What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol The relationship between physical activity, sedentary behaviour and psychological wellbeing among adolescents A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial. Objective vs. Self-Reported Physical Activity and Sedentary Time: Effects of Measurement Method on Relationships with Risk Biomarkers Trends in physical activity and sedentary behaviour in adolescence: ethnic and socioeconomic differences Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Physical activity, sedentary behavior, and cause-specific mortality in black and white adults in the Southern Community Cohort Study. Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol The ProActive trial protocol – a randomised controlled trial of the efficacy of a family-based, domiciliary intervention programme to increase physical activity among individuals at high risk of diabetes [ISRCTN61323766] A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes) The Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial: study protocol for a randomized controlled trial Association of dietary habits with levels of physical activity and screen time among adolescents living in Saudi Arabia. Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults Normal weight children have higher cognitive performance – Independent of physical activity, sleep, and diet Randomised controlled trial of primary school based intervention to reduce risk factors for obesity Compliance with the Australian national physical activity guidelines for children: relationship to overweight status. Determinants of sufficient daily activity in Australian primary school children. Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review Reducing office workers’ sitting time: rationale and study design for the Stand Up Victoria cluster randomized trial The effect of a healthy lifestyle programme on 8–9 year olds from social disadvantage Effects of recreational soccer on physical fitness and health indices in sedentary healthy and unhealthy subjects To remove or to replace traditional electronic games? A crossover randomised controlled trial on the impact of removing or replacing home access to electronic games on physical activity and sedentary behaviour in children aged 10–12 years The Relationship of Objectively Measured Physical Activity and Sedentary Behaviour with Gestational Weight Gain and Birth Weight Research priorities for child and adolescent physical activity and sedentary behaviours: an international perspective using a twin-panel Delphi procedure Acute effects of advertisements on children's choices, preferences, and ratings of liking for physical activities and sedentary behaviours: a randomised controlled pilot study. Long-chain n-3 PUFA supplementation decreases physical activity during class time in iron-deficient South African school children. Associations Between Screen-Based Sedentary Behavior and Cardiovascular Disease Risk Factors in Korean Youth Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews Evaluation of a family intervention programme for the treatment of overweight and obese children (Nereu Programme): a randomized clinical trial study protocol Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials MVPA Is Associated with Lower Weight Gain in 8–10 Year Old Children: A Prospective Study with 1 Year Follow-Up Calibration and validation of the ActiGraph GT3X+ in 2-3 year olds. The Malaysian Childhood Obesity Treatment Trial (MASCOT). Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Performance of thigh-mounted triaxial accelerometer algorithms in objective quantification of sedentary behaviour and physical activity in older adults The effect of experimentally induced sedentariness on mood and psychobiological responses to mental stress Intervention of childhood and adolescents obesity in Shantou city.
Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background Previous studies examining the relationship between physical activity levels and broad-based measures of psychological wellbeing in adolescents have been limited by not controlling for potentially confounding variables . The present study examined the relationship between adolescents ’ self-reported physical activity level , sedentary behaviour and psychological wellbeing ; while controlling for a broad range of sociodemographic , health and developmental factors . Methods The study entailed a  cross-sectional school-based survey in ten British towns . Two thous and six hundred and twenty three adolescents ( aged 13–16 years ) reported physical activity levels , patterns of sedentary behaviour  ( TV/computer/video usage )  and completed the strengths and difficulties question naire ( SDQ ) .  Results Lower levels of self-reported physical activity and higher levels of sedentary behaviour showed grade d associations with higher SDQ total difficulties scores , both for boys ( P < 0.001 ) and girls ( P < 0.02 ) after adjustment for age and town . Additional adjustment for social class , number of parents , predicted school examination results , body mass index , ethnicity , alcohol intake and smoking status had little effect on these findings . Conclusions Low levels of self-reported physical activity are independently associated with diminished psychological wellbeing  among adolescents . Longitudinal studies may provide further insights into the relationship between wellbeing and activity levels in this population . Ultimately , r and omised controlled trials are needed to evaluate the effects of increasing physical activity on psychological wellbeing among adolescents 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 ABSTRACT Lack of  physical activity  (  PA  ) and high levels of sedentary behaviour ( SB ) have been associated with health problems . This systematic review evaluates the effectiveness of school-based interventions to increase PA  and decrease SB  among 15–19-year-old adolescents , and examines whether intervention characteristics ( intervention length , delivery mode and intervention provider ) and intervention content ( i.e. behaviour change techniques , BCTs ) are related to intervention effectiveness . A systematic search of r and omised or cluster r and omised controlled trials with outcome measures of PA and /or SB rendered 10 results . Risk of bias was assessed using the Cochrane risk of bias tool . Intervention content was coded using Behaviour Change Technique Taxonomy v1 . Seven out of 10 studies reported significant increases in PA . Effects were generally small and short-term ( Cohen 's d ranged from 0.132 to 0.659 ) . Two out of four studies that measured SB reported significant reductions in SB . Interventions that increased PA  included a higher number of BCTs , specific BCTs ( e.g. , goal setting , action planning and self-monitoring ) , and were delivered by research staff . Intervention length and mode of delivery were unrelated to effectiveness . More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents INTRODUCTION Replacing sedentary behaviour with light intensity physical activity ( ie , activities classified as less than three metabolic equivalents , such as slow-paced walking ) may be a more realistic strategy for reducing cardiometabolic risk in people with chronic obstructive pulmonary disease than only aim ing to increase levels of moderate-vigorous intensity physical activity . Behaviour change interventions to reduce sedentary behaviour in people with chronic obstructive pulmonary disease have not yet been developed or tested . RESEARCH QUESTIONS Is a 6-week behaviour change intervention effective and feasible in reducing sedentary time in people with chronic obstructive pulmonary disease ? DESIGN This study will be a multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis , comparing a 6-week behaviour change intervention aim ed at reducing sedentary time with a sham intervention in people with chronic obstructive pulmonary disease . PARTICIPANTS AND SETTING Seventy participants will be recruited from the waiting lists for pulmonary rehabilitation programs at Royal Prince Alfred Hospital and Prince of Wales Hospital , Sydney , Australia . INTERVENTION The behaviour change intervention aims to reduce sedentary time through a process of guided goal setting with participants to achieve two target behaviours : ( 1 ) replace sitting and lying down with light-intensity physical activity where possible , and ( 2 ) st and up and move for 2minutes after 30minutes of continuous sedentary time . Three face-to-face sessions and three phone sessions will be held with a physiotherapist over the 6-week intervention period . The ' capability ' , ' opportunity ' , ' motivation ' and ' behaviour ' ( COM-B ) model will be applied to each participant to determine which components of behaviour ( capability , opportunity or motivation ) need to change in order to reduce sedentary time . Based on this ' behavioural diagnosis ' , the Behaviour Change Wheel will be used to systematic ally select appropriate behaviour change techniques to assist participants in achieving their weekly goals . Behaviour change techniques will include providing information about the health consequences of sedentary behaviour , self-monitoring and review of weekly goals , problem-solving of barriers to achieving weekly goals , and providing feedback on sedentary time using the Jawbone UP3 activity monitor . CONTROL The sham intervention will consist of weekly phone calls for 6 weeks , to enquire whether the participants ' health status has changed over the intervention period ( eg , hospitalised for an acute exacerbation ) . No instructions regarding physical activity or exercise will be given . MEASUREMENTS Outcomes will be assessed at baseline , at the end of the 6-week intervention period , and at the 3-month follow-up . Primary outcome measures will be : ( 1 ) total sedentary time , including the pattern of accumulation of sedentary time , assessed by the activPAL3 activity monitor , and ( 2 ) feasibility of the intervention assessed by uptake and retention of participants , participant compliance , self-reported achievement of weekly goals , and adverse events . Secondary outcome measures will include functional exercise capacity , health-related quality of life , domain-specific and behaviour-specific sedentary time , patient activation , and anxiety and depression .  Semi-structured interviews will be conducted with participants who receive the behaviour change intervention to explore acceptability and satisfaction with the different components of the intervention . ANALYSIS Analysis of covariance ( ANCOVA ) will be used to calculate between-group comparisons of total sedentary time and the number of bouts of sedentary time>30minutes after adjusting baseline values . Uncertainty about the size of the mean between-group differences will be quantified with 95 % CI . Within-group comparisons will be examined using paired t-tests and described as mean differences with 95 % CIs . Secondary outcome measures will be analysed similarly . The feasibility measures will be analysed descriptively . Semi-structured interviews will be conducted until data saturation is achieved and there are no new emerging themes . De-identified interview transcripts will be coded independently by two research ers and analysed alongside data collection using the COM-B model as a thematic framework . DISCUSSION / SIGNIFICANCE If behaviour change interventions are found to be an effective and feasible method for reducing sedentary time , such interventions may be used to reduce cardiometabolic risk in people with chronic obstructive pulmonary disease . An approach that emphasises participation in light-intensity physical activity may increase the confidence and willingness of people with chronic obstructive pulmonary disease to engage in more intense physical activity , and may serve as an intermediate goal to increase uptake of pulmonary rehabilitation Purpose Imprecise measurement of physical activity variables might attenuate estimates of the beneficial effects of activity on health-related outcomes . We aim ed to compare the cardiometabolic risk factor dose-response relationships for physical activity and sedentary behaviour between accelerometer- and question naire-based activity measures . Methods  Physical activity and sedentary behaviour  were assessed in 317 adults by 7-day accelerometry and International Physical Activity Question naire ( IPAQ ) . Fasting blood was taken to determine insulin , glucose , triglyceride and total , LDL and HDL cholesterol concentrations and homeostasis model-estimated insulin resistance ( HOMAIR ) . Waist circumference , BMI , body fat percentage and blood pressure were also measured . Results For both accelerometer-derived sedentary time ( < 100 counts.min−1 ) and IPAQ-reported sitting time significant positive ( negative for HDL cholesterol ) relationships were observed with all measured risk factors – i.e. increased sedentary behaviour was associated with increased risk ( all p≤0.01 ) . However , for HOMAIR and insulin the regression coefficients were > 50 % lower for the IPAQ-reported compared to the accelerometer-derived measure ( p<0.0001 for both interactions ) . The relationships for moderate-to-vigorous physical activity ( MVPA ) and risk factors were less strong than those observed for sedentary behaviours , but significant negative relationships were observed for both accelerometer and IPAQ MVPA measures with glucose , and insulin and HOMAIR values ( all p<0.05 ) . For accelerometer-derived MVPA only , additional negative relationships were seen with triglyceride , total cholesterol and LDL cholesterol concentrations , BMI , waist circumference and percentage body fat , and a positive relationship was evident with HDL cholesterol ( p = 0.0002 ) . Regression coefficients for HOMAIR , insulin and triglyceride were 43–50 % lower for the IPAQ-reported compared to the accelerometer-derived MVPA measure ( all p≤0.01 ) . Conclusion Using the IPAQ to determine sitting time and MVPA reveals some , but not all , relationships between these activity measures and metabolic and vascular disease risk factors . Using this self-report method to quantify activity can therefore underestimate the strength of some relationships with risk factors Objective : To assess developmental trends in physical activity and sedentary behaviour in British adolescents in relation to sex , ethnicity and socioeconomic status ( SES ) . Design : A 5-year longitudinal study of a diverse cohort of students aged 11–12 years at baseline in 1999 . Setting : 36 London schools sample d using a stratified r and om sampling procedure . Participants : A total of 5863 students categorised as white , black or Asian , and stratified for SES using the Townsend Index  . Main outcome measures : Number of days per week of vigorous activity leading to sweating and breathing hard . Hours of sedentary behaviour , including watching television and playing video games .  Data were analysed using multilevel , linear , mixed models . Results : Marked reductions in physical activity and increases in sedentary behaviour were noticed between ages 11–12 and 15–16 years . Boys were more active than girls , and the decline in physical activity was greater in girls ( 46 % reduction ) than in boys ( 23 % ) . Asian students were less active than whites , and this was also true of black girls but not boys . Black students were more sedentary than white students . Levels of sedentary behaviour were greater in respondents from lower SES . Most differences between ethnic and SES groups were present at age 11 years , and did not evolve over the teenage years . Conclusions : Physical activity declines and sedentary behaviour becomes more common during adolescence . Ethnic and SES differences are observed in physical activity and sedentary behaviour in British youth that anticipate adult variations in adiposity and cardiovascular disease risk . These are largely established by age 11–12 years , so reversing these patterns requires earlier intervention The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight There is limited evidence demonstrating the benefits of physical activity with regard to mortality risk or the harms associated with sedentary behavior in black adults , so we examined the relationships between these health behaviors and cause-specific mortality in a prospect i ve study that had a large proportion of black adults . Participants ( 40 - 79 years of age ) enrolled in the Southern Community Cohort Study between 2002 and 2009 ( n = 63,308 ) were prospect ively followed over 6.4 years , and 3,613 and 1,394 deaths occurred in blacks and whites , respectively . Black adults who reported the highest overall physical activity level ( ≥32.3 metabolic equivalent-hours/day vs. < 9.7 metabolic equivalent-hours/day ) had lower risks of death from all causes ( hazard ratio ( HR ) = 0.76 . 95 % confidence interval ( CI ) : 0.69 , 0.85 ) , cardiovascular disease ( HR = 0.81 , 95 % CI : 0.67 , 0.98 ) , and cancer ( HR = 0.76 , 95 % CI : 0.62 , 0.94 ) . In whites , a higher physical activity level was associated with a lower risk of death from all causes ( HR = 0.76 , 95 % CI : 0.64 , 0.90 ) and cardiovascular disease ( HR = 0.69 , 95 % CI : 0.49 , 0.99 ) but not cancer ( HR = 0.95 , 95 % CI : 0.67 , 1.34 ) . Spending more time being sedentary ( > 12 hours/day vs. < 5.76 hours/day ) was associated with a 20%-25 % increased risk of all-cause mortality in blacks and whites . Blacks who reported the most time spent being sedentary ( ≥10.5 hours/day ) and lowest level of physical activity ( < 12.6 metabolic equivalent-hours/day ) had a greater risk of death ( HR = 1.47 , 95 % CI : 1.25 , 1.71 ) . Our study provides evidence that suggests that health promotion efforts to increase physical activity level and decrease  sedentary time could help reduce mortality risk in black adults Objective To investigate the effectiveness of a school based intervention to increase physical activity , reduce sedentary behaviour , and increase fruit and vegetable consumption in children . Design Cluster r and omised controlled trial . Setting 60 primary schools in the south west of Engl and . Participants Primary school children who were in school year 4 ( age 8 - 9 years ) at recruitment and baseline assessment , in year 5 during the intervention , and at the end of year 5 ( age 9 - 10 ) at follow-up assessment . Intervention The Active for Life Year 5 ( AFLY5 ) intervention consisted of teacher training , provision of lesson and child-parent interactive homework plans , all material s required for lessons and homework , and written material s for school newsletters and parents . The intervention was delivered when children were in school year 5 ( age 9 - 10 years ) . Schools allocated to control received st and ard teaching . Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day , accelerometer assessed minutes of sedentary behaviour per day , and reported daily consumption of servings of fruit and vegetables . Results 60 schools with more than 2221 children were recruited ; valid data were available for fruit and vegetable consumption for 2121 children , for accelerometer assessed physical activity and sedentary behaviour for 1252 children , and for secondary outcomes for between 1825 and 2212 children for the main analyses . None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group . The difference in means comparing the intervention group with the control group was –1.35 ( 95 % confidence interval –5.29 to 2.59 ) minutes per day for moderate to vigorous physical activity , –0.11 ( –9.71 to 9.49 ) minutes per day for sedentary behaviour , and 0.08 ( –0.12 to 0.28 ) servings per day for fruit and vegetable consumption . The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account : self reported time spent in screen viewing at the weekend ( –21 ( –37 to –4 ) minutes per day ) , self reported servings of snacks per day ( –0.22 ( –0.38 to –0.05 ) ) , and servings of high energy drinks per day ( –0.26 ( –0.43 to –0.10 ) ) were all reduced . Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results . Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity , decreasing sedentary behaviour , and increasing fruit and vegetable consumption in primary school children . Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level , as well as at the school environment level . These findings have relevance for research ers , policy makers , public health practitioners , and doctors who are involved in health promotion , policy making , and commissioning services . Trial registration Current Controlled Trials IS RCT N50133740 Background Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide . Most chronic diseases are associated with underlying preventable risk factors , such as elevated blood pressure , high blood glucose or glucose intolerance , high lipid levels , physical inactivity , excessive sedentary behaviours , and overweight/obesity . The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood . Sugar-sweetened beverages are known to be significant sources of additional caloric intake , and given recent attention to their contribution in the development of chronic diseases , a systematic review is warranted . We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are . Methods / Design Of interest are studies addressing sugar-sweetened beverage consumption , taking a broad perspective . Both direct consumption studies as well as those evaluating interventions that influence consumption ( e.g. school policy , educational ) will be relevant . Non-specific or multi-faceted behavioural , educational , or policy interventions may also be included subject to the level of evidence that exists for the other interventions /exposures . Comparisons of interest and endpoints of interest are pre-specified . We will include r and omized controlled trials , controlled clinical trials , interrupted time series studies , controlled before-after studies , prospect i ve and retrospective comparative cohort studies , case – control studies , and nested case – control design s. The MEDLINE ® , Embase , The Cochrane Library , CINAHL , ERIC , and PsycINFO ® data bases and grey literature sources will be search ed . The processes for selecting studies , abstract ing data , and resolving conflicts are described . We will assess risk of bias using design -specific tools . To determine sets of confounding variables that should be adjusted for , we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessment s. Meta- analysis will be conducted where appropriate ; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach will be used to determine the quality of evidence for outcomes . Systematic review registration PROSPERO CRD42014009641 Background Increasing prevalence of obesity and disorders associated with sedentary living constitute a major global public health problem . While previous evaluations of interventions to increase  physical activity  have involved communities or individuals with established disease , less attention has been given to interventions for individuals at risk of disease . Methods / design ProActive aims to evaluate the efficacy of a theoretical , evidence - and family-based intervention programme to increase physical activity  in a sedentary population , defined as being at-risk through having a parental family history of diabetes . Primary care diabetes or family history registers were used to recruit 365 individuals aged 30–50 years , screened for activity level . Participants were assigned by central r and omisation to three intervention programmes : brief written advice ( comparison group ) , or a psychologically based behavioural change programme , delivered either by telephone ( distance group ) or face-to-face in the family home over one year . The protocol -driven intervention programme is delivered by trained facilitators , and aims to support increases in physical activity through the introduction and facilitation of a range of self-regulatory skills ( e.g. goal setting ) . The primary outcome is daytime energy expenditure and its ratio to resting energy expenditure , measured at baseline and one year using individually calibrated heart rate monitoring . Secondary measures include self-report of individual and family activity , psychological mediators of behaviour change , physiological and biochemical correlates , acceptability , and costs , measured at baseline , six months and one year . The primary intention to treat analysis will compare groups at one-year post r and omisation . Estimation of the impact on diabetes incidence will be modelled using data from a parallel ten-year cohort study using similar measures . Discussion ProActiveis the first efficacy trial of an intervention programme to promote physical activity in a defined high-risk group accessible through primary care . The intervention programme is based on psychological theory and evidence ; it introduces and facilitates the use of self-regulatory skills to support behaviour change and maintenance . The trial addresses a range of method ological weaknesses in the field by careful specification and quality assurance of the intervention programme , precise characterisation of participants , year-long follow-up and objective measurement of physical activity . Due to report in 2005 , ProActivewill provide estimates of the extent to which this approach could assist at-risk groups who could benefit from changes in behaviours affecting health , and inform future pragmatic trials Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT Background Low levels of physical activity , high levels of sedentary behaviour and low levels of fruit and vegetable consumption are common in children and are associated with adverse health outcomes . The aim of this paper is to describe the protocol for a cluster r and omised controlled trial ( RCT ) design ed to evaluate a school-based intervention that aims to increase levels of physical activity  , decrease  sedentary behaviour  and increase consumption of fruit and vegetables in school children . Methods / design The Active for Life Year 5 ( AFLY5 ) study is a school-based , cluster RCT that targets school children in Year 5 ( age 9 - 10 years ) . All state junior/ primary schools in the area covered by Bristol City and North Somerset Council are invited to participate ; special schools are excluded . Eligible schools are r and omised to one of two arms : intervention arm ( receive the intervention 2011 - 2012 ) and control arm ( receive the intervention after the final follow-up assessment , 2013 - 2014 ) . The primary outcomes of the trial are levels of accelerometer assessed physical activity and sedentary behaviour and question naire assessed fruit and vegetable consumption . A number of secondary outcomes will also be measured , including body mass index , waist circumference and overweight/obesity . Outcomes will be assessed at baseline ( prior to intervention when the children are in Year 4 ) , at the end of intervention ' immediate follow-up ' and ' 12 months long-term ' follow-up . We will use r and om effects linear and logistic regression models to compare outcomes by r and omised arm . The economic evaluation from a societal perspective will take the form of a cost consequence analysis . Data from focus groups and interviews with pupils , parents and teachers will be used to increase underst and ing of how the intervention has any effect and is integrated into normal school activity . Discussion The results of the trial will provide information about the public health effectiveness of a school-based intervention aim ed at improving levels of physical activity , sedentary behaviour and diet in children . Trial registration IS RCT BACKGROUND Underst and ing the inter-relationships between lifestyle factors in youth is important with respect to the development of effective promotional programmes for healthy eating and active living . The present study aim ed to explore the associations of dietary habits ( DH ) with physical activity ( PA ) and screen time ( ST )  among Saudi adolescents aged between 15 and 19 years of age relative to gender . METHODS Data were obtained from the Arab Teens Lifestyle Study , a school-based multicentre lifestyle study conducted in 2009/2010 in three major cities in Saudi Arabia . A multistage stratified cluster r and om sampling technique was used . The number of participants with complete data for  DH  and  PA  was 2886 and the respective number for DH and ST was 2822 . Assessment included weight , height , body mass index , total daily ST ( television viewing , video/computer games and Internet use ) , PA and DH using self-reported question naires . RESULTS Females were significantly more sedentary and less active than males ( P < 0.001 ) . Two-way analysis of covariance , controlling for age , showed significant ( P < 0.05 ) gender by PA and gender by ST interactions for several DH . Logistic regression analyses revealed significant associations of higher PA with a higher consumption of fruit , vegetables , milk , French fries/potato chips and energy drinks , whereas higher ST was significantly associated with a higher consumption of sugar-sweetened drinks , fast foods , cake/doughnuts and energy drinks . CONCLUSIONS Healthful dietary habits were associated mostly with  PA  , whereas sedentary behaviours , independent of PA , negatively impacted upon eating behaviours . The low PA levels and high sedentary levels of Saudi females represent a great concern . The results reported in the present study have important implication s for both youth public health policies and intervention programmes Adults are sedentary for an alarming 9 to 10 hours per day ( 1 ) . Accordingly , the popular press has coined the phrase sitting is the new smoking to describe a current epidemic of developed nations ( 24 ) . Evidence indicates that sedentary time is associated with incident cardiovascular disease , incidence of cardiovascular diseaserelated risk factors , and mortality ( 5 , 6 ) . Of note , the risk conferred by prolonged sedentariness is eliminated only by high levels of moderate- to vigorous-intensity physical activity ( MVPA ) ( about 60 to 75 min/d ) , which exceed physical activity recommendations ( 7 , 8) . As such , sedentary behavior is now believed to represent a clinical ly important aspect of a person 's physical activity profile and is no longer considered simply the extreme low end of the physical activity continuum ( 5 ) . Studies linking sedentary behavior to health outcomes have relied almost exclusively on self-reported  sedentary time  , which is subject to reporting bias and measurement error ( 9 ) . A 2015 systematic review ( 5 ) identified only 1 study ( NHANES [ National Health and Nutrition Examination Survey ] ) that examined the association between objective ly measured sedentary time and health outcomes , a study limited by a small event rate ( 10 ) . New studies using NHANES data have since been published , with longer follow-up and higher event rates ( 1115 ) . However , some of these studies have reported an association between objective ly measured sedentary time and mortality ( 11 , 14 , 15 ) , but others have not ( 12 , 13 ) . Additional cohort studies are thus needed to rectify evidence gaps . Furthermore , studies using accelerometers to objective ly measure sedentary behavior conventionally operationalize sedentary time as the total number of sedentary minutes per day . This approach ignores patterns of accumulated sedentary behavior over time . For example , accumulation of sedentary time in a few long bouts or many short bouts represents 2 distinct patterns of sedentary time accrual . Experimental studies have shown that acute periods of prolonged , uninterrupted sedentary behavior cause greater detrimental cardiometabolic effects than sedentary behavior that is periodically interrupted ( 1618 ) , suggestive that it is not just total sedentary time that is relevant to health outcomes , but also the manner in which it is accumulated . Few longitudinal studies , however , have explored the association between prolonged , uninterrupted sedentary behavior and mortality to corroborate these findings . To inform guidelines on reducing sedentary behavior ( target reductions in overall sedentary time or target interruption of prolonged sedentary bouts ) , evidence from prospect i ve studies is needed to 1 ) confirm the association between total sedentary time and mortality using objective measures , 2 ) determine whether prolonged sedentary bouts confer risk for death , and 3 ) eluci date whether the total volume of sedentary time and its pattern of accumulation individually or jointly contribute to risk for death . The purpose of this study , therefore , was to examine the association between objective ly measured sedentary time ( both total volume and accrual in prolonged bouts ) and all-cause mortality in a national cohort of U.S. middle-aged and older adults enrolled in the REGARDS ( Reasons for Geographic and Racial Differences in Stroke ) study . Methods Study Population REGARDS is a population -based study design ed to examine racial and regional disparities in stroke . It comprises 30239 white and black adults aged 45 years or older enrolled between 2003 and 2007 from across the contiguous United States ( 19 , 20 ) . Detailed design and methods for REGARDS are described elsewhere ( 21 ) . Briefly , demographic and cardiovascular risk factor data were collected by telephone interview and an in-home physical assessment on enrollment . A detailed summary of baseline measures is provided in the Supplement . Participants ( or their proxies ) were then followed for 6-month intervals to ascertain vital status . Objective measurements of sedentary behavior were collected from active REGARDS participants from 2009 to 2013 ( mean time from study enrollment , 5.7 years [ SD , 1.5 ] ; range , 1.9 to 9.5 years ) ( 22 ) . A total of 7985 participants adhered to accelerometer wear requirements ( 4 days with accelerometer wear 10 hours ) , provided follow-up data , and were available for the current analyses ( Supplement Figure 1 ) . Supplement Table 1 shows the characteristics of included versus excluded REGARDS participants . The REGARDS study protocol was approved by the institutional review boards of participating institutions . All participants provided informed consent . Supplement . Supplementary Material Accelerometer Data Collection Methods for accelerometer data collection are described elsewhere ( 22 ) . Briefly , participants were fitted with an Actical ( Philips Respironics ) accelerometer secured to their right hip using a nylon belt and were instructed to wear the device during waking hours for 7 consecutive days . The Actical had been vali date d formeasurement of physical activity and sedentary behavior and was shown to have acceptable reliability ( 2325 ) . Activity counts were summed over 1-minute epochs . Nonwear periods were defined as at least 150 consecutive minutes of 0 activity counts . This nonwear algorithm was previously vali date d against daily log sheets in REGARDS participants ( 26 ) . Measurements of 0 to 49 , 50 to 1064 , and at least 1065 counts per minute were defined as sedentary behavior , light-intensity physical activity , and MVPA , respectively , as determined in a laboratory-based calibration study ( 27 ) . A sedentary bout was defined as consecutive minutes in which the accelerometer registered fewer than 50 counts per minute . A sedentary break was defined as at least 1 minute in which 50 or more counts per minute were registered after a sedentary bout . Both sedentary bouts and breaks were exclusively continuous periods , with no interruptions or nonwear intervals allowed in the definition . Outcome Ascertainment All-cause mortality was the primary outcome , defined as any death after completion of the accelerometer protocol regardless of cause . Date s of death were confirmed through review of death certificates , medical records , and administrative data bases . Deaths through 4 September 2015 were included in the current analysis . Statistical Analysis Sedentary and physical activity variables were averaged across compliant days ( 10 hours of wear ) . Because of a high correlation between total sedentary time and wear time ( Supplement Figure 2 ) , we corrected for the influence of wear time by st and ardizing total sedentary time to 16 hours of wear time per day using the residuals obtained when regressing total sedentary time on wear time ( see Methods section of the Supplement ) ( 2830 ) . Participants were stratified into quartiles according to total sedentary time and , separately , mean sedentary bout duration ( a measure of overall prolonged , uninterrupted sedentary behavior ) . Cox proportional hazards regression modeling was used to calculate the hazard ratio ( HR ) for all-cause mortality associated with quartiles of total sedentary time ( and separately , mean sedentary bout length ) . Crude HRs were initially calculated . Subsequent HRs were calculated after adjustment for age , race , sex , region of residence , education , and season the accelerometer was worn ( model 1 ) , with further adjustment for current smoking , alcohol use , body mass index ( BMI ) , diabetes , hypertension , dyslipidemia , estimated glomerular filtration rate less than 60 mL/min/1.73 m2 , atrial fibrillation , history of coronary heart disease , and history of stroke ( model 2 ) . Models were additionally adjusted for MVPA expressed continuously ( model 3 ) . Tests for linear trend across quartiles were conducted by including the quartile for each participant as an ordinal variable in regression models . Proportional hazards assumptions were confirmed with a Kolmogorov-type supremum test ( 31 ) . The above analyses were then repeated in a fully adjusted model , testing interactions for age ( < 65 and 65 years ) , sex ( male and female ) , race ( black and white ) , BMI category ( normal weight and overweight or obese ) , and MVPA category ( < 150 min/wk and 150 min/wk ) . As a secondary analysis , we examined the continuous doseresponse relationship between each sedentary characteristic and all-cause mortality in a fully adjusted model ( model 3 ) using restricted cubic splines ( 32 ) . Cubic polynomials were fitted with the mean of each sedentary characteristic set as the reference and knots placed at the 5th , 35th , 65th , and 95th percentiles ( 33 ) . Nonlinear associations were evaluated using the likelihood ratio test . For nonlinear associations , spline models were used to describe the associations and when the association was determined to be linear , a linear model was used . Because of multicollinearity between total sedentary time and mean sedentary bout duration ( r= 0.61 ) , both variables were not included in the same model . Alternatively , to examine the individual and joint associations of total sedentary time and prolonged , uninterrupted sedentary behavior with mortality , participants were classified into 4 categories : low total sedentary time ( < 750 min/d ) and low prolonged sedentary bout time ( < 10 min/bout ) , low total sedentary time  and high prolonged sedentary bout time  ( 10 min/bout ) , high total sedentary time  ( 750 min/d ) and low prolonged sedentary bout time , and high total sedentary time and high prolonged sedentary bout time . Hazard ratios for all-cause mortality were calculated for each joint category in comparison with the lowlow group in a fully adjusted model ( model 3 ) . Thresholds for total sedentary time ( 750 min/d ) and mean sedentary bout duration ( 10 min/bout ) were selected on the basis of the restricted cubic splines and were confirmed using a method described by Contal and O'Quigley ( see Methods section of the Supplement ) ( 34 ) . To allow for the possibility that sedentary bouts BACKGROUND / OBJECTIVES Aside from the health consequences , observational studies indicate that being overweight may also negatively affect cognitive function . However , existing evidence has to a large extent not controlled for the possible confounding effect of having different lifestyles . Therefore , the objective was to examine the independent associations between weight status and lifestyle indicators with cognitive performance in 8 - 11year old Danish children . SUBJECTS/ METHODS The analyses included 828 children ( measured in 2011 - 2012 ) each having one to three measurement occasions separated by approximately 100days .  Dietary intake , physical activity , sedentary time , and sleep duration were measured using dietary records and accelerometers . The Children 's Sleep Habits Question naire was used to access sleep problems and the And ersen test was carried out to estimate cardio-respiratory fitness ( CRF ) . Weight status ( underweight , normal weight , and overweight/obese ) was defined according to body mass index and cognitive performance was assessed using the d2-test of attention , a reading test , and a math test . A linear mixed model including a number of fixed and r and om effects was used to test associations between lifestyle indicators as well as BMI category and cognitive performance . RESULTS After adjustment for demographics , socioeconomics , and multiple lifestyle indicators , normal weight children had higher cognitive test scores than overweight/obese and underweight children of up to 89 % and 48 % of expected learning within one school year ( P<0.05 ) . Daily breakfast consumption , fewer sleep problems , higher CRF , less total physical activity , more sedentary time , and less light physical activity were associated with higher cognitive performance independently of each other in at least one of the three cognitive tests ( P<0.05 ) . CONCLUSIONS Normal weight children had higher cognitive performance compared to overweight/obese as well as underweight children , independent of multiple lifestyle indicators Abstract Objective : To assess if a school based intervention was effective in reducing risk factors for obesity . Design : Group r and omised controlled trial . Setting : 10 primary schools in Leeds . Participants : 634 children aged 7 - 11 years . Intervention : Teacher training , modification of school meals , and the development of school action plans targeting the curriculum , physical education , tuck shops , and playground activities . Main outcome measures : Body mass index , diet , physical activity , and psychological state . Results : Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group ( weighted mean difference 0.3 portions/day , 95 % confidence interval 0.2 to 0.4 ) , representing a difference equivalent to 50 % of baseline consumption . Fruit consumption was lower in obese children in the intervention group ( −1.0 , −1.8 to −0.2 ) than those in the control group . The three day diary showed higher consumption of high sugar foods ( 0.8 , 0.1 to 1.6 ) ) among overweight children in the intervention group than the control group . Sedentary behaviour was higher in overweight children in the intervention group ( 0.3 , 0.0 to 0.7 ) . Global self worth was higher in obese children in the intervention group ( 0.3 , 0.3 to 0.6 ) . There was no difference in body mass index , other psychological measures , or dieting behaviour between the groups . Focus groups indicated higher levels of self reported behaviour change , underst and ing , and knowledge among children who had received the intervention . Conclusion : Although it was successful in producing changes at school level , the programme had little effect on children 's behaviour other than a modest increase in consumption of vegetables . What is already known on this topic Obesity is increasing among school children and dem and s preventive strategies R and omised controlled trials of school based primary prevention programmes have all used a prescriptive approach What this study adds Behavioural changes were disappointing with this programme based on the health promoting schools philosophy , despite changes at school level The only positive outcome was a modest increase in vegetable consumption The discrepancy between changes achieved at the individual and school level raises issues regarding the problems inherent in such Childhood obesity incidence has increased substantially and it has been argued that decreasing physical activity levels , coinciding with an increase in sedentary behaviours , are responsible . Australian guidelines were published in 2004 , recommending that children participate in a minimum of 60 min of physical activity daily and spend no more than 2h a day using electronic media for entertainment . We aim ed to compare compliance with these guidelines amongst children of differing weight status . The Childhood Injury Prevention Study ( CHIPS ) collected data from a r and omly selected sample of Brisbane primary and preschool children aged 5 - 12 years . The following data were available for 518 participants : age , gender , measured height and weight and estimated time per week from a parent-completed 7 days diary in physical activity out of school and sedentary leisure activities including television viewing and computer use . Using age st and ardised body mass index estimates , approximately 20 % of the cohort were overweight . Non-compliance with guidelines was 14.7 % for out of school physical activity participation , and 30.9 % for excess electronic media entertainment use . There was a 63 % increase in the odds of overweight status amongst children who were non-compliant with the electronic entertainment recommendations than those who were compliant ( adjusted odds ratio=1.63 ; 95 % CI=1.05 - 2.54 ) . Female gender and school level socioeconomic category were also independently associated with overweight status . Non-compliance with the minimal physical activity guideline increased the odds of being overweight by 28 % , however this difference was not statistically significant . One in seven children from the Greater Brisbane area are at risk for being insufficiently active whilst a third overuse electronic media . Given that overuse of electronic entertainment was positively associated with childhood obesity , these children should be the target of public health campaigns to promote alternative leisure time activities AIMS Australian guidelines recommend that children participate in at least one hour of physical activity every day . We aim ed to measure physical activity  participation in a r and om sample of Australian primary school children and to determine the biological , behavioural , environmental and social influences associated with insufficient daily activity . METHOD We analysed the following cross-section data from a r and omly selected sample of children ( N=518 ) aged 5 to 12 years : age , gender , socioeconmic status ( SES ) indicators , family size , home play equipment availability , transport method to school , and estimated time per week in physical and sedentary activity . Logistic regression analysis was performed to determine variables that were associated with insufficient ( < 60 minutes ) daily activity . RESULTS Seventy-six children ( 15 % of the cohort ) failed to meet the minimum activity recommendations of 60 minutes of daily activity . These children were significantly less likely to walk or cycle to school ( adjusted odds ratio ( OR ) 0.43 ; 95 % CI=0.24 - 0.77 ) or participate in organised sports or activity ( OR 0.42 ; 95 % CI=0.28 - 0.64 ) and were more likely to spend in excess of 2 hours a day watching television of using a computer for entertainment ( OR 2.10 ( 1.16 - 3.78 ) . Age , gender , SES and family size were not significantly associated with insufficient activity . CONCLUSION There exists a significant proportion of the paediatric population who are insufficiently active . Interventions to encourage increased activity  in this sub-group may be successful if they seek to alter sedentary behaviour ( namely television use ) and method of transportation to and from school Background Worldwide in 2000 , 10 % of children aged five to 17 years were reported as being overweight with an additional 2‐3 % being obese . Overweight and obesity in childhood can adversely impact on both physical and psychological health . The rise in the prevalence of childhood obesity is a complex issue but widely recognised contributors include increased energy intake , decreased levels of physical activity and greater time spent in sedentary pursuits . A large number of environmental and cultural factors have also been identified as contributing to the problem . Evidence to support an optimal approach to treating childhood obesity is limited with many studies showing only modest results at best in the long‐term . However , the importance of family‐based treatment that combines diet , physical activity and behavioral components has been acknowledged in a recent Cochrane Systematic Review . It has also been suggested that interventions offered in the community setting may help overcome barriers to participation , by making programs more accessible and allowing the targeting of specific sub‐groups of the population . Objectives The objective of this review was to identify the effectiveness of parent‐centred interventions implemented in the community setting in modifying eating and physical activity behaviors or weight‐related outcomes of children . Inclusion criteria Types of participants This review considered studies that included free‐living children of pre‐school , primary and secondary school age and /or their parents/guardians aged > 18 years . Types of intervention(s)/phenomena of interest Intervention programs were required to have a parental component , to target eating and /or exercise behaviors for the prevention or treatment of obesity , and child weight status reported . Types of studies All intervention studies were included in the review including : r and omized controlled trials ( RCTs ) ; non‐r and omized controlled trials , longitudinal studies , cohort ( both retrospective and prospect i ve ) , case control and time series studies which had been conducted in a community setting . Types of outcomes This review considered studies that included overweight/obesity related outcomes , eating behavior outcomes , physical activity behaviour outcomes , and sedentary behavior outcomes and constructs . Search strategy A literature search of community‐based parent‐centred intervention studies to promote nutrition and physical activity for the prevention and treatment and of childhood overweight and obesity was performed in eight electronic data bases dating from 1975 to April 2009 . Method ological quality Studies were critically appraised for method ological quality using st and ardized tools . Data collection Data was extracted by one review er using a st and ardized data extraction form developed by the research ers and checked for accuracy and consistency by a second review er . Data synthesis Data in relation to setting , methodology , intervention components and effect on weight , dietary intake and physical activity was extracted , and described in a narrative synthesis . Where possible a meta‐ analysis was undertaken . Results Of the home‐based interventions , five of nine studies reported statistically significant changes in anthropometric outcomes post intervention . Of the 10 studies in the before and after school care setting , seven reported a significant decrease in a weight‐related outcome post intervention , with only one reporting an increase . Conclusions Results from the review support the after‐school setting as the most promising for community intervention setting for targeting parents as agents of change within child obesity prevention and treatment programs . Implication s for practice At this stage , interventions to support parents should target the after‐school environment as opposed to being conducted in the home , summer camps , leisure centers or churches . Targeting a decrease in energy intake and sweetened beverages in parallel with increasing number of daily steps and decreasing screen time use . Implication s for research Future studies of high quality are needed across the full range of community setting s. Given that currently most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after‐school setting , further studies in this area using similar method ologies to those already published will facilitate future meta‐analyses in this area Background Excessive time spent in sedentary behaviours ( sitting or lying with low energy expenditure ) is associated with an increased risk for type 2 diabetes , cardiovascular disease and some cancers . Desk-based office workers typically accumulate high amounts of daily sitting time , often in prolonged unbroken bouts . The St and Up Victoria study aims to determine whether a 3-month multi-component intervention in the office setting reduces workplace sitting , particularly prolonged , unbroken sitting time , and results in improvements in cardio-metabolic biomarkers and work-related outcomes , compared to usual practice . Methods / Design A two-arm cluster-r and omized controlled trial ( RCT ) , with worksites as the unit of r and omization , will be conducted in 16 worksites located in Victoria , Australia . Work units from one organisation ( Department of Human Services , Australian Government ) will be allocated to either the multi-component intervention ( organisational , environmental [ height-adjustable workstations ] , and individual behavioural strategies ) or to a usual practice control group . The recruitment target is 160 participants ( office-based workers aged 18–65 years and working at least 0.6 full time equivalent ) per arm . At each assessment ( 0- [ baseline ] , 3- [ post intervention ] , and 12-months [ follow-up ] ) , objective measurement via the activPAL3 activity monitor will be used to assess workplace : sitting time ( primary outcome ) ; prolonged sitting time ( sitting time accrued in bouts of ≥30 minutes ) ; st and ing time ; sit-to-st and transitions ; and , moving time . Additional outcomes assessed will include : non-workplace activity ; cardio-metabolic biomarkers and health indicators ( including fasting glucose , lipids and insulin ; anthropometric measures ; blood pressure ; and , musculoskeletal symptoms ) ; and , work-related outcomes ( presenteeism , absenteeism , productivity , work performance ) . Incremental cost-effectiveness and identification of both workplace and individual-level mediators and moderators of change will also be evaluated . Discussion St and Up Victoria will be the first cluster- RCT to evaluate the effectiveness of a multi-component intervention aim ed at reducing prolonged workplace sitting in office workers . Strengths include the objective measurement of activity and assessment of the intervention on markers of cardio-metabolic health . Health- and work-related benefits , as well as the cost-effectiveness of the intervention , will help to inform future occupational practice .Trial registration Aims This study assessed the efficacy of a school-based healthy lifestyle intervention ( Sport for LIFE ) for increasing physical activity , decreasing sedentary behaviour , reducing screen time behaviour , encouraging healthy attitudes and behaviour to nutrition , and reducing body mass index ( BMI ) in 8–9-year-old primary school children from lower socioeconomic background s in Northern Irel and . Methods A non-r and omised controlled trial of 416 children from 24 schools took part . Schools were r and omly assigned to one of two groups , an intervention or control group with 12 schools in each group . The intervention group received a 12-week school-based programme based on social cognitive theory . At baseline and follow-up , groups completed question naires assessing physical activity , screen time behaviour and dietary patterns . On each occasion anthropometric assessment  s of height and weight were taken . Physical activity and sedentary behaviour were measured by accelerometry . Results Significant effects were observed for vigorous , moderate and light activity for the intervention group at follow-up . Sedentary behaviour was significantly reduced for the intervention group but not for the control group . No significant effects of the intervention on BMI , screen time behaviour or attitudes to nutrition , with the exception of non-core foods , were shown . Conclusions The programme was effective in increasing physical activity and reducing sedentary behaviour , however no significant changes in screen time behaviour and attitude to nutrition , with the exception of non-core foods , were observed . Future research ideas are offered for tackling low levels of physical activity in children Recreational soccer ( RS ) is becoming a popular alternative to the classical continuous exercise mode used for the improvement of cardiovascular and metabolic fitness in untrained people . The objective of this paper was to conduct a detailed systematic review of the literature , identifying the physiological responses to RS and the training effects of RS on aerobic fitness and health in untrained healthy individuals and clinical patients . PubMed , Google Scholar and ScienceDirect data bases were search ed using terms related to recreational soccer . Inclusion criteria were r and omized controlled trials ( RCT ) that assessed acute physiological responses to RS or the training effects of RS on physical fitness and health in sedentary , untrained subjects of any age or health status . All studies were assessed for method ological quality using the PEDro scale . Thirty-five articles met the inclusion criteria ; seven examined the acute response to RS , and 28 assessed training effects . Clear evidence was found that RS had positive effects on many health-related indices and variables , including VO2max ( gains of 7 - 16 % ) , blood pressure ( reductions of 6 - 13 mmHg ) , body composition ( decreased fat mass and improved indices of bone health ) , and metabolic and cardiac function . These positive effects were observed in both healthy individuals and clinical patients , irrespective of age or sex . Although this review provides clear evidence of the positive effects of RS on health , most studies had limitations of methodology ( an average PEDro score < 6 ) . Furthermore , many of the training studies were from a small number of research groups . Future studies should be extended to other countries and institutions to ensure generality of the results . Regular RS training leads to significant cardiovascular and muscular adaptations and gains of health both in sedentary individuals and clinical patients at all ages , suggesting that RS is a potentially highly motivational method to enhance population health Objective To evaluate the impact of ( 1 ) the removal of home access to traditional electronic games or ( 2 ) their replacement with active input electronic games , on daily physical activity and sedentary behaviour in children aged 10–12 years . Design Crossover r and omised controlled trial , over 6 months . Setting Family homes in metropolitan Perth , Australia from 2007 to 2010 . Participants 10-year-old to 12-year-old children were recruited through school and community media . From 210 children who were eligible , 74 met inclusion criteria , 8 withdrew and 10 had insufficient primary outcome measures , leaving 56 children ( 29 female ) for analysis . Intervention A counterbalanced r and omised order of three conditions sustained for 8 weeks each : no home access to electronic games , home access to traditional electronic games and home access to active input electronic games . Main outcome measures Primary outcome was accelerometer assessed moderate/vigorous physical activity ( MVPA ) . Secondary outcomes included sedentary time and diary assessed physical activity and sedentary behaviours . Results Daily MVPA across the whole week was not significantly different between conditions . However , compared with home access to traditional electronic games , removal of all electronic games result ed in a significant increase in MVPA ( mean 3.8 min/day , 95 % CI 1.5 to 6.1 ) and a decrease in sedentary time ( 4.7 min/day , 0.0 to 9.5 ) in the after-school period . Similarly , replacing traditional games with active input games result ed in a significant increase in MVPA ( 3.2 min/day , 0.9 to 5.5 ) and a decrease in sedentary time ( 6.2 min/day , 1.4 to 11.4 ) in the after-school period . Diary reports supported an increase in physical activity and a decrease in screen-based sedentary behaviours with both interventions . Conclusions Removal of sedentary electronic games from the child 's home and replacing these with active electronic games both result ed in small , objective ly measured improvements in after-school activity and sedentary time . Parents can be advised that replacing sedentary electronic games with active electronic games is likely to have the same effect as removing all electronic games . Trial Registration Australia and New Zeal and Clinical Trials Registry ( ACTRN 12609000279224 Objective . To evaluate the relationship of physical activity ( PA ) and sedentary behaviour with  gestational weight gain ( GWG ) and birth weight . Design . Combined data from two prospect i ve studies : ( 1 ) nulliparous pregnant women without BMI restrictions and ( 2 ) overweight and obese pregnant women at risk for gestational diabetes . Methods . Daily PA and sedentary behaviour were measured with an accelerometer around 15 and at 32–35 weeks of gestation . The association between time spent in moderate-to-vigorous PA ( MVPA ) and in  sedentary activities  with GWG and birth weight was determined . Main outcome measures were GWG between 15 and 32 weeks of gestation , average GWG per week , and birth weight . Results . We studied 111 women . Early in pregnancy , 32 % of women spent ≥30 minutes/day in at least moderate PA versus 12 % in late pregnancy . No significant associations were found between time spent in MVPA or sedentary behaviour with GWG or birth weight . Conclusions . We found no relation  between MVPA and sedentary behaviour with GWG or birth weight . The small percentage of women meeting the recommended levels of PA indicates the need to inform and support pregnant women to maintain regular PA , as there seems to be no adverse effect on birth weight and maintaining PA increases overall health Background The quantity and quality of studies in child and adolescent physical activity and sedentary behaviour have rapidly increased , but research directions are often pursued in a reactive and uncoordinated manner . Aim To arrive at an international consensus on research priorities in the area of child and adolescent physical activity and sedentary behaviour . Methods Two independent panels , each consisting of 12 experts , undertook three rounds of a Delphi methodology . The Delphi methodology required experts to anonymously answer questions put forward by the research ers with feedback provided between each round . Results The primary outcome of the study was a ranked set of 29 research priorities that aim ed to be applicable for the next 10 years . The top three ranked priorities were : developing effective and sustainable interventions to increase children ’s physical activity long-term ; policy and /or environmental change and their influence on children ’s physical activity and sedentary behaviour ; and prospect i ve , longitudinal studies of the independent effects of physical activity and sedentary behaviour on health . Conclusions These research priorities can help to guide decisions on future research directions The acute decision prompting effects of social marketing via television ( TV ) advertisements promoting physical activity  to children are unknown . This pilot study aim ed to determine the acute effects of an Australian government-sponsored TV advertisement ( called ' Get Moving ' ) , promoting more physical activity and less sedentary behaviour , on children 's choices , preferences , and ratings of liking for physical activities and sedentary behaviours . Thirty-one children aged 10 - 12 years were recruited from a single public school , and r and omised to one of two treatment groups or two control groups ( Solomon four-group design ) . Treatment participants watched an episode of The Simpsons embedded every 10min with three 30s Get Moving advertisements plus st and ard advertisements . Control participants watched the same episode plus st and ard advertisements , but without the Get Moving advertisements . The following dependent variables were assessed immediately before and /or after exposure : activity preference ( participants selected either verbally or by pointing to one of eight picture cards depicting four physical activities and four sedentary behaviours ) ; ratings of liking ( participants rated how much they liked or disliked each of these activities/behaviours either verbally or by pointing to one of nine values with an adjacent smile or frown on a Likert-type scale ) ; and time spent in physical activities was assessed by direct observation during a 10min free-time session . No significant effects or trends were seen for any of the dependent variables . Further research is needed to determine whether different content and /or higher doses of exposure to physical activity promoting advertisements are needed to influence children 's activity choices Both Fe deficiency and poor n-3 fatty acid status have been associated with behavioural changes in children . In the present study , we investigated the effects of Fe and DHA+EPA supplementation , alone or in combination , on physical activity during school days and on teacher-rated behaviour in healthy Fe-deficient school children . In a 2 × 2 factorial design , children ( n 98 , 6 - 11 years ) were r and omly assigned to receive ( 1 ) Fe ( 50 mg ) plus DHA ( 420 mg)+EPA ( 80 mg ) , ( 2 ) Fe plus placebo , ( 3 ) placebo plus DHA+EPA or ( 4 ) placebo plus placebo as oral supplements ( 4 d/week ) for 8.5 months . Physical activity was measured during four school days at baseline and endpoint using accelerometers , and data were stratified into morning class time ( 08.00 - 10.29 hours ) , break time ( 10.30 - 11.00 hours ) and after-break class time ( 11.01 - 12.00 hours ) for analysis . Classroom behaviour was assessed at endpoint using Conners ' Teacher Rating Scales . DHA+EPA supplementation decreased physical activity counts during morning class time , increased sedentary physical activity , and decreased light- and moderate-intensity physical activities . Consistently , DHA+EPA supplementation increased sedentary physical activity and decreased light-intensity physical activity during after-break class time . Even though there were no treatment effects found on teacher-rated behaviour , lower physical activity during morning class time was associated with lower levels of teacher-rated hyperactivity and oppositional behaviour at endpoint . Despite a positive association between Fe status and physical activity during break time at baseline , Fe supplementation did not affect physical activity during break time and class time . Our findings suggest that DHA+EPA supplementation may decrease physical activity levels during class time , and further indicate that accelerometry might be a useful tool to assess classroom behaviour in healthy children The purpose s of this study were to : 1 ) describe the patterns of screen-based sedentary behaviors  , and 2 ) examine the association between  screen-based sedentary behavior and cardiovascular disease ( CVD ) risk factors in representative Korean children and adolescents , aged 12 to 18 yr , in the Korean National Health and Nutrition Examination Survey .  Screen-based sedentary behavior  was measured using self-report question naires that included items for time spent watching TV and playing PC/video games . Physical activity  was measured using items for frequency and duration of moderate-to-vigorous physical activity ( MVPA )  . CVD risk factors such as body mass index ( BMI ) , waist circumference , LDL cholesterol , HDL cholesterol , total cholesterol , triglycerides , glucose , systolic blood pressure , and diastolic blood pressure were measured . Boys spent more time playing PC/video games , and girls spent more time watching TV . After adjusting for age , gender , annual household income , and MVPA , an additional hour of watching TV was significantly associated with the risk of overweight ( OR 1.17 [ 95 % CI 1.03 - 1.33 ] ) , high abdominal adiposity ( OR 1.27 [ 1.06 - 1.51 ] ) , and low HDL cholesterol ( OR 1.27 [ 1.10 - 1.47 ] ) . An additional hour spent playing PC/video games  also increased the risk of high abdominal adiposity ( OR 1.20 [ 1.03 - 1.40 ] ) . Prospect i ve observations and interventions are needed to determine causal relationships between  screen-based sedentary behavior  and CVD risk profiles in Korean youth PURPOSE Health interventions based on theory may be more effective than those that are not . This review of review s synthesizes all published r and omized controlled trial ( RCT ) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective  adult health behaviour change interventions . METHODS Systematic review s including meta-analyses were identified by search ing Medline , CINAHL , PsycINFO , and CDSR . A narrative synthesis was used to summarize and analyse the evidence . Only review s including RCTs of health behaviour change interventions with adults aged 18 + published from 2007 to 2017 were included . RESULTS Of 8,659 articles , nine systematic review s met inclusion criteria . The majority of review s ( n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour . Less than half of the RCTs included in the review s reported the use of theory ( 85/183 ) . Two review s suggested interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Method ological and reporting issues limit the conclusions . CONCLUSIONS Theory-based interventions as currently operationalized in systematic review s were not found to be more effective than non-theory-based interventions . Method ological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions . The promotion of theory use may benefit from using a multifaceted argument , rather than a narrow focus of increased effectiveness . Statement of contribution What is already known on this subject ? Theory use is regularly promoted by cl aim ing that it will lead to more effective behaviour change interventions . Theory use has been frequently linked to effectiveness within systematic review s of behaviour change interventions . The theory-effectiveness hypothesis has not been systematic ally examined at the systematic review level . What does this study add ? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic review s examining r and omized controlled trials of behaviour change interventions in adults . Interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Theory use should be promoted using a multifaceted argument , and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this cl aim Background Obesity is mainly attributed to environmental factors . In developed countries , the time spent on physical activity tasks is decreasing , whereas sedentary behaviour patterns are increasing . The purpose of the intervention is to evaluate the effectiveness of an intensive family-based behavioural multi-component intervention ( Nereu programme ) and compared it to counselling intervention such as a health centre intervention programme for the management of children ’s obesity . Methods / Design The study design is a r and omized controlled multicenter clinical trial using two types of interventions : Nereu and Counselling . The Nereu programme is an 8-month intensive family-based multi-component behavioural intervention . This programme is based on a multidisciplinary intervention consisting of 4 components : physical activity sessions for children , family theoretical and practical sessions for parents , behaviour strategy sessions involving both , parents and children , and lastly , weekend extra activities for all . Counselling is offered to the family in the form of a monthly physical health and eating habits session .  Participants will be recruited according the following criteria : 6 to 12 year-old-children , referred from their paediatricians due to overweight or obesity according the International Obesity Task Force criteria and with a sedentary profile ( less than 2 hours per week of physical activity ) , they must live in or near the municipality of Lleida ( Spain ) and their healthcare paediatric unit must have previously accepted to cooperate with this study . The following variables will be evaluated : a ) cardiovascular risk factors ( anthropometric parameters , blood test and blood pressure ) , b ) sedentary and physical activity behaviour and dietary intake , c ) psychological aspects d ) health related quality of life ( HRQOL ) , e ) cost-effectiveness of the intervention in relation to HRQOL . These variables will be then be evaluated 4 times longitudinally : at baseline , at the end of the intervention ( 8 months later ) , 6 and 12 months after the intervention . We have considered necessary to recruit 100 children and divide them in 2 groups of 50 to detect the differences between the groups . Discussion This trial will provide new evidence for the long-term effects of childhood obesity management , as well as help to know the impact of the present intervention as a health intervention tool for healthcare centres . Trial registration Clinical Trials.gov , Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting Background Studies relating physical activity ( PA ) to  weight gain in children have produced mixed results , although there is some evidence for stronger associations with more intense physical activities . The present study tested the hypothesis that weight gain over one year in 8–10 year olds would be more strongly predicted by moderate and vigorous physical activity ( MVPA ) than total physical activity ( total PA ) or sedentary behaviour . Methodology Participants were 280 children taking part in the Physical Exercise and Appetite in Children Study ( PEACHES ) .  Weight status was assessed using body mass index ( BMI ) , fat mass index ( FMI ) , and waist circumference ( WC ) in school Year 4 ( baseline ; age 8.7 yrs ) and Year 5 ( follow-up ; age 9.7 yrs ) .  Physical activity  was measured at baseline using the Actigraph GT1 M accelerometer to assess total PA ( mean accelerometers counts per minute ) , MVPA ; ≥4000 counts per minute ) and sedentary time  ( < 100 counts per minute ) . Principal Findings After adjustment for baseline BMI , SES , sex and ethnicity , MVPA  was significantly associated with follow – up BMI ( adjusted β = −0.07 ; p = 0.002 ) . This association was independent of total PA or sedentary time  . Similar results were observed for FMI ; again MVPA was significantly associated with follow up FMI ( β = −0.16 ; p = 0.001 ) independent  of total PA or sedentary time . The pattern was similar for WC ( β = −0.07 ) , but the association between MVPA and WC did not reach significance at p = 0.06 . Conclusion The results of this study strongly support promotion of MVPA in children OBJECTIVES To calibrate and vali date the ActiGraph GT3X+ to measure sedentary behaviour and physical activity in 2 - 3 year olds , using 5-s epochs ; and to compare the predictive validity of the result ing cut-points with that of NHANES ' , Trost 's , and Pate 's 15-s cut-points . DESIGN Cross-sectional study . METHODS Eighteen children ( 2.86 ± 0.60 years ) wore an ActiGraph GT3X+ during video-recorded semi-structured calibration activity sessions . Activity was coded following Children 's Activity Rating Scale . Receiver Operating Characteristic analysis was used to derive Axis1 and vector magnitude cut-points for sedentary behaviour and moderate-to-vigorous physical activity at 5-s epochs . Agreement with Children 's Activity Rating Scale was assessed with Cohen 's kappa , Lin 's concordance , and Bl and -Altman plots . Predictive validity of all cut-points was assessed in an independent sample of 20 children ( 2.99 ± 0.48 years ) video-recorded during free-play , using the same procedures as the calibration phase . RESULTS During calibration , vector magnitude cut-points ( sedentary behaviour ≤ 96.12 counts ; moderate-to-vigorous physical activity ≥ 361.94 counts ) showed slightly better classification agreement with Children 's Activity Rating Scale than Axis1 cut-points ( sedentary behaviour ≤ 5 counts ; moderate-to-vigorous physical activity ≥ 165 counts ) , but the latter showed the lowest bias in estimated sedentary behaviour and moderate-to-vigorous physical activity time . In the validation sample , 5-s Axis1 cut-points showed the best predictive validity and lowest mean differences of all cut-points between predicted and observed sedentary behaviour ( -2.31 % ) , light physical activity ( -24.40 % ) , and total physical activity time ( -0.95 % ) . Moderate-to-vigorous physical activity time was significantly overestimated by all cut-points ( 128.33 - 184.17 % ) . CONCLUSIONS Because moderate-to-vigorous physical activity was highly overestimated , using only the 5-s Axis1 sedentary behaviour cut-point to distinguish sedentary behaviour from total physical activity is advised . The high accuracy indicates that these cut-points are useful for epidemiological studies involving the sedentary behaviour and physical activity of 2 - 3 year olds INTRODUCTION The present study describes a r and omised controlled trial ( RCT ) based on a novel , generalisable intervention for childhood obesity , comparing the intervention with a no-treatment control group . METHOD The Malaysian Childhood Obesity Treatment Trial ( MASCOT ) was a single-blind RCT of a dietetic treatment for childhood obesity in children of primary school age ( 7 to 11 years old ) in Kuala Lumpur , Malaysia . The MASCOT comprising eight sessions , of an 8-hour family-centred group treatment programme is described , based on behavioural change techniques . The study sample was characterised by BMI z-score , health related quality of life reported by participants and their parents ( PedsQL question naire ) , objective ly measured habitual physical activity and sedentary behaviour ( Actigraph accelerometry ) RESULTS The MASCOT sample of 107 children was characterised by a low quality of life , mean total score on PedsQL 67.7 ( 4.5 ) as reported by the children , and 66.0 ( 16.4 ) as reported by their parents . The children spent , on average , 89 % of their waking day on sedentary activity , and 1 % of the day in moderate-vigorous intensity physical activity , equivalent to only around 8 minutes/day . CONCLUSION Obese children in the MASCOT study had an impaired quality of life , high levels of sedentary behaviour and very low levels of physical activity Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes Accurate monitoring of sedentary behaviour and physical activity is key to investigate their exact role in healthy ageing . To date , accelerometers using cut-off point models are most preferred for this , however , machine learning seems a highly promising future alternative . Hence , the current study compared between cut-off point and machine learning algorithms , for optimal quantification of sedentary behaviour and physical activity intensities in the elderly . Thus , in a heterogeneous sample of forty participants ( aged ≥60 years , 50 % female ) energy expenditure during laboratory-based activities ( ranging from sedentary behaviour through to moderate-to-vigorous physical activity ) was estimated by indirect calorimetry , whilst wearing triaxial thigh-mounted accelerometers . Three cut-off point algorithms and a R and om Forest machine learning model were developed and cross-vali date d using the collected data . Detailed analyses were performed to check algorithm robustness , and examine and benchmark both overall and participant-specific balanced accuracies . This revealed that the four models can at least be used to confidently monitor sedentary behaviour and moderate-to-vigorous physical activity . Nevertheless , the machine learning algorithm outperformed the cut-off point models by being robust for all individual ’s physiological and non-physiological characteristics and showing more performance of an acceptable level over the whole range of physical activity intensities . Therefore , we propose that R and om Forest machine learning may be optimal for objective assessment of sedentary behaviour and physical activity in older adults using thigh-mounted triaxial accelerometry Background Evidence suggests a link between sedentary behaviours and depressive symptoms . Mechanisms underlying this relationship are not understood , but inflammatory processes may be involved . Autonomic and inflammatory responses to stress may be heightened in sedentary individuals contributing to risk , but no study has experimentally investigated this . Aims To examine the effect of sedentary time on mood and stress responses using an experimental design . Method Forty-three individuals were assigned to a free-living sedentary condition  and to  a control condition ( usual activity ) in a cross-over , r and omised fashion and were tested in a psychophysiology laboratory after spending 2 weeks in each condition . Participants completed mood question naires ( General Health Question naire and Profile of Mood States ) and wore a motion sensor for 4 weeks . Results Sedentary time increased by an average of 32 min/day ( P = 0.01 ) during the experimental condition compared with control . Being sedentary result ed in increases in negative mood independent of changes in moderate to vigorous physical activity ( ΔGHQ = 6.23 , ΔPOMS = 2.80 ) . Mood disturbances were associated with greater stress-induced inflammatory interleukin-6 ( IL-6 ) responses ( β = 0.37 ) . Conclusions Two weeks of exposure to greater free-living sedentary time result ed in mood disturbances independent of reduction in physical activity . Stress-induced IL-6 responses were associated with changes in mood OBJECTIVES The purpose of this study was to evaluate the effects of multicomponent school based intervention constituted of diet modification , regular exercise and psychosocial consultation on body status in overweight and obese children and adolescents . And to come up with an appropriate intervention protocol for controlling children and adolescents obesity in Shantou city . METHODS Two schools were r and omised to intervention group and control group respectively . A total of 41 students enrolled were diagnosed as overweight or obese . Twenty-six students of the intervention group completed the one-year intervention programme consisted of diet modification , regular exercise and psychological consultation except two of them were transferred to another school . The differences of BMI , anthropometric measures , metabolic profile and the scores of question naire and the scale were compared to evaluate the effects of the intervention programme . RESULTS After one-year intervention , it observed in the intervention group that BMI -Z score , WHR and WHtR had significant improvements , and there was a nonsignificant trend ( P=0.053 ) for a decrease in BMI -P. Fasting plasma glucose , cholesterol ( CH ) and low-density-lipoprotein cholesterol ( LDL-C ) levels in the intervention group showed nonsignificant trend for a decrease ( PFPG=0.084 , PCH=0.057 , PLDLC=0.098 ) , compared with a significant increase of triglycerides ( TG ) and LDL-C levels in the control group ( PTG=0.041 , PLDL-C=0.038 ) . There were some positive dietary , physical activity , or sedentary behaviour changes found in the students of the intervention group as the scores of the question naire got significant improvement ( P=0.04 ) . CONCLUSIONS Our one-year multicomponent school-based intervention programme did have positive effects to some extents on health state and lifestyle behaviour of overweight and obese children and adolescents , which indicated that it is feasible and important to implement such a school-based intervention programme in Shantou city
There is a large body of evidence from all study design s which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5 - 17 years .
In particular , the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health , and that lowering sedentary time leads to reductions in BMI
Accumulating evidence suggests that , independent of physical activity levels , sedentary behaviours are associated with increased risk of cardio-metabolic disease , all-cause mortality , and a variety of physiological and psychological problems .
Therefore , the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5 - 17 years .