health promotion intervention for Dutch adolescents (defined as persons between 12 and 14 years of age) would be successful in influencing body composition and dietary and physical activity behavior in both the short and long terms.
                Randomized controlled trial.
                Ten intervention and 8 control prevocational secondary schools.
                A total of 1108 adolescents (mean age, 12.7 years). Intervention An interdisciplinary program with an adapted curriculum for 11 lessons in biology and physical education and environmental change options.
                Body height and weight, waist circumference, 4 skinfold thickness measurements, and dietary and physical activity behavior data.
                Multilevel analyses showed that the intervention remained effective in preventing unfavorable increases in important measures of body composition after 20-month follow-up in girls (biceps skinfold and sum of 4 skinfolds) and boys (triceps, biceps, and subscapular skinfolds). Consumption of sugar-containing beverages was significantly lower in intervention schools both after intervention (boys: -287 mL/d; 95% confidence interval [CI], -527 to -47; girls: -249; -400 to -98) and at 12-month follow-up (boys: -233; -371 to -95; girls: -271; -390 to -153). For boys, screen-viewing behavior was significantly lower in the intervention group after 20 months (-25 min/d; 95% CI, -50 to -0.3). No significant intervention effects on consumption of snacks or active commuting to school were found.
                The Dutch Obesity Intervention in Teenagers program resulted in beneficial effects on the sum of skinfold thickness measurements in girls and consumption of sugar-containing beverages in both boys and girls in both the short and long terms. Physical Activity Across the Curriculum (PAAC) was a three-year cluster randomized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children.
                Twenty-four elementary schools were cluster randomized to the Physical Activity Across the Curriculum intervention or served as control. All children in grades two and three were followed to grades four and five. Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers. Body Mass Index was the primary outcome, daily Physical activity and academic achievement were secondary outcomes.
                The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9, respectively (NS). However, change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum. Schools with > or =75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had <75 min of Physical Activity Across the Curriculum (1.8+/-1.8 vs. 2.4+/-2.0, p=0.02). Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores.
                The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children. Additionally, 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index. To assess the impact of a physical activity program on obesity in primary school children.
                Cluster-randomized controlled trial with 10 intervention and 10 control schools.
                A total of 1044 children, mean age 9.4 years (s.d.=0.7) at baseline, of the Province of Cuenca, Spain.
                Recreational, non-competitive physical activity program conducted after school hours on school premises. The program consisted of three 90-min sessions per week, for 24 weeks.
                Body mass index (BMI), triceps skin-fold thickness (TST) and percentage body fat. Secondary measures were blood lipids and blood pressure. Measurements were made at the beginning (September 2004) and at the end of the program (June 2005). Since schools rather than children were randomized, mixed regression models were used to adjust for individual-level covariates under cluster randomization.
                There were no differences in BMI between the intervention and control groups. Compared with controls, intervention children showed a decrease in TST in both boys (-1.14 mm; 95% confidence interval (CI) -1.71 to -057; P<0.001) and girls (-1.55 mm; 95% CI -2.38 to -0.73; P<0.001), as well as a reduction in the percentage of body fat in girls (-0.58%; 95% CI -1.04 to -0.11; P=0.02). Furthermore, the intervention boys exhibited a decrease in apolipoprotein (apo) B levels (-4.59; 95% CI -8.81 to -0.37; P=0.03) and an increase in apo A-I levels (13.57; 95% CI 7.95-19.20; P<0.001). Blood lipid results in girls were very similar. No changes in total cholesterol, triglycerides or blood pressure were associated with the intervention in either sex, except for an increase in diastolic blood pressure (1.55 mm Hg; 95% CI 0.19-2.91; P=0.03) in the intervention versus control boys.
                An after-school program of recreational physical activity reduced adiposity, increased apo A-I and decreased apo B in primary school children. To determine whether a school obesity prevention project developed in the United States can be adapted for use in England.
                A pilot cluster randomised controlled trial and interviews with teachers were carried out in 19 primary schools in South West England. Participants included 679 children in year 5 (age 9-10). Baseline and follow-up assessments were completed for 323 children (screen viewing) and 472 children (body mass index). Sixteen lessons on healthy eating, physical activity and reducing TV viewing were taught over 5 months by teachers. Main outcome measures were hours of screen activities, body mass index, mode of transport to school and teachers' views of the intervention.
                Children from intervention schools spent less time on screen-viewing activities after the intervention but these differences were imprecisely estimated: mean difference in minutes spent on screen viewing at the end of the intervention (intervention schools minus control schools) adjusted for baseline levels and clustering within schools was -11.6 (95% CI -42.7 to 19.4) for a week day and was -15.4 (95% CI -57.5 to 26.8) for a Saturday. There was no difference in mean body mass index or the odds of obesity.
                It is feasible to transfer this US school-based intervention to UK schools, and it may be effective in reducing the time children spend on screen-based activities. The study has provided information for a full-scale trial, which would require 50 schools ( approximately 1250 pupils) to detect effects on screen viewing and body mass index over 2 years of follow-up. A five-year intervention study of the effectiveness of the "Know Your Body" program in reducing coronary heart disease risk factors among black students in the District of Columbia, who were in grades 4-6 at baseline, was begun in 1983. Nine schools were stratified on socioeconomic status and randomly assigned to control and intervention groups. The "Know Your Body" curriculum focuses on nutrition, fitness, and the prevention of cigarette smoking. At baseline, 1,234 students were eligible for the screening in which the following target risk factors were measured: systolic and diastolic blood pressures, ponderosity index, triceps skinfold thickness, postexercise pulse recovery rate, serum total and high density lipoprotein (HDL) cholesterol, and serum thiocyanate. After two years of intervention, results indicated that the program may have had a favorable impact on the following risk factors: systolic and diastolic pressures, HDL cholesterol, ratio of total to HDL cholesterol, fitness (postexercise pulse recovery rate), and smoking. Significant net changes in the favorable direction also were found for health knowledge and attitude toward smoking. Blood pressure reduction was associated with decreased ponderosity and improved fitness, and increased HDL cholesterol was associated with decreased ponderosity. These results are consistent with other evaluations of the "Know Your Body" program, suggesting that the program may be effective in reducing chronic disease risk in diverse school populations. This study evaluated the effects of the Lifestyle Education for Activity Program (LEAP), a comprehensive school-based intervention emphasizing changes in instruction and school environment, on variables derived from social-cognitive theory (SCT) as mediators of change in physical activity among black and white adolescent girls.
                Twenty-four high schools paired on enrollment size, racial composition, urban, suburban, or rural location, and class structure were randomized into control (n = 12) or experimental (n = 12) groups. There were 1038 girls in the control group and 1049 girls in the experimental group. The multicomponent intervention emphasized the enhancement of self-efficacy and development of behavioral skills by using curricular activities within physical education classes and health education instruction. The primary outcomes were self-efficacy, outcome-expectancy value, goal setting, satisfaction, and physical activity.
                Latent variable structural equation modeling indicated that: (1) self-efficacy and satisfaction exhibited synchronous, cross-sectional relationships with physical activity; (2) the intervention had direct effects on self-efficacy, goal setting, and physical activity; and (3) self-efficacy partially mediated the effect of intervention on physical activity.
                To our knowledge, this study provides the first evidence from a randomized controlled trial that manipulation of self-efficacy results in increased physical activity among black and white adolescent girls. The results encourage the use of self-efficacy as a targeted, mediator variable in interventions designed to increase physical activity among girls. A school-based obesity prevention study (Medical College of Georgia FitKid Project) started in the fall of 2003 in 18 elementary schools. Half of the schools were randomized to an after-school program that included moderate-to-vigorous physical activity, healthy snacks, homework assistance, and academic enrichment. All third graders were invited to enroll. The objective of this study was to assess the cost-effectiveness (CE) of the first-year intervention.
                Standard CE analysis methods and a societal perspective were used. Program delivery costs incurred during the first-year intervention and the usual after-school care costs that would occur in the absence of the intervention were estimated (in 2003 dollars). Net intervention costs were calculated by subtracting the usual after-school care costs from the intervention costs. The effectiveness of the intervention was measured as percent body fat (%BF) reduction compared with a control condition. The CE was assessed as the net intervention cost divided by the effectiveness of the intervention.
                The intervention costs totaled $174,070, $558/student, or $956/student who attended > or = 40% of the intervention sessions. The usual after-school care costs were estimated at $639/student. Students who attended > or = 40% of the intervention reduced %BF by 0.76% (95% confidence interval: -1.42 to -0.09) at an additional cost of $317/student.
                Subjects who attended > or = 40% of the intervention achieved a significant reduction in %BF at a relatively low cost. School-based obesity prevention programs of this type are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners. The aim of the present study was to evaluate the effects of a middle school physical activity and healthy eating intervention, including an environmental and computer-tailored component, and to investigate the effects of parental involvement. A random sample of 15 schools with seventh and eight graders was randomly assigned to one of three conditions: (i) intervention with parental involvement, (ii) intervention alone and (iii) control group. In 10 schools, an intervention, combining environmental changes with computer-tailored feedback, was implemented over 2 school years. In five intervention schools, increased parental support was added. Physical activity was measured with questionnaires in the total sample and with accelerometers in a sub-sample of children. Fat intake, fruit, water and soft drink consumption were measured using food-frequency questionnaires. Results showed significant positive intervention effects on physical activity in both genders and on fat intake in girls. Parental involvement did not increase intervention effects. It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal interventions. The use of personalized computer-tailored interventions seems to be a promising tool for targeting adolescents but needs to be further explored. During recess, children can be active on a daily basis, making it an important school environmental factor for the promotion of health-related physical activity. The aim of the present study was to investigate the effects of providing game equipment on children's physical activity levels during morning recess and lunch break in elementary schools.
                Seven elementary schools were randomly assigned to the intervention group (four schools), including 122 children (75 boys, 47 girls, mean age: 10.8 +/- 0.6 years), and to the control group (three schools), including 113 children (46 boys, 67 girls, mean age: 10.9 +/- 0.7 years). Children's activity levels were measured before and three months after providing game equipment, using MTI accelerometers.
                During lunch break, children's moderate and vigorous physical activity significantly increased in the intervention group (moderate: from 38 to 50%, vigorous: from 10 to 11%), while it decreased in the control group (moderate: from 44 to 39%, vigorous: from 11 to 5%). At morning recess, providing game equipment was effective in increasing children's moderate physical activity (from 41 to 45%), while it decreased in the control group (from 41 to 34%).
                Providing game equipment during recess periods was found to be effective in increasing children's physical activity levels. This finding suggests that promoting physical activity through game equipment provision during recess periods can contribute to reach the daily activity levels recommended for good health. To investigate the differences in effects of a computer tailored physical activity advice as compared to generic information in adolescents.
                Students (mean age, 14.6+/-1.2) out of 90 classes from six different Flemish schools were randomly assigned to the tailored intervention (n=563) or the generic non-tailored intervention (n=608) condition. Both interventions included information on public health recommendations and tips on becoming more active. Participants in both groups received their assessment and feedback at baseline, at 4 weeks and at 3 months during school hours. Physical activity levels were determined using an adolescent adaptation of the International Physical Activity Questionnaire (IPAQ).
                After 4 weeks, almost all physical activity scores increased over time in both the generic and the tailored intervention group. No differences between groups were found (all F< or =0.07). After 3 months, the generic intervention was more effective for increasing 'walking in leisure time' among students not complying with recommendations. For all other physical activity scores, no differences between groups were found (all F< or =2.3).
                In contrast to the expectations, changes in physical activity scores did not differ between the tailored and the non-tailored intervention group. For most of the physical activity scores increases were found in both groups.
                2009 Elsevier Ireland Ltd. To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.
                A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).
                A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.
                Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.
                At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures.
                In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.
                The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years. The Wise Mind pilot study compared the efficacy of an environmental approach for prevention of inappropriate weight gain in children with an active control condition that used an environmental approach for modifying expectancies related to the use of alcohol, tobacco, and drugs.
                A total of 670 second to sixth grade students from four schools were enrolled in the study. The study spanned 2 academic years, and 586 students were available for evaluation at the end of the study. Two schools were randomly assigned to each treatment arm. The environmental approach for weight gain prevention focused on modification of eating habits and physical activity, and the active control group focused on modification of expectancies related to substance use.
                Using an intention to treat design, the study found no differences in weight gain prevention between the two interventions. The weight gain prevention program was associated with reduction of total caloric intake, reduction of dietary fat intake, reduction of protein intake, and increased physical activity in comparison with the active control group and relative to baseline. These changes in food intake were attributed to changes in food selections that resulted from modification of school cafeteria menus and food preparation.
                The Wise Mind school-based weight gain prevention program induced behavioral changes in healthy eating and physical activity but did not induce significant changes in body weight in comparison with the control arm. Recommendations for future research are provided. Population-based studies directed at promoting physical activity in youth have shown limited success in obesity prevention.
                To assess whether an intervention integrating environmental changes to induce sustained changes in physical activity, prevents overweight in adolescents.
                Four-year randomized trial started in 2002 in eight middle schools of Eastern France. The intervention, randomized at school level, was designed to promote physical activity by changing attitudes through debates and attractive activities, and by providing social support and environmental changes encouraging physical activity.Subjects:Nine hundred and fifty four 12-year-old six-graders.
                Body mass index (BMI), body composition, physical activity by questionnaire, plasma lipids and glucose, insulin resistance.
                Intervention students had a lower increase in BMI (P=0.01) and age- and gender-adjusted BMI (P<0.02) over time than controls. The differences across groups of the age- and gender-adjusted BMI changes (95% confidence interval (CI)) were -0.29 (-0.51; -0.07) kg/m2 at 3 years, -0.25 (-0.51; 0.01) kg/m2 at 4 years. An interaction with baseline weight status was noted. The intervention had a significant effect throughout the study in initially non-overweight adolescents (-0.36 (-0.60;-0.11) kg/m2 for adjusted BMI at 4 years), corresponding to a lower increase in fat mass index (P<0.001). In initially overweight adolescents, the differences observed across groups at 2 years (-0.40 (-0.94; 0.13) kg/m2 for adjusted BMI) did not persist over time. At 4 years, 4.2% of the initially non-overweight adolescents were overweight in the intervention schools, 9.8% in the controls (odds ratio=0.41 (0.22; 0.75); P<0.01). Independent of initial weight status, compared with controls, intervention adolescents had an increase in supervised physical activity (P<0.0001), a decrease of TV/video viewing (P<0.01) and an increase of high-density cholesterol concentrations (P<0.0001).
                Enhancing physical activity with a multilevel program prevents excessive weight gain in non-overweight adolescents. Our study provides evidence that prevention of obesity in youth is feasible. This study evaluated the effects of aerobic exercise physical education on blood pressure in high-risk, predominantly African-American, adolescent girls.
                Ninth-grade girls (n = 99) with blood pressure above the 67th percentile were randomized to 1 semester of aerobic exercise classes or standard physical education classes.
                The study was completed by 88 girls. At posttest, only members of the aerobic exercise group increased their estimated cardiorespiratory fitness. The aerobic exercise group had a greater decrease in systolic blood pressure than the standard physical education group (P < .03).
                Aerobic exercise physical education is a feasible and effective health promotion strategy for high-risk adolescent girls. Some observational studies have found an association between television viewing and child and adolescent adiposity.
                To assess the effects of reducing television, videotape, and video game use on changes in adiposity, physical activity, and dietary intake.
                Randomized controlled school-based trial conducted from September 1996 to April 1997.
                Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif.
                Of 198 third- and fourth-grade students, who were given parental consent to participate, 192 students (mean age, 8.9 years) completed the study.
                Children in 1 elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use.
                Changes in measures of height, weight, triceps skinfold thickness, waist and hip circumferences, and cardiorespiratory fitness; self-reported media use, physical activity, and dietary behaviors; and parental report of child and family behaviors. The primary outcome measure was body mass index, calculated as weight in kilograms divided by the square of height in meters.
                Compared with controls, children in the intervention group had statistically significant relative decreases in body mass index (intervention vs control change: 18.38 to 18.67 kg/m2 vs 18.10 to 18.81 kg/m2, respectively; adjusted difference -0.45 kg/m2 [95% confidence interval [CI], -0.73 to -0.17]; P = .002), triceps skinfold thickness (intervention vs control change: 14.55 to 15.47 mm vs 13.97 to 16.46 mm, respectively; adjusted difference, -1.47 mm [95% CI, -2.41 to -0.54]; P=.002), waist circumference (intervention vs control change: 60.48 to 63.57 cm vs 59.51 to 64.73 cm, respectively; adjusted difference, -2.30 cm [95% CI, -3.27 to -1.33]; P<.001), and waist-to-hip ratio (intervention vs control change: 0.83 to 0.83 vs 0.82 to 0.84, respectively; adjusted difference, -0.02 [95% CI, -0.03 to -0.01]; P<.001). Relative to controls, intervention group changes were accompanied by statistically significant decreases in children's reported television viewing and meals eaten in front of the television. There were no statistically significant differences between groups for changes in high-fat food intake, moderate-to-vigorous physical activity, and cardiorespiratory fitness.
                Reducing television, videotape, and video game use may be a promising, population-based approach to prevent childhood obesity. Although adolescence is a time when physical activity levels decline, few interventions have targeted high school-aged girls in the school setting.
                To evaluate the effects of a life skills-oriented physical activity intervention for increasing overall physical activity in high school-aged girls.
                Randomized controlled trial.
                Baltimore magnet high school.
                A total of 221 ninth-grade girls, 83.0% of whom were African American. Intervention Participants were randomized to an 8-month physical intervention conducted in physical education class or to a standard physical education class (control).
                Self-reported estimated daily energy expenditure (physical activity), self-reported sedentary activities (television viewing and computer or Internet use), cardiorespiratory fitness, and selected cardiovascular disease risk factors.
                Intervention classes spent 46.9% of physical education class time in moderate to vigorous activity compared with 30.5% of time for control classes (P<.001). There were no significant between-treatment group differences for mean daily energy expenditure (P = .93), moderate-intensity energy expenditure (P = .77), or hard to very hard energy expenditure (P = .69). The proportion of participants who spent 3 or more hours viewing television during school days declined from 22.3% to 17.0% in the intervention group, but remained at 26.7% for the control group (P = .03). Both groups improved their cardiorespiratory fitness (P<.001).
                A life skills-oriented physical education curriculum may need to be combined with other approaches to increase the magnitude of effects on physical activity behavior in predominantly African American high school-aged girls. Weight-related problems are prevalent in adolescent girls.
                To evaluate New Moves, a school-based program aimed at preventing weight-related problems in adolescent girls.
                School-based group-randomized controlled design.
                356 girls (mean age=15.8±1.2 years) from six intervention and six control high schools. More than 75% of the girls were racial/ethnic minorities and 46% were overweight or obese. Data were collected in 2007-2009 and analyzed in 2009-2010.
                An all-girls physical education class, supplemented with nutrition and self-empowerment components, individual sessions using motivational interviewing, lunch meetings, and parent outreach.
                Percentage body fat, BMI, physical activity, sedentary activity, dietary intake, eating patterns, unhealthy weight control behaviors, and body/self-image.
                New Moves did not lead to significant changes in the girls' percentage body fat or BMI but improvements were seen for sedentary activity, eating patterns, unhealthy weight control behaviors, and body/self-image. For example, in comparison to control girls, at 9-month follow-up, intervention girls decreased their sedentary behaviors by approximately one 30-minute block a day (p=0.050); girls increased their portion control behaviors (p=0.014); the percentage of girls using unhealthy weight control behaviors decreased by 13.7% (p=0.021); and improvements were seen in body image (p=0.045) and self-worth (p=0.031). Additionally, intervention girls reported more support by friends, teachers, and families for healthy eating and physical activity.
                New Moves provides a model for addressing the broad spectrum of weight-related problems among adolescent girls. Further work is needed to enhance the effectiveness of interventions to improve weight status of youth.
                Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. To assess the feasibility, acceptability, and potential efficacy of a school-based obesity prevention program among adolescent boys with sub-optimal cardiorespiratory fitness.
                In 2007, a 6-month, 2-arm parallel group, randomized controlled pilot trial was conducted in a single school setting (Sydney, Australia). Thirty-three 7th Grade boys (mean age=12.5+/-0.4 years) were randomly assigned to intervention (n=16) or active comparison group (n=17). The intervention consisted of one 60-minute curriculum session and two 20-minute lunchtime physical activity sessions per week. The active comparison group continued with their usual physical activity curriculum sessions (Friday afternoons 2-3 pm). The pilot trial's curriculum sessions were additional to Physical Education (PE) lessons. The primary outcome was BMI, and secondary outcomes included waist circumference, percentage body fat, cardiorespiratory fitness, objectively measured physical activity and small screen recreation time.
                Screening, recruitment and retention goals were exceeded. The majority of data were collected as planned. Implementation and attendance rates were acceptable. At follow-up, compared with boys in the active comparison group, boys in the intervention group displayed a smaller increase in BMI (adjust diff.=-0.2, 95% confidence interval [CI] -0.78, 0.39; Cohen's d=0.05); greater reductions in waist circumference (-1.65 cm [-4.67, 1.36]; d=0.15); percentage body fat (-1.69% [-4.98, 1.60]; d=0.22) and time spent in small screen recreation on weekends (-1.13 h [-5.06, 2.80]; d=0.19); and a greater increase in cardiorespiratory fitness (2.13 laps [6.22, 10.48]; d=0.16); and participation in total weekday physical activity (140.74 counts/min [-159.44, 440.92]; d=0.36).
                This study verified the feasibility, acceptability and potential efficacy of a multifaceted school-based intervention to prevent unhealthy weight gain among adolescent boys. Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls.
                Group randomized controlled trial.
                Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502).
                A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities.
                The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry.
                After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean= -0.4, 95% CI= -8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint.
                A school-based, community-linked intervention modestly improved physical activity in girls. To evaluate the impact of a school-based diabetes mellitus prevention program on low-income fourth-grade Mexican American children.
                A randomized controlled trial with 13 intervention and 14 control schools.
                Elementary schools in inner-city neighborhoods in San Antonio, Tex.
                Eighty percent of participants were Mexican American and 94% were from economically disadvantaged households. Baseline and follow-up measures were collected from 1419 (713 intervention and 706 control) and 1221 (619 intervention and 602 control) fourth-grade children, respectively.
                The Bienestar Health Program consists of a health class and physical education curriculum, a family program, a school cafeteria program, and an after-school health club. The objectives are to decrease dietary saturated fat intake, increase dietary fiber intake, and increase physical activity.
                The primary end point was fasting capillary glucose level, and the secondary end points were percentage of body fat, physical fitness level, dietary fiber intake, and dietary saturated fat intake. Fasting capillary glucose level, bioelectric impedance, modified Harvard step test, three 24-hour dietary recalls, weight, and height were collected at baseline and 8 months later.
                Children in the intervention arm attended an average of 32 Bienestar sessions. Mean fasting capillary glucose levels decreased in intervention schools and increased in control schools after adjusting for covariates (-2.24 mg/dL [0.12 mmol/L]; 95% confidence interval, -6.53 to 2.05 [-0.36 to 0.11 mmol/L]; P =.03). Fitness scores (P =.04) and dietary fiber intake (P =.009) significantly increased in intervention children and decreased in control children. Percentage of body fat (P =.56) and dietary saturated fat intake (P =.52) did not differ significantly between intervention and control children.
                This intervention showed some positive results, but additional research is needed to examine long-term benefits, translation, and cost-effectiveness.
The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.