Physical activity, diet and BMI in children aged 6–8 years: a cross-sectional analysis American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Objectively measured physical activity level and sedentary behavior in Norwegian children during a week in preschool☆ Individuals Underestimate Moderate and Vigorous Intensity Physical Activity A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors Evaluation of policies to promote physical activity in afterschool programs: are we meeting current benchmarks? Exercise for people with cancer: a clinical practice guideline. Association of available parkland, physical activity, and overweight in America's largest cities. A cluster-randomized controlled trial of strategies to increase adolescents’ physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial Adherence to physical activity guidelines in mid-pregnancy does not reduce sedentary time: an observational study A self-regulation-based intervention to increase physical activity in cancer patients Objectively measured physical activity in four-year-old British children: a cross-sectional analysis of activity patterns segmented across the day The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial Energy Cost of Single‐Set Resistance Training in Older Adults A randomized trial to promote physical activity among breast cancer patients. Rationale and study protocol for the supporting children’s outcomes using rewards, exercise and skills (SCORES) group randomized controlled trial: A physical activity and fundamental movement skills intervention for primary schools in low-income communities A school-based physical activity program to improve health and fitness in children aged 6–13 years ("Kinder-Sportstudie KISS"): study design of a randomized controlled trial [ISRCTN15360785] Change in energy expenditure and physical activity in response to aerobic and resistance exercise programs The effect of supervised exercise therapy on physical activity and ambulatory activities in patients with intermittent claudication. Home-based physical activity intervention for breast cancer patients. Assessment of a two-year school-based physical activity intervention among 7-9-year-old children Exercise impact on sustained attention of ADHD children, methylphenidate effects A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Level of moderate-intensity leisure-time physical activity and reduced mortality in middle-aged and elderly Chinese Associations between Physical Activity and Health Parameters in Adolescent Pupils in Egypt A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: A pilot study Chemotherapy-induced peripheral neuropathy, physical activity and health-related quality of life among colorectal cancer survivors from the PROFILES registry Greater Adherence to Recommended Morning Physical Activity is Associated With Greater Total Intervention-Related Physical Activity Changes in Bariatric Surgery Patients. Randomised controlled trial of a home-based physical activity intervention in breast cancer survivors Feasibility of a telephone and web-based physical activity intervention for women shift workers Associations between physical activity and bone mass in black and white South African children at age 9 yr. Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions Minimal Intensity Physical Activity (Standing and Walking) of Longer Duration Improves Insulin Action and Plasma Lipids More than Shorter Periods of Moderate to Vigorous Exercise (Cycling) in Sedentary Subjects When Energy Expenditure Is Comparable Association between bone stiffness and nutritional biomarkers combined with weight-bearing exercise, physical activity, and sedentary time in preadolescent children. A case-control study.
Objective To assess relationships between current physical activity ( PA ) , dietary intake and body mass index (  BMI ) in English children . Design and setting Longitudinal birth cohort study in northeast Engl and , cross-sectional analysis . Participants 425 children ( 41 % of the original cohort ) aged 6–8 years ( 49 % boys ) . Main outcome measures  PA  over 7 days was measured objective ly by an accelerometer ; three categories of PA were created : ‘ active ’ ≥60 min/day moderate-to-vigorous-intensity PA ( MVPA ) ; ‘ moderately active ’ 30–59 min/day MVPA ; ‘ inactive ’ < 30 min/day MVPA . Dietary intake  over 4 days was measured using a prospect i ve dietary assessment tool which incorporated elements of the food diary and food frequency methods . Three diet categories were created : ‘ healthy ’ , ‘ unhealthy ’ and ‘ mixed ’ , according to the number of portions of different foods consumed . Adherence to the ‘ 5-a-day ’ recommendations for portions of fruit and vegetables was also assessed . Children were classified as ‘ healthy weight ’ or ‘ overweight or obese ’ ( OW/OB ) according to International Obesity Taskforce cutpoints for BMI . Associations between weight status and PA/diet categories were analysed using logistic regression . Results Few children met the UK-recommended guidelines for either MVPA or fruit and vegetable intake , with just 7 % meeting the recommended amount of MVPA of 60 min/day , and 3 % meeting the 5-a-day fruit and vegetable recommendation .  Higher PA  was associated with a lower OR for OW/OB in boys only ( 0.20 , 95 % CI 0.04 to 0.88 ) . There was no association detected between dietary intake and OW/OB in either sex . Conclusions Increasing MVPA may help to reduce OW/OB in boys ; however , more research is required to examine this relationship in girls . Children are not meeting the UK guidelines for diet and PA , and more needs to be done to improve this situation Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( NHLBI ) encourage a 10 % reduction in weight , although considerable literature indicates reduction in health risk with 3 % to 5 % reduction in weight . Physical activity ( PA ) is recommended as a component of weight management for prevention of weight gain , for weight loss , and for prevention of weight regain after weight loss . In 2001 , the American College of Sports Medicine ( ACSM ) published a Position St and that recommended a minimum of 150 min wk(-1 ) of moderate-intensity PA for overweight and obese adults to improve health ; however , 200 - 300 min wk(-1 ) was recommended for long-term weight loss . More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss . To this end , we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain , for weight loss , and prevention of weight regain . Evidence supports moderate-intensity PA between 150 and 250 min wk(-1 ) to be effective to prevent weight gain .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will provide only modest weight loss . Greater amounts of PA ( > 250 min wk(-1 ) ) have been associated with clinical ly significant weight loss .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction . Cross-sectional and prospect i ve studies indicate that after weight loss , weight maintenance is improved with PA > 250 min wk(-1 ) . However , no evidence from well- design ed r and omized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss .  Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk . Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk . There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain Although many studies have reported on  physical activity ( PA ) levels using accelerometers , a thorough description of the PA pattern in preschool children during their stay in the preschool , is lacking in the current literature . Furthermore , there remains a lack of underst and ing of the PA level and pattern in children in the lower end of the PA continuum . The first aim of this study was therefore to describe the PA pattern during a week-long stay in a preschool in all children born in 2011 ( either three or four-year-olds ) attending public preschools in a municipality in Norway . The second aim was to describe the PA level and pattern of the children who are the least physically active . This cross-sectional study included baseline data from 95 % of children ( N = 111 ) participating in a r and omized controlled physical activity intervention ( Active Kindergarten – Active Children study ) . The participants wore an Actigraph accelerometer , in week 39 in 2015 , from when they arrived at the preschool on Monday morning and throughout their stay of five consecutive days . The amount of moderate- to vigorous-intensity PA ( MVPA ) per day ranged from 16 min to 116 min , and sedentary time ranged from 2.7 h to 6.5 h per day in the least and most sedentary child , respectively . The least physically active 25 % of children were less active throughout the entire day , and only a few of them managed to achieve the recommended level of MVPA on any weekday . The physical activity levels and patterns among the least active children described in this study may help to inform interventions targeting this group Background It is unclear whether the common physical activity ( PA ) intensity descriptors used in PA guidelines worldwide align with the associated percent heart rate maximum method used for prescribing relative PA intensities consistently between sexes , ethnicities , age categories and across body mass index ( BMI ) classifications . Objectives The objectives of this study were to determine whether individuals properly select light , moderate and vigorous intensity PA using the intensity descriptions in PA guidelines and determine if there are differences in estimation across sex , ethnicity , age and BMI classifications . Methods 129 adults were instructed to walk/jog at a “ light , ” “ moderate ” and “ vigorous effort ” in a r and omized order . The PA intensities were categorized as being below , at or above the following % HRmax ranges of : 50–63 % for light , 64–76 % for moderate and 77–93 % for vigorous effort . Results On average , people correctly estimated light effort as 51.5±8.3%HRmax but underestimated moderate effort as 58.7±10.7%HRmax and vigorous effort as 69.9±11.9%HRmax . Participants walked at a light intensity ( 57.4±10.5%HRmax ) when asked to walk at a pace that provided health benefits , wherein 52 % of participants walked at a light effort pace , 19 % walked at a moderate effort and 5 % walked at a vigorous effort pace . These results did not differ by sex , ethnicity or BMI class . However , younger adults  underestimated moderate and vigorous intensity more so than middle-aged adults ( P<0.05 ) . Conclusion When the common PA guideline descriptors were aligned with the associated % HRmax ranges , the majority of participants underestimated the intensity of PA that is needed to obtain health benefits . Thus , new subjective descriptions for moderate and vigorous intensity may be warranted to aid individuals in correctly interpreting PA intensities Purpose Over half of young adult cancer survivors do not meet physical activity ( PA ) guidelines . PA interventions can enhance health and quality of life among young adult cancer survivors . However , few exercise interventions have been design ed and tested in this population . This study evaluated the feasibility and preliminary efficacy of a 12-week , Facebook-based intervention ( FITNET ) aim ed at increasing moderate-to-vigorous intensity PA  compared with a Facebook-based self-help comparison ( SC ) condition . Methods Young adult cancer survivors ( n = 86 ) were r and omly assigned to the FITNET or SC group . All participants were asked to complete self-administered online question naires at baseline and after 12 weeks . Results Seventy-seven percent of participants completed postintervention assessment s , and most participants reported using intervention components as intended . Participants in both groups would recommend the program to other young adult cancer survivors ( FITNET , 46.9 vs. SC , 61.8 % ; p = 0.225 ) . Over 12 weeks , both groups increased self-reported weekly minutes of moderate-to-vigorous PA ( FITNET , 67 min/week ( p = 0.009 ) vs. SC , 46 min/week ( p = 0.045 ) ) , with no significant difference between groups . Increases in light PA were 135 min/week greater in the FITNET group relative to the SC group ( p = 0.032 ) , and the FITNET group reported significant weight loss over time ( −2.1 kg , p = 0.004 ; p = 0.083 between groups ) . Conclusion Facebook-based intervention approaches demonstrated potential for increasing PA in young adult cancer survivors . Implication s for Cancer SurvivorsSocial networking sites may be a feasible way for young adult cancer survivors to receive health information and support to promote PA and healthy behaviors BACKGROUND Policies now recommend afterschool programs ( ASP , 3 - 6 pm ) provide children a minimum amount of physical activity daily . We examined the extent to which children attending ASPs meet existing national and state-level policies that specify expected levels of physical activity ( PA ) . METHODS Accelerometer-derived physical activity ( light and moderate-to-vigorous , MVPA ) of 253 children ( 5 - 13 years ) was compared to policies that recommend varying amounts of PA children should achieve during an ASP . RESULTS The proportion of children achieving a policy ranged from 0.0 % ( California 60 min MVPA and North Carolina 20 % of daily program time devoted to MVPA ) , 1.2 % ( California 30 min MVPA ) , to 48.2 % ( National Afterschool Association 30 min light plus MVPA ) . R and om effects logistic models indicated boys ( odds ratio [ OR ] range 2.0 to 6.27 ) and children from a minority background ( Black/Hispanic , OR range 1.87 to 3.98 ) were more likely to achieve a recommended level of physical activity , in comparison to girls and White children . Neither age nor BMI were related to achieving a policy . CONCLUSIONS The PA of children attending ASP falls below policy recommended levels ; however , these policies were developed in absence of data on expected PA levels during ASPs . Thus , concerted effort towards building a stronger ASP evidence -base for policy refinement is required BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group , a group organized by Cancer Care Ontario 's Program in Evidence -Based Care ( pebc ) . The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer , focusing on the benefits of specific types of exercise , recommendations about screening requirements for new referrals , and safety concerns . METHODS Consistent with the pebc 's st and ardized approach , a systematic search was conducted for existing guidelines , and systematic literature search es were performed in medline and embase for both systematic review s and primary literature . Content and methodology experts performed an internal review , which was followed by an external review by targeted experts and intended users . RESULTS The search identified three guidelines , eighteen systematic review s , and twenty-nine r and omized controlled trials with relevance to the topic . The present guideline provides recommendations for the duration , frequency , and intensity of exercise appropriate for people living with cancer . It also provides recommendations for pre-exercise assessment , safety concerns , and delivery models . CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment , and that it does not cause harm . The present guideline is intended to support the Canadian Society for Exercise Physiology 's Canadian physical activity guidelines . The recommendations are intended for clinicians and institutions treating cancer patients in Ontario , and for policymakers and program planners involved in the delivery of exercise programs for cancer patients OBJECTIVE To examine associations between the densities of available parkl and , parkl and provided per capita , and levels of  physical activity ( PA ) and overweight in urban United States . DESIGN Cross-sectional correlation research using data drawn from the Trust for Public L and 's 2010 City Park Facts and The Behavioral Risk Factor Surveillance System ( BRFSS ) . City Park Facts is a report containing " basic information on urban park systems -- from acreage , to facilities , to staffing , to budgets , to usership , and more " for America 's 85 largest cities . The Behavioral Risk Factor Surveillance System is a state-based surveillance system that collects information on health risk behaviors , preventive health practice s , and health care access primarily related to chronic disease and injury . SETTING Sixty-seven metropolitan statistical areas in the United States that provided data for both reports . PARTICIPANTS R and omly selected adults aged 18 years and older who participated in the 2009 Behavioral Risk Factor Surveillance Survey in the 67 metropolitan statistical areas . MAIN OUTCOME MEASURE(S ) Total parkl and per acre of metropolitan area was correlated to inactivity , engaging in recommended levels of moderate or vigorous PA , engaging in recommended levels of vigorous PA , and body weight . Parkl and acreage per 1000 residents was correlated to these same variables . Multilevel models considered these relationships while controlling for race , family income , and age of respondents and accounting for clustering by metropolitan statistical area . RESULTS There were significant , positive correlations between park density and PA ( r(s ) = 0.37 , n = 67 , P < .01 ) and between park density and exercise ( r(s ) = 0.35 , n = 67 , P < .01 ) , and a negative correlation between park density and being above normal weight ( r(s ) = -0.32 , n = 67 , P < .01 ) . Adjusted multilevel models showed that parkl and density in the highest versus lowest quartile was associated with significantly higher odds of meeting PA guidelines ( aOR = 1.19 , 95 % CI : 1.08 - 1.30 ) and reduced odds of being overweight/obese ( aOR = 0.85 , 95 % CI : 0.76 - 0.95 ) . CONCLUSIONS Each of these findings substantiates the need for providing parkl and in a community . As such , this research helps to support the notion that the development of a strong park system may lead to positive PA and health outcomes for that community Background The physical activity ( PA ) levels of many children and adolescents in Australia are currently insufficient to promote health benefits . Physical education ( PE ) programs aim to promote PA and reach nearly all school-aged children , but PA levels within PE lessons are often low . PE teachers may influence children ’s motivation to be physically active in PE lessons , but little is known about teacher strategies that effectively motivate children to participate in PA , and few intervention studies have examined motivational strategies in PE . The purpose of this study was to compare the effect of three motivational strategies , each based on Self-Determination Theory ( SDT ) , on PA levels , and their hypothesized antecedents , during year 8 PE lessons . Methods / design This study employed a cluster-r and omized controlled trial design . Following a familiarization session , PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson .  Teachers ( n = 16 ) and their classes from five secondary schools in Sydney , Australia were r and omly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions : ( 1 ) explaining the relevance of activities ; ( 2 ) providing choice from PA options selected by the teacher ; ( 3 ) providing equipment and free choice of activities ; or ( 4 ) usual practice . The primary outcomes were lesson time spent in moderate-to-vigorous PA , and motivation towards the lesson . Secondary outcomes were perceptions of teacher behavior , psychological needs satisfaction , and lesson time spent in sedentary behavior . PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers . Teacher behavior , psychological needs satisfaction , and motivation were assessed via question naires at the end of each lesson . Linear mixed-model analyses will be run on all outcomes , with students nested within teachers as a r and om effect . Discussion Study findings will inform the development of effective SDT-based teaching strategy interventions to enhance students ’ psychological needs satisfaction , motivation , and PA levels . More effective teaching strategies may be identified that are capable of improving  adolescents ’ PA levels , and thereby provide beneficial population health outcomes .Trial registration This trial is registered with Current Controlled Trials and is traceable as IS RCT N07038258 Background Physical activity ( PA ) interventions design ed to prevent prenatal complications have focused on increasing moderate PA yielding conflicting results . Minimal attention has focused on the evaluation of sleep , sedentary behavior ( SB ) , light activity or total daily PA during pregnancy . The purpose of this prospect i ve , longitudinal study was to 1 ) objective ly quantify and compare habitual PA and SB during the 2nd and 3rd trimester ; and 2 ) evaluate differences in activity patterns for women meeting prenatal PA guidelines versus those that did not . Methods Forty-six participants wore 2 PA monitors ( SenseWear ® Mini and activPAL ™ ) during week 18 and week 35 of pregnancy . We compared differences in sleep duration , postural allocation , daily steps , and PA between the 2nd and 3rd trimester and for women who met and did not meet PA guidelines . Results During the 2nd trimester , 30 % of the women ’s day ( 24-hours ) was total sleep ; 52 % SB ; 13 % light ; 3 % moderate ; and 0 % vigorous PA . Light ( P = 0.05 ) , vigorous ( P = 0.02 ) , and moderate-vigorous PA ( MET-minutes ; P = 0.02 ) , decreased with a trend in increased SB ( P = 0.07 ) . Activity of other intensities and sleep duration did not significantly change . Only 39 % and 37 % of participants slept between 7–9 hours/night at week 18 and 35 , respectively . Forty-six percent ( n = 21 ) and 28 % ( n = 13 ) of participants met prenatal PA guidelines during the 2nd and 3rd trimester , respectively . At week 18 , no differences in total sleep , SB , or light PA existed for women who met PA guidelines versus those who did not ; total PA was significantly greater for women who met guidelines . At week 35 , women that met PA guidelines had significantly less SB ( P < 0.005 ) than women who did not . Conclusions This study demonstrates that pregnant women spend the majority of their day in SB . Significant reductions in total activity across pregnancy may be attributed , in part to shifts in light PA and increased SB . Based on the lifestyle of our sample , regardless of meeting PA guidelines in mid-pregnancy , no significant difference exists in time spent in SB , however meeting PA recommendations in late pregnancy may reduce SB . Future interventions should target reducing SB by increasing light and moderate PA beyond volitional exercise The study examined whether a behavior-change intervention focusing on self-regulatory strategies and emphasizing role model support increases physical activity ( PA ) among insufficiently active ( not meeting PA guidelines of 150 min/week ) cancer patients . Ambulatory cancer patients [ N = 72 ; 54 % female ; M = 56 years , SD = 12.34 ; most with breast or colon cancer ( 34 , 15 % ) ] were enrolled in the MOTIVACTION- study , a 4-week intervention ( 1-hr counseling , followed by weekly phone calls ) , with pretest ( T1 ) , posttest ( T2 ) and a 10-week follow-up ( T3 ) . Participants were r and omized to either an exercise or to a stress management intervention ( active control ) . The exercise intervention emphasized self-regulatory strategies ( e.g. action- and coping planning and self-monitoring ) ; patients were also encouraged to contact a physically active same-sex role model as a potential exercise partner . The active control condition consisted of coping and relaxation techniques .  Sixty-seven patients remained in the study and completed the SQUASH assessment of PA and a measure of perceived stress . PA was vali date d by Actigraph accelerometry . At T2 , 46 % of the patients in the exercise group and 19 % of stress management patients increased their activity levels to meet PA guidelines ( > 150 min/week ; χ2(1 ) = 5.51 , p = .019 ) . At T3 , participants in the exercise intervention maintained their exercise level ( 46 % ) , but also 31 % of the stress management patients met the guidelines . All patients reported reductions in perceived stress . Additional analyses comparing patients in the exercise group by role model contact ( 63 % realized contact ) revealed that those who had contact with their role model were significantly more likely to adhere to the recommended guidelines ( T2:50 % ; T3:64 % ) compared to those who did not have contact with a role model ( T2:39 % ; T3:15 % ) , suggesting the potential of mobilizing role model support to facilitate PA . In sum , cancer patients may not only benefit from an exercise intervention emphasizing self-regulation , but also from stress management , regarding both reducing stress and increasing PA Background Little is known about preschool-aged children ’s levels of  physical activity ( PA ) over the course of the day . Using time-stamped data , we describe the levels and patterns of PA in a population -based sample of four-year-old British children . Methods Within the Southampton Women ’s Survey the PA levels of 593 4-year-old children ( 51 % female ) were measured using ( Actiheart ) accelerometry for up to 7 days . Three outcome measures : minutes spent sedentary ( < 20 cpm ) ; in light ( LPA : ≥20 – 399 cpm ) and in moderate-to-vigorous activity ( MVPA : ≥400 cpm ) were derived . Average daily activity levels were calculated and then segmented across the day ( morning , afternoon and evening ) . MVPA was log-transformed . Two-level r and om intercept models were used to analyse associations between activity level and temporal and demographic factors . Results Children were active for 67 % ( mean 568.5 SD 79.5 minutes ) of their daily registered time on average , with 88 % of active time spent in LPA . All children met current UK guidelines of 180 minutes of daily activity . There were no differences in children ’s average daily levels of sedentary activity and LPA by temporal and demographic factors : differences did emerge when activity was segmented across the day . Sex differences were largest in the morning , with girls being more sedentary , spending fewer minutes in LPA and 18 % less time in MVPA than boys . Children were more sedentary and less active ( LPA and MVPA ) in the morning if they attended childcare full-time compared to part-time , and on weekend mornings compared to weekdays . The reverse was true for weekend afternoons and evenings . Children with more educated mothers were less active in the evenings . Children were less sedentary and did more MVPA on summer evenings compared to winter evenings . Conclusions Preschool-aged children meet current physical activity guidelines , but with the majority of their active time spent in LPA , investigation of the importance of activity intensity in younger children is needed . Activity levels over the day differed by demographic and temporal factors , highlighting the need to consider temporality in future interventions . Increasing girls ’ morning activity and providing opportunities for daytime activity in winter months may be worthwhile Regular physical activity ( PA ) and the avoidance of prolonged sitting are essential for children ’s healthy growth , and for the physical and mental wellbeing of both children and adults . In the context of exercise , music may promote behavioral change through increased exercise adherence and participation . The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior ( SB ) and increase PA in mother-child pairs in the home environment . A r and omized controlled trial was conducted in the Pirkanmaa region , Finl and , in 2014–2016 . The participants consisted of 228 mother-child pairs ( child age 5–7 years ) . The primary outcomes of interest were tri-axial accelerometer-derived SB and PA , which were measured in weeks one ( baseline ) , two , and eight in both the intervention and control groups . Further , the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight . Secondary outcomes included self-reported screen time . The statistical methods employed comprised an intention-to-treat and linear mixed effects model design . No statistically significant differences between groups were found in primary or secondary outcomes . Among the children in the control group  , light PA  decreased significantly over time and screen time increased from 89 ( st and ard deviation , SD 37 ) to 99 ( SD 41 ) min/d . Among mothers and children in the intervention group , no statistical differences were found . In supplementary analysis , the children who stayed at home instead of attending daycare/preschool had on average 25 ( 95 % confidence interval , CI 19–30 ) min/d more sedentary time and 11 ( 95 % CI 8–14 ) min/d less moderate-to-vigorous PA than those who were at daycare/preschool . The higher body mass index of mothers was related with 5 ( 95 % CI 2–7 ) min/d more sedentary time and 1 ( 95 % CI 0–2 ) min/d less moderate-to-vigorous PA . The movement-to-music video program did not change the objective ly measured SB or PA of the mother-child pairs . However , mothers and children seemed to be more sedentary at home , and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment & NA ; Phillips , W.T. , and J.R. Ziuraitis . Energy cost of single‐set resistance training in older adults . J. Strength Cond . Res . 18(3):606–609 . 2004.—The purpose of this study was ( a ) to assess the intensity and energy cost of a single‐set resistance training ( RT ) protocol as recommended by the recent American College of Sports Medicine ( ACSM ) guidelines for older adults and ( b ) to compare obtained values to those recently reported as eliciting health benefits via endurance‐based physical activity ( PA ) . Five males and 5 females ( 73.1 ± 5.5 years ) performed 1 set of 15 repetitions of 8 RT exercises while connected to a portable metabolic unit ( CosMed K4b2 ) . The RT intensity ( metabolic equivalents [ METs ] ) was 3.3 ± 0.7 ( males ) and 3.0 ± 0.6 ( females ) . Energy cost ( kcal ) was 84.2 ± 14.6 ( males ) and 69.7 ± 17.4 ( females ) . We conclude that a single‐set 8‐exercise RT protocol may be a feasible alternative for achieving moderate intensity ( 3–6 METs ) for older adults but that additional sets and /or repetitions appear to be necessary to accumulate moderate amounts ( 150–200 kcal ) of PA OBJECTIVE  Physical activity ( PA ) has been shown to provide health benefits for breast cancer patients . The effects of augmenting oncology health care provider ( HCP ) advice for PA with 3 months of telephone counseling versus contact control were evaluated in a r and omized trial . METHODS After receiving brief HCP advice to become physically active , 192 women ( age in years : M = 60.0 , SD = 9.9 ) who had completed treatment for Stage 0-IV breast cancer were r and omized to telephone counseling to support PA ( n = 106 ) or contact control ( n = 86 ) . Their PA , motivational readiness , fatigue , and physical functioning were assessed at baseline ( before receiving HCP advice ) , 3 , 6 , and 12 months . RESULTS Telephone counseling produced significant effects on the primary outcome of moderate-intensity PA of about 30 min/week at both 3 months ( 95 % CI = 0.44 , 57.32 ) and 6 months ( 95 % CI = 3.06 , 61.26 ) . Intervention participants were also more than twice as likely as control participants to report improvements in achieving PA guidelines of at least 150 min/week at 3 ( OR = 2.43 , 95 % CI = 1.18 , 4.98 ) and 6 months ( OR = 2.11 , 95 % CI = 1.00 - 4.48 ) . Telephone counseling was significantly more effective than contact control in increasing motivational readiness for PA at all follow-ups ( ORs = 3.93 - 6.28 , all ps < .003 ) . No between-groups differences were found for fatigue , while differential improvements in physical functioning did not remain significant past 3 months ( p = .01 ) . CONCLUSION HCP advice plus telephone counseling improved PA among breast cancer patients at 3 and 6 months and also differentially improved patients ' motivational readiness at all follow-ups , suggesting the potential for exercise promotion in cancer follow-up care Background Many Australian children are insufficiently active to accrue health benefits and physical activity ( PA ) levels are consistently lower among youth of low socio-economic position .  PA levels decline dramatically during adolescence and evidence suggests that competency in a range of fundamental movement skills ( FMS ) may serve as a protective factor against this trend . Methods / design The Supporting Children ’s Outcomes Using Rewards Exercise and Skills ( SCORES ) intervention is a multi-component PA and FMS intervention for primary schools in low-income communities , which will be evaluated using a group r and omized controlled trial . The socio-ecological model provided a framework for the 12-month intervention , which includes the following components : teacher professional learning , student leadership workshops ( including leadership accreditation and rewards , e.g. , stickers , water bottles ) , PA policy review , PA equipment packs , parental engagement via newsletters , FMS homework and a parent evening , and community partnerships with local sporting organizations . Outcomes will be assessed at baseline , 6- and 12-months . The primary outcomes are PA ( accelerometers ) , FMS ( Test of Gross Motor Development II ) and cardiorespiratory fitness ( multi-stage fitness test ) . Secondary outcomes include body mass index [ using weight (kg)/height ( m2 ) ] , perceived competence , physical self-esteem , and resilience . Individual and environmental mediators of behavior change ( e.g. social support and enjoyment ) will also be assessed . The System for Observing Fitness Instruction Time will be used to assess the impact of the intervention on PA within physical education lessons . Statistical analyses will follow intention-to-treat principles and hypothesized mediators of PA behavior change will be explored . Discussion SCORES is an innovative primary school-based PA and FMS intervention design ed to support students attending schools in low-income communities to be more skilled and active . The findings from the study may be used to guide teacher pre-service education , professional learning and school policy in primary schools . Trial registration Australian New Zeal and Clinical Trials Registry No : Background Childhood obesity is the result of a long lasting imbalance between energy intake and energy expenditure . A major contributing factor is physical inactivity which is closely linked to bone health , cardiovascular disease risk , fitness and psychological factors . The school seems to provide an excellent setting to enhance levels of  physical activity ( PA ) .  However , there is insufficient data from previous school-based intervention trials on how to enhance overall PA . It is also unknown whether an intervention aim ed at increasing PA is effective in improving the children 's health . The purpose of this paper is to outline the design of a school-based r and omized , controlled trial ( RCT ) aim ing to increase overall PA and to improve fitness and health in 6- to 13-year-old children . Methods / Design 15 schools were r and omized to the intervention ( n = 9 ) or the control ( n = 6 ) group , stratified by geographic region ( urban vs. rural ) and by age ( 1st and 5th grade ) . Participation was given for all children in the intervention group since in this group the intervention was part of the normal school curriculum . The intervention during one academic year consisted of : 1 . two additional physical education classes per week given by trained physical education teachers adding up to a total of five PA classes per week , 2 . short PA breaks ( 2–5 min each ) during academic lessons , 3 . PA home work , and 4 . adaptation of recreational areas around the school . All children underwent  anthropometric measurements , blood pressure assessment , fitness testing , measurement of PA  and they filled out question naires . At least 70 % of all children agreed to blood sampling and measurements of body composition and bone mineral measurements by dual energy x-ray absorptiometry . The primary endpoints of the study after one year were an increase in total PA by accelerometry , an increase in aerobic fitness measured by the 20 m shuttle run , a decrease in percent body fat derived from skinfold measurements and an increase in quality of life as assessed by the child health question naire in the intervention group compared to the control group . Secondary outcomes were overall fitness , differences in body composition including body fat distribution , cardiovascular risk factors , psychosocial health , bone mineral content and density of femur , lumbar spine and total body and food intake . Discussion Our preliminary data suggest that the children were representative of Swiss children with respect to sex , socio-demographic status , and body mass index . Short-term results can be expected by the beginning of 2007 . We hypothesized that our intervention will lead to an increase in PA , fitness and overall health . Based on our data , we aim to provide important information regarding the influence of such an intervention on these outcome measures in school-aged children and to provide nationwide guidelines to improve PA in children Exercise is considered an important component of a healthy lifestyle but there remains controversy on effects of exercise on non-exercise  physical activity ( PA ) . The present study examined the prospect i ve association of aerobic and resistance exercise with total daily energy expenditure and PA in previously sedentary , young men . Nine men ( 27.0 ± 3.3 years ) completed two 16-week exercise programs ( 3 exercise sessions per week ) of aerobic and resistance exercise separated by a minimum of 6 weeks in r and om order .  Energy expenditure and PA  were measured with the SenseWear Mini Armb and prior to each intervention as well as during week 1 , week 8 and week 16 of the aerobic and resistance exercise program . Body composition was measured via dual x-ray absorptiometry . Body composition did not change in response to either exercise  intervention . Total daily energy expenditure on exercise days increased by 443 ± 126 kcal/d and 239 ± 152 kcal/d for aerobic and resistance exercise , respectively ( p < 0.01 ) . Non-exercise moderate-to-vigorous PA , however , decreased on aerobic exercise days ( −148 ± 161 kcal/d ; p = 0.03 ) . There was no change in total daily energy expenditure and PA on non-exercise days with aerobic exercise while resistance exercise was associated with an increase in moderate-to-vigorous PA during non-exercise days ( 216 ± 178 kcal/d , p = 0.01 ) . Results of the present study suggest a compensatory reduction in PA in response to aerobic exercise . Resistance exercise , on the other h and , appears to facilitate non-exercise PA , particularly on non-exercise days , which may lead to more sustainable adaptations in response to an exercise program OBJECTIVE / BACKGROUND Intermittent claudication ( IC ) is associated with a reduction in physical activity ( PA ) and a more rapid functional decline leading to a higher mortality rate compared with healthy individuals . Supervised exercise therapy ( SET ) is known to increase the walking capacity of patients with IC . However , it is unclear whether SET increases PA . The aim of this study was to investigate the effect of SET on PA levels and ambulatory activities in patients with IC . METHODS Patients newly diagnosed with IC were requested to wear an activity monitor 1 week prior to and 1 week immediately after 3 months of SET . The primary outcome was the percentage of patients meeting the minimum recommendations of PA ( American College of Sports Medicine [ACSM]/American Heart Association [ AHA ] recommendation for public health of ≥ 67 metabolic equivalents [METs]/min/day , in bouts of ≥ 10 min ) at baseline and after 3 months of SET . Additionally , daily PA level ( METs/min ) , duration of ambulatory activities , daily number of steps , pain free walking distance ( PFWD ) , maximal walking distance ( MWD ) , and Short Form Health Survey ( SF-36 ) health surveys were compared before and after SET . RESULTS Data from 41 participants were available for analysis . A higher number of participants met the ACSM minimum recommendation for PA at the 3 month follow up ( baseline : 43 % ; 3 months : 63 % ; p = .003 ) . Despite significant increases in PFWD ( baseline : 210 m ; 3 months : 390 m ; p = .001 ) , MWD ( baseline : 373 m ; 3 months : 555 m ; p = .002 ) and physical functioning score ( SF-36 )  following SET , no increase in the mean daily PA level was found ( 395 ± 220 vs. 411 ± 228 METs/min ; p = .43 ) . Furthermore , the total number of steps and time spent in ambulatory activities did not change following SET . CONCLUSION Three months of SET for IC leads to more patients meeting the ACSM/AHA public health minimum recommendations for PA . Assessment of PA could be incorporated as an outcome parameter in future research comparing different treatment modalities for peripheral arterial disease PURPOSE The efficacy of a home-based physical activity ( PA ) intervention for early-stage breast cancer patients was evaluated in a r and omized controlled trial . PATIENTS AND METHODS Eighty-six sedentary women ( mean age , 53.14 years ; st and ard deviation , 9.70 years ) who had completed treatment for stage 0 to II breast cancer were r and omly assigned to a PA or contact control group . Participants in the PA group received 12 weeks of PA counseling ( based on the Transtheoretical Model ) delivered via telephone , as well as weekly exercise tip sheets . Assessment s were conducted at baseline , after treatment ( 12 weeks ) , and 6 and 9 month after baseline follow-ups . The post-treatment outcomes are reported here . RESULTS Analyses showed that , after treatment , the PA group reported significantly more total minutes of PA , more minutes of moderate-intensity PA , and higher energy expenditure per week than controls . The PA group also out-performed controls on a field test of fitness . Changes in PA were not reflected in objective activity monitoring . The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines . No significant group differences were found in body mass index and percent body fat . Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group . There was a positive trend in intervention effects on overall mood and body esteem . CONCLUSION The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients . The success of a home-based PA intervention has important implication s for promoting recovery in this population Background  Physical activity ( PA )  in children has declined in recent decades , highlighting the need for effective intervention programs for school-aged children . The main objective of this study was to assess to what extent PA during and after school hours changed among children who received a progressive two-year long intervention vs. that of children who only received general curriculum-based PA .  Methods A cluster r and omized intervention study was conducted and six elementary schools r and omly assigned to serve as control- or intervention schools . All children attending second grade ( mean age = 7.4 years - born in 1999 ) were invited to participate in the fall of 2006 ( N = 320 , 82 % participated ) , again in 2007 ( midpoint ) and 2008 ( end of intervention ) . The intervention consisted of multi-component PA-intervention during school hours and was conducted by teachers at each intervention school . PA  was assessed by means of accelerometers and subjectively at the intervention schools via teachers ' PA log-books . Results There was no difference in PA intensity ( minutes of moderate-to-vigorous physical activity - min of MVPA ) between the two study groups at baseline , but children in the intervention schools were more physically active at moderate-to-vigorous intensity compared to those in control schools after one year of intervention ( mean difference of MVPAlog-minutes : 0.61 , 95%CI : 0.02 , 1.20 , p = 0.04 ) . Moreover , the model for minutes of MVPA during school hours , showed a significant three-way interaction between time at mid-point , group and gender ( mean difference of MVPAlog-minutes : 1.06 , 95%CI : 0.15 , 1.97 , p = .02 ) , indicating a significantly greater increase among the boys in the intervention schools compared to girls . No difference in PA was detected between the study groups at the end of the study period after two years of intervention . Conclusions The results suggest that the objective of increasing PA at school was met after one year of intervention , and it was more pronounced among boys . The lack of increase at the end of the study period suggested that any increase in  PA  during school may highly depend on both motivation and training of general teachers . Boys may respond better to PA interventions such as the one described in this study Attention deficit hyperactivity disorder ( ADHD ) is related to a deficiency of central catecholamines ( CA ) in cognitive , biochemical , and physical tests , and pharmaceutical intervention may have no effect if it is not accompanied by changes in the environment . The objective of our study was to test the hypothesis that central CA are responsible for the increase in speed reaction seen after physical activity ( PA ) and to measure the impact of high intensity PA on the sustained attention of 25 children diagnosed with ADHD consistent with the Disease Statistical Mental-IV ( DSM-IV ) criteria . It is possible that practicing sports assists in the management of the disorder . The children were divided between users ( US ) and non-users ( NUS ) of methylpheni date ( MTP ) , and the groups were compared to evaluate the effect of the drug on cognition after PA . Post-exercise performance on Conner ’s Continuous Performance Test-II ( CPT ) was not affected by MTP , we observed significant improvements in response time , and we saw normalization in the impulsivity and vigilance measures . These results suggest that the improvements in cognition after physical effort are not CA dependent . Additionally , our results suggest that  children ’s attention deficits can be minimized through PA irrespective of treatment with MTP . Additional studies are necessary to confirm that exercise mitigates the harmful symptoms of ADHD Background Physical activity ( PA ) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior ( SB ) may be detrimental to children 's health independent of PA . The primary aim of the Transform-Us ! study is to determine whether an 18-month , behavioral and environmental intervention in the school and family setting s results in higher levels of PA and lower rates of SB among 8 - 9 year old children compared with usual practice ( post-intervention and 12-months follow-up ) . The secondary aims are to determine the independent and combined effects of PA and SB on  children 's cardio-metabolic health risk factors ; identify the factors that mediate the success of the intervention ; and determine whether the intervention is cost-effective . Methods / design A four-arm cluster-r and omized controlled trial ( RCT ) with a 2 × 2 factorial design , with schools as the unit of r and omization . Twenty schools will be allocated to one of four intervention groups , sedentary behavior ( SB-I ) , physical activity ( PA-I ) , combined SB and PA ( SB+PA-I ) or current practice control ( C ) , which will be evaluated among approximately 600 children aged 8 - 9 years in school year 3 living in Melbourne , Australia . All children in year 3 at intervention schools in 2010 ( 8 - 9 years ) will receive the intervention over an 18-month period with a maintenance ' booster ' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessment s. To maximize the sample and to capture new students arriving at intervention and control schools , recruitment will be on-going up to the post-intervention time point . Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey . Discussion To our knowledge , Transform-Us ! is the first RCT to examine the effectiveness of intervention strategies for reducing children 's overall sedentary time , promoting PA and optimizing health outcomes . The integration of consistent strategies and messages to children from teachers and parents in both school and family setting s is a critical component of this study , and if shown to be effective , may have a significant impact on educational policies as well as on pedagogical and parenting practice s . Trial registration ACTRN12609000715279 ; Current Controlled Trials IS RCT Background Few studies have prospect ively evaluated the association of leisure-time physical activity ( LTPA ) with  mortality in Asians , who are more susceptible to insulin resistance than their Caucasian counterparts . Methods Data from two large prospect i ve cohort studies conducted in Shanghai were evaluated . After excluding participants who had a history of cancer , coronary heart disease or stroke at baseline , or who died within the first 3 years after study enrolment , 53 839 men and 66 888 women , followed for an average of 9.2 and 14.7 years , respectively , remained for the study . Results Compared with those who reported no exercise , a reduction in mortality with an HR of 0.86 ( 95 % CI 0.80 to 0.93 ) was observed in those who regularly engage in moderate-intensity LTPA , even those who reported an LTPA level lower than the minimum amount recommended by the current physical activity guidelines ( 150 min or 7.5 metabolic equivalent hours per week ) . The association between  moderate-intensity exercise and mortality followed a dose – response pattern until the amount of LTPA reached 3–5 times the recommended minimum level . A similar pattern of association was observed for cause-specific mortality due to cardiovascular disease ( CVD ) , cancer or other causes . Conclusion Regular participation in moderate-intensity LTPA was associated with reduced mortality , particularly CVD mortality , even when the LTPA was below the minimum level recommended by current guidelines . Increasing the amount of moderate-intensity LTPA was associated with further risk reduction up to a potential threshold of 3–5 times the recommended minimum Physical activity ( PA ) could be protective against  hypertension  , atherosclerosis , coronary heart disease and cardiovascular disease . This quantitative study assessed the association between a PA intervention and three anthropometric parameters ( weight , body mass index , body fat ) and four physiological parameters ( cholesterol level , systolic blood pressure , diastolic blood pressure , heart rate ) among secondary school pupils ( N = 160 ) in Egypt through the school term . The pupils were r and omised to an intervention group ( 80 pupils ) and controls ( 80 pupils ) . Measurements were obtained for all pupils twice : at baseline ; and then again after three months . The PA intervention programme comprised an ‘ afterschool ’ one hour of moderate exercise three times a week for three months . Both the controls and the intervention pupils attended the ‘ normal ’ exercise schedule provided by the school ; in addition , the intervention group attended afterschool PA programme from about 2–3 o’clock in the afternoon . At baseline , employing pupil ’s BMI , 27.5 % and 28.8 % of the intervention and control pupils respectively were classified as overweight . After three months , the percentage of overweight decreased to 12.5 % in the intervention pupils , while it increased to 37.3 % in the controls . At the end of the three months period , there were significant improvements across most anthropometric and physiological parameters of the intervention pupils when compared with the control children . The correlation coefficient of the improvements for the boys and the girls was 0.97 , indicating clearly that the intervention was having nearly the same beneficial effect for boys and girls . A moderate PA programme for a modest period of 3 months could be effective in maintaining or enhancing pupil ’s anthropometric and physiological parameters in comparison to the controls where there was deterioration in both parameters . Policy makers and secondary schools in Egypt might need to pay more attention to PA programmes conducted on school days , in order to motivate pupils to attend such programmes . There is also an urgent need to look at current PA systems within schools in Egypt in order to assess PA outside school times BACKGROUND Physical activity ( PA ) may be important for preventing chronic diseases for adolescent and young adult ( AYA ) childhood cancer survivors . R and omized controlled trials ( RCTs ) of PA interventions for AYA survivors are sparse , but necessary to determine effective programs for increasing PA among this population . Thus , we conducted a pilot RCT , testing the feasibility of a mobile health ( mHealth ) intervention to promote PA among AYA survivors . PROCEDURE We recruited 14- to 18-year-olds who were ≥1-year post cancer therapy from Seattle Children 's Hospital . The 10-week intervention consisted of a wearable PA-tracking device ( Fitbit Flex ) and a peer-based virtual support group ( Facebook group ) . Research staff helped set step goals and awarded badges weekly . Controls received usual care . Baseline assessment s occurred before r and omization and follow-up assessment s occurred during weeks 8 - 10 of the intervention period . Feasibility criteria are defined below . Qualitative interviews assessed acceptability . Exploratory outcomes included PA , quality of life , and motivation for PA . RESULTS All feasibility criteria were met : we recruited 60 survivors , intervention participants wore the Fitbit  on the majority ( 71.5 % ) of intervention days , and ≥90 % of all participants completed question naires . Qualitative data confirmed intervention acceptability . Exploratory analyses found no significant adjusted group differences for change in moderate-to-vigorous PA ( 4.4 vs. 5.0 min/day ; P = 0.92 ) or sedentary time ( -4.5 vs. 1.0 min/day ; P = 0.73 ) , comparing intervention subjects to controls . Some modest differences were found for select subscales of quality of life and motivation for PA . CONCLUSIONS This mHealth PA intervention was feasible and acceptable to AYA childhood cancer survivors and warrants a fully powered RCT Purpose To gain insight into the association of physical activity ( PA ) , chemotherapy-induced peripheral neuropathy ( CIPN ) and health-related quality of life among colorectal cancer survivors , up to 11 years after diagnosis . Methods Data of the second data wave of a Dutch prospect i ve population -based survey among colorectal cancer survivors diagnosed between 2000 and 2009 as registered by the Eindhoven Cancer Registry was used . Eighty-three percent ( n = 1648 ) of patients filled out the  EORTC QLQ-C30  and the EORTC QLQ-CIPN20  of which 506 patients ( 31 % ) were treated with chemotherapy .  Results Treatment with chemotherapy was associated with a higher percentage of patients reporting CIPN symptoms regardless of PA . Furthermore , not meeting the Dutch PA guideline of 150 min of moderate to vigorous PA a week was associated with more CIPN among patients treated with chemotherapy . Also patients not treated with chemotherapy reported CIPN-like symptoms , especially when not meeting the PA guideline . Statistically significant and clinical ly relevant worse scores on almost all EORTC QLQ-C30 subscales were reported by those not meeting the PA guideline compared to those who did meet the guideline , regardless of CIPN symptoms . However , these differences were more pronounced in the group with many CIPN symptoms ( e.g. upper 30 % ) . Implication s for Cancer SurvivorsAlertness among health care professionals and patients for the importance of PA is warranted , as meeting the PA guideline was associated with less CIPN-like symptoms and a higher health-related quality of life regardless of treatment with chemotherapy BACKGROUND This study examines whether performance of bout-related physical activity ( PA ) during morning hours is related to greater overall bout-related PA increases within a preoperative PA intervention for bariatric surgery ( BS ) patients . METHODS Participants with severe obesity ( n = 33 ; mean age = 45.6 ± 9.6 years ; BMI = 45.7 ± 7.0 kg/m2 ) seeking BS were r and omized to and completed 6 weeks of preoperative PA counseling ( retention = 82.5 % ) . Participants were encouraged to walk daily at a moderate intensity in bouts ≥ 10 minutes during morning hours to overcome time-related obstacles and establish a PA habit . Timing and amount of bout-related moderate-to-vigorous PA ( MVPA )  was assessed via objective monitor at pre- and postintervention . RESULTS Greater proportion of bout-related MVPA performed during morning hours ( 4:00 AM-12:00 PM ) at postintervention was associated with larger total increases in bout-related MVPA minutes/day ( β = .40 , P = .03 ) . At postintervention , a greater proportion of participants whose longest MVPA bouts occurred during morning hours ( n = 11 ) achieved the public health guideline ( ie , ≥150 bout-related MVPA minutes/week ) versus those whose longest MVPA bouts occurred during nonmorning hours ( n = 19 ; 63.6 % vs. 26.3 % , P = .04 ) . CONCLUSIONS Intervention-related increases in PA  tended to be greatest when PA was performed in the morning . Morning exercise may be a viable strategy for promoting habitual PA in inactive BS patients Background To improve adherence to physical activity ( PA ) , behavioural support in the form of behavioural change counselling may be necessary . However , limited evidence of the effectiveness of home-based PA combined with counselling in breast cancer patients exists . The aim of this current r and omised controlled trial with a parallel group design was to evaluate the effectiveness of a home-based PA intervention on PA levels , anthropometric measures , health-related quality of life ( HRQoL ) , and blood biomarkers in breast cancer survivors . Methods Eighty post-adjuvant therapy invasive breast cancer patients ( age = 53.6 ± 9.4 years ; height = 161.2 ± 6.8 cm ; mass = 68.7 ± 10.5 kg ) were r and omly allocated to a 6-month home-based PA intervention or usual care . The intervention group received face-to-face and telephone PA counselling aim ed at encouraging the achievement of current recommended PA guidelines . All patients were evaluated for our primary outcome , PA ( International PA Question naire ) and secondary outcomes , mass , BMI , body fat % , HRQoL ( Functional assessment of Cancer Therapy-Breast ) , insulin resistance , triglycerides ( TG ) and total ( TC ) , high-density lipoprotein ( HDL-C ) and low-density lipoprotein ( LDL-C ) cholesterol were assessed at baseline and at 6-months . Results On the basis of linear mixed-model analyses adjusted for baseline values performed on 40 patients in each group , total , leisure and vigorous PA significantly increased from baseline to post-intervention in the intervention compared to usual care ( between-group differences , 578.5 MET-min∙wk−1 , p = .024 , 382.2 MET-min∙wk−1 , p = .010 , and 264.1 MET-min∙wk−1 , p = .007 , respectively ) . Both body mass and BMI decreased significantly in the intervention compared to usual care ( between-group differences , −1.6 kg , p = .040 , and −.6 kg/m2 , p = .020 , respectively ) . Of the HRQoL variables , FACT-Breast , Trial Outcome Index , functional wellbeing , and breast cancer subscale improved significantly in the PA group compared to the usual care group ( between-group differences , 5.1 , p = .024 ; 5.6 , p = .001 ; 1.9 p = .025 ; and 2.8 , p = .007 , respectively ) . Finally , TC and LDL-C was significantly reduced in the PA group compared to the usual care group ( between-group differences , −.38 mmol∙L−1 , p = .001 ; and −.3 mmol∙L−1 , p = .023 , respectively ) . Conclusions We found that home-based PA result ed in significant albeit small to moderate improvements in self-reported PA , mass , BMI , breast cancer specific HRQoL , and TC and LDL-C compared with usual care . Clinical Trials.gov identifierNCT02408107 ( March 25 , 2015 INTRODUCTION Shift work ( an occupation requiring work between 2200 and 0500H ) comprises approximately 20 % of the workforce in Europe and North America [ 1 ] . This is likely to increase , with many shift workers ( SWs ) in emergency services , retail , hospitality , healthcare , transportation and manufacturing [ 2 ] . SWs are at increased risk for negative health outcomes , including cancer and other chronic diseases [ 3 , 4 ] . Biological changes from poor lifestyle habits related to shift work ( e.g. low physical activity ( PA ) , poor nutrition , obesity ) are thought to contribute to this risk ; these factors are also amenable to lifestyle intervention [ 5 ] . PA in particular , reduces cancer risk [ 6 ] , and has many positive physical and psychological benefits [ 7 ] . It is a simple , cost-effective strategy that may be implemented by individual workers or within workplaces to mitigate risk . Unfortunately , SWs are unlikely to engage in regular PA [ 8 ] . In Canada , only 15.9 % of SWsmeet the PA guidelines and have lower levels of aerobic fitness than those of day workers [ 9 ] . Few behavioural interventions improving health outcomes in SWs have been published [ 10 ] . In a targeted PA intervention , nurses r and omised to 4 months of supervised PA  improved aerobic fitness , muscular strength , fatigue and musculoskeletal symptoms . However , authors reported low adherence and large loss to follow-up , perhaps due to the supervised scheduled sessions [ 11 , 12 ] . Sustained behaviour change is a challenge and requires targeted efforts to encourage individuals to reach an adequate dose of PA to change health outcomes [ 13 ] . Due to irregular schedules and time constraints , SWs may be less likely to adhere to a traditional supervised PA intervention with face-to-face behavioural support [ 12 ] . Women SWs cite work schedule interference and lack of time as PA barriers and report scheduling flexibility as the most important in PA [ 14 ] . This highlights the need for a creative and innovative programming to promote PA in SWs . Distance-based interventions , in which individuals exercise independent of study staff or participants , may include telephone counselling and website or smart phone app-based technology . These interventions are highly flexible and may help overcome barriers related to timing and scheduling that are important for SWs . In a review of telephone-based PA interventions , 14 of 17 found evidence for behaviour change [ 15 ] . These may be a way to implement scalable , individuallytailored interventions in SWs . The primary objective of this study was to test the feasibility of a distance-based PA intervention in women SWs . Feasibility studies are important for establishing effective processes and underst and ing re sources required before attempting a r and omised controlled trial ( RCT ) , in order to put forward interventions that are most likely to be efficacious [ 16 ] . As this work was funded by a grant to examine the role of lifestyle in reducing breast cancer risk in SWs , only women were included . A secondary objective was to conduct a preliminary evaluation of intervention efficacy , to estimate effect size for future studies We investigated differences in physical activity ( PA ) levels between black and white South African 9-yr-old children and their association with bone mineral content ( BMC ) and density ( BMD ) by using dual-energy X-ray absorptiometry . PA was analyzed in terms of a metabolic ( METPA ; weighted metabolic score of intensity , frequency , and duration ) and a mechanical ( MECHPA ; sum of all ground reaction forces multiplied by duration ) component . There were significant ethnic differences in patterns of activity . White children expended a significantly greater energy score ( METPA of 21.7 + /- 2.9 ) than black children ( METPA of 9.5 + /- 0.5 ) ( P < 0.001 ) . When children were divided into quartiles according to the amount and intensity of sport played , the most active white children ( using METPA scores ) had significantly higher whole body BMD and higher hip and spine BMC and BMD than less active children . White children in the highest MECHPA quartile also showed significantly higher whole body , hip , and spine BMC and BMD than those children in the lowest quartile . No association between  exercise and bone mass of black children was found . In this population ,  PA  has an osteogenic association with white children , but not black children , which may be explained by the lower levels of  PA  in the black children . Despite this , black children had significantly greater bone mass at the hip and spine ( girls only ) ( P < 0.001 ) even after adjustment for body size . The role of exercise in increasing bone mass may become increasingly critical as a protective mechanism against osteoporosis in both ethnic groups , especially because the genetic benefit exhibited by black children to higher bone mass may be weakened with time , as environmental influences become stronger At the end of a long week in the office , you sink back into your chair , reflecting on some of the more memorable patients you cared for and counseled . Through gentle history taking , you discovered that urinary incontinence is the underlying cause of an elderly patient 's increasing social isolation . During a careful physical examination , you detected bruising on the torso of a woman with chronic headaches and began to explore the longst and ing abusive relationship between the woman and her alcoholic partner . You discontinued procainamide therapy in a 72-year-old man who had asymptomatic premature ventricular contractions after myocardial infa rct ion . To prevent bleeding from esophageal varices , you started -blocker therapy in a woman with long-st and ing cryptogenic cirrhosis and portal hypertension . In couples ' therapy , discussing the future quality of life of a middle-aged gay man with human immunodeficiency virus infection , you journeyed through emotionally intense dialogue about advance directives . You presented the risk factors for major and minor bleeding to a 39-year-old woman who was considering warfarin therapy because of recently diagnosed atrial fibrillation and valvular heart disease . You listened to , made diagnoses for , treated , advised , and comforted many patients . Yet there were some hiccoughs in your practice along the way . You stumbled while debating the pros and cons of breast cancer screening with a healthy 48-year-old woman who has been staying current with information on the Internet . You question ed the merits of a personalized walking program suggested to you by a motivated 66-year-old man with severe claudication . Explaining that you wanted to review the best current evidence on these issues , you resolved to address your uncertainties before these patients made their next office visits , in a week 's time . Sighing deeply , you acknowledge that you have little time to read . You subscribe to three journals , which you browse months after they arrive-either when your journal stack becomes precariously high or when your guilt is sufficiently motivational . You sometimes find the conclusions of individual articles conflicting or confusing . You know that some of the decisions and suggestions you made this week , specifically your decisions about stopping procainamide therapy and starting -blocker therapy and your advice about bleeding risks from anticoagulant therapy , were based on the best current research evidence [ 1 - 3 ] . On the other h and , your patients ' inquiries about breast cancer screening and exercise treatment for claudication highlight your need for a concise , current , rigorous synthesis of the best available evidence on each of these topics : in brief , a systematic review [ 4 , 5 ] . Incorporating Research Evidence into Clinical Decision Making The foregoing scenario is familiar to practitioners . In a typical week , we encounter patients with diverse problems ; exercise numerous clinical , interpersonal , and technical skills ; and make many decisions . The factors that affect these decisions and their outcomes are complex . For instance , each patient has unique sociodemographic characteristics , cultural circumstances , and personal preferences . Each physician has unique knowledge , experiences , and values . Moreover , practitioners and their patients make decisions within the context of a rapidly changing health care system that influences the availability , accessibility , and cost of diagnostic tests and therapies [ 6 ] . Timely , useful evidence from the biomedical literature should be an integral component of clinical decision making . If one treatment has been shown to be better than another , we need to know , so that we can recommend the treatment to the appropriate patients . The worldwide effort to develop new tests and treatments , and to determine their usefulness , has never been stronger , and our patients and their families expect us to be fonts of the knowledge that results from this effort [ 7 ] . Unfortunately , it is easy for current best research evidence to pass us by [ 8 ] . We may lack the time , motivation , and basic skills needed to find , critically appraise , and synthesize information , all of which we must do if we are to integrate the results of original studies into our practice . Fortunately , several potent methods are emerging that can greatly enhance our ability to interpret and apply research evidence ; foremost among them is the systematic review . This article begins a series in Annals that will examine systematic review s in detail and explore their many applications . Systematic review s represent the best chance that most practitioners will have to underst and and accurately apply the key signals arising from the robust and increasingly productive search for solutions to medical problems . A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest , and it does so concisely and transparently . What Is a Systematic Review ? Systematic review s are scientific investigations in themselves , with pre-planned methods and an assembly of original studies as their subjects . They synthesize the results of multiple primary investigations by using strategies that limit bias and r and om error [ 9 , 10 ] . These strategies include a comprehensive search of all potentially relevant articles and the use of explicit , reproducible criteria in the selection of articles for review . Primary research design s and study characteristics are appraised , data are synthesized , and results are interpreted . When the results of primary studies are summarized but not statistically combined , the review may be called a qualitative systematic review . A quantitative systematic review , or meta- analysis , is a systematic review that uses statistical methods to combine the results of two or more studies . The term overview is sometimes used to denote a systematic review , whether quantitative or qualitative . Summaries of research that lack explicit descriptions of systematic methods are often called narrative review s. Review articles are one type of integrative publication ; practice guidelines , economic evaluations , and clinical decision analyses are others . These other types of integrative articles often incorporate the results of systematic review s. For example , practice guidelines are systematic ally developed statements intended to assist practitioners and patients with decisions about appropriate health care for specific clinical circumstances [ 11 ] . Evidence -based practice guidelines are based on systematic review s of the literature , appropriately adapted to local circumstances and values . Economic evaluations compare both the costs and the consequences of different courses of action ; the knowledge of consequences that are considered in these evaluations is often generated by systematic review s of primary studies . Decision analyses quantify both the likelihood and the valuation of the expected outcomes associated with competing alternatives . Differences between Systematic and Narrative Review s All review s , narrative and systematic alike , are retrospective , observational research studies and are therefore subject to systematic and r and om error . Accordingly , the quality of a review - and thus its worth-depends on the extent to which scientific review methods have been used to minimize error and bias . This is the key feature that distinguishes traditional narrative review s from systematic review s ( Table 1 ) . If a review is prepared according to the steps outlined in the right column of Table 1 , it is more likely to be systematic and to provide unbiased conclusions . If review methods approximate those found in the middle column of Table 1 , the article is more likely to be a narrative review , and the conclusions are less likely to be based on an unbiased summary of all relevant evidence . Table 1 . Differences between Narrative Review s and Systematic Review s Systematic review s are generated to answer specific , often narrow , clinical questions in depth . These questions can be formulated explicitly according to four variables : a specific population and setting ( such as elderly out patients ) , the condition of interest ( for example , hypertension ) , an exposure to a test or treatment ( such as pharmacologic management ) , and one or more specific outcomes ( such as cardiovascular and cerebrovascular events and mortality ) [ 12 ] . Thus , an example of a well-formulated , clinical ly relevant question is , Does pharmacologic treatment of hypertension in the elderly prevent strokes and myocardial infa rct ions or delay death ? If the question that is driving the review is not clear from the title , abstract , or introduction , or if no methods section is included , the paper is more likely to be a narrative review than a systematic review [ 13 ] . Most narrative review articles deal with a broad range of issues related to a given topic rather than addressing a particular issue in depth [ 9 ] . For example , a narrative review on diabetes ( such as that which might be found in a textbook chapter ) might include sections on the physiology and pathophysiology of carbohydrate , lipid , and protein metabolism ; the epidemiology of and prognosis associated with diabetes ; diagnostic and screening approaches ; and preventive , therapeutic , rehabilitative , and palliative interventions . Thus , narrative review s may be most useful for obtaining a broad perspective on a topic ; they are less often useful in furnishing quantitative answers to specific clinical questions . Narrative review s are appropriate for describing the history or development of a problem and its management . Narrative review s may better describe cutting-edge developments if research is scant or preliminary or if studies are very limited by flawed design or execution [ 13 ] . They may be particularly useful for discussing data in light of underlying theory and context . Narrative review s can draw analogies and can conceptually integrate two independent fields of research , such as Background Epidemiological studies suggest that excessive sitting time is associated with increased health risk , independent of the performance of exercise . We hypothesized that a daily bout of exercise can not compensate the negative effects of inactivity during the rest of the day on insulin sensitivity and plasma lipids . Methodology /Principal Findings Eighteen healthy subjects , age 21±2 year , BMI 22.6±2.6 kgm−2 followed r and omly three physical activity regimes for four days . Participants were instructed to sit 14 hr/day ( sitting regime ) ; to sit 13 hr/day and to substitute 1 hr of sitting with vigorous exercise 1 hr ( exercise regime ) ; to substitute 6 hrs sitting with 4 hr walking and 2 hr st and ing ( minimal intensity physical activity ( PA ) regime ) . The sitting and exercise regime had comparable numbers of sitting hours ; the exercise and minimal intensity PA regime had the same daily energy expenditure . PA was assessed continuously by an activity monitor ( ActivPAL ) and a diary . Measurements of insulin sensitivity ( oral glucose tolerance test , OGTT ) and plasma lipids were performed in the fasting state , the morning after the 4 days of each regime . In the sitting regime , daily energy expenditure was about 500 kcal lower than in both other regimes . Area under the curve for insulin during OGTT was significantly lower after the minimal intensity PA regime compared to both sitting and exercise regimes 6727.3±4329.4 vs 7752.0±3014.4 and 8320.4±5383.7 mU•min/ml , respectively . Triglycerides , non-HDL cholesterol and apolipoprotein B plasma levels improved significantly in the minimal intensity PA regime compared to sitting and showed non-significant trends for improvement compared to exercise . Conclusions One hour of daily physical exercise can not compensate the negative effects of inactivity on insulin level and plasma lipids if the rest of the day is spent sitting . Reducing inactivity by increasing the time spent walking/st and ing is more effective than one hour of physical exercise , when energy expenditure is kept constant Physical activity ( PA ) and micronutrients such as calcium ( Ca ) , vitamin D ( 25OHD ) , and phosphate ( PO ) are important determinants of skeletal development . This case-control study examined the association of these nutritional biomarkers and different PA behaviours , such as habitual PA , weight-bearing exercise ( WBE ) and sedentary time ( SED ) with bone stiffness ( SI ) in 1819 2 - 9-year-old children from the IDEFICS study ( 2007 - 2008 ) .  SI was measured on the calcaneus using quantitative ultrasound .  Serum and urine Ca and PO and serum 25OHD were determined . Children 's sports activities were reported by parents using a st and ardised question naire . A sub sample of 1089 children had accelerometer-based PA data ( counts per minute , cpm ) . Moderate-to-vigorous PA ( MVPA ) and SED were estimated . Children with poor SI ( below the 15th age-/sex-/height-specific percentile ) were defined as cases ( N=603 ) . R and omly selected controls ( N=1216 ) were matched by age , sex , and country . Odds ratios ( OR ) for poor SI were calculated by conditional logistic regression for all biomarkers and PA behaviour variables separately and combined ( expressed as tertiles and dichotomised variables , respectively ) . ORs were adjusted for fat-free mass , dairy product consumption , and daylight duration . We observed increased ORs for no sports ( OR=1.39 , p<0.05 ) , PA levels below 524 cpm ( OR=1.85 , p<0.05 ) and MVPA below 4.2 % a day ( OR=1.69 , p<0.05 ) compared to WBE , high PA levels ( < 688 cpm ) and high MVPA ( 6.7 % ) , respectively . SED was not associated with SI . ORs were moderately elevated for low serum Ca and 25OHD . However , biomarkers were not statistically significantly associated with SI and did not modify the association between PA behaviours and SI . Although nutritional biomarkers appear to play a minor role compared to the osteogenic effect of PA and WBE , it is noteworthy that the highest risk for poor SI was observed for no sports or low MVPA combined with lower serum Ca ( < 2.5 mmol/l ) or lower 25OHD ( < 43.0 nmol/l )
Results Overall , exercise intolerance is prevalent in pediatric chronic disease .
Background Physical activity ( PA ) is associated with a diverse range of health benefits .
International guidelines suggest that children should be participating in a minimum of 60 min of moderate to vigorous intensity PA per day to achieve these benefits .
However , current guidelines are intended for healthy children , and thus may not be applicable to children with a chronic disease .
Specifically , the dose of PA and disease specific exercise considerations are not included in these guidelines , leaving such children with few , if any , evidence -based informed suggestions pertaining to PA .
Thus , the purpose of this narrative review was to consider current literature in the area of exercise as medicine and provide practical applications for exercise in five prevalent pediatric chronic diseases : respiratory , congenital heart , metabolic , systemic inflammatory/autoimmune , and cancer .