title: The effect of a healthy lifestyle programme on 8–9 year olds from social disadvantage The effect of the UP4FUN pilot intervention on objectively measured sedentary time and physical activity in 10–12 year old children in Belgium: the ENERGY-project Examination of mid-intervention mediating effects on objectively assessed sedentary time among children in the Transform-Us! cluster-randomized controlled trial 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 Examining the validity of the ActivPAL monitor in measuring posture and ambulatory movement in children The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Evaluation of the UP4FUN Intervention: A Cluster Randomized Trial to Reduce and Break Up Sitting Time in European 10-12-Year-Old Children Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! randomised intervention study Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial What helps children to move more at school recess and lunchtime? Mid-intervention results from Transform-Us! cluster-randomised controlled trial The validation of a novel activity monitor in the measurement of posture and motion during everyday activities Do school-based physical activity interventions increase or reduce inequalities in health?
abstract: 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 BakckgroundThe first aim was to examine the effect of the UP4FUN pilot intervention on children ’s total sedentary time . The second aim was to investigate if the intervention had an effect on  children ’s physical activity ( PA ) level . Finally , we aim ed to investigate demographic differences ( i.e. age , gender , ethnicity , living status and having siblings ) between children in the intervention group who improved in sedentary time and PA at post-test and children in the intervention group who worsened in sedentary time and PA at post-test . Methods The six weeks UP4FUN intervention was tested in a r and omized controlled trial with pre-test post-test design with five intervention and five control schools in Belgium and included children of the 5th and 6th grade . The children wore accelerometers for seven days at pre- and post-test . Analyses included children with valid accelerometer data for at least two weekdays with minimum 10h-wearing time and one weekend day with 8h-wearing time . Result Final analyses included 372 children ( 60 % girls , mean age = 10.9 ± 0.7 years ) . There were no significant differences in the change in sedentary time or light PA between intervention and control schools for the total sample or for the subgroup analyses by gender . However , children ( specifically girls ) in the intervention group had a higher decrease in moderate-to-vigorous PA than children in the control group . In the intervention group , children who lived with both parents and children with one or more siblings were less likely to reduce sedentary time after exposure to the intervention . Older children , girls and children who lived with both parents were less likely to increase light PA after the intervention . Conclusion The UP4FUN intervention did not result in an effect on children ’s sedentary time . Based on the high amounts of accelerometer-derived sedentary time in this age group , more efforts are needed to develop strategies to reduce children ’s sedentary time Background The optimal targets and strategies for effectively reducing sedentary behavior among young people are unknown . Intervention research that explores changes in mediated effects as well as in outcome behaviors is needed to help inform more effective interventions . Therefore , the purpose of this study was to examine the mid-intervention mediating effects on children ’s objective ly assessed classroom and total weekday sedentary time in the Transform-Us ! intervention . Methods The results are based on 293 children , aged 7- to 9-years-old at baseline , from 20 schools in Melbourne , Australia . Each school was r and omly allocated to one of four groups , which targeted reducing sedentary time in the school and family setting s ( SB ; n = 74 ) , increasing or maintaining moderate- to vigorous-intensity physical activity in the school and family setting s ( PA ; n = 75 ) , combined SB and PA ( SB + PA ; n = 80 ) , or the current practice control ( C ; n = 64 ) . Baseline and mid-intervention data ( 5–9 months ) were collected in 2010 and analyzed in 2012 . Classroom and total weekday sedentary time was objective ly assessed using ActiGraph accelerometers . The hypothesized mediators including , child enjoyment , parent and teacher outcome expectancies , and child perceived access to st and ing opportunities in the classroom environment , were assessed by question naire . Results The SB + PA group spent 13.3 min/day less in weekday sedentary time at mid-intervention compared to the control group . At mid-intervention , children in the SB group had higher enjoyment of st and ing in class ( 0.9 units ; 5-unit scale ) and all intervention groups had more positive perceptions of access to st and ing opportunities in the classroom environment ( 0.3 - 0.4 units ; 3-unit scale ) , compared to the control group . However , none of the hypothesized mediator variables had an effect on sedentary time ; thus , no mediating effects were observed . Conclusions While beneficial intervention effects were observed on some hypothesized mediating variables and total weekday sedentary time at mid-intervention , no significant mediating effects were found . Given the dearth of existing information , future intervention research is needed that explores mediated effects . More work is also needed on the development of reliable mediator measures that are sensitive to change overtime . Trial registration ACTRN12609000715279IS RCT 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 Decreasing sedentary activities that involve prolonged sitting may be an important strategy to reduce obesity and other physical and psychosocial health problems in children . The first step to underst and ing the effect of sedentary activities on children ’s health is to objective ly assess these activities with a valid measurement tool . Purpose To examine the validity of the ActivPAL monitor in measuring sitting/lying , st and ing , and walking time , transition counts and step counts in children in a laboratory setting . Methods Twenty five healthy elementary school children ( age 9.9 ± 0.3 years ; BMI 18.2 ± 1.9 ; mean ± SD ) were r and omly recruited across the Auckl and region , New Zeal and . Children were fitted with ActivPAL monitors and observed during simulated free-living activities involving sitting/lying , st and ing and walking , followed by treadmill and over-ground activities at various speeds ( slow , normal , fast ) against video observation ( criterion measure ) . The ActivPAL sit-to-st and and st and -to-sit transition counts and steps were also compared with video data . The accuracy of step counts measured by the ActivPAL was also compared against the New Lifestyles NL-2000 and the Yamax Digi-Walker SW-200 pedometers . Results We observed a perfect correlation between the ActivPAL monitor in time spent sitting/lying , st and ing , and walking in simulated free-living activities with direct observation . Correlations between the ActivPAL and video observation in total numbers of sit-to-st and and st and -to-sit transitions were high ( r = 0.99 ± 0.01 ) . Unlike pedometers , the ActivPAL did not misclassify fidgeting as steps taken . Strong correlations ( r = 0.88 - 1.00 ) between ActivPAL step counts and video observation in both treadmill and over-ground slow and normal walking were also observed . During treadmill and over-ground fast walking and running , the correlations were low ( r = 0.21 - 0.46 ) . Conclusion The ActivPAL monitor is a valid measurement tool for assessing time spent sitting/lying , st and ing , and walking , sit-to-st and and st and -to-sit transition counts and step counts in slow and normal walking . The device did not measure accurately steps taken during treadmill and over-ground fast walking and running in children Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background The UP4FUN intervention is a family-involved school-based intervention aim ing at reducing and breaking up sitting time at home ( with special emphasis on screen time ) , and breaking up sitting time in school among 10–12 year olds in Europe . The purpose of the present paper was to evaluate its short term effects . Methodology /Principal Findings A total of 3147 pupils from Belgium , Germany , Greece , Hungary and Norway participated in a school-r and omized controlled trial . The intervention included 1–2 school lessons per week for a period of six weeks , along with assignments for the children and their parents . Screen time and breaking up sitting time were registered by self-report and total sedentary time and breaking up sitting time by accelerometry . The effect of the intervention on these behaviors was evaluated by multilevel regression analyses . All analyses were adjusted for baseline values and gender . Significance level was p≤0.01 . No significant intervention effects were observed , neither for self-reported TV/DVD or computer/game console time , nor for accelerometer-assessed total sedentary time and number of breaks in sitting time . The intervention group , however , reported more positive attitudes towards ( β = 0.25 ( 95 % CI 0.11 , 0.38 ) ) and preferences/liking for ( β = 0.20 ( 95 % CI 0.08 , 0.32 ) ) breaking up sitting time than the control group . Conclusions / Significance No significant intervention effect on self-reported screen time or accelerometer-assessed sedentary time or breaks in sitting time was observed , but positive effects on beliefs regarding breaking up sitting time were found in favor of the intervention group . Overall , these results do not warrant wider dissemination of the present UP4FUN intervention . Trial Registration International St and ard R and omized Controlled Trial Number Registry IS RCT Background This pragmatic evaluation investigated the effectiveness of the Children ’s Health , Activity and Nutrition : Get Educated ! ( CHANGE ! ) Project , a cluster r and omised intervention to promote healthy weight using an educational focus on physical activity and healthy eating . Methods Participants ( n = 318 , aged 10–11 years ) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011 . This consisted of a teacher-led curriculum , learning re sources , and homework tasks . Primary outcome measures were waist circumference , body mass index ( BMI ) , and BMI z-scores . Secondary outcomes were objective ly-assessed physical activity and sedentary time , and food intake . Outcomes were assessed at baseline , at post-intervention ( 20 weeks ) , and at follow-up ( 30 weeks ) . Data were analysed using 2-level multi-level modelling ( levels : school , student ) and adjusted for baseline values of the outcomes and potential confounders . Differences in intervention effect by subgroup ( sex , weight status , socio-economic status ) were explored using statistical interaction . Results Significant between-group effects were observed for waist circumference at post-intervention ( β for intervention effect = −1.63 ( 95 % CI = −2.20 , -1.07 ) cm , p<0.001 ) and for BMI z-score at follow-up ( β=−0.24 ( 95 % CI = −0.48 , -0.003 ) , p=0.04 ) . At follow-up there was also a significant intervention effect for light intensity physical activity ( β=25.97 ( 95 % CI = 8.04 , 43.89 ) min , p=0.01 ) . Interaction analyses revealed that the intervention was most effective for overweight/obese participants ( waist circumference : β=−2.82 ( 95 % CI = −4.06 , -1.58 ) cm , p<0.001 ) , girls ( BMI : β=−0.39 ( 95 % CI = −0.81 , 0.03 ) kg/m2 , p=0.07 ) , and participants with higher family socioeconomic status ( breakfast consumption : β=8.82 ( 95 % CI = 6.47 , 11.16 ) , p=0.07 ) . Conclusions The CHANGE ! intervention positively influenced body size outcomes and light physical activity , and most effectively influenced body size outcomes among overweight and obese children and girls . The findings add support for the effectiveness of combined school-based physical activity and nutrition interventions . Additional work is required to test intervention fidelity and the sustained effectiveness of this intervention in the medium and long term . Trial registration Current Controlled Trials IS RCT N03863885 Background There is increasing evidence for the effectiveness of parental support programmes to promote healthy behaviours and prevent obesity in children , but only few studies have been conducted among groups with low socio-economic status . The aim of this study was to develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas . Methods A cluster-r and omised controlled trial was carried out in disadvantaged areas in Stockholm . Participants were six-year-old children ( n = 378 ) and their parents . Thirty-one school classes from 13 schools were r and omly assigned to intervention ( n = 16 ) and control groups ( n = 15 ) . The intervention lasted for 6 months and included : 1 ) Health information for parents , 2 ) Motivational Interviewing with parents and 3 ) Teacher-led classroom activities with children .  Physical activity was measured by accelerometry , dietary intake and screen time with a question naire , body weight and height were measured and BMI st and ard deviation score was calculated . Measurements were conducted at baseline , post-intervention and at 5months follow-up . Group effects were examined using Mixed-effect Regression analyses adjusted for sex , parental education and baseline values . Results Fidelity to all three intervention components was satisfactory . Significant intervention effects were found regarding consumption of unhealthy foods ( p = 0.01 ) and unhealthy drinks ( p = 0.01 ) . At follow-up , the effect on intake of unhealthy foods was sustained for boys ( p = 0.03 ) . There was no intervention effect on physical activity . Further , the intervention had no apparent effect on BMI sds for the whole sample , but a significant difference between groups was detected among children who were obese at baseline ( p = 0.03 ) which was not sustained at follow-up . Conclusions The Healthy School Start study shows that it is possible to influence intake of unhealthy foods and drinks and weight development in obese children by providing individual parental support in a school context . However , the effects were short-lived . Therefore , the programme needs to be prolonged and /or intensified in order to obtain stronger and sustainable effects . This study is an important contribution to the further development of evidence -based parental support programmes to prevent overweight and obesity in children in disadvantaged areas Background To investigate the interpersonal and physical environment mediators of the Transform-Us ! mid-intervention effects on  physical activity ( PA )  during recess and lunchtime . Methods Transform-Us ! is a clustered r and omised school-based intervention with four groups : sedentary behaviour intervention ( SB-I ) , PA intervention ( PA-I ) , combined PA+SB-I and control group .  All children in grade 3 from 20 participating primary schools in Melbourne , Australia were eligible to complete annual evaluation assessment s. The outcomes were the proportion of time spent in moderate-to-vigorous PA ( MVPA ) and light PA ( LPA )  during recess and lunchtime assessed by accelerometers . Potential mediators included : perceived social support from teachers ; perceived availability of line markings ; perceived accessibility of sports equipment ; and perceived school play environment . Generalised linear models were used and mediation effects were estimated by product-of-coefficients ( a·b ) approach . Results 268 children ( 8.2 years , 57 % girls at baseline ) provided complete data at both time points . A significant intervention effect on MVPA during recess in the SB-I and PA-I groups compared with the control group ( proportional difference in MVPA time ; 38 % ( 95 % CI 21 % to 57 % ) and 40 % ( 95 % CI 20 % to 62 % ) , respectively ) was found . The perceived school play environment was significantly positively associated with MVPA at recess among girls . An increase in perceived social support from teachers suppressed  the PA+SB-I effect on light PA  during recess ( a·b= −0.03 , 95 % CI −0.06 to −0.00 ) . No significant mediating effects  on PA during recess and lunchtime were observed . Conclusions A positive perception of the school play environment was associated with higher MVPA during recess among girls . Future studies should conduct mediation analyses to explore underlying mechanisms of PA interventions Background : Accurate measurement of physical activity patterns can be used to identify sedentary behaviour and may facilitate interventions aim ed at reducing inactivity . Objective : To evaluate the activPAL physical activity monitor as a measure of posture and motion in everyday activities using observational analysis as the criterion st and ard . Methods : Wearing three activPAL monitors , 10 healthy participants performed a range of r and omly assigned everyday tasks incorporating walking , st and ing and sitting . Each trial was captured on a digital camera and the recordings were synchronised with the activPAL . The time spent in different postures was visually classified and this was compared with the activPAL output . Results : Intraclass correlation coefficients ( ICC 2,1 ) for interdevice reliability ranged from 0.79 to 0.99 . Using the Bl and and Altman method , the mean percentage difference between the activPAL monitor and observation for total time spent sitting was 0.19 % ( limits of agreement −0.68 % to 1.06 % ) and for total time spent upright was −0.27 % ( limits of agreement −1.38 % to 0.84 % ) . The mean difference for total time spent st and ing was 1.4 % ( limits of agreement −6.2 % to 9.1 % ) and for total time spent walking was −2.0 % ( limits of agreement −16.1 % to 12.1 % ) . A second-by-second analysis between observer and monitor found an overall agreement of 95.9 % . Conclusion : The activPAL activity monitor is a valid and reliable measure of posture and motion during everyday physical activities Little is known about the effectiveness of school-based health promotion on physical activity inequalities among children from low-income areas . This study compared the two-year change in physical activity among 10 - 11 year-old children attending schools with and without health promotion programs by activity level , body weight status , and socioeconomic background s to assess whether health promotion programs reduce or exacerbate health inequalities . This was a quasi-experimental trial of a Comprehensive School Health ( CSH ) program implemented in schools located in socioeconomically disadvantaged neighbourhoods in Edmonton , Alberta , Canada . In the spring of 2009 and 2011 , pedometer ( 7 full days ) and demographic data were collected from cross-sectional sample s of grade five children from 10 intervention and 20 comparison schools . Socioeconomic status was determined from parent self-report . Low-active , active , and high-active children were defined according to step-count tertiles . Multilevel linear regression methods adjusted for potential confounders were used to assess the relative inequity in physical activity and were compared between groups and over-time . In 2009 , a greater proportion of students in the intervention schools were overweight ( 38 % vs. 31 % p = 0.03 ) and were less active ( 10,827 vs. 12,265 steps/day p < 0.001 ) . Two years later , the relative difference in step-counts between intervention and comparison schools reduced from -15.5 % to 0 % among low-active students , from -13.4 % to 0 % among active students , and from -15.1 % to -2.7 % among high-active students . The relative difference between intervention and comparison schools reduced from -11.1 % to -1.6 % among normal weight students , from -16.8 % to -1.4 % among overweight students , and was balanced across socioeconomic subgroups . These findings demonstrate that CSH programs implemented in socioeconomically disadvantaged neighbourhoods reduced inequalities in physical activity . Investments in school-based health promotion are a viable , promising , and important approach to improve physical activity and prevent childhood obesity , and may also reduce inequalities in health
target: Conclusions Multicomponent interventions which also include the use of st and ing desks may be an effective method for reducing  children 's sedentary time  in a school-based intervention .
background: Introduction Prolonged , uninterrupted periods of sedentary time may be associated with increased risk of Type II diabetes , cardiovascular disease and all-cause mortality even if the minimum recommended levels of daily physical activity are achieved .
  It is reported that children spend approximately 80 % of their day engaged in sedentary behaviours .
  Since children spend a large portion of their waking time at school , school-based interventions targeting excessive or interrupted periods of sedentary time have been investigated in a number of studies .
  However , results of the effectiveness of studies to- date have been inconsistent .
  Aim To conduct a systematic review to evaluate the effectiveness of school-based interventions design ed to reduce sedentary behaviour on objective ly measured sedentary time in children .