Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. Influence of a health education intervention on physical activity and screen time in primary school children: 'Switch Off--Get Active'. Preliminary findings of the effect of a 3-year after-school physical activity intervention on fitness and body fat: the Medical College of Georgia Fitkid Project. Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. A controlled trial of health promotion programs in 11-year-olds using physical activity "enrichment" for higher risk children. Effects of integrating pedometers, parental materials, and E-mail support within an extracurricular school sport intervention. Evaluation of implementation and effect of primary school based intervention to reduce risk factors for obesity. Effectiveness of physician-based assessment and counseling for exercise in a staff model HMO. Effect of community health education on physical activity knowledge, attitudes, and behavior. The Stanford Five-City Project. Impact of Promoting Lifestyle Activity for Youth (PLAY) on children's physical activity. Promoting healthy lifestyles among adolescent boys: the Fitness Improvement and Lifestyle Awareness Program RCT. Population-based randomized controlled trial of a stage-targeted physical activity intervention. Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children. Effect of individual counseling on physical activity fitness and health: a randomized controlled trial in a workplace setting. Development and exploratory cluster-randomised opportunistic trial of a theory-based intervention to enhance physical activity among adolescents. Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care. Evaluation of a 2-year physical activity and healthy eating intervention in middle school children. Self-efficacy partially mediates the effect of a school-based physical-activity intervention among adolescent girls. Promotion of physical activity among high-school girls: a randomized controlled trial. Reducing overweight through a multidisciplinary school-based intervention. School-based obesity prevention in Chilean primary school children: methodology and evaluation of a controlled study. Project GRAD: two-year outcomes of a randomized controlled physical activity intervention among young adults. Graduate Ready for Activity Daily. Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls. Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial. Effects of a life skills intervention for increasing physical activity in adolescent girls. Physician-based physical activity counseling for middle-aged and older adults: a randomized trial. Promoting physical activity in a low-income multiethnic district: effects of a community intervention study to reduce risk factors for type 2 diabetes and cardiovascular disease: a community intervention reducing inactivity. Effectiveness of a computer tailored physical activity intervention in adolescents compared to a generic advice. Changes in BMI and blood pressure after a school based intervention: the CHILDREN study. Physical activity and health outcomes three months after completing a physical activity behavior change intervention: persistent and delayed effects. Effectiveness of telephone support in increasing physical activity levels in primary care patients. Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Increasing physical activity and decreasing sedentary activity in adolescent girls--the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study. New Moves: a school-based obesity prevention program for adolescent girls. Evaluation of a pilot school programme aimed at the prevention of obesity in children. Supplemental fitness activities and fitness in urban elementary school classrooms. Move to Improve: a randomized workplace trial to increase physical activity. Results of the "Active by Choice Today" (ACT) randomized trial for increasing physical activity in low-income and minority adolescents. Project SPARK. Effects of physical education on adiposity in children. Reaching out to promote physical activity in Australia: a statewide randomized controlled trial of a stage-targeted intervention. Team sports for overweight children: the Stanford Sports to Prevent Obesity Randomized Trial (SPORT). The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care.
To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren.
                Cluster randomised controlled trial.
                28 classes from 15 elementary schools in Switzerland randomly selected and assigned in a 4:3 ratio to an intervention (n=16) or control arm (n=12) after stratification for grade (first and fifth grade), from August 2005 to June 2006.
                540 children, of whom 502 consented and presented at baseline.
                Children in the intervention arm (n=297) received a multi-component physical activity programme that included structuring the three existing physical education lessons each week and adding two additional lessons a week, daily short activity breaks, and physical activity homework. Children (n=205) and parents in the control group were not informed of an intervention group. For most outcome measures, the assessors were blinded.
                Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). Secondary outcome measures included body mass index and cardiovascular risk score (average z score of waist circumference, mean blood pressure, blood glucose, inverted high density lipoprotein cholesterol, and triglycerides).
                498 children completed the baseline and follow-up assessments (mean age 6.9 (SD 0.3) years for first grade, 11.1 (0.5) years for fifth grade). After adjustment for grade, sex, baseline values, and clustering within classes, children in the intervention arm compared with controls showed more negative changes in the z score of the sum of four skinfolds (-0.12, 95 % confidence interval -0.21 to -0.03; P=0.009). Likewise, their z scores for aerobic fitness increased more favourably (0.17, 0.01 to 0.32; P=0.04), as did those for moderate-vigorous physical activity in school (1.19, 0.78 to 1.60; P<0.001), all day moderate-vigorous physical activity (0.44, 0.05 to 0.82; P=0.03), and total physical activity in school (0.92, 0.35 to 1.50; P=0.003). Z scores for overall daily physical activity (0.21, -0.21 to 0.63) and physical quality of life (0.42, -1.23 to 2.06) as well as psychological quality of life (0.59, -0.85 to 2.03) did not change significantly.
                A school based multi-component physical activity intervention including compulsory elements improved physical activity and fitness and reduced adiposity in children. Trial registration Current Controlled Trials ISRCTN15360785. Low levels of physical activity coupled with high levels of television viewing have been linked with obesity in children. The objective of this study was to assess the efficacy of 'Switch Off-Get Active', a 16-week controlled health education intervention, in increasing physical activity and reducing screen time and BMI in primary school children. A secondary objective was to compare children with high and low screen time. Participants were 312 children aged 10.2+/-0.7 years, attending nine schools in areas of social disadvantage. The 10-lesson, teacher-led intervention, conducted in spring 2003, emphasised self-monitoring, budgeting of time and selective viewing. Differences, adjusted for baseline values by ANCOVA, existed between intervention and control children at follow-up for self-reported physical activity (intervention +0.84 30 min blocks/day, 95%CI 0.11-1.57, p<0.05) and self-efficacy for physical activity (p<0.05) but not self-reported screen time (intervention--0.41 blocks/day, 95%CI--0.93-0.12, p=0.13) or BMI (p=0.63). Cross-sectional comparisons at baseline indicated lower physical activity, self-efficacy for physical activity and aerobic fitness and a higher BMI in children with high screen time. In conclusion, health education interventions can increase physical activity in primary school children but follow-ups of longer duration may be needed to demonstrate intervention effects on BMI. To evaluate the effect of a 3-year after-school physical activity (PA) intervention on aerobic fitness and percent body fat (%BF).
                In total, 18 schools were randomized into intervention or control arms. Measurements were made at the beginning and end of the third, fourth and fifth grades. Fitness was measured with heart rate response to a bench-stepping task.%BF and bone density were measured with dual-energy x-ray absorptiometry. The intervention included 40 min of academic enrichment activities, during which healthy snacks were provided, and 80 min of moderate-to-vigorous PA (MVPA).
                Data analyses were performed on 206 youths who remained in the same schools for the 3-year period, who were measured at all six time points and, for the intervention group, who attended at least 40% of the sessions in each of the 3 years. The group by time interactions were significant for fitness (p < 0.01) and %BF (p < 0.05). Children in intervention schools improved in fitness and %BF during the school years and returned to levels similar to those in control schools during the summers. Over the six measurement points, the intervention group increased more than the control group in bone density (p < 0.01), fat-free soft tissue (p < 0.01), weight (p < 0.01), height (p < 0.01), and body mass index (p < 0.05).
                An after-school program focusing on MVPA had a beneficial effect on fitness and body composition. During the summers, the beneficial effect of the previous year's participation on fitness and %BF was lost. This highlights the importance of year-round programs to promote healthy growth in youths. Regular physical activity is associated with a reduced risk of all-cause mortality, and mortality due to cardiovascular disease and cancer. Among adolescents, physical activity is associated with benefits in the prevention and control of emotional distress, and improvement of self-esteem. Countries in transitional epidemiological scenarios, such as Chile, need to develop effective strategies to improve physical activity as a way to face the epidemic of chronic diseases. The objective of this study was to evaluate the effects of a school-based physical activity program on physical fitness and mental health status of adolescents living in a low socioeconomic status area in Santiago, Chile. A quasi-experimental design was used to evaluate the effects of the program over one academic year. The study included 198 students aged 15 years old. Two ninth grade classes were randomly selected as the intervention group, with two classes of the same grade as controls. A social planning approach was used to develop the intervention. The program was designed and implemented based on student preferences, teachers' expertise and local resources. Changes in physiological and mental health status were assessed. After the intervention, maximum oxygen capacity achieved a significant increase of 8.5% in the intervention versus 1.8% in the control group (p < 0.0001). Speed and jump performance scores improved significantly more in the intervention versus the control group (p > 0.01). Anxiety score decreased 13.7% in the intervention group versus 2.8% in the control group (p < 0.01), and self-esteem score increased 2.3% in the intervention group and decreased 0.1% in the control group after the end of the program (p < 0.0001). No significant change was observed in the depressive score. Student participation and compliance with the program was > 80%. To conclude, a school-based program to improve physical activity in adolescents of low socioeconomic status, obtained a high level of participation and achieved significant benefits in terms of physical fitness and mental health status. To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.
                A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).
                A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.
                Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.
                At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures.
                In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.
                The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years. To evaluate the short and long term benefits of a school and home based physical activity "enrichment" program for children at higher risk of cardiovascular disease as identified by cluster analysis.
                During two 10-week school terms, 800 11-year-olds took part in a randomized controlled trial with the standard physical activity and nutrition program in six schools, the standard program in a further seven schools but with the addition of physical activity enrichment for higher risk children in those schools, and no program in five control schools. Cluster analysis identifying the 29% or so highest risk children used systolic blood pressure, percent body fat, physical fitness, and blood cholesterol.
                Fitness improved significantly in program schools, particularly with enrichment in higher risk boys. Substantial improvements persisted 6 months later in girls from program schools. At "Enrichment" schools, cholesterol showed significant benefits in higher risk girls and, 6 months later, in both boys and higher risk girls. Sodium intake and, in girls, subscapular skinfolds were lower in "Enrichment" schools when the program ended, but not 6 months later.
                Two-semester health programs with physical activity enrichment for higher risk children can produce benefits sustained for at least 6 months. Improvements extend to lower risk children exposed indirectly to the enrichment. Attenuation of effects on diet and body composition in the longer-term suggest the need for on-going programs. The objective of this study was to evaluate the impact of a school-based intervention (Program X) incorporating pedometers and e-mail support on physical activity, sedentary behavior, and healthy eating in adolescents.
                A randomized control trial was used to evaluate the impact of the Program X intervention. Six schools (N = 124 participants; mean age 14.1 +/- .8 years) were randomized to intervention or control conditions for the 6-month study period. Objectively recorded physical activity (mean steps/day), self-reported sedentary behavior, and dietary habits were measured at baseline and at 6-month follow-up and intervention effects were assessed using repeated-measures analysis of variance and chi(2) tests.
                Participants in the intervention group increased their step counts by 956 +/- 4107 steps/day (boys) and 999 +/- 1999 (girls). Repeated-measures analysis of variance revealed significant group-by-time interactions for boys (F = 7.4, p = .01, d = .80) and girls (F = 29.6, p <.001, d = 1.27) for mean steps/day. The intervention significantly decreased the number of energy-dense/low-nutrient snacks consumed by boys (chi(2) = 4.0, p = .043) and increased the number of fruit serves among girls (chi(2) = 4.8, p = .028). The intervention did not have a statistically significant effect on sedentary behavior.
                A school-based intervention incorporating physical activity monitoring using pedometers and e-mail support was successful in promoting physical activity and selected healthy eating behaviors in adolescent boys and girls. To implement a school based health promotion programme aimed at reducing risk factors for obesity and to evaluate the implementation process and its effect on the school.
                Data from 10 schools participating in a group randomised controlled crossover trial were pooled and analysed.
                10 primary schools in Leeds.
                634 children (350 boys and 284 girls) aged 7-11 years.
                Response rates to questionnaires, teachers' evaluation of training and input, success of school action plans, content of school meals, and children's knowledge of healthy living and self reported behaviour.
                All 10 schools participated throughout the study. 76 (89%) of the action points determined by schools in their school action plans were achieved, along with positive changes in school meals. A high level of support for nutrition education and promotion of physical activity was expressed by both teachers and parents. 410 (64%) parents responded to the questionnaire concerning changes they would like to see implemented in school. 19 out of 20 teachers attended the training, and all reported satisfaction with the training, resources, and support. Intervention children showed a higher score for knowledge, attitudes, and self reported behaviour for healthy eating and physical activity.
                This programme was successfully implemented and produced changes at school level that tackled risk factors for obesity. Few primary care physicians routinely counsel for exercise, despite the benefits of physical activity and the high prevalence of inactivity. The objective of this study is to assess the effectiveness of Physician-Based Assessment and Counseling for Exercise (PACE), a brief, behavior-based tool for primary care providers counseling healthy adults.
                This study is a randomized controlled trial of 812 patients age 30 years or older registered for well visits at 32 primary care physician offices at a staff model health maintenance organization. Intervention physicians were trained to deliver PACE exercise counseling protocols at the index visit, and one reminder telephone call occurred at 1 month. An enhanced intervention group received additional activity reminders.
                At the 6-month follow-up, the control group did not differ significantly from the intervention group for energy expended (2,048 kcal/week versus 2,108 kcal/ week, P = 0.77), time spent in walking or other moderate to vigorous activities (202 min/week versus 187 min/ week, P = 0.99), mental health, physical function, or behaviors previously shown to predict activity change. Among the intervention patients, the stages-of-change score for Contemplators increased significantly compared with controls (P = 0.03), but without a significant change in energy expended. Baseline levels of physical activity counseling were high (50%), as were baseline patient physical activity levels (61% exercised at least three times a week).
                These results suggest that a one-time PACE counseling session with minimal reinforcement, in a setting with high baseline levels of activity, does not further increase activity. The finding that Contemplators advanced in stage of behavior change suggests that further studies are needed to examine long-term, repeated counseling interventions. The authors studied the effectiveness of community-wide health education on physical activity knowledge, attitudes, self-efficacy, and behavior. Random samples of residents aged 18-74 years who lived in four central California cities (baseline, n = 1,056 men and 1,183 women) were evaluated in 1979-1980 and approximately every 2 years thereafter to obtain four independent samples. Moreover, every subject in the initial independent samples was asked to return for follow-up every 2 years thereafter; subjects who completed all four examinations constituted the cohort sample (n = 408 men and 499 women). Two medium-sized cities received health education and two similarly sized cities served as controls. Results indicated little consistent evidence of a treatment effect on physical activity knowledge, attitudes, or self-efficacy in either men or women. Among physical activity measures, there was an indication of a positive treatment effect for men in the independent samples for estimated daily energy expenditure and percent participation in vigorous activities (p < 0.01), and for women in the independent (p = 0.014) and cohort (p < 0.01) samples for engagement in the number of moderate activities. These results underscore the need for development of more effective interventions to change physical activity than is provided by a broad-based, community-wide health education program and for more sensitive and reliable measures of knowledge, attitudes, and behavior with regard to physical activity. This study examined effects of a school-based intervention called PLAY (Promoting Lifestyle Activity for Youth) on physical activity levels and body mass index (BMI) of students. Participants included 606 fourth-grade students selected from a stratified sample of 35 schools in Arizona and placed into four groups: PLAY & PE, PLAY Only, PE Only, and No Treatment. A treatment-control, post-measurement design assessed physical activity using the YAMAX pedometer, and height and weight data were collected following the intervention. One-way ANOVAs were used to analyze the data. Results indicated the treatment was effective at increasing the physical activity level of children, especially girls. No significant differences between groups were found for BMI. Programs such as PLAY, which can increase the activity level of children, may have significant health implications for youth. To assess the feasibility, acceptability, and potential efficacy of a school-based obesity prevention program among adolescent boys with sub-optimal cardiorespiratory fitness.
                In 2007, a 6-month, 2-arm parallel group, randomized controlled pilot trial was conducted in a single school setting (Sydney, Australia). Thirty-three 7th Grade boys (mean age=12.5+/-0.4 years) were randomly assigned to intervention (n=16) or active comparison group (n=17). The intervention consisted of one 60-minute curriculum session and two 20-minute lunchtime physical activity sessions per week. The active comparison group continued with their usual physical activity curriculum sessions (Friday afternoons 2-3 pm). The pilot trial's curriculum sessions were additional to Physical Education (PE) lessons. The primary outcome was BMI, and secondary outcomes included waist circumference, percentage body fat, cardiorespiratory fitness, objectively measured physical activity and small screen recreation time.
                Screening, recruitment and retention goals were exceeded. The majority of data were collected as planned. Implementation and attendance rates were acceptable. At follow-up, compared with boys in the active comparison group, boys in the intervention group displayed a smaller increase in BMI (adjust diff.=-0.2, 95% confidence interval [CI] -0.78, 0.39; Cohen's d=0.05); greater reductions in waist circumference (-1.65 cm [-4.67, 1.36]; d=0.15); percentage body fat (-1.69% [-4.98, 1.60]; d=0.22) and time spent in small screen recreation on weekends (-1.13 h [-5.06, 2.80]; d=0.19); and a greater increase in cardiorespiratory fitness (2.13 laps [6.22, 10.48]; d=0.16); and participation in total weekday physical activity (140.74 counts/min [-159.44, 440.92]; d=0.36).
                This study verified the feasibility, acceptability and potential efficacy of a multifaceted school-based intervention to prevent unhealthy weight gain among adolescent boys. Intervention trials with self-selected participants have shown that mailed stage-targeted print materials can increase participation in physical activity in the short term. We examined the effects of a mailed stage-targeted print intervention designed to promote physical activity, in a random sample of adults living in a regional city.
                Participants (n = 462, 40-60 years of age) were randomly allocated to an intervention (n = 227) or control group (n = 235). Measures included validated 2-week physical activity recall and stage of motivational readiness for physical activity. The intervention consisted of a single mailing of a letter and full-color stage-targeted booklets (specific to precontemplation, contemplation, preparation, and action/maintenance) 1 week postbaseline. Follow-up interviews were conducted at 2 and 6 months postbaseline.
                After 2 months, participants in the intervention group were significantly more likely to meet the current American College of Sports Medicine/Centers for Disease Control and Prevention recommendation for sufficient physical activity than those in the control group (adjusted odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.44-3.99). After 6 months, intervention participants who reported receiving and reading the intervention materials were significantly more likely to be meeting the sufficient physical activity criterion compared with the control group (adjusted OR = 2.03; 95% CI = 1.16-3.56).
                The stage-targeted print intervention was effective in promoting short-term increases in physical activity and was most effective for participants who recognized and used the materials. This low-cost, generalizable intervention has demonstrated potential as a practical population-based physical activity promotion strategy. Further research is required before widespread dissemination would be justified, as additional strategies may be required to ensure sustained change. Our primary objective was to determine whether a novel 'active school' model--Action Schools! BC--improved the cardiovascular disease (CVD) risk profile in elementary-school children. Our secondary objective was to determine the percentage of children with elevated CVD risk factors.
                We undertook a cluster-randomized controlled school-based trial with 8 elementary schools across 1 school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268, age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools) or intervention (INT, 6 schools) groups. We assessed change between groups in cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index (BMI, wt/ht(2)). We evaluated total cholesterol (TC), total:high-density cholesterol (TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and fibrinogen on a subset of volunteers (n=77).
                INT children had a 20% greater increase in fitness and a 5.7% smaller increase in BP compared with children attending UP schools (P<0.05). Forty five percent of children had at least one elevated risk factor (fitness, BP or BMI) at baseline. There were no significant differences between groups for change in BMI or in any of the blood variables.
                Action Schools! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children. Our multi-component intervention exposed children to fitness enhancing physical activity. It may be important for education stakeholders to adequately resource the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis. Physical inactivity and obesity are major public health problems. Our objective was to investigate the effectiveness of an individual counseling intervention at the workplace on physical activity fitness and health. Counseling content derived from the Patient-centered Assessment and Counseling for Exercise and Nutrition (PACE) program.
                A total of 299 employees of three municipal services in the Dutch town of Enschede were randomly allocated into intervention (n =131) and control group (n =168). Over a 9-month period, intervention group subjects were offered seven counseling sessions. Counseling was based on the individual's stage of behavioral change using PACE physical activity and nutrition protocols. Subjects in both the intervention and control group received written information about several lifestyle factors. Primary outcome measures were physical activity (total energy expenditure, during sports activities, during physical activity leisure time other than sports, and meeting the moderate-intensity public health recommendations); cardiorespiratory fitness; and prevalence of musculoskeletal symptoms. Secondary outcome measures were body composition (body mass index [BMI], and percentage of body fat measured via skinfold thicknesses); blood pressure; and blood cholesterol.
                There were significant positive effects on total energy expenditure, physical activity during sports, cardiorespiratory fitness, percentage of body fat, and blood cholesterol. No effects were found for the proportion of subjects meeting the public health recommendation of moderate-intensity physical activity, physical activity during leisure time other than sports, prevalence of musculoskeletal symptoms, body mass index, and blood pressure.
                Individual face-to-face counseling at the workplace based on PACE protocols positively influenced physical activity levels and some components of physical fitness. The implementation of workplace counseling programs for individuals should therefore be promoted. This article reports the development and exploratory testing of a school-based intervention programme designed to enhance levels of physical activity in adolescents. The intervention is based on social cognitive theory (SCT), self-regulation theory (SRT) and planning as evidence-based mediators of physical activity changes. Two classes, paired on socio-economic variables, were selected from each of eight Portuguese schools and randomly assigned to an intervention or control group (N = 291). Primary outcome was 'moderate to vigorous physical activity' (International Physical Activity Questionnaire) measured pre and post intervention and at three and nine months follow-up. SCT, SRT and planning variables were secondary outcomes measured pre and post intervention. At post test, participants in the intervention group reported 18 min per week more physical activity (PA), adjusted for pre-intervention, age and sex, than those in the control group (95% confidence interval -10 to 46; p = 0.249). This difference increased to 33 min (95% CI-4 to 71; p = 0.082) at three months and to 57 min (95% CI 13 to 101, p = 0.008) at nine month follow-up. Moreover, the intervention resulted in changes of some of the theoretical target variables, including outcome expectancies and coping planning. However, no evidence was found for the changes in theoretical moderators to mediate the intervention effects on behaviour. Implications for theory and for future research are discussed. Over the last 10 years 'exercise referral schemes' have been popular even though the evidence for effectiveness of any one-to-one intervention in primary care is deficient. We report the results of a primary care based one-to-one intervention that compared the effect of two communication styles with a no-intervention control group on self-reported physical activity at 12 months.
                In all, 1658 middle-aged men and women were randomly assigned to 30 minutes of brief negotiation or direct advice in primary care or a no-intervention control group. The main outcome was self-reported physical activity at 12 months. Secondary outcome measures included change in blood pressure and body mass index.
                Intention-to-treat analysis revealed no significant differences in physical activity between groups. Brief negotiation group participants who completed the study increased their physical activity significantly more than controls. There was no change in body mass index in any group. The brief negotiation group produced a greater reduction in diastolic blood pressure than direct advice.
                If patients whose health may benefit from increased physical activity seek advice in primary care, 20-30 minutes of brief negotiation to increase physical activity is probably more effective than similar attempts to persuade or coerce. However, blanket physical activity promotion in primary care is not effective. The most effective way of increasing physical activity in primary care has yet to be determined. The aim of the present study was to evaluate the effects of a middle school physical activity and healthy eating intervention, including an environmental and computer-tailored component, and to investigate the effects of parental involvement. A random sample of 15 schools with seventh and eight graders was randomly assigned to one of three conditions: (i) intervention with parental involvement, (ii) intervention alone and (iii) control group. In 10 schools, an intervention, combining environmental changes with computer-tailored feedback, was implemented over 2 school years. In five intervention schools, increased parental support was added. Physical activity was measured with questionnaires in the total sample and with accelerometers in a sub-sample of children. Fat intake, fruit, water and soft drink consumption were measured using food-frequency questionnaires. Results showed significant positive intervention effects on physical activity in both genders and on fat intake in girls. Parental involvement did not increase intervention effects. It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal interventions. The use of personalized computer-tailored interventions seems to be a promising tool for targeting adolescents but needs to be further explored. This study evaluated the effects of the Lifestyle Education for Activity Program (LEAP), a comprehensive school-based intervention emphasizing changes in instruction and school environment, on variables derived from social-cognitive theory (SCT) as mediators of change in physical activity among black and white adolescent girls.
                Twenty-four high schools paired on enrollment size, racial composition, urban, suburban, or rural location, and class structure were randomized into control (n = 12) or experimental (n = 12) groups. There were 1038 girls in the control group and 1049 girls in the experimental group. The multicomponent intervention emphasized the enhancement of self-efficacy and development of behavioral skills by using curricular activities within physical education classes and health education instruction. The primary outcomes were self-efficacy, outcome-expectancy value, goal setting, satisfaction, and physical activity.
                Latent variable structural equation modeling indicated that: (1) self-efficacy and satisfaction exhibited synchronous, cross-sectional relationships with physical activity; (2) the intervention had direct effects on self-efficacy, goal setting, and physical activity; and (3) self-efficacy partially mediated the effect of intervention on physical activity.
                To our knowledge, this study provides the first evidence from a randomized controlled trial that manipulation of self-efficacy results in increased physical activity among black and white adolescent girls. The results encourage the use of self-efficacy as a targeted, mediator variable in interventions designed to increase physical activity among girls. Many adolescent girls fail to meet national guidelines for physical activity, and the prevalence of obesity is increasing among this group. Our study examined the effects of a comprehensive school-based intervention on physical activity among high-school girls.
                A group-randomized controlled field trial was conducted at 24 high schools. A school-based sample of 2744 girls (48.7% African American, 46.7% White) participated in a measurement protocol when they were in eighth and then ninth grade. A comprehensive physical activity intervention was designed to change the instructional program and the school environment to increase support for physical activity among girls.
                At follow-up, 45% of girls in the intervention schools and 36% of girls in the control schools reported vigorous physical activity during an average of 1 or more 30-minute time blocks per day over a 3-day period.
                A comprehensive school-based intervention can increase regular participation in vigorous physical activity among high-school girls. This study sought to evaluate the effectiveness of a multidisciplinary elementary school-based intervention entitled Wellness, Academics & You. The primary areas of impact examined were BMI, consumption of fruits and vegetables, and physical activity.
                The sample consisted of 1013 students in fourth and fifth grades from 69 classes in four states. Intervention and comparison classes were randomly selected at each school. Intervention teachers participated in workshops on the intervention and received program materials. BMI was calculated for baseline and post-data points based on measured height and weight collected by trained research teams. Baseline surveys were administered by the students' teacher in the presence of one of the research team members and collected.
                SPSS (SPSS, Inc., Chicago, IL) analysis of post-data shows significant positive shifts (p = 0.01) in BMI in the intervention group compared with the comparison group. Notable increases in the consumption of fruits and vegetables and increased physical activity levels were reported in the intervention group.
                Data from this study indicate that this school-based program may contribute to the reduction of overweight and obesity. The intervention was well received by the classroom teachers and shows promise for a school-based obesity prevention initiative. This program has shown the capacity to effect positive changes in BMI through consumption of fruits and vegetables and physical activity. The evaluation covered a limited time period and, therefore, warrants additional studies to determine whether long-term program fidelity will result in continued improvement. To assess the impact of a 6 months nutrition education and physical activity intervention on primary school children through changes in adiposity and physical fitness.
                Longitudinal school-based controlled evaluation study.
                Children from 1st to 8th grade, 2141 in intervention and 945 in control schools.
                Nutrition education for children and parents, 'healthier' kiosks, 90 min of additional physical activity (PA) weekly, behavioral PA program and active recess.
                Adiposity indices (BMI, BMI Z-score, triceps skinfold thickness (TSF), waist circumference and physical fitness (20 m shuttle run test and lower back flexibility).
                Positive effect on adiposity indices (except TSF) was observed in boys (P<0.001 for BMI Z), while both physical fitness parameters increased significantly in both boys (P<0.001 for each test) and girls (P<0.0001 for each test). A differential effect in BMI Z was observed according to baseline nutritional status.
                This intervention showed a robust effect on physical fitness in both genders and decreased adiposity only in boys. Project Graduate Ready for Activity Daily evaluated a program to promote physical activity through the transition of university graduation in a randomized controlled trial.
                Three hundred thirty-eight university seniors participated in either a cognitive-behavioral intervention course or a knowledge-oriented general health course during the semester before graduation. Behaviorally oriented phone and mail follow-up was delivered to the intervention group for 18 months. Physical activity outcomes and mediating variables were assessed at baseline, 1 and 2 years (93% retention rate).
                There were no significant intervention effects on physical activity outcomes at 2 years for either men or women. Experiential and behavioral processes of change were significantly improved for intervention women over 2 years.
                Despite excellent participation in a theoretically based, well-attended intervention, few long-term effects on physical activity or its mediators were found. Additional research is needed to determine optimal interventions for physical activity and to validate or alter current behavior change theory. Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls.
                Group randomized controlled trial.
                Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502).
                A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities.
                The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry.
                After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean= -0.4, 95% CI= -8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint.
                A school-based, community-linked intervention modestly improved physical activity in girls. To assess the impact of a physical activity program on obesity in primary school children.
                Cluster-randomized controlled trial with 10 intervention and 10 control schools.
                A total of 1044 children, mean age 9.4 years (s.d.=0.7) at baseline, of the Province of Cuenca, Spain.
                Recreational, non-competitive physical activity program conducted after school hours on school premises. The program consisted of three 90-min sessions per week, for 24 weeks.
                Body mass index (BMI), triceps skin-fold thickness (TST) and percentage body fat. Secondary measures were blood lipids and blood pressure. Measurements were made at the beginning (September 2004) and at the end of the program (June 2005). Since schools rather than children were randomized, mixed regression models were used to adjust for individual-level covariates under cluster randomization.
                There were no differences in BMI between the intervention and control groups. Compared with controls, intervention children showed a decrease in TST in both boys (-1.14 mm; 95% confidence interval (CI) -1.71 to -057; P<0.001) and girls (-1.55 mm; 95% CI -2.38 to -0.73; P<0.001), as well as a reduction in the percentage of body fat in girls (-0.58%; 95% CI -1.04 to -0.11; P=0.02). Furthermore, the intervention boys exhibited a decrease in apolipoprotein (apo) B levels (-4.59; 95% CI -8.81 to -0.37; P=0.03) and an increase in apo A-I levels (13.57; 95% CI 7.95-19.20; P<0.001). Blood lipid results in girls were very similar. No changes in total cholesterol, triglycerides or blood pressure were associated with the intervention in either sex, except for an increase in diastolic blood pressure (1.55 mm Hg; 95% CI 0.19-2.91; P=0.03) in the intervention versus control boys.
                An after-school program of recreational physical activity reduced adiposity, increased apo A-I and decreased apo B in primary school children. Although adolescence is a time when physical activity levels decline, few interventions have targeted high school-aged girls in the school setting.
                To evaluate the effects of a life skills-oriented physical activity intervention for increasing overall physical activity in high school-aged girls.
                Randomized controlled trial.
                Baltimore magnet high school.
                A total of 221 ninth-grade girls, 83.0% of whom were African American. Intervention Participants were randomized to an 8-month physical intervention conducted in physical education class or to a standard physical education class (control).
                Self-reported estimated daily energy expenditure (physical activity), self-reported sedentary activities (television viewing and computer or Internet use), cardiorespiratory fitness, and selected cardiovascular disease risk factors.
                Intervention classes spent 46.9% of physical education class time in moderate to vigorous activity compared with 30.5% of time for control classes (P<.001). There were no significant between-treatment group differences for mean daily energy expenditure (P = .93), moderate-intensity energy expenditure (P = .77), or hard to very hard energy expenditure (P = .69). The proportion of participants who spent 3 or more hours viewing television during school days declined from 22.3% to 17.0% in the intervention group, but remained at 26.7% for the control group (P = .03). Both groups improved their cardiorespiratory fitness (P<.001).
                A life skills-oriented physical education curriculum may need to be combined with other approaches to increase the magnitude of effects on physical activity behavior in predominantly African American high school-aged girls. Sedentary behavior among older adults increases risk for chronic diseases. Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients. The Physically Active for Life (PAL) project was a randomized, controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels. The physical activity counseling was based on the Transtheoretical Model of Change and social learning theory. Twenty-four community-based primary care medical practices were recruited into the study; 12 were randomized to the Intervention condition and 12 to the Control condition. Physicians in the Intervention practices received training in the delivery of brief physical activity counseling. Subjects in the Intervention practices (n=181) received brief activity counseling matched to their stage of motivational readiness for physical activity, a patient manual, a follow-up appointment with their physician to discuss activity counseling, and newsletter mailings. Subjects in the Control practices (n=174) received standard care. Measures of motivational readiness for physical activity and the Physical Activity Scale for the Elderly (PASE) were administered to subjects in both conditions at baseline, 6 weeks following their initial appointment, and at 8 months. Results showed that at the 6-week follow-up, subjects in the Intervention condition were more likely to be in more advanced stages of motivational readiness for physical activity than subjects in the Control condition. This effect was not maintained at the 8 month follow-up and the intervention did not produce significant changes in PASE scores. Results suggest that more intensive, sustained interventions may be necessary to promote the adoption of physical activity among sedentary, middle-aged, and older adults in primary care medical practices. The aim was to assess the net effects on risk factors for type 2 diabetes and cardiovascular disease of a community-based 3-year intervention to increase physical activity.
                A pseudo-experimental cohort design was used to compare changes in risk factors from an intervention and a control district with similar socioeconomic status in Oslo, Norway, using a baseline investigation of 2,950 30- to 67-year-old participants and a follow-up investigation of 1,776 (67% of those eligible, 56% women, 18% non-Western immigrants) participants. A set of theory-based activities to promote physical activity were implemented and tailored toward groups with different psychosocial readiness for change. All results reported are net changes (the difference between changes in the intervention and control districts). At both surveys, the nonfasting serum levels of lipids and glucose were adjusted for time since last meal.
                The increase in physical activity measured by two self-reported questionnaires was 9.5% (P = 0.008) and 8.1% (P = 0.02), respectively. The proportion who increased their body mass was 14.2% lower in the intervention district (P < 0.001), implying a 50% relative reduction compared with the control district, and was lower across subgroups. Beneficial effects were seen for triglyceride levels (0.16 mmol/l [95% CI 0.06-0.25], P = 0.002), cholesterol-to-HDL cholesterol ratio (0.12 [0.03-0.20], P = 0.007), systolic blood pressure (3.6 mmHg [2.2-4.8], P < 0.001), and for men also in glucose levels (0.35 mmol/l [0.03-0.67], P = 0.03). The net proportion who were quitting smoking was 2.9% (0.1-5.7, P = 0.043).
                Through a theory-driven, low-cost, population-based intervention program, we observed an increase in physical activity levels, reduced weight gain, and beneficial changes in other risk factors for type 2 diabetes and cardiovascular disease. To investigate the differences in effects of a computer tailored physical activity advice as compared to generic information in adolescents.
                Students (mean age, 14.6+/-1.2) out of 90 classes from six different Flemish schools were randomly assigned to the tailored intervention (n=563) or the generic non-tailored intervention (n=608) condition. Both interventions included information on public health recommendations and tips on becoming more active. Participants in both groups received their assessment and feedback at baseline, at 4 weeks and at 3 months during school hours. Physical activity levels were determined using an adolescent adaptation of the International Physical Activity Questionnaire (IPAQ).
                After 4 weeks, almost all physical activity scores increased over time in both the generic and the tailored intervention group. No differences between groups were found (all F< or =0.07). After 3 months, the generic intervention was more effective for increasing 'walking in leisure time' among students not complying with recommendations. For all other physical activity scores, no differences between groups were found (all F< or =2.3).
                In contrast to the expectations, changes in physical activity scores did not differ between the tailored and the non-tailored intervention group. For most of the physical activity scores increases were found in both groups.
                2009 Elsevier Ireland Ltd. Identification of the behavioural, normative and control beliefs influencing children's behaviour is an important prerequisite in designing effective interventions. The current study aims to evaluate the effectiveness of an intervention program, based on the Theory of Planned Behaviour (TPB), on obesity indices and blood pressure (BP) in Ioannina, Greece.
                Participants were 646 fifth grade pupils (360 girls and 286 boys). The intervention group (IG) consisted of 321 children in 13 randomly selected schools while the rest (n = 325 children) served as the control group (CG). Based on the outcome of the TPB questionnaire, the intervention focused on overcoming the barriers in accessing physical activity areas, increasing the availability of fruits and vegetables and increasing parental support. General linear mixed model and mediating variable analysis were used to evaluate the differences between the two groups and to test whether changes in certain dietary, physical activity and anthropometrical indices mediated the effect of the intervention on BP.
                IG had higher consumption of fruits and lower consumption of fats/oils and sweets/beverages compared with the CG. Intervention's effect on BMI could be explained by the changes in fruit and fats/oils intake whereas the reduction of systolic and diastolic BP could be explained by the reduction of BMI.
                The findings indicate favourable changes in BP and obesity indices after the implementation of a 1-year school-based intervention program based on the TPB. These results highlight the importance of developing a social and physical environment that promotes balanced eating behaviours and extra-curricular access to physical activity venues. We previously reported the effectiveness of a 12-week physical activity behavior change intervention for breast cancer survivors postintervention with this report, aiming to determine delayed and/or persistent effects 3 months after intervention completion.
                Forty-one sedentary women with stage I, II, or IIIA breast cancer currently receiving hormonal therapy were randomly assigned to receive the 12-week Better Exercise Adherence after Treatment for Cancer intervention or usual care. Assessments occurred at baseline, postintervention, and 3 months postintervention.
                Weekly minutes of greater than or equal to moderate intensity physical activity measured by accelerometer showed a significant group by time interaction (F = 3.51; P = 0.035; between group difference in the mean change from baseline to 3 months postintervention, 100.1 minute, P = 0.012). Significant group by time interactions also showed sustained improvements from baseline to 3 months postintervention in strength (F = 3.82; P = 0.027; between group difference, 11.2 kg; P = 0.026), waist-to-hip ratio (F = 3.36; P = 0.041; between group difference, -0.04; P = 0.094), and social well-being (F = 4.22; P = 0.023; between group difference, 3.9; P = 0.039). A delayed reduction in lower extremity dysfunction 3 months postintervention was noted (F = 3.24; P = 0.045; between group difference in the mean change from postintervention to 3 months follow-up; P = -7.6; P = 0.015). No group by time effect was noted for fitness, body mass index, percent fat, bone density, total quality of life (Functional Assessment of Cancer Therapy-General), fatigue, endocrine symptoms, cognitive function, or sleep.
                The intervention resulted in sustained improvements in physical activity, strength, central adiposity, and social well-being with lower extremity function benefits appearing 3 months after intervention completion. Testing translation in a multisite study is warranted. Physician counseling of patients to increase physical activity has had limited success in changing behavior. Providing organizational support to primary care providers and their patients may increase effectiveness.
                This study evaluates the effectiveness of a telephone-based intervention to increase physical activity among patients who exercised <15 minutes daily and wanted to increase their physical activity over a 6-month period.
                This was a randomized controlled trial, conducted from 1997 to 1998, of 316 patients aged 18 to 65 who were recruited from a mailed health risk assessment. Baseline and 6-month post-intervention telephone assessments were conducted by telephone.
                One family physician's patients in a suburban community.
                Three sessions of telephone-delivered motivational counseling.
                Physical activity score (11-item Physician-Based Assessment and Counseling for Exercise [PACE]) 6 months after the intervention.
                After adjusting for baseline exercise, there was a significantly higher level of self-reported exercise among individuals randomized to the intervention at the 6-month follow-up. The mean level of activity at follow-up for the intervention group was a PACE score of 5.37, compared to 4.98 in the control group (p<0.05). In the secondary analysis, which was limited to individuals who received the intervention, the effect was stronger (PACE score of 5.58 compared to 4.94, p<0.013).
                Patients can be recruited using a health-screening questionnaire to receive a telephone-delivered behavioral intervention to successfully increase their physical activity levels. Physical Activity Across the Curriculum (PAAC) was a three-year cluster randomized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children.
                Twenty-four elementary schools were cluster randomized to the Physical Activity Across the Curriculum intervention or served as control. All children in grades two and three were followed to grades four and five. Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers. Body Mass Index was the primary outcome, daily Physical activity and academic achievement were secondary outcomes.
                The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9, respectively (NS). However, change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum. Schools with > or =75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had <75 min of Physical Activity Across the Curriculum (1.8+/-1.8 vs. 2.4+/-2.0, p=0.02). Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores.
                The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children. Additionally, 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index. Lack of regular physical activity and consequent sub-optimal bone mass acquisition in youth has been implicated as a primary cause of adult-onset osteoporosis. IMPACT was a behavioral theory-based 1 1/2 year randomized controlled field study aimed at increasing bone accretion in middle school girls. The objective of this study was to determine the intervention effects of the IMPACT program upon key physical and sedentary activity endpoints among schools that participated in the IMPACT study. Endpoints examined included weight bearing physical activity (WBPA); moderate to vigorous physical activity (MVPA); vigorous physical activity (VPA); MET (metabolic equivalent) - weighted WBPA and MVPA; sedentary activity; before/after-school physical activity; and weekend physical activity.
                Primary data analysis using a pretest-posttest control group design was conducted utilizing mixed model analysis of covariance. Data gathered from the IMPACT cohort from 2000-2002 were analyzed to determine baseline versus follow-up differences in activity endpoints. Confounders investigated included ethnicity, body mass index, menarcheal status, participation in 7th grade PE/athletics, friend/familial support and neighborhood safety.
                Follow-up means were higher for participating intervention schools relative to control schools for all physical activity variables but were statistically significant only for the following variables: daily minutes of vigorous physical activity (mean difference between Intervention (I) and Control (C) = 6.00 upward arrow minutes, 95% CI = 5.82-6.18, p = 0.05), daily after school activity minutes (mean difference between I and C = 8.95 upward arrow minutes, 95% CI = 8.69-9.21, p = 0.04), and daily weekend activity minutes (mean difference between I and C = 19.00 upward arrow minutes, 95% CI = 18.40-19.60, p = 0.05). The intervention significantly reduced duration of student daily TV/Video watching (mean difference between I and C = 12.11 downward arrow minutes, 95% CI = 11.74-12.48, p = 0.05) and total daily sedentary activity minutes (mean difference between I and C = 16.99 downward arrow minutes, 95% CI = 16.49-17.50, p = 0.04).
                A well designed and implemented school based health and physical activity intervention can result in a positive influence upon increasing physical activity levels and decreasing sedentary activity. Future interventions should consider a more structured intervention component to obtain significant changes in WBPA. This study tests the feasibility of an innovative school-based program for obesity prevention among adolescent girls. New Moves was implemented as a multicomponent, girls-only, high-school physical education class.
                Six schools were equally randomized into intervention and control conditions. Data were collected at baseline, postintervention, and 8-month follow-up to assess program impact on physical activity, eating patterns, self-perceptions, and body mass index (BMI) among 89 girls in the intervention and 112 girls in the control conditions. Program evaluation also included interviews with school staff, parent surveys, and participant interviews and process evaluation surveys.
                The feasibility of implementing New Moves was high, as indicated by strong satisfaction among participants, parents, and school staff, and by program sustainability. Participants perceived a positive program impact on their physical activity, eating patterns, and self-image. Girls in the intervention significantly progressed in their stage of behavioral change for physical activity from baseline to follow-up. However, for the majority of outcome variables, differences between intervention and control schools at postintervention and follow-up were not statistically significant.
                New Moves was well received and fills a needed niche within school physical education programs. An expanded intervention and evaluation is needed to enhance and assess long-term program effectiveness. This paper describes the development, implementation and evaluation of a school- and family-based intervention to prevent obesity in children aged 5-7 years. In addition, the efficacy of three different intervention programmes was compared. Children aged 5-7 years (n=213) were recruited from three primary schools in Oxford and randomly allocated to a control group or one of three intervention groups: nutrition group, physical activity group, and combined nutrition and physical activity group. The setting for the interventions was lunchtime clubs, where an interactive and age-appropriate nutrition and/or physical activity curriculum was delivered. The intervention lasted for 20 weeks over four school terms (approximately 14 months). Children's growth, nutrition knowledge, diet and physical activity were assessed at baseline and at the end of the intervention. Significant improvements in nutrition knowledge were seen in all children (p<0.01) between baseline and post-intervention, and results were highly significant in the nutrition and combined group (p<0.001). Overall, fruit and vegetable intake increased significantly (p<0.01 and <0.05, respectively), with changes seen in fruit consumption in the nutrition group (p<0.05) and the control group (p<0.05) in particular. No significant changes in the rates of overweight and obesity were seen as a result of the intervention. Gender differences were not detected in the majority of assessments and there was no clear effect of programme type per se. This pilot study has demonstrated that school may be a suitable setting for the promotion of healthy lifestyles in children, but requires replication in other social settings. Future initiatives should be long-lasting, multi-faceted and sustainable, involving all children in a school, and should target the whole environment and be behaviourally focused. The ultimate goal of any such programme is to lead to positive behaviour change which will have a beneficial effect on long-term health. Successful targeting of the family remains a challenge to such interventions. The physical activity levels of US children are declining. Opportunities for physical activity within city schools are constrained by time and space limits. This study determined whether a supplemental program of physical activity would significantly alter the fitness levels of low-income, minority, urban elementary schoolchildren.
                Ninety-nine students from two Cleveland Public Schools served as subjects. One school received a 15-week intervention program where teams of two medical students met with urban elementary schoolchildren three times a week for physical activity sessions. The other school served as a control and received no supplemental activity other than a regularly scheduled physical education class held once a week. We obtained field measurements of skinfold thickness, heart rate response to submaximal exercise, and sit and reach flexibility.
                The supplemental activity group showed significant improvements in flexibility, body composition, and heart rate response to submaximal exercise.
                This investigation indicates that a program of fitness activities conducted within the classroom can significantly improve levels of fitness in urban elementary schoolchildren. Workplaces are important settings for interventions to increase physical activity, but effects have been modest.
                To evaluate the efficacy of Move to Improve, a social-ecologic intervention delivered at the workplace to increase leisure-time physical activity.
                A group-randomized 12-week intervention consisting of organizational action and personal and team goal-setting was implemented in Fall 2005, with a multi-racial/ethnic sample of 1442 employees at 16 worksites of The Home Depot, Inc. Change in physical activity was analyzed in Fall 2007 using latent growth modeling and latent transition analysis.
                Participants in the intervention had greater increases in moderate and vigorous physical activity and walking compared to participants in a health education control condition. The proportion of participants that met the Healthy People 2010 recommendation for regular participation in either moderate or vigorous physical activity remained near 25% at control sites during the study but increased to 51% at intervention sites. During the last 6 weeks of the study, intervention participants exceeded 300 weekly minutes of self-reported moderate-to-vigorous physical activity and 9000 daily pedometer steps.
                The results support the feasibility and efficacy of the Move to Improve intervention and the role of goal-setting for attaining increased physical activity levels. This study reports the results of the "Active by Choice Today" (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents.
                The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduce lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program.
                The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention.
                At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention.
                Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA. Project SPARK evaluates multiple effects of a health-related physical education (PE) program for elementary school students. Seven schools were randomly assigned to one of three conditions: usual PE or control, trained classroom teachers, or PE specialists. The intervention was implemented throughout the fourth and fifth grades. Data are available from one cohort of 550 children who were measured in the fall and spring of both grades. Adiposity was assessed by triceps and calf skinfolds, and body mass index (BMI) was also measured. Data at each measurement point were analyzed by ANOVAs, covarying for baseline values. At no measurement point were there significant group differences in total skinfold. At both fifth grade measurement points for boys and girls, however, there was a trend for the control group to have higher skinfold values than the two intervention groups. At the final measure, the difference between the highest and lowest groups was about 3 mm for girls and 2 mm for boys. BMIs were significantly lower at some measurement points for boys and girls, but this could be due to increased lean body mass in intervention students. After two years, there was a trend for the children exposed to the PE intervention to have lower levels of body fat, but the differences were not significant. This study examined the broader use of a print-media intervention, which was previously shown to be effective at promoting physical activity to participants recruited from a regional Australian community, as a strategy suitable for a more diverse statewide population sample.
                Participants were randomly selected adults who responded to a telephone interview conducted by the New South Wales Health Department and consented to participate in a randomized controlled trial. Consenters were allocated to either intervention (n = 361) or control (n = 358) conditions. The intervention, a personalized letter plus stage-targeted booklets, was sent 1 week postbaseline. Data were collected via telephone interview at baseline and 2 and 8 months and were analyzed using repeated measures analysis of variance (ANOVA) and chi2 statistics.
                The groups were similar at baseline (mean age 43 +/- 3 years; 64% women). Process evaluation showed high intervention recall (76% at 2 months) and high follow-up response rates (> 85% at 8 months) were achieved. Nonsignificant increases in physical activity were observed (F1,719 = 2.18, p = .14).
                A single mailing of stage-targeted print materials was not effective in promoting increases in physical activity among participants selected from the statewide population. Future research could examine how the effectiveness of print media might be enhanced, possibly by using supplementary media, community-based prompts, or other incentives. To evaluate the feasibility, acceptability, and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children.
                Six-month, 2-arm, parallel-group, pilot randomized controlled trial.
                Low-income, racial/ethnic minority community.
                Twenty-one children in grades 4 and 5 with a body mass index at or above the 85th percentile.
                The treatment intervention consisted of an after-school soccer program. The "active placebo" control intervention consisted of an after-school health education program.
                Implementation, acceptability, body mass index, physical activity measured using accelerometers, reported television and other screen time, self-esteem, depressive symptoms, and weight concerns.
                All 21 children completed the study. Compared with children receiving health education, children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily, moderate, and vigorous physical activity at 3 months.
                An after-school team soccer program for overweight children can be a feasible, acceptable, and efficacious intervention for weight control. To evaluate the effectiveness of combinations of three methods to promote physical activity.
                Randomised controlled trial. Baseline assessment with post-intervention follow up at 12 weeks and 1 year.
                One urban general practice, 1995-7. Participants: 523 adults aged 40 to 64 years, randomised to four intervention groups and a control group.
                Brief (one interview) or intensive (six interviews over 12 weeks) motivational interviewing based on the stages of change model of behaviour change, with or without financial incentive (30 vouchers entitling free access to leisure facilities).
                Physical activity score; sessions of moderate and vigorous activity in the preceding four weeks.
                Response rate was 81% at 12 weeks and 85% at one year. More participants in the intervention group reported increased physical activity scores at 12 weeks than controls (38% v 16%, difference 22%, 95% confidence interval for difference 13% to 32%), with a 55% increase observed in those offered six interviews plus vouchers. Vigorous activity increased in 29% of intervention participants and 11% of controls (difference 18%, 10% to 26%), but differences between the intervention groups were not significant. Short term increases in activity were not sustained, regardless of intensity of intervention.
                The most effective intervention for promoting adoption of exercise was the most intensive. Even this did not promote long term adherence to exercise. Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of questionable effectiveness.
The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.