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Changes in physical activity and psychosocial determinants of physical activity in children and adolescents treated for obesity. Test of an Educational Intervention for Osteoporosis Prevention With U.S. Adolescents Childhood physical fitness tests: predictor of adult physical activity levels? Effectiveness of a school-based intervention on physical activity for high school students in Brazil: the Saude na Boa project. Effects of the CATCH physical education intervention: teacher type and lesson location. Results of the "Active by Choice Today" (ACT) randomized trial for increasing physical activity in low-income and minority adolescents. Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving. 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abstract: BACKGROUND Pathways , a multisite school-based study aim ed at promoting healthful eating and increasing physical activity , was a r and omized field trial including 1704 American Indian third to fifth grade students from 41 schools ( 21 intervention , 20 controls ) in seven American Indian communities . METHODS The intervention schools received four integrated components : a classroom curriculum , food service , physical activity , and family modules . The curriculum and family components were based on Social Learning Theory , American Indian concepts , and results from formative research . Process evaluation data were collected from teachers ( n=235 ) , students ( n=585 ) , and families .  Knowledge , Attitudes , and Behavior Question naire data were collected from 1150 students including both intervention and controls . RESULTS There were significant increases in knowledge and cultural identity in children in intervention compared to control schools with a significant retention of knowledge over the 3 years , based on the results of repeating the third and fourth grade test items in the fifth grade . Family members participated in Family Events and take-home activities , with fewer participating each year . CONCLUSION A culturally appropriate school intervention can promote positive changes in knowledge , cultural identity , and self-reported healthful eating and physical activity in American Indian children and environmental change in school food service Background . Previous research has shown that children can increase their muscular strength and muscular endurance as a result of regular participation in a progressive resistance training program . However , the most effective exercise prescription regarding the number of repetitions remains question able . Objective . To compare the effects of a low repetition – heavy load resistance training program and a high repetition – moderate load resistance training program on the development of muscular strength and muscular endurance in children . Design . Prospect i ve , controlled trial . Setting . Community-based youth fitness center . Subjects . Eleven girls and 32 boys between the ages of 5.2 and 11.8 years . Intervention . In twice-weekly sessions of resistance training for 8 weeks , children performed 1 set of 6 to 8 repetitions with a heavy load ( n = 15 ) or 1 set of 13 to 15 repetitions with a moderate load ( n = 16 ) on child-size exercise machines . Children in the control group ( n = 12 ) did not resistance train . One repetition maximum ( RM ) strength and muscular endurance ( repetitions performed posttraining with the pretraining 1-RM load ) were determined on the leg extension and chest press exercises . Results . One RM leg extension strength significantly increased in both exercise groups compared with that in the control subjects . Increases of 31.0 % and 40.9 % , respectively , for the low repetition – heavy load and high repetition – moderate load groups were observed . Leg extension muscular endurance significantly increased in both exercise groups compared with that in the control subjects , although gains result ing from high repetition – moderate load training ( 13.1 ± 6.2 repetitions ) were significantly greater than those result ing from low repetition – heavy load training ( 8.7 ± 2.9 repetitions ) . On the chest press exercise , only the high repetition – moderate load exercise group made gains in 1-RM strength ( 16.3 % ) and muscular endurance ( 5.2 ± 3.6 repetitions ) that were significantly greater than gains in the control subjects . Conclusion . These findings support the concept that muscular strength and muscular endurance can be improved during the childhood years and favor the prescription of higher repetition – moderate load resistance training programs during the initial adaptation period BACKGROUND Although school-based behavioral interventions for increasing physical activity ( PA ) in children and adolescents have been conducted , little evidence suggests that these curriculum-based approaches lead to increases in overall activity outside of program days . The overall goal of the " Active by Choice Today " ( ACT ) trial is to exp and the body of knowledge concerning the factors that influence long-term increases in PA in underserved adolescents ( low socioeconomic status , minorities ) during their middle school years . DESIGN AND SETTING An overview of the ACT study design , theoretical framework , process evaluation , and primary hypotheses is presented . The trial involves twenty-four middle schools ( 1560 6th grade rs ) in South Carolina that are r and omly assigned to one of two after-school programs ( motivational and life skills intervention , or general health education ) .  INTERVENTION The intervention integrates constructs from Self-Determination and Social Cognitive Theories to enhance intrinsic motivation and behavioral skills for PA . The intervention targets skill development for PA outside of program days and the after-school program social environment ( autonomy , choice , participation , belongingness , fun , enjoyment , support ) is design ed to positively impact cognitive mediators ( self-efficacy , perceived competence ) , and motivational orientation ( intrinsic motivation , commitment , positive self-concept ) . MAIN HYPOTHESES/ OUTCOMES : It is hypothesized that the 17-week motivational and life skills intervention will lead to greater increases in moderate-to-vigorous PA ( based on 7-day accelerometry estimates ) at post-intervention as compared to the general health education program . CONCLUSIONS Implication s of this innovative school-based trial are discussed The primary aim of the Trial of Activity in Adolescent Girls ( TAAG ) is to test an intervention to reduce by half the age-related decline in moderate to vigorous physical activity  ( MVPA ) in middle school girls . The intervention will be evaluated using a group-r and omized trial involving 36 middle schools . The primary endpoint is the mean difference in intensity-weighted minutes ( i.e. , MET-minutes ) of MVPA between intervention and comparison schools assessed using accelerometry . The TAAG study design calls for two cross-sectional sample s , one drawn from 6th grade rs at the beginning of the study and the second drawn from 8th grade rs at the end of the study following the 2-year implementation of the intervention . An important strength of this design over a cohort design is the consistency with the goals of TAAG , which focus on environmental-level rather than individual-level interventions to produce change . The study design specifies a recruitment rate of 80 % and a smaller sample of girls at baseline ( n=48 per school ) than at follow-up ( n=96 per school ) . A two-stage model will be used to test the primary hypothesis . In the first stage , MET-weighted minutes of MVPA will be regressed on school , time ( baseline or follow-up ) , their interaction , ethnicity and week of data collection . The second stage analysis will be conducted on the 72 adjusted means from the first stage . In the main-effects model , we will regress the follow-up school mean MET-weighted minutes of MVPA on study condition , adjusting for the baseline school mean . The TAAG study addresses an important health behavior , and also advances the field of group-r and omized trials through the use of a study design and analysis plan tailored to serve the main study hypothesis OBJECTIVE The objective of this study was to test whether heart-rate feedback prompts increased physical activity ( PA ) in primary school students . METHODS A controlled trial with 210 9 - 11 year olds from subsidized Hong Kong Government primary schools was completed in December 2006 . Schools were r and omly assigned to one of three groups : Control ( CG ) ; Educational program ( EG ) ; No-educational program ( NEG ) . INTERVENTION In a short-term school-based intervention , heart-rate feedback was given either in combination with an educational program ( EG ) or in isolation ( NEG ) . Long-term retention was assessed in comparison to the control group after 6 months follow-up . MAIN OUTCOME MEASURES Physical activity and changes in attraction to PA . RESULTS In the short-term , heart-rate monitor feedback increased total daily PA by an average of 24 % ( p<0.001 ) and vigorous PA by 0.6 % ( p<0.05 ) . No change was found for moderate PA . Increases occurred regardless of involvement in the educational program , and in the absence of any change in attitudes towards PA . No long-term retention was apparent . CONCLUSIONS The findings from the study suggest that feedback from heart-rate monitors encourages low intensity PA , but when removed increases do not persist PURPOSE The objectives of this study were to examine 1 ) whether changes in total physical activity  ( PA ; counts per minute , cpm ) and time spent in moderate to vigorous PA ( MVPA ) are associated with changes in adiposity and 2 ) whether energy intake influences the relationship between changes in PA and changes in adiposity in overweight Hispanic adolescents . METHODS Analysis included 38 overweight ( body mass index , > 85th percentile ) Hispanic adolescents with complete pretest and posttest data on relevant variables after participating in a 16-wk intervention . The intervention treatment did not influence PA , so the sample was combined and the r and omization group was adjusted for in the analysis . Body composition by dual-energy x-ray absorptiometry , 7-d PA by accelerometry , and dietary intake by 3-d diet records were assessed before and after intervention . RESULTS Within individuals , the mean increase of PA ( n = 19 ) and mean decrease of PA ( n = 19 ) was approximately 105 cpm . A 100-cpm increase in total PA was associated with a decrease of 1.3 kg of fat mass and 0.8 % body fat after adjusting for pretest adiposity , PA , age , sex , and treatment ( P < 0.05 ) . Controlling for energy intake modestly strengthened the relationships between total PA and fat mass and percent body fat . Changes in MVPA were not related to changes in adiposity after controlling for total PA ( P > 0.05 ) . CONCLUSIONS Increasing total PA  by 28 % ( 100 cpm ) was associated with a decrease of 1.4 kg of fat mass and 1 % body fat for 16 wk in overweight Hispanic adolescents independent of intervention group assignment . Increases in total PA , compared with MVPA , may be sufficient to improve body composition in overweight Hispanic adolescents The effect of exercise training , particularly relatively brief periods , on bone turnover markers in adolescents has been poorly studied . Thirty-eight healthy males ( 16+/-0.7 years ) participated in a 5-week  summer school program in which 20 subjects were r and omly assigned to a training group consisting of 2 h/day , 5 days/week of endurance exercise , and 18 subjects were assigned to a control group .  Bone formation was assessed by measurements of circulating osteocalcin , bone-specific alkaline phosphatase ( BSAP ) , and the C-terminal procollagen peptide ( PICP ) . Bone resorption was assessed by urinary levels of free deoxypyridinoline cross-links ( dPYR ) and the C-(CTX ) and N-terminal ( NTX ) telopeptide cross-links . Prior to training , there was a weak positive correlation between fitness and PICP ( r = 0.27 , p < 0.05 ) , but no correlations were observed between fitness and either the other markers of bone formation or bone resorption . Training led to a significant increase in ( 1 ) osteocalcin ( 15+/-4 % , p < 0.03 ) , ( 2 ) BSAP ( 21+/-6 % , p < 0.02 ) , and ( 3 ) PICP ( 30+/-11 % , p < 0.03 ) and to a significant decrease in NTX ( -21 + /- 3 % , p < 0.05 ) . These bone turnover markers did not change in the control subjects ( osteocalcin , 0+/-4 % ; BSAP , 2+/-4 % ; PICP , -4 + /- 6 % ; NTX , -6 + /- 4 % ) . There was no change in urinary dPYR and CTX in either control or trained subjects . Fitness is only weakly , if at all , correlated with bone formation , but a relatively brief period of endurance training leads to a substantial increase in bone formation markers in adolescent males . School-based , short-term exercise training programs could play a role in enhancing bone formation in adolescents OBJECTIVE To test the feasibility , acceptability , and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , among African-American girls . DESIGN Twelve-week , 2-arm parallel group , r and omized controlled trial . SETTING Low-income neighborhoods . PARTICIPANTS Sixty-one 8 - 10-year-old African-American girls and their parents/guardians . INTERVENTIONS The treatment intervention consisted of after-school dance classes at 3 community centers , and a 5-lesson intervention , delivered in participants ' homes , and design ed to reduce television , videotape , and video game use . The active control intervention consisted of disseminating newsletters and delivering health education lectures . MAIN OUTCOME MEASURES Implementation and process measures , body mass index , waist circumference , physical activity measured by accelerometry , self-reported media use , and meals eaten with TV . RESULTS Recruitment and retention goals were exceeded . High rates of participation were achieved for assessment s and intervention activities , except where transportation was lacking . All interventions received high satisfaction ratings . At follow up , girls in the treatment group , as compared to the control group , exhibited trends toward lower body mass index ( adjusted difference = -.32 kg/m2 , 95 % confidence interval [ CI ] -.77 , .12 ; Cohen 's d = .38 st and ard deviation units ) and waist circumference ( adjusted difference = -.63 cm , 95 % CI -1.92 , .67 ; d = .25 ) ; increased after-school physical activity ( adjusted difference = 55.1 counts/minute , 95 % CI -115.6 , 225.8 ; d = .21 ) ; and reduced television , videotape , and video game use ( adjusted difference = -4.96 hours/week , 95 % CI -11.41 , 1.49 ; d = .40 ) . The treatment group reported significantly reduced household television viewing ( d = .73 , P = .007 ) and fewer dinners eaten while watching TV ( adjusted difference = -1.60 meals/week , 95 % CI -2.99 , -.21 ; d = .59 ; P = .03 ) . Treatment group girls also reported less concern about weight ( d = .60 ; P = .03 ) , and a trend toward improved school grade s ( d = .51 ; P = .07 ) . CONCLUSIONS This study confirmed the feasibility , acceptability , and potential efficacy of using dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , in African-American girls Background : Population -based studies directed at promoting physical activity in youth have shown limited success in obesity prevention . Objective : To assess whether an intervention integrating environmental changes to induce sustained changes in physical activity , prevents overweight in adolescents . Design : Four-year r and omized trial started in 2002 in eight middle schools of Eastern France . The intervention , r and omized at school level , was design ed to promote physical activity by changing attitudes through debates and attractive activities , and by providing social support and environmental changes encouraging physical activity . Subjects : Nine hundred and fifty four 12-year-old six- grade rs . Measurements : Body mass index ( BMI ) , body composition , physical activity by question naire , plasma lipids and glucose , insulin resistance . Results : Intervention students had a lower increase in BMI ( P=0.01 ) and age- and gender-adjusted BMI ( P<0.02 ) over time than controls . The differences across groups of the age- and gender-adjusted BMI changes ( 95 % confidence interval ( CI ) ) were −0.29 ( −0.51 ; −0.07 ) kg/m2 at 3 years , −0.25 ( −0.51 ; 0.01 ) kg/m2 at 4 years . An interaction with baseline weight status was noted . The intervention had a significant effect throughout the study in initially non-overweight adolescents ( −0.36 ( −0.60;−0.11 ) kg/m2 for adjusted BMI at 4 years ) , corresponding to a lower increase in fat mass index ( P<0.001 ) . In initially overweight adolescents , the differences observed across groups at 2 years ( –0.40 ( −0.94 ; 0.13 ) kg/m2 for adjusted BMI ) did not persist over time . At 4 years , 4.2 % of the initially non-overweight adolescents were overweight in the intervention schools , 9.8 % in the controls ( odds ratio=0.41 ( 0.22 ; 0.75 ) ; P<0.01 ) . Independent of initial weight status , compared with controls , intervention adolescents had an increase in supervised physical activity ( P<0.0001 ) , a decrease of TV/video viewing ( P<0.01 ) and an increase of high-density cholesterol concentrations ( P<0.0001 ) . Conclusion : Enhancing physical activity with a multilevel program prevents excessive weight gain in non-overweight adolescents . Our study provides evidence that prevention of obesity in youth is feasible Background Physical Activity Across the Curriculum ( PAAC ) is a 3-year elementary school-based intervention to determine if increased amounts of moderate intensity physical activity performed in the classroom will diminish gains in body mass index ( BMI ) . It is a cluster-r and omized , controlled trial , involving 4905 children ( 2505 intervention , 2400 control ) . Methods We collected both qualitative and quantitative process evaluation data from 24 schools ( 14 intervention and 10 control ) , which included tracking teacher training issues , challenges and barriers to effective implementation of PAAC lessons , initial and continual use of program specified activities , and potential competing factors , which might contaminate or lessen program effects . Results Overall teacher attendance at training sessions showed exceptional reach . Teachers incorporated active lessons on most days , result ing in significantly greater student physical activity levels compared to controls ( p < 0.0001 ) . Enjoyment ratings for classroom-based lessons were also higher for intervention students . Competing factors , which might influence program results , were not carried out at intervention or control schools or were judged to be minimal . Conclusion In the first year of the PAAC intervention , process evaluation results were instrumental in identifying successes and challenges faced by teachers when trying to modify existing academic lessons to incorporate physical activity OBJECTIVE To evaluate the feasibility , acceptability , and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children . DESIGN Six-month , 2-arm , parallel-group , pilot r and omized controlled trial . SETTING Low-income , racial/ethnic minority community . PARTICIPANTS Twenty-one children in grade s 4 and 5 with a body mass index at or above the 85th percentile . INTERVENTIONS The treatment intervention consisted of an after-school soccer program . The " active placebo " control intervention consisted of an after-school health education program . MAIN OUTCOME MEASURES Implementation , acceptability , body mass index , physical activity measured using accelerometers , reported television and other screen time , self-esteem , depressive symptoms , and weight concerns . RESULTS 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 . CONCLUSION An after-school team soccer program for overweight children can be a feasible , acceptable , and efficacious intervention for weight control Abstract Objective : To assess if a school based intervention was effective in reducing risk factors for obesity . Design : Group r and omised controlled trial . Setting : 10 primary schools in Leeds . Participants : 634 children aged 7 - 11 years . Intervention : Teacher training , modification of school meals , and the development of school action plans targeting the curriculum , physical education , tuck shops , and playground activities . Main outcome measures : Body mass index , diet , physical activity , and psychological state . Results : Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group ( weighted mean difference 0.3 portions/day , 95 % confidence interval 0.2 to 0.4 ) , representing a difference equivalent to 50 % of baseline consumption . Fruit consumption was lower in obese children in the intervention group ( −1.0 , −1.8 to −0.2 ) than those in the control group . The three day diary showed higher consumption of high sugar foods ( 0.8 , 0.1 to 1.6 ) ) among overweight children in the intervention group than the control group . Sedentary behaviour was higher in overweight children in the intervention group ( 0.3 , 0.0 to 0.7 ) . Global self worth was higher in obese children in the intervention group ( 0.3 , 0.3 to 0.6 ) . There was no difference in body mass index , other psychological measures , or dieting behaviour between the groups . Focus groups indicated higher levels of self reported behaviour change , underst and ing , and knowledge among children who had received the intervention . Conclusion : Although it was successful in producing changes at school level , the programme had little effect on children 's behaviour other than a modest increase in consumption of vegetables . What is already known on this topic Obesity is increasing among school children and dem and s preventive strategies R and omised controlled trials of school based primary prevention programmes have all used a prescriptive approach What this study adds Behavioural changes were disappointing with this programme based on the health promoting schools philosophy , despite changes at school level The only positive outcome was a modest increase in vegetable consumption The discrepancy between changes achieved at the individual and school level raises issues regarding the problems inherent in such OBJECTIVES Motivating adolescents to adopt proper nutrition and physical activity behaviors is important in this nation 's fight to prevent obesity and chronic diseases . This study was conducted to determine which health education delivery method would elicit a greater behavior change . METHOD The intervention was conducted in three schools ( control , computer-based , and traditional education ) .  RESULTS Students who received the computer-based intervention showed increased knowledge ( p<0.001 ) , physical activity ( p=0.001 ) , self-efficacy ( p<0.001 ) , and social support ( p<0.001 ) , and decreased meals skipped ( p<0.001 ) . CONCLUSION The computer-based group showed more positive behavior changes . However , future programs may be enhanced by including group discussion and individual feedback BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity The effects of cardiovascular risk reduction are typically assessed by self-reported behavior change and physiological outcomes . There is a need to enhance evaluation protocol s by including direct observation measures of targeted health behaviors . To improve the evaluation of a family-based diet and physical activity change program , families were observed during a planned visit to the San Diego Zoo . This st and ardized environment afforded many options for dietary intake and physical activity . Thirty families who had participated in a 1-year intervention program and 30 control families were observed . Caucasian and Mexican-American families were equally represented . Observations in this st and ard environment discriminated between intervention and control families , and the findings indicated that intervention effects generalized to this novel setting . Intervention families consumed fewer calories , ate less sodium , and walked further than did control families . Ethnic differences were noted To reduce the risk for chronic disease , adolescents should eat at least five servings of fruit and vegetables and be physically active daily . The Healthy Youth Places Project will test if an intervention strategy that implements school environmental change -- with adult leader and youth participation -- will influence and maintain  adolescent fruit and vegetable consumption and physical activity . Using an experimental design , middle schools will be r and omized ( eight intervention and eight control schools ) , and the health behavior of a cohort of adolescents will be assessed during Grade s 6 ( baseline ) , 7 and 8 ( intervention ) , and 9 ( follow-up ) . The project uses an ecologically informed social cognitive model to inform a place-based intervention that encourages participation in the process of planning and implemented environmental change in targeted adolescent physical and social environments ( school lunch place and after school program place ) . Environmental change is defined as implemented practice s , programs and policies that promote critical elements ( connection , autonomy , skill-building and healthy norms ) in places . These critical elements are hypothesized environmental antecedents of social cognitive mediators of behavior change . The Project develops a place-based dissemination model of multiple levels ( project , school and place ) that are hypothesized to build the skills and efficacy of leaders ( school staff and youth ) that implement environmental changes OBJECTIVE To evaluate the effectiveness of a program to increase walking to and from school . DESIGN A cluster r and omised controlled trial . SETTING 24 primary public schools in inner west Sydney , Australia . PARTICIPANTS 1996 students aged 10 - 12 years and their parents . INTERVENTION A two-year multi-component program included classroom activities , development of school Travel Access Guides , parent newsletters and improving environments with local councils . MEASURES Two measures were used : a survey completed by students on how they travelled to and from school over five days , and a survey completed by their parents on how their child travelled to and from school in a usual week . RESULTS The percentage of students who walked to and from school increased in both the intervention and control schools . Data from parent surveys found that 28.8 % of students in the intervention group increased their walking , compared with 19 % in the control group ( a net increase of 9.8 % , p=0.05 ) . However this effect was not evident in the student data . CONCLUSION The study produced a mixed result , with a high variation in travel patterns from school to school . Intervention research should address the complexity of multiple factors influencing student travel to school with a focus on changing local environments and parents ' travel to work Self-monitoring is often used in health behaviour change programs ; but it is not known to what extent self-monitoring data are valid and useful in predicting changes in cardiovascular disease ( CVD ) risk .  Subjects included 72 Anglo adults , 68 Anglo children , 80 Mexican-American adults and 94 Mexican-American children . Subjects were families with fifth and sixth grade children who participated in an 18-session family-based diet and exercise change program design ed to reduce CVD risk . During the intervention , each participant self-monitored diet and aerobic physical activity .  Families were measured at baseline , 3 , 12 , and 24 months . For adults , self-monitored changes in diet correlated with changes in body mass index , systolic blood pressure , total cholesterol and LDL 1 and 2 years later . Correlations between self-monitored diet and diet-related risk factor changes were not observed among children . Correlations between self-monitored exercise and subsequent risk factor changes were not observed among adults . For children , self monitored changes in aerobic physical activity correlated significantly with changes in VO2Max and HDL/LDL ratio 1 and 2 years later . Thus , this study provides some support for the predictive validity of  diet self-monitoring  in adults and exercise self-monitoring in children PURPOSE To determine the effect of increasing the aerobic component of the school 's physical activity program and improving the knowledge about weight control and blood pressure on the blood pressure and body fat of early adolescents . METHODS The subjects were 1140 youth aged 11 to 14 years ( 630 females , 510 males ; 64 % white , 24.4 % African-American , and 11.6 % " other " ) , who were r and omly assigned by school into four treatment groups : exercise only , education only , exercise and education combined , and control group . Heights , weights , and skinfold thicknesses were measured , and body mass index ( BMI ) was computed kg/m(2 ) . Blood pressure was obtained in duplicate using a r and om-zero mercury sphygmomanometer . Maximal oxygen uptake was predicted from a submaximal cycle ergometer test . Data were analyzed using analysis of covariance statistics , adjusting for gender , ethnicity , age , socioeconomic status , and initial baseline characteristics . RESULTS Systolic and diastolic blood pressures increased more in the control group than in the intervention groups ( p = .001 ) . The BMI did not change significantly ( p = .709 ) , but the sum of skinfolds increased less in subjects in the exercise intervention groups than the education only or control groups ( p = .0001 ) . The small increase in (p)VO(2)max of the combined exercise and education group was significantly greater than the education only group ( p = .0001 ) . CONCLUSION An exercise program for youth can have a positive effect on blood pressure independent of body weight loss BACKGROUND The purpose of this study was to examine the impact of the Pathways intervention on pychosocial variables related to physical activity and diet in American Indian children . METHODS Schools serving American Indian children were r and omized to a multicomponent intervention or control condition . At baseline ( fall of third grade ) and in the spring semester of third , fourth , and fifth grade s 755 boys and 692 girls completed a classroom-administered question naire . The question naire assessed self-efficacy , knowledge , and behavioral intentions related to diet and physical activity , as well as weight loss behaviors and body image . RESULTS Knowledge of nutrition and physical activity messages increased in both boys and girls in the intervention group compared to controls ; however , knowledge of which foods contained more fat did not increase consistently . Compared to controls , self-efficacy to be physically active increased among girls in intervention schools , but not among boys , whereas self-efficacy to make more healthy food choices did not increase more than in controls in either gender . In the intervention group , compared to controls , healthy food intentions and participation in physically active behaviors increased in both boys and girls . Perception of healthy body size and weight loss attempts did not differ in the intervention and control groups . CONCLUSION The Pathways intervention program had a positive impact on several aspects of obesity-related knowledge , attitudes , and behaviors The aim of this study was to evaluate the effect of increasing the amount of time spent in physical education classes on bone mineral accrual and gain in bone size in prepubertal Danish children . A total of 135 boys and 108 girls , aged 6–8 years , were included in a school-based curriculum intervention program where the usual time spent in physical education classes was doubled to four classes ( 180 min ) per week . The control group comprised age-matched children ( 62 boys and 76 girls ) recruited from a separate community who completed the usual Danish school curriculum of physical activity ( 90 min/week ) . Dual-energy X-ray absorptiometry was used to evaluate bone mineral content ( BMC ; g ) , bone mineral density ( g/cm2 ) , and bone width at the calcaneus and distal forearm before and after 3 years of intervention . Anthropometrics and Tanner stages were evaluated on the same occasions . General physical activity was measured with an accelerometer worn for 4 days . In girls , the intervention group had a 12.5 % increase ( P = 0.04 ) in distal forearm BMC and a 13.2 % increase ( P = 0.005 ) in distal forearm scanned area compared with girls in the control group . No differences were found between the intervention and control groups in boys . Increasing the frequency of physical education classes for prepubertal children is associated with a higher accrual of bone mineral and higher gain in bone size after 3 years in girls but not in boys Interpretation of the actual level of aerobic endurance in a growing child is difficult . Endurance capacity per se is influenced by a number of factors , e.g. by genetic endowment , developmental rate , body composition and habitual physical activity . The respective effects of these factors can not be distinctly separated from one another , so their particular role is not clearly definable in the various age periods . The aim of our investigation was to define the actual level of aerobic endurance performance in children aged 7 - 9 , and to analyse the relevant factors that may affect this kind of performance according to the different level of sport activities . Two primary school classes ( N=42 ) were selected for the experiment . Both groups had physical education classes every day ( five times a week ) . One group ( AG , N=31 ) consisted of children taking part in regular sport courses at least twice a week ( e.g. basket ball , karate , triathlon swimming and gymnastics )  , as well , the other group ( NAG , N=11 ) served as comparison group . Aerobic performance was estimated by measuring cardiorespiratory response during a Jaeger treadmill run using a " vita maxima " ( all-out ) testing protocol . The subjects were measured in the Laboratory for Spiroergometry of the Hungarian University of Physical Education twice , in 1997 and 1998 .  Body composition was assessed by the Drinkwater-Ross [ 4 ] body mass fractionation technique . Robustness of the body was described by using the plastic index ( PLX ) of Conrad 's growth type [ 2 ] , morphological age ( MORF AGE ) was estimated by using the method of Mészáros and Mohácsi [ 5 ] . Exercise performance was studied in the laboratory by using a Jaeger 6000 LE model treadmill and a Jaeger mu- DATA SPIR model gas analyser . The functional status of the subjects ' cardiopulmonary system was estimated by spiroergometric parameters and total mechanical work ( WORK ) . The AG group had a better endurance performance in 1998 than that of non-athletic group . A factor analytic study ( principal component method ) of the employed variables revealed that the higher level of endurance fitness in the athletic group was not only affected by growth in size , but also by an increased level of cardiorespiratory performance capacity UNLABELLED Obesity in childhood , which is associated with cardiovascular risk factors such as hypertension , is on the increase . Counter measures are necessary . In this paper , we present the baseline and final data from the StEP TWO programme , a prospect i ve study to prevent overweight and obesity in primary schools . METHODS We recorded and calculated , from 1689 children , anthropometric data , including analyses of bioelectric impedance , waist and hip circumferences , body mass index and its st and ard deviation , and the ratio of waist to hip . Blood pressure was measured after 5 minutes at rest . From the three schools involved in a programme of intervention , 121 children were invited to take part , and 40 ( 33.1 per cent ) completed the programme . The effect was compared with 155 overweight and obese children identified at the 4 control schools . RESULTS 830 ( 49.5 per cent ) boys and 848 girls ( 50.5 per cent ) took part . Their mean age was 8.2 plus or minus 1.3 years , their height was 1.31 plus or minus 0.09 metres , they weighed 30.0 plus or minus 8.2 kilograms , and their mean index of body mass was 17.1 plus or minus 2.9 kilograms per metre squared . Of the children , 7.3 per cent were obese , 10.4 per cent were overweight , 75.7 per cent had normal weights , and 6.6 per cent were underweight . Resting hypertension was observed in 2.3 per cent of the children . Increased blood pressure was associated with a higher body weight , body mass index , st and ard deviation score for body mass index , and waist and hip circumferences ( each p < 0.001 ) , but not with the ratio of waist to hip . Hypertension at rest was also found in 11.0 per cent of obese children , 4.4 per cent of those who were overweight , 1.2 per cent of those with normal weight , and 1.0 per cent of underweight children ( p < 0.001 ) . After the intervention , the increase of the body mass index tended to be lower in those in whom we had intervened ( p = 0.069 ) , and in these the decrease of the st and ard deviation score for body mass index was significantly higher ( p = 0.028 ) . Systolic blood pressure was reduced by about 10 millimetres of mercury in those in whom we had intervened ( p = 0.002 ) , while there were no changes in the control group . Diastolic blood pressure was lowered by 3 millimetres of mercury , but this was not significant . CONCLUSION Obese children had the highest values for systolic and diastolic blood pressure . Increased levels of blood pressure are associated with other parameters of obesity , such as the circumference of the waist and hip . Early preventive measurements in childhood are necessary , and appropriate intervention appears to be effective ISSUE ADDRESSED This study investigated the effectiveness of Traditional Indigenous Games ( TIG ) to improve physical activity and cultural connectedness among primary school students in the community renewal areas of Townsville in North Queensl and . METHODS A cluster r and omised control trial was conducted in four primary schools in 2007 . Baseline and post implementation surveys were conducted in two intervention and two control schools and the results were compared . RESULTS TIG delivered in primary schools every week over period of three months did not contribute to any statistically significant improvement in intervention and control groups in physical activity levels or cultural connectedness . CONCLUSIONS Further research specifically in terms of intensity and duration of TIG may inform whether physical activity may be improved . Enhancing the Indigenous cultural features of the existing TIG kit might positively influence Indigenous cultural connectedness Background Computer tailoring may be a promising technique for prevention of overweight in adolescents . However , very few well-developed , evidence -based computer-tailored interventions are available for this target group . We developed and evaluated a computer-tailored intervention for adolescents targeting energy balance-related behaviours : i.e. consumption of snacks , sugar-sweetened beverages , fruit , vegetables , and fibre , physical activity , and sedentary behaviours . This paper describes the planned development of a school-based computer-tailored intervention aim ed at improving energy balance-related behaviours in order to prevent excessive weight gain in adolescents , and the protocol for evaluating this intervention . Methods / design Intervention development : Informed by the Pre caution Adoption Process Model and the Theory of Planned Behaviour , the computer-tailored intervention provided feedback on personal behaviour and suggestions on how to modify it . The intervention ( VETisnietVET translated as ' FATaintPHAT ' ) has been developed for use in the first year of secondary school during eight lessons . Evaluation design : The intervention will be evaluated in a cluster-r and omised trial including 20 schools with a 4-months and a 2-years follow-up . Outcome measures are BMI , waist circumference , energy balance-related behaviours , and potential determinants of these behaviours . Process measures are appreciation of and satisfaction with the program , exposure to the program 's content , and implementation facilitators and barriers measured among students and teachers . Discussion This project result ed in a theory and evidence -based intervention that can be implemented in a school setting . A large-scale r and omised controlled trial with a short and long-term follow-up will provide sound statements about the effectiveness of this computer-tailored intervention in adolescents . Trial Registration IS RCT PURPOSE The present study investigates the effect of the Activ-O-Meter , an internet-based computer-tailored physical activity intervention in adolescents in six European centers involved in the HELENA study . METHODS Adolescents ( 12 - 17 years old ) from Vienna , Ghent , Heraklion , Dortmund , Athens , and Stockholm were r and omized into intervention and control schools . Participants in the intervention condition received the computer-tailored advice at baseline and after 1 month . Participants in the control condition received a generic st and ard advice . Effects were evaluated after 1 ( n = 675 ) and 3 months ( n = 494 ) using multi-level modeling . Physical activity levels were measured using the International Physical Activity Question naire for adolescents ( IPAQ-A ) . RESULTS After 1 month , the intervention group reported higher levels of moderate ( beta = -32.8 , 95 % CI ( confidence interval ) : -64.2 to -1.4 ) and vigorous ( beta = -28.0 , 95 % CI : -50.7 to -5.3 ) physical activity in leisure time , as well as higher levels of cycling for transport ( beta = -19.1 , 95 % CI : -34.4 to -7.6 ) compared to the control group . After 3 months , when the intervention group had received the tailored feedback twice , intervention effects were even stronger . Favorable changes in physical activity levels of all intensities and in different context s were found in the tailored group compared to the control group . Among adolescents not reaching the physical activity recommendations at baseline similar effects as in the total sample were found . CONCLUSIONS The data indicated that the computer-tailored physical activity intervention had positive effects on physical activity levels among the adolescents . However , the implementation of the computer-tailored intervention in the schools was not feasible in all countries Background : Previous studies have shown that choice and self-initiated behavior change are important for increasing intrinsic motivation and physical activity ( PA )  , however , little of this research has focused on underserved adolescents . Purpose : This study examined the effects of a 4-week student-centered intervention on increasing PA  in underserved adolescents . Methods : Twenty-eight students in the intervention school were matched ( on race , percentage on free or reduced-price lunch program , gender , and age ) with 20 students from another school who served as the comparison group ( 30 girls , 18 boys ; ages 10–12 years ; 83 % African American ; 83 % on free or reduced-price lunch ) . The student-centered intervention was consistent with self-determination ( motivation ) theory and social cognitive theory in that it emphasized increasing intrinsic motivation and behavioral skills for PA . Intervention adolescents took ownership in selecting a variety of PA activities in which to participate , and they generated coping strategies for making effective PA behavior changes . Results : Intervention participants showed greater increases in accelerometer estimates of time spent in moderate PA , moderate-to-vigorous PA , and vigorous PA from baseline to Week 4 of the intervention than the comparison group . Intervention participants also showed greater increases in PA motivation and positive self-concept for PA than comparison adolescents . Conclusions : This study provides preliminary evidence that increasing adolescent involvement and choice of activities may be important in developing future PA interventions for underserved adolescents BACKGROUND The aim of this study was to determine the impact of pedometer use and self-regulation strategies on  adolescents '  daily physical activity . METHODS Junior high school students ( n=113 ) enrolled in seventh- and eighth- grade physical education classes ( 52 girls , 61 boys ) volunteered to participate in a 5-week study to assess daily step counts . Ten physical education classes were r and omly assigned to 1 of 3 groups : ( a ) self-regulation , ( b ) open , and ( c ) control . RESULTS A repeated- measures , mixed-model analysis of variance revealed a significant 3x4 ( Group by Time ) interaction effect , F6,290=2.64 , P<.02 . Follow-up analyses indicated participants in the self-regulation group took 2071 to 4141 more steps/d than the control . No other significant differences emerged among groups on step counts . CONCLUSIONS It appears that having access to and charting daily step counts ( ie , self-regulatory strategies ) positively influenced young adolescents to attain a higher number of steps/d Background Schools are the most frequent target for intervention programs aim ed at preventing child obesity ; however , the overall effectiveness of these programs has been limited . It has therefore been recommended that interventions target multiple ecological levels ( community , family , school and individual ) to have greater success in changing risk behaviors for obesity . This study examined the immediate and short-term , sustained effects of the Switch program , which targeted three behaviors ( decreasing children 's screen time , increasing fruit and vegetable consumption , and increasing physical activity ) at three ecological levels ( the family , school , and community ) . Methods Participants were 1,323 children and their parents from 10 schools in two states . Schools were matched and r and omly assigned to treatment and control . Measures of the key behaviors and body mass index were collected at baseline , immediately post-intervention , and 6 months post-intervention . Results The effect sizes of the differences between treatment and control groups ranged between small ( Cohen 's d = 0.15 for body mass index at 6 months post-intervention ) to large ( 1.38 ; parent report of screen time at 6 months post-intervention ) , controlling for baseline levels . There was a significant difference in parent-reported screen time at post-intervention in the experimental group , and this effect was maintained at 6 months post-intervention ( a difference of about 2 hours/week ) . The experimental group also showed a significant increase in parent-reported fruit and vegetable consumption while child-reported fruit and vegetable consumption was marginally significant . At the 6-month follow-up , parent-reported screen time was significantly lower , and parent and child-reported fruit and vegetable consumption was significantly increased . There were no significant effects on pedometer measures of physical activity or body mass index in the experimental group . The intervention effects were moderated by child sex ( for fruit and vegetable consumption , physical activity , and weight status ) , family involvement ( for fruit and vegetable consumption ) , and child body mass index ( for screen time ) . The perception of change among the experimental group was generally positive with 23 % to 62 % indicating positive changes in behaviors . Conclusion The results indicate that the Switch program yielded small-to-modest treatment effects for promoting children 's fruit and vegetable consumption and minimizing screen time . The Switch program offers promise for use in youth obesity prevention BACKGROUND It is unclear how moderate and vigorous intensities of physical activity ( PA ) are associated with cardiovascular fitness ( CVF ) and percentage of body fat ( % BF ) in adolescents . OBJECTIVE We tested the hypothesis that vigorous PA , to a greater degree than moderate PA , would be associated with better CVF and lower % BF . DESIGN This was a cross-sectional study of 421 black and white high school students ( x age : 16 y ) .  PA was measured with 5 d of accelerometry and expressed in min/d of moderate or vigorous PA .  CVF was measured with a multistage treadmill test and was expressed as the oxygen consumption at a heart rate of 170 bpm . % BF was measured with dual-energy X-ray absorptiometry . Multiple regressions were used to determine the degree to which variance in CVF and % BF was explained by PA , after control for age , sex , race , and the sex x race interaction . RESULTS A higher index for CVF was associated with higher amounts of moderate and vigorous PA ;  more variance was explained by vigorous than by moderate PA .  Lower % BF was associated with higher amounts of vigorous PA but not with the amount of moderate PA . CONCLUSION Black and white adolescents who engaged in relatively large amounts of free-living vigorous exercise were likely to be relatively fit and lean BACKGROUND Little is known about how the intensity of exercise influences cardiovascular fitness and body composition , especially in obese adolescents . OBJECTIVE Our goal was to determine the effects of physical training intensity on the cardiovascular fitness , percentage of body fat ( % BF ) , and visceral adipose tissue ( VAT ) of obese adolescents . DESIGN Obese 13 - 16-y-olds ( n = 80 ) were assigned to 1 ) biweekly lifestyle education ( LSE ) , 2 ) LSE + moderate-intensity physical training , or 3 ) LSE + high-intensity physical training . The intervention lasted 8 mo . Physical training was offered 5 d/wk , and the target energy expenditure for all subjects in physical training groups was 1047 kJ ( 250 kcal)/session . Cardiovascular fitness was measured with a multistage treadmill test , % BF with dual-energy X-ray absorptiometry , and VAT with magnetic resonance imaging . RESULTS The increase in cardiovascular fitness in the high-intensity physical training group , but not in the moderate-intensity group , was significantly greater than that in the LSE alone group ( P = 0.009 ) ; no other comparisons of the 3 groups were significant . Compared with the LSE alone group , a group composed of subjects in both physical training groups combined who attended training sessions > or=2 d/wk showed favorable changes in cardiovascular fitness ( P < 0.001 ) , % BF ( P = 0.001 ) , and VAT ( P = 0.029 ) . We found no evidence that the high-intensity physical training was more effective than the moderate-intensity physical training in enhancing body composition . CONCLUSIONS The cardiovascular fitness of obese adolescents was significantly improved by physical training , especially high-intensity physical training . The physical training also reduced both visceral and total-body adiposity , but there was no clear effect of the intensity of physical training The objective of the study was to assess the prevalence of obesity and /or undernutrition and evaluate diet and activity patterns among schoolchildren from an ethnically diverse low income urban population . A cross-sectional survey of 498 children aged 9 - 12 y from 24 schools in low income multiethnic neighborhoods in Montreal , Canada was undertaken . Height , weight , dietary intake , physical activity record , and lifestyle and demographic characteristics were measured . There was no evidence of undernutrition because linear growth was appropriate for age , but 39.4 % of children were overweight ( > 85th percentile NHANES II ) .  Dietary fat intake  was higher in children from single-parent families ( P < 0.001 ) and those with mothers born in Canada .  Intake of vitamins A , C , iron and folate was directly related to income sufficiency . Children who did more physical activity had significantly higher intakes of energy , calcium , iron , zinc and fiber but were not heavier . Dietary intake  was systematic ally underreported among overweight children , i.e. , their reported intakes did not meet calculated energy needs . This underreporting makes it difficult to attribute the accumulated energy imbalance to either energy intake or expenditure BACKGROUND Little is known about the effects of physical training on plasma leptin concentrations in children . OBJECTIVE We sought to determine the effects of 4-mo periods with and without physical training on leptin in obese children and to explore the determinants of leptin at baseline and in response to physical training . DESIGN Participants were 34 obese 7 - 11-y-old children r and omly assigned to engage in physical training during either the first or second 4 mo of the 8-mo study . RESULTS Total body composition , visceral adiposity , and insulin were all positively correlated with leptin at baseline ( P < or = 0.05 ) ; however , only fat mass was retained in the final stepwise regression ( P = 0.0001 , R2 = 0.57 ) . Leptin decreased during the 4-mo periods of physical training and increased in the 4 mo after cessation of physical training ( P < 0.001 for the time by group interaction ) . Decreases in leptin were greatest in children with higher pretraining leptin concentrations , those whose total mass increased least , and those whose insulin concentrations decreased most ( P < or = 0.05 ) ; only pretraining leptin concentration ( P = 0.009 ) and change in total mass ( P = 0.0002 ) were retained in the final regression ( R2 = 0.53 ) . CONCLUSIONS In obese children , leptin concentration decreased during 4 mo of physical training and increased during a subsequent 4-mo period without physical training , fat mass was highly correlated with baseline leptin , and greater reductions in leptin during 4 mo of physical training were seen in children with higher pretraining leptin and in those whose total mass increased least Exercise has been found to be effective for prevention of weight gain and maintenance of a stable weight in adults . The objective of this study was to evaluate the effect of a school-based aerobic exercise program on the obesity indexes of preschool children . Subjects were 292 second-year elementary school pupils from 2 kindergartens in Hat Yai municipality , Songkhla province , southern Thail and . A specially design ed exercise program , including a 15-min walk before beginning the morning class and a 20-min aerobic dance session after the afternoon nap , 3 times a week , was conducted for 29.6 wk . Weight , height , and triceps skinfold thickness were measured 4 times . At the end of the study , the prevalence of obesity , using 95th percentile National Center for Health Statistics triceps-skinfold-thickness cutoffs , of both the exercise and control groups decreased . That of the exercise group decreased from 12.2 % at baseline to 8.8 % ( Wilcoxon signed-rank test , P = 0.058 ) , whereas that of the control group decreased from 11.7 % to 9.7 % ( Wilcoxon signed-rank test , P = 0.179 ) . A sex difference in the response of body mass index ( BMI ) to exercise was observed . Girls in the exercise group had a lower likelihood of having an increasing BMI slope than the control girls did ( odds ratio : 0.32 ; 95 % CI : 0.18 , 0.56 ) . In conclusion , our study suggests that a 29.6-wk school-based exercise program can prevent BMI gain in girls and may induce a remission of obesity in preschool-age children BACKGROUND Childhood obesity is a major public health problem in the United States , particularly among American Indian communities . OBJECTIVE The objective was to evaluate the effectiveness of a school-based , multicomponent intervention for reducing percentage body fat in American Indian schoolchildren . DESIGN This study was a r and omized , controlled , school-based trial involving 1704 children in 41 schools and was conducted over 3 consecutive years , from 3rd to 5th grade s , in schools serving American Indian communities in Arizona , New Mexico , and South Dakota . The intervention had 4 components : 1 ) change in dietary intake , 2 ) increase in physical activity , 3 ) a classroom curriculum focused on healthy eating and lifestyle , and 4 ) a family-involvement program . The main outcome was percentage body fat ; other outcomes included dietary intake , physical activity , and knowledge , attitudes , and behaviors . RESULTS The intervention result ed in no significant reduction in percentage body fat . However , a significant reduction in the percentage of energy from fat was observed in the intervention schools . Total energy intake ( by 24-h dietary recall ) was significantly reduced in the intervention schools but energy intake ( by direct observation ) was not . Motion sensor data showed similar activity levels in both the intervention and control schools . Several components of knowledge , attitudes , and behaviors were also positively and significantly changed by the intervention . CONCLUSIONS These results document the feasibility of implementing a multicomponent program for obesity prevention in elementary schools serving American Indian communities . The program produced significant positive changes in fat intake and in food- and health-related knowledge and behaviors . More intense or longer interventions may be needed to significantly reduce adiposity in this population OBJECTIVE To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grade s 6 to 8 . DESIGN R and omized , controlled field trial with 5 intervention and 5 control schools . Outcomes were assessed using preintervention ( fall 1995 ) and follow-up measures ( spring 1997 ) , including prevalence , incidence , and remission of obesity . PARTICIPANTS A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities . INTERVENTION Students participated in a school-based interdisciplinary intervention over 2 school years . Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education . Sessions focused on decreasing television viewing , decreasing consumption of high-fat foods , increasing fruit and vegetable intake , and increasing moderate and vigorous physical activity . MAIN OUTCOME MEASURES Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles . Because schools were r and omized , rather than students , the generalized estimating equation method was used to adjust for individual-level covariates under cluster r and omization . RESULTS The prevalence of obesity among girls in intervention schools was reduced compared with controls , controlling for baseline obesity ( odds ratio , 0.47 ; 95 % confidence interval , 0.24 - 0.93 ; P = .03 ) , with no differences found among boys . There was greater remission of obesity among intervention girls vs. control girls ( odds ratio , 2.16 ; 95 % confidence interval , 1.07 - 4.35 ; P = .04 ) . The intervention reduced television hours among both girls and boys , and increased fruit and vegetable consumption and result ed in a smaller increment in total energy intake among girls . Reductions in television viewing predicted obesity change and mediated the intervention effect . Among girls , each hour of reduction in television viewing predicted reduced obesity prevalence ( odds ratio , 0.85 ; 95 % confidence interval , 0.75 - 0.97 ; P = .02 ) . CONCLUSION Planet Health decreased obesity among female students , indicating a promising school-based approach to reducing obesity among youth An interim evaluation was conducted to underst and the implementation quality of the  Tier 1 Program ( Secondary 2 Curriculum )  of the Project P.A.T.H.S. ( Positive Adolescent Training through Holistic Social Programs ) in the Experimental Implementation Phase . Twenty-five schools were r and omly selected to participate in personal and /or telephone interviews to provide information on the implementation details of the program and perceived attributes of the worker-support scheme ( “ Co-Walker Scheme ” ) . Results showed that a majority of the workers perceived that the students had positive responses to the program and the program was helpful to the students . They also identified several good aspects in the program and the Co-Walker Scheme , albeit expressing some negative comments on the program design and difficulties in the implementation process . In conjunction with other findings reported previously , the present findings suggest that the Tier 1 Program is well received by different stakeholders and it promotes the positive development of secondary school students in Hong Kong OBJECTIVE To determine whether a multicomponent health promotion intervention for Dutch adolescents ( defined as persons between 12 and 14 years of age ) would be successful in influencing body composition and dietary and physical activity behavior in both the short and long terms . DESIGN R and omized controlled trial . SETTING Ten intervention and 8 control prevocational secondary schools . PARTICIPANTS A total of 1108 adolescents ( mean age , 12.7 years ) . Intervention An interdisciplinary program with an adapted curriculum for 11 lessons in biology and physical education and environmental change options . MAIN OUTCOME MEASURES Body height and weight , waist circumference , 4 skinfold thickness measurements , and dietary and physical activity behavior data . RESULTS Multilevel analyses showed that the intervention remained effective in preventing unfavorable increases in important measures of body composition after 20-month follow-up in girls ( biceps skinfold and sum of 4 skinfolds ) and boys ( triceps , biceps , and subscapular skinfolds ) . Consumption of sugar-containing beverages was significantly lower in intervention schools both after intervention ( boys : -287 mL/d ; 95 % confidence interval [ CI ] , -527 to -47 ; girls : -249 ; -400 to -98 ) and at 12-month follow-up ( boys : -233 ; -371 to -95 ; girls : -271 ; -390 to -153 ) . For boys , screen-viewing behavior was significantly lower in the intervention group after 20 months ( -25 min/d ; 95 % CI , -50 to -0.3 ) . No significant intervention effects on consumption of snacks or active commuting to school were found . CONCLUSION The Dutch Obesity Intervention in Teenagers program result ed in beneficial effects on the sum of skinfold thickness measurements in girls and consumption of sugar-containing beverages in both boys and girls in both the short and long terms Background — The aim of this prospect i ve , r and omized study was to examine whether additional school exercise lessons would result in improved peak oxygen uptake ( primary end point ) and body mass index – st and ard deviation score , motor and coordinative abilities , circulating progenitor cells , and high-density lipoprotein cholesterol ( major secondary end points ) . Methods and Results — Seven sixth- grade classes ( 182 children , aged 11.1±0.7 years ) were r and omized to an intervention group ( 4 classes with 109 students ) with daily school exercise lessons for 1 year and a control group ( 3 classes with 73 students ) with regular school sports twice weekly . The significant effects of intervention estimated from ANCOVA adjusted for intraclass correlation were the following : increase of peak & OV0312;o2 ( 3.7 mL/kg per minute ; 95 % confidence interval , 0.3 to 7.2 ) and increase of circulating progenitor cells evaluated by flow cytometry ( 97 cells per 1 × 106 leukocytes ; 95 % confidence interval , 13 to 181 ) . No significant difference was seen for body mass index – st and ard deviation score ( −0.08 ; 95 % confidence interval , −0.28 to 0.13 ) ; however , there was a trend to reduction of the prevalence of overweight and obese children in the intervention group ( from 12.8 % to 7.3 % ) . No treatment effect was seen for motor and coordinative abilities ( 4 ; 95 % confidence interval , −1 to 8) and high-density lipoprotein cholesterol ( 0.03 mmol/L ; 95 % confidence interval , −0.08 to 0.14 ) . Conclusions — Regular physical activity by means of daily school exercise lessons has a significant positive effect on physical fitness ( & OV0312;o2max ) . Furthermore , the number of circulating progenitor cells can be increased , and there is a positive trend in body mass index – st and ard deviation score reduction and motor ability improvement . Therefore , we conclude that primary prevention by means of increasing physical activity should start in childhood . Clinical Trial Registration — URL : http://www . clinical trials.gov . Identifier : NCT00176371 The HEALTHY study was a multi-site r and omized trial design ed to determine whether a 3-year school-based intervention targeting nutrition and physical activity behaviors could effectively reduce risk factors associated with type 2 diabetes in middle school children . Pilot and formative studies were conducted to inform the development of the intervention components and the process evaluation methods for the main trial . During the main trial , both qualitative and quantitative assessment s monitored the fidelity of the intervention and motivated modifications to improve intervention delivery . Structured observations of physical education classes , total school food environments , classroom-based educational modules , and communications and promotional campaigns provided verification that the intervention was delivered as intended . Interviews and focus groups yielded a multidimensional assessment of how the intervention was delivered and received , as well as identifying the barriers to and facilitators of the intervention across and within participating schools . Interim summaries of process evaluation data were presented to the study group as a means of ensuring st and ardization and quality of the intervention across the seven participating centers . Process evaluation methods and procedures documented the fidelity with which the HEALTHY study was implemented across 21 intervention schools and identified ways in which the intervention delivery might be enhanced throughout the study OBJECTIVE To assess differences through grade 8 in diet , physical activity , and related health indicators of students who participated in the Child and Adolescent Trial for Cardiovascular Health ( CATCH ) school and family intervention from grade s 3 through 5 . DESIGN Follow-up of the 4-center , r and omized , controlled field trial with 56 intervention and 40 control elementary schools . PARTICIPANTS We studied 3714 ( 73 % ) of the initial CATCH cohort of 5106 students from ethnically diverse background s in California , Louisiana , Minnesota , and Texas at grade s 6 , 7 , and 8 . RESULTS Self-reported daily energy intake from fat at baseline was virtually identical in the control ( 32.7 % ) and intervention ( 32.6 % ) groups . At grade 5 , the intake for controls remained at 32.2 % , while the intake for the intervention group declined to 30.3 % ( P<.001 ) . At grade 8 , the between-group differential was maintained ( 31.6 % vs 30.6 % , P = .01 ) . Intervention students maintained significantly higher self-reported daily vigorous activity than control students ( P = .001 ) , although the difference declined from 13.6 minutes in grade 5 to 11.2 , 10.8 , and 8.8 minutes in grade s 6 , 7 , and 8 , respectively . Significant differences in favor of the intervention students also persisted at grade 8 for dietary knowledge and dietary intentions , but not for social support for physical activity . No impact on smoking behavior or stages of contemplating smoking was detected at grade 8 . No significant differences were noted among physiologic indicators of body mass index , blood pressure , or serum lipid and cholesterol levels . CONCLUSION The original CATCH results demonstrated that school-level interventions could modify school lunch and school physical education programs as well as influence student behaviors . This 3-year follow-up without further intervention suggests that the behavioral changes initiated during the elementary school years persisted to early adolescence for self-reported dietary and physical activity behaviors Purpose . Identify if outreach support increases school-aged children 's  participation in recreational activities . Design . Cluster r and omized trial . Setting . Sixteen schools in economically vulnerable neighborhoods were r and omized to either an intervention or control group . Subjects . Children in grade s 3 to 5 and their families were invited to participate . Intervention . Children in intervention schools were assigned a “ connector ” ( outreach worker ) to facilitate participation in recreation activities . Measures . The Children 's Assessment of Participation and Enjoyment ( CAPE ) was the primary measure at baseline , middle , and end of 1 year . Demographics , body mass index , child physical and psychosocial health , coordination , and self-esteem were measured . Analysis . A generalized linear model was used to test differences between intervention and control groups . Results . Three hundred and sixty children enrolled , and 306 ( 85 % ) completed the study . A greater proportion of children in the intervention group compared with the control group increased participation in physical activity ( 21 % vs. 10 % , p = .02 ) . Children who increased their activity were more likely to have higher levels of contact with the connectors ( 31 % vs. 8 % , p = .001 ) . Study limitations included ( I ) 29 % of eligible families participated , ( 2 ) first use of the CAPE instrument as a longitudinal measure , and ( 3 ) connectors were not blinded to group assignment . Conclusion . Children living in vulnerable neighborhoods benefit from outreach workers to connect them with physical activity programs PURPOSE Physical activity in childhood has many health benefits ; however , the majority of children in many countries , including Mexico , are insufficiently active . The objective of this investigation was to test the effect of a school-based environmental intervention on the physical activity and physical fitness of students attending public primary schools in Mexico City . METHODS Twenty-seven schools were r and omly assigned to basic or plus intervention or control . The basic and plus groups were exposed to school environment and policy changes to enhance physical activity .  Physical activity was evaluated in 699 r and omly selected fourth- and fifth- grade students by measuring school-day and all-day ( 24 h ) steps using pedometers worn for 5 d before and after the 6-month intervention . Physical fitness was assessed by measuring the 9-min run , flexibility , and sit-ups . We calculated the average change in school-day and all-day steps and fitness measures from baseline to follow-up . Using linear regression , we tested the effect of intervention on change controlling for baseline measures and covariates and accounting for the design effect of school . Using logistic regression , we tested the effect of intervention on reaching step cutoffs at baseline and follow-up . RESULTS The plus group significantly ( P < 0.05 ) increased school-day steps relative to control ( change = 687 vs -639 ) . Significantly ( P < 0.05 ) more participants in the basic ( 25.8 % ) and plus ( 36.4 % ) groups reached step cutoffs during school relative to control ( 12.0 % ) . The basic group significantly ( P < 0.05 ) increased all-day steps relative to control ( change = 581 vs -419 ) . The plus group significantly ( P = 0.05 ) increased sit-ups relative to control ( change = 0.3 vs -1.7 ) . CONCLUSIONS A school-based environmental intervention improved student  physical activity during school in public schools in Mexico City OBJECTIVE : To evaluate the 6-month impact of a physical activity ( PA ) multilevel intervention on activity patterns and psychological predictors of  PA among adolescents . The intervention was directed at changing knowledge and attitudes and at providing social support and environmental conditions that encourage PA of adolescents inside and outside school . SUBJECTS AND DESIGN : R and omised , controlled ongoing field trial ( ICAPS ) in middle-school 's first-level adolescents from eight schools selected in the department of the Bas-Rhin ( Eastern France ) with a cohort of 954 adolescents ( 92 % of the eligible students ) initially aged 11.7±0.6 y. The 6-month changes in participation in leisure organised PA ( LOPA ) , high sedentary ( SED ) behaviour ( > 3h/day ) , self-efficacy ( SELF ) and intention ( INTENT ) towards PA  were analysed after controlling for baseline measures and different covariables ( age , overweight , socioprofessional occupation ) , taking into account the cluster r and omisation design . RESULTS : The proportion of intervention adolescents not engaged in organised PA  was reduced by 50 % whereas it was unchanged among control students . After adjustment for baseline covariables , LOPA participation significantly increased among the intervention adolescents ( odds ratio ( 95 % confidence interval ) (OR)=3.38 ( 1.42–8.05 ) in girls ; 1.73 ( 1.12–2.66 ) in boys ) , while high SED was reduced ( OR=0.54 ( 0.38–0.77 ) in girls ; 0.52 ( 0.35–0.76 ) in boys ) . The intervention improved SELF in girls , whatever their baseline LOPA ( P<10−4 ) and INTENT in girls with no baseline LOPA ( P=0.04 ) . SELF tended to improve in boys with no baseline LOPA , without reaching statistical significance . When included in the regression , follow-up LOPA was associated with improvement of SELF in girls ( P=0.02 ) and of INTENT in girls with no baseline PA ( P<0.02 ) . The intervention effect was then attenuated . CONCLUSION : After 6 months of intervention , ICAPS was associated with a significant improvement of activity patterns and psychological predictors , indicating a promising approach for modifying the long-term PA level of adolescents Objective : To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children . Design : Cluster-r and omized , controlled study .Subjects : A total of 3135 boys and girls in grade s 1–4 were included in the study . Methods : Ten schools were selected in Stockholm county area and r and omized to intervention ( n=5 ) and control ( n=5 ) schools .  Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools .  Physical activity ( PA )  was aim ed to increase by 30 min day−1 during school time and sedentary behaviour restricted during after school care time . PA was measured by accelerometry .  Eating habits at home were assessed by parental report . Eating disorders were evaluated by self-report . Results : The prevalence of overweight and obesity decreased by 3.2 % ( from 20.3 to 17.1 ) in intervention schools compared with an increase of 2.8 % ( from 16.1 to 18.9 ) in control schools ( P<0.05 ) . The results showed no difference between intervention and controls , after cluster adjustment , in the longitudinal analysis of BMI sds changes . However , a larger proportion of the children who were initially overweight reached normal weight in the intervention group ( 14 % ) compared with the control group ( 7.5 % ) , P=0.017 . PA  did not differ between intervention and control schools after cluster adjustment . Eating habits at home were found to be healthier among families with children in intervention schools at the end of the intervention . There was no difference between children in intervention and control schools in self-reported eating disorders . Conclusions : A school-based intervention can reduce the prevalence of overweight and obesity in 6 to 10-year-old children and may affect eating habits at home . The effect of the intervention was possibly due to its effect on healthy eating habits at school and at home rather than on increased levels of PA OBJECTIVE To evaluate the effect of a 3-year after-school physical activity ( PA ) intervention on aerobic fitness and percent body fat ( % BF ) . METHODS In total , 18 schools were r and omized into intervention or control arms . Measurements were made at the beginning and end of the third , fourth and fifth grade s. 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 ) . RESULTS 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 ) . CONCLUSIONS 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 This paper examines structured opportunities for student physical activity in Ontario elementary and secondary schools . R and om sample s of elementary and secondary schools were selected , and  telephone surveys of 353 elementary and 360 secondary school personnel were conducted in 1998 . The findings indicate that elementary schools offered physical education , on average , just under three days per week . The duration of physical education class and , in some cases , the duration of vigorous physical activity in class and the weekly amount of vigorous activity in class , were significantly higher at successive grade levels . The physical education enrollment rate in secondary schools was significantly lower at successive grade levels . Student participation in secondary school intramurals and interschool sports was 22.8 % and 28.7 % respectively . These findings suggest increasing the weekly frequency of physical education in elementary schools and increasing participation in physical education classes in secondary schools . Also , intramural opportunities and participation should be promoted Background Childhood obesity is not only associated with adult obesity but also with increased risk of adult onset of type 2 diabetes and subsequent coronary heart disease . The potential effects of school-based health intervention programmes on cardiovascular risk and surrogate markers are unclear , as only few studies have attempted to investigate a complete risk profile including a detailed laboratory analysis or micro- and macrovascular function . In this study a comprehensive school-based r and omized intervention programme will be investigated in 10 - 14-year old children addressing the influence of lifestyle intervention on inactivity , cardiometabolic risk factors and early signs of vascular disease . Methods / Design 15 secondary schools in Southern Germany are r and omly assigned to intervention or control schools . Children in the fifth grade ( 10 - 11 years ) will be observed over four years . The study combines a school-based with a home-based approach , aim ing at children , teachers and parents . The main components are weekly lifestyle-lessons for children , taught by regular classroom teachers to increase physical activity in- and outside of school , to improve eating patterns at school and at home , to reduce media consumption and to amplify well-being . In 4 - 6 annual meetings , teachers receive information about health-related topics with worksheets for children and supporting equipment , accounting for school-specific needs and strategies . Parents ' trainings are provided on a regular basis . All examinations are performed at the beginning and at the end of every school year . Anthropometry includes measurements of BMI , waist and upper arm circumferences , skinfold thickness as well as peripheral blood pressure . Blood sampling includes lipid parameters , insulin , glucose , hsCRP , adiponectin , and IL-6 as well as testosteron and estrogen to determine maturation status . Vascular function is non-invasively assessed by measuring arterial stiffness in large arteries using a sphygmograph and by analysing arteriolar and venular diameters in the retinal microcirculation using a non-mydriatric vessel analyser . A question naire is filled out to determine daily physical activity , motivational factors , dietary habits , quality of life ( KINDL-R ) and socio-economic data . Physical fitness is assessed by a six-item test battery . Discussion Our study aims to provide a feasible long-term intervention strategy to re-establish childhood health and to prevent obesity-related cardiovascular dysfunction in children . Trial Registration BACKGROUND The aim of this study was to investigate stability of physical activity  from childhood and adolescence to adulthood in multiple age cohorts , and analyze how well adult physical activity can be predicted by various physical activity variables measured in childhood and adolescence . METHODS The data were drawn from the Cardiovascular Risk in Young Finns Study . The study was started in 1980 , when cohorts of r and omly sample d boys and girls aged 3 , 6 , 9 , 12 , 15 , and 18 years ( total of 2309 subjects ) were examined for the first time . The measurements were repeated in 1983 , 1986 , 1989 , 1992 , and 2001 . In 2001 , the subjects ( n = 1563 , 68 % ) were aged 24 , 27 , 30 , 33 , 36 , and 39 years , respectively .  Physical activity  was measured by means of a short self-report question naire that was administered individually in connection with a medical examination . On the basis of a question naire , a physical activity index ( PAI ) was calculated . There were no significant differences in the 1980 PAI between participants and dropouts in 2001 . RESULTS Spearmans rank order correlation coefficients for the 21-year tracking period varied from 0.33 to 0.44 in males , and from 0.14 to 0.26 in females . At shorter time intervals the correlation was higher . On average , the tracking correlation was lower in females than in males . Persistent physical activity , defined as a score in the most active third of the PAI in two or three consecutive measurements , increased the odds that an individual would be active in adulthood . Odds ratios for 3-year continuous activity versus continuous inactivity varied from 4.30 to 7.10 in males and 2.90 to 5.60 in females . The corresponding odds ratios for 6-year persistence were 8.70 to 10.80 and 5.90 to 9.40 . CONCLUSIONS It was concluded that a high level of physical activity at ages 9 to 18 , especially when continuous , significantly predicted a high level of adult physical activity . Although the correlations were low or moderate , we consider it important that school-age physical activity appears to influence adult physical activity , and through it , the public health of the general population This study was design ed to create , implement , and test a school-based multiple risk factor reduction program for high school students . All tenth grade rs in four senior high schools ( N = 1447 ) from two school districts participated in the study . Within each district , one school was assigned at r and om to receive a special 20-session CVD risk reduction intervention and one school served as a control . The schools were matched for size and distribution of racial groups before r and omization . At a two-month follow-up , knowledge gains were significantly greater for students in the treatment group on each of the risk factor domains tested : nutrition/diet ( p less than 0.0001 ) , physical activity ( p less than 0.0001 ) , and cigarette smoking ( p less than 0.0001 ) . Compared to controls , a higher proportion of those in the treatment group who were not exercising regularly at baseline , reported regular exercise at follow-up ( p less than 0.0003 ) . Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up while only 5.6 % of baseline experimental smokers in the treatment group graduated to regular smoking compared to 10.3 % in the control group ( p = 0.009 ) . Students in the treatment group were more likely to report that they would choose heart healthy snack items ( p less than 0.0001 ) . Beneficial treatment effects were observed for resting heart rate ( p less than 0.0001 ) , BMI ( p = 0.05 ) , triceps skinfold thickness ( p = 0.003 ) , and subscapular skinfold thickness ( p = 0.01 ) . The results suggest that it is feasible to provide CVD risk reduction training to a large segment of the population through school-based primary prevention approaches Cardiovascular disease is recognized as a serious public health problem . Because the underlying pathological processes start shortly after birth , tracking of recognized cardiovascular disease indicators during childhood and adolescence can help in developing preventive pediatric strategies . A prospect i ve follow-up of both genetic and behavioral lifestyle parameters ( serum cholesterol , blood pressure , percentage body fat , maximal oxygen uptake ( VO2max ) , smoking , physical inactivity , and type A behavior ) was design ed . In the Amsterdam Growth and Health Study a population of 93 males and 107 females was measured annually from 1977 to 1980 and a fifth measurement was made in 1985 . In that way longitudinal data covering a period of 8 years was collected for a group of adolescents/adults between 13 and 21 years of age . Analyses of these parameters provided the following results : The stability over the 9 years of tracking cardiovascular disease indicators , measured as the interperiod correlations , is fairly high . It varies from 0.4 to 0.8 in percentage body fat , cholesterol , and VO2max . Blood pressure values are low ( between 0.3 and 0.4 ) . The probability of 13-year-olds having relatively high values of cardiovascular disease indicators on the basis of a quartile distribution with that at age 21 indicated a moderate to high predictive value . According to the literature , the levels of subjects that are continuously relatively high over the years are more in the direction of optimal health than risk values . The exception is for percentage body fat . Interrelation of the seven cardiovascular disease indicators in constantly relatively high-risk and relatively low-risk groups during the teenage period , measured during young adulthood ( 21.5 years ) , appeared to be weak : only males and females with a high percentage body fat and a low VO2max showed significantly high total cholesterol , low high-density lipoprotein cholesterol , and high total cholesterol/high-density lipoprotein cholesterol levels . From the three environmental cardiovascular disease indicators ( smoking , physical activity , and type A/B behavior ) measured in 1985 , only physical activity was significantly correlated among males and females with high-density lipoprotein cholesterol , percentage body fat , and VO2max . It can be concluded that measurement of percentage body fat in the early teenage period seems to be the most important cardiovascular disease indicator in predicting risk levels in the young adult . The amount of physical activity measured at young adult age is the only behavioral parameter to show a significant interrelation with other cardiovascular disease risk indicators . ( ABSTRACT TRUNCATED AT 400 WORDS CONTEXT Some observational studies have found an association between television viewing and child and adolescent adiposity .  OBJECTIVE To assess the effects of reducing television , videotape , and video game use on changes in adiposity , physical activity , and dietary intake . DESIGN R and omized controlled school-based trial conducted from September 1996 to April 1997 . SETTING Two sociodemographically and scholastically matched public elementary schools in San Jose , Calif. PARTICIPANTS Of 198 third- and fourth- grade students , who were given parental consent to participate , 192 students ( mean age , 8.9 years ) completed the study . INTERVENTION Children in 1 elementary school received an 18-lesson , 6-month classroom curriculum to reduce television , videotape , and video game use . MAIN OUTCOME MEASURES Changes in measures of height , weight , triceps skinfold thickness , waist and hip circumferences , and cardiorespiratory fitness ; self-reported media use , physical activity , and dietary behaviors ; and parental report of child and family behaviors . The primary outcome measure was body mass index , calculated as weight in kilograms divided by the square of height in meters . RESULTS Compared with controls , children in the intervention group had statistically significant relative decreases in body mass index ( intervention vs control change : 18.38 to 18.67 kg/m2 vs 18.10 to 18.81 kg/m2 , respectively ; adjusted difference -0.45 kg/m2 [ 95 % confidence interval [ CI ] , -0.73 to -0.17 ] ; P = .002 ) , triceps skinfold thickness ( intervention vs control change : 14.55 to 15.47 mm vs 13.97 to 16.46 mm , respectively ; adjusted difference , -1.47 mm [ 95 % CI , -2.41 to -0.54 ] ; P=.002 ) , waist circumference ( intervention vs control change : 60.48 to 63.57 cm vs 59.51 to 64.73 cm , respectively ; adjusted difference , -2.30 cm [ 95 % CI , -3.27 to -1.33 ] ; P<.001 ) , and waist-to-hip ratio ( intervention vs control change : 0.83 to 0.83 vs 0.82 to 0.84 , respectively ; adjusted difference , -0.02 [ 95 % CI , -0.03 to -0.01 ] ; P<.001 ) . Relative to controls , intervention group changes were accompanied by statistically significant decreases in children 's reported television viewing and meals eaten in front of the television . There were no statistically significant differences between groups for changes in high-fat food intake , moderate-to-vigorous physical activity , and cardiorespiratory fitness . CONCLUSIONS Reducing television , videotape , and video game use may be a promising , population -based approach to prevent childhood obesity Exercise during growth has a positive influence on bone mineral accrual , yet little is known about how bone geometry and strength adapt to loading during growth . Our primary objective was to compare changes in proximal femur bone geometry and strength between 31 prepubertal ( Tanner Stage 1 ) boys who participated in a school-based , high-impact circuit intervention ( 12 min , three times a week ) for 20 months and 33 maturity-matched controls . Our secondary objective was to compare changes in total body ( TB ) , proximal femur ( PF ) , and lumbar spine ( LS ) bone mineral content ( BMC ) and bone area ( BA ) in these groups . We assessed geometric variables and bone strength at the narrow neck ( NN ) , intertrochanteric ( TR ) region , and femoral shaft regions by applying the Hip Structure Analysis program to proximal femur dual energy X-ray absorptiometry scans ( DXA , Hologic QDR 4500 ) . Further , we assessed total body , lumbar spine , and proximal femur BMC and BA by DXA and derived total body lean mass and fat mass from total body scans . Intervention ( 10.2 + /- 0.5 years ) and control boys ( 10.1 + /- 0.5 years ) had similar baseline height ( 140.8 vs. 141.3 cm ) and weight ( 36.9 vs. 35.4 kg ) , and average 20-month physical activity scores ( Physical Activity Question naire for Children , PAQ-C ) and calcium intakes ( 861 vs. 852 mg/day , food frequency question naire ) . Twenty-month height and weight changes were not significantly different between groups ; lean mass changed more ( P < 0.05 ) in intervention boys ( 22.8 % ) than control boys ( 18.6 % ) . At the NN region , intervention boys had greater bone expansion on both the periosteal ( + 2.6 % , P = 0.1 ) and endosteal ( + 2.7 % , P = 0.2 ) surfaces , result ing in significantly greater changes in section modulus ( bone bending strength ) ( + 7.5 % , P = 0.02 , ANCOVA , adjusting for height change , final Tanner Stage , and baseline bone values ) . Changes at the intertrochanteric and femoral shaft regions were not significantly different between groups . Femoral neck ( FN ) BMC changes were significantly greater in intervention boys ( + 4.3 % , P < 0.01 ) ; changes in BA and BMC for other regions were not significantly different between groups . In summary , a school-based , high-impact exercise intervention implemented three times a week for 12 min is an effective strategy for site-specific gains in bone strength at the narrow neck region of the proximal femur This study examined whether feedback or feedback plus physical activity information could increase the number of pedometer steps taken during 1 school week . One hundred seventy-seven students ( mean age 9.124 + /- 1.11 years ) in three elementary schools participated . Schools were r and omly assigned to control ( CON ) , feedback ( FB ) , or feedback plus information ( FB+I ) groups . Children wore pedometers during school time for 5 consecutive weekdays . The total steps of the groups were recorded at the end of each school day , with students in the FB and FB+I groups free to view their step counts . In addition , the FB+I group received information and ideas about how they could increase their daily steps . The CON group received no step-count feedback or information . Students in the FB+I group achieved significantly more steps per minute ( 17.17 + /- 4.87 ) than those in the FB ( 13.77 + /- 4.06 , p = 0.003 ) and CON ( 12.41 + /- 3.12 , p = 0.0001 ) groups . Information , as well as step-count feedback , increased elementary students ' school-based physical activity ( number of steps ) in the short term . A longer intervention period is necessary to assess the sustained impact of this type of approach Background Childhood obesity and physical inactivity are increasing dramatically worldwide . Children of low socioeconomic status and /or children of migrant background are especially at risk . In general , the overall effectiveness of school-based programs on health-related outcomes has been disappointing . A special gap exists for younger children and in high risk groups . Methods / Design This paper describes the rationale , design , curriculum , and evaluation of a multicenter preschool r and omized intervention study conducted in areas with a high migrant population in two out of 26 Swiss cantons . Twenty preschool classes in the German ( canton St. Gallen ) and another 20 in the French ( canton Vaud ) part of Switzerl and were separately selected and r and omized to an intervention and a control arm by the use of opaque envelopes . The multidisciplinary lifestyle intervention aim ed to increase physical activity and sleep duration , to reinforce healthy nutrition and eating behaviour , and to reduce media use . According to the ecological model , it included children , their parents and the teachers . The regular teachers performed the majority of the intervention and were supported by a local health promoter . The intervention included physical activity lessons , adaptation of the built infrastructure ; promotion of regional extracurricular physical activity ; playful lessons about nutrition , media use and sleep , funny homework cards and information material s for teachers and parents . It lasted one school year . Baseline and post-intervention evaluations were performed in both arms . Primary outcome measures included BMI and aerobic fitness ( 20 m shuttle run test ) . Secondary outcomes included total ( skinfolds , bioelectrical impedance ) and central ( waist circumference ) body fat , motor abilities ( obstacle course , static and dynamic balance ) , physical activity and sleep duration ( accelerometry and question naires ) , nutritional behaviour and food intake , media use , quality of life and signs of hyperactivity ( question naires ) , attention and spatial working memory ability ( two vali date d tests ) . Research ers were blinded to group allocation . Discussion The purpose of this paper is to outline the design of a school-based multicenter cluster r and omized , controlled trial aim ing to reduce body mass index and to increase aerobic fitness in preschool children in culturally different parts of Switzerl and with a high migrant population .Trial Registration Trial Registration : clinical trials.gov Background : Because physical inactivity poses serious health risks , interventions are urgently needed to reverse the increasingly sedentary lifestyles of adolescent girls . Objective : The aim of this study was to determine the feasibility of " Girls on the Move , " an individually tailored computerized physical activity ( PA ) program plus nurse counseling intervention , in increasing PA . Methods : A pretest-posttest control group design was used with 77 racially diverse sedentary girls in Grade s 6 , 7 , and 8 from two middle schools . Each of the instructional grade s was r and omly assigned to either an intervention or control condition . After completing computerized question naires , each girl in the control group received a h and out listing the PA recommendations . To encourage PA , each girl in the intervention group received computerized , individually tailored feedback messages based on her responses to the question naires , individual counseling from the school 's pediatric nurse practitioner ( PNP ) , and telephone calls and mailings from a trained research assistant . At 12 weeks , girls in both groups responded to the question naires . Results : No differences in self-reported PA emerged between the intervention and control groups at Weeks 1 ( baseline ) and 12 ( postintervention ) . Repeated measures ANOVA showed a significant interaction between group and time for social support for PA , F(1 , 69 ) = 5.73 , p = .019 , indicating that the intervention group had significantly greater social support across time than did the control group . From baseline to postintervention , social support increased for the intervention group but decreased for the control group . Discussion : Reasons for the lack of significant differences between the groups on the PA measures were cited . Important information that could inform subsequent studies that test interventions to increase youth PA was acquired from conducting this study . Future efforts to increase PA participation might include this approach for enhancing social support for PA BACKGROUND Professional sport organizations in the United States have notable celebrity status , and several teams have used this " star power " to collaborate with local school districts toward the goal of affecting children 's health . Program effectiveness is unknown due to the absence of comprehensive evaluations for these initiatives . The Memphis Grizzlies , the city 's National Basketball Association franchise , launched " Get Fit with the Grizzlies , " a 6-week , curricular addition focusing on nutrition and physical activity for the fourth and fifth grade s in Memphis City Schools ( MCS ) . The health-infused mini-unit was delivered by physical education teachers during their classes . The purpose of this study was to evaluate the " Get Fit " program effectiveness . METHODS Survey research was employed which measured health knowledge acquisition and health behavior change using a matched pre/posttest design in r and omly chosen schools ( n = 11 ) from all elementary schools in the MCS system ( N = 110 ) . The total number of matched pre/posttests ( n = 888 ) equaled approximately 5 % of the total fourth-/fifth- grade population . McNemar 's test for significance ( p < .05 ) was applied . Odds ratios were calculated for each question . RESULTS Analyses confirmed that there was significant health knowledge acquisition ( 7 of 8 questions ) with odds ratios confirming moderate to strong associations . Seven out of 10 health behavior change questions significantly improved after intervention , whereas odds ratios indicated a low level of association after intervention . CONCLUSIONS This community-school-home initiative using a professional team 's celebrity platform within a certain locale is largely overlooked by school districts and should be considered as a positive strategy to confront childhood obesity Childhood obesity is a chronic disease that is associated with significant co-morbidity . Successful treatment and prevention of childhood obesity requires a multidisciplinary approach , including diet , nutrition education , behavior modification , and exercise . We studied 87 children ( 39 males , 48 females ; aged 7 - 17 years ) enrolled in a one-year multidisciplinary weight reduction program .  Subjects were placed on a very low calorie/high protein diet , a moderate-intensity progressive exercise program , and behavior modification sessions for 10 weeks . Measures were taken at baseline 10 weeks , and 1 year . Significant anthropometric changes in weight , percent of ideal body weight , and percent body-fat were observed in all patients . We conclude that a multidisciplinary weight reduction program including diet , behavior modification , and exercise is an effective instrument to achieve weight loss in obese children and adolescents OBJECTIVE 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 . STUDY DESIGN During two 10-week school terms , 800 11-year-olds took part in a r and omized controlled trial with the st and ard physical activity and nutrition program in six schools , the st and ard 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 . RESULTS 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 . CONCLUSION 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 We determined the effect of a school-based exercise training ( ET ) without dietary intervention , on body composition , fitness and cardiovascular risk in overweight/obese children . Subjects were 51 overweight/obese 6.5- to 12.5-year-old children ( 23 boys , 28 girls ; BMI 25.6+/-4.3 kg/m 2 ) , of whom 48 completed the program . Participants were enrolled in a 15-week aerobic training ( three 60-minute sessions/week ) . Working heart rate was between 120 - 185 beats/minute . Participation rate was 87 % . BMI , waist circumference , body composition ( bioimpedance ) , aerobic capacity ( treadmill ) , blood pressure , lipids and insulin sensitivity ( HOMA ) were assessed . Waist circumference ( 85.9+/-12.4 vs. 80.9+/-10.2 cm ) , muscle mass ( 32.4+/-6.2 vs. 33.7+/-6.1 kg ) , maximal oxygen consumption ( 37.0+/-3.9 vs. 42.6+/-11.2 ml/kg per minute ) , systolic blood pressure ( 113.3+/-11.2 vs. 106.7+/-11.6 mmHg ) and LDL cholesterol ( 2.4+/-0.6 vs. 1.9+/-0.6 mM/l ) improved significantly . Number of children with abdominal obesity ( 29 vs. 20 ) , hypertension ( 10 vs. 5 ) and elevated triglyceride ( 18 vs. 14 ) also declined significantly over time . We concluded that as a result of high attendance and appropriate training program , cardiovascular fitness and abdominal obesity improved in overweight/obese children along with the improvement in metabolic risk factor profile This is the first long-term , controlled study evaluating the effectiveness of a prevention curriculum design ed to modify the eating attitudes and unhealthful weight regulation practice s of young adolescent girls . Nine hundred sixty-seven sixth and seventh- grade girls were r and omized to experimental healthy weight regulation curriculum or no-treatment control classes . A prevention intervention was developed around three principal components : ( 1 ) Instruction on the harmful effects of unhealthful weight regulation ; ( 2 ) promotion of healthful weight regulation through the practice of sound nutrition and dietary principles and regular aerobic physical activity ; ( 3 ) development of coping skills for resisting the diverse sociocultural influences that appear linked to the current popular obsessions with thinness and dieting . The intervention failed to achieve the hoped-for impact . We did observe a significant increase in knowledge among girls receiving the intervention and among high-risk students only , there was a small albeit statistically significant effect on body mass index . These findings question the wisdom of providing a curriculum directed at all young adolescents , most of whom are not at risk to develop an eating disorder . Rather than targeting the entire population , a healthy weight curriculum design ed to modify the eating attitudes and unhealthful weight regulation practice s of young adolescent girls might better focus on " at risk " students Two pilot studies were conducted to examine whether 6th grade students can achieve moderate to vigorous physical activity ( MVPA ) from 1 ) activity-based physical education ( AB-PE ) with 585 participants and 2 ) a curricular-based ( CB-PE ) program with 1,544 participants and r and omly sample d heart rates during lessons . AB-PE participants spent between 54 - 66 % with a heart rate > 140 bpm .  CB-PE participants spent between 49 - 58 % with a heart rate > 140 bpm . Girls ' mean heart rate was 3.7 bpm lower than the boys . PE can be readily modified so that students spend more than 50 % of time in MVPA OBJECTIVE To evaluate the impact of a multifaceted , school-based intervention on inner city youth at high risk for type 2 diabetes mellitus ( T2DM ) and to determine whether the addition of coping skills training ( CST ) and health coaching improves outcomes . METHOD 198 students in New Haven , CT at risk for T2DM ( BMI > 85th percentile and family history of diabetes ) were r and omized by school to an educational intervention with or without the addition of CST and health coaching .  Students were enrolled from 2004 to 2007 and followed for 12 months . RESULTS Students in both groups showed some improvement in anthropometric measures , lipids , and depressive symptoms over 12 months . BMI was not improved by the intervention . Students who received CST showed greater improvement on some indicators of metabolic risk than students who received education only . CONCLUSION A multifaceted , school-based intervention may hold promise for reducing metabolic risk in urban , minority youth Background Childhood obesity is the result of a long lasting imbalance between energy intake and energy expenditure . A major contributing factor is physical inactivity which is closely linked to bone health , cardiovascular disease risk , fitness and psychological factors . The school seems to provide an excellent setting to enhance levels of  physical activity ( PA ) .  However , there is insufficient data from previous school-based intervention trials on how to enhance overall PA . It is also unknown whether an intervention aim ed at increasing PA is effective in improving the children 's health . The purpose of this paper is to outline the design of a school-based r and omized , controlled trial ( RCT ) aim ing to increase overall PA and to improve fitness and health in 6- to 13-year-old children . Methods / Design 15 schools were r and omized to the intervention ( n = 9 ) or the control ( n = 6 ) group , stratified by geographic region ( urban vs. rural ) and by age ( 1st and 5th grade ) . Participation was given for all children in the intervention group since in this group the intervention was part of the normal school curriculum . The intervention during one academic year consisted of : 1 . two additional physical education classes per week given by trained physical education teachers adding up to a total of five PA classes per week , 2 . short PA breaks ( 2–5 min each ) during academic lessons , 3 . PA home work , and 4 . adaptation of recreational areas around the school . All children underwent  anthropometric measurements , blood pressure assessment , fitness testing , measurement of PA  and they filled out question naires . At least 70 % of all children agreed to blood sampling and measurements of body composition and bone mineral measurements by dual energy x-ray absorptiometry . The primary endpoints of the study after one year were an increase in total PA by accelerometry , an increase in aerobic fitness measured by the 20 m shuttle run , a decrease in percent body fat derived from skinfold measurements and an increase in quality of life as assessed by the child health question naire in the intervention group compared to the control group . Secondary outcomes were overall fitness , differences in body composition including body fat distribution , cardiovascular risk factors , psychosocial health , bone mineral content and density of femur , lumbar spine and total body and food intake . Discussion Our preliminary data suggest that the children were representative of Swiss children with respect to sex , socio-demographic status , and body mass index . Short-term results can be expected by the beginning of 2007 . We hypothesized that our intervention will lead to an increase in PA , fitness and overall health . Based on our data , we aim to provide important information regarding the influence of such an intervention on these outcome measures in school-aged children and to provide nationwide guidelines to improve PA in children Objectives : The authors measured and recorded the physical ( outdoor playing ) and mental ( home study ) activity behavior and blood pressure amongst school going children and observed their association with the blood pressure levels . Method : It was a cross sectional school-based study from 12 primary schools ; selected by stratified r and om sampling . Participants included 2250 children aged 10 years and above . Explanatory variables were age , sex , outdoor playing ( hours/ day ) and home- study ( hours/ day ) . Outcome variables were mean and st and ard deviation ( SD ) of systolic and diastolic blood pressures in various activity groups . Statistical tools used were proportions , correlation co-efficient ( r ) , coefficient of determination ( r2 ) and Regression analysis . Results : 47.8 % boys and 2.5 % girls were engaged in outdoor playing for more than two hours . No trend was observed for systolic blood pressure ( SBP ) in both the sexes in various activity groups of outdoor playing . Both mean diagnostic blood pressure ( DBP ) and mean BMI showed decreasing trend in boys . Mean BMI had an inverse relationship with outdoor playing in girls . Correlation of age and weight with both SBP and DBP was highly significant in both the sexes and in all the age groups except that of the 15-year age . Both SBP and DBP were not associated with home study in all sex and age groups except the age group of 10 and 12 years . Both SBP and DBP were significantly associated with the outdoor playing taking the whole sample as one group , but not in different sex or age groups ; except that the SBP was significantly cor-related with outdoor playing in 10 to 13 years age groups in boys . Conclusion : Boys spent twice the time in outdoor playing than girls . They were spending more time on outdoor playing than on home study . Conversely girls spent more time in home study . A weak negative correlation was observed between outdoor playing  and blood pressures . Less time spent in physical activities by the girls may have contributed to their higher BMI . They need behavior change communication for involvement in physical Background Studies relating physical activity ( PA ) to  weight gain in children have produced mixed results , although there is some evidence for stronger associations with more intense physical activities . The present study tested the hypothesis that weight gain over one year in 8–10 year olds would be more strongly predicted by moderate and vigorous physical activity ( MVPA ) than total physical activity ( total PA ) or sedentary behaviour . Methodology Participants were 280 children taking part in the Physical Exercise and Appetite in Children Study ( PEACHES ) .  Weight status was assessed using body mass index ( BMI ) , fat mass index ( FMI ) , and waist circumference ( WC ) in school Year 4 ( baseline ; age 8.7 yrs ) and Year 5 ( follow-up ; age 9.7 yrs ) .  Physical activity  was measured at baseline using the Actigraph GT1 M accelerometer to assess total PA ( mean accelerometers counts per minute ) , MVPA ; ≥4000 counts per minute ) and sedentary time  ( < 100 counts per minute ) . Principal Findings After adjustment for baseline BMI , SES , sex and ethnicity , MVPA  was significantly associated with follow – up BMI ( adjusted β = −0.07 ; p = 0.002 ) . This association was independent of total PA or sedentary time  . Similar results were observed for FMI ; again MVPA was significantly associated with follow up FMI ( β = −0.16 ; p = 0.001 ) independent  of total PA or sedentary time . The pattern was similar for WC ( β = −0.07 ) , but the association between MVPA and WC did not reach significance at p = 0.06 . Conclusion The results of this study strongly support promotion of MVPA in children BACKGROUND Cardiovascular health promotion in children has the potential to reduce the risk of atherosclerosis in both the individual child and the population at large . It thus seems eminently reasonable to initiate healthful lifestyle training in childhood to promote improved cardiovascular health in adult life . AIMS To test the hypothesis that a year long , classroom-based education for the third and fourth grade rs could change their knowledge scores about healthy heart . SETTING S AND DESIGN A r and omized , controlled trial in elementary schools of Bushehr/Iran . METHODS AND MATERIAL S A total of 14 elementary schools , categorized by socioeconomic types and male and female setting were selected and r and omized into control or intervention groups . Subjects were 1128 third and fourth grade rs , aged 9 to 10 years ( 49.1 % boys and 50.9 % girls ) . Over a course of 8 weeks , health educators and sport teachers of the elementary schools presented two hours sessions per week on heart function , nutrition , and exercise for healthy heart and living tobacco free for the intervention group . The education program was based on HeartPower ! Program , an American Heart Association program . STATISTICAL ANALYSIS Mann-Whitney U test and Wilcoxon matched-pairs signed rank test and Bonferroni correction for the two pair wise comparisons were used . RESULTS Total heart knowledge at posttest was 25 % correct higher in the intervention than in the control group ( p < 0.001 ) . Difference in means of total healthy heart knowledge scores between control and intervention group increased from 1.43 points in baseline to 4.02 points in posttest ( p < 0.001 ) . CONCLUSION It can be concluded that the classroom-based cardiovascular health promotion had a significant effect on the heart healthy knowledge . Therefore , schools provide an excellent setting for introducing comprehensive healthy heart education and promotion of cardiovascular health to the general population Media consumption may contribute to  childhood obesity . This study developed and evaluated a theory-based , parent-focused intervention to reduce television and other media consumption to prevent and reduce childhood obesity .  Families ( n = 202 ) with children ages 6 - 9 were recruited from a large , urban multiethnic population into a r and omized controlled trial ( 101 families into the intervention group and 101 into the  control group ) , and were followed for 6 months . The intervention consisted of a 2-hour workshop and six bimonthly newsletters . Behavioral objectives included : ( i ) reduce TV watching ; ( ii ) turn off TV when nobody is watching ; ( iii ) no TV with meals ;  ( iv ) no TV in the child 's bedroom ; and ( v ) engage in fun non-media related activities .  Parents were 89 % female , 44 % white , 28 % African American , 17 % Latino , and 11 % Asian , mean age 40 years ( s.d . = 7.5 ) ; 72 % were married . Children were 49 % female , mean age 8 years ( s.d . = 0.95 ) . Sixty-five percent of households had three or more TVs and video game players ; 37 % had at least one h and held video game , and 53 % had three or more computers . Average children 's weekday media exposure was 6.1 hours . At 6 months follow-up , the intervention group was less likely to report the TV being on when nobody was watching ( adjusted odds ratio ( AOR ) = 0.23 , P < 0.05 ) , less likely to report eating snacks while watching TV ( AOR = 0.47 , P < 0.05 ) , and less likely to have a TV in the child 's bedroom ( AOR = 0.23 , P < 0.01 ) . There was a trend toward reducing actual media consumption but these outcomes did not reach statistical significance . Effective strategies to reduce children 's TV viewing were identified PURPOSE This study was conducted to determine the effect of physical education class enrollment and physical activity on academic achievement in middle school children . METHODS Participants were 214 sixth- grade students r and omly assigned to physical education during either first or second semesters .  Moderate and vigorous physical activity ( MVPA ) ( number of 30-min time blocks ) outside of school was assessed using the 3-d physical activity recall ( 3DPAR ) . The 3DPAR time blocks were converted to ordinal data with scores of 1 ( no activity ) , 2 ( some activity ) , or 3 ( activity meeting Healthy People 2010 guidelines ) . Academic achievement was assessed using grade s from four core academic classes and st and ardized test scores ( Terra Nova percentiles ) . RESULTS Grade s were similar regardless of whether students were enrolled in physical education during first or second semesters . Physical education classes averaged only 19 min of MVPA . Students who either performed some or met Healthy People 2010 guidelines for vigorous activity had significantly higher grade s ( P < 0.05 ) than students who performed no vigorous activity in both semesters . Moderate physical activity did not affect grade s. St and ardized test scores were not significantly related to physical education class enrollment or physical activity levels . CONCLUSION Although academic achievement was not significantly related to physical education enrollment , higher grade s were associated with vigorous physical activity , particularly activity meeting recommended Healthy People 2010 levels OBJECTIVE To determine whether a multicomponent health promotion intervention for Dutch adolescents would be successful in influencing body composition and aerobic fitness . DESIGN R and omized controlled trial . SETTING Ten intervention and 8 control prevocational secondary schools . PARTICIPANTS A total of 978 adolescents ( mean age , 12.7 years ) . INTERVENTION An interdisciplinary multicomponent intervention program with an adapted curriculum for 11 biology and physical education lessons and environmental change options , including additional lessons on physical education and advice on the school canteen selection . MAIN OUTCOME MEASURES Body height and weight , hip and waist circumference , 4 skinfold thickness measurements , and aerobic fitness . RESULTS Multilevel analyses showed significant differences in changes after the 8-month intervention period in favor of the intervention group with regard to hip circumference ( mean difference , 0.53 cm ; 95 % confidence interval , 0.07 to 0.98 ) and sum of skinfolds among girls ( mean difference , -2.31 mm ; 95 % confidence interval , -4.34 to -0.28 ) . In boys , the intervention result ed in a significant difference in waist circumference ( mean difference , -0.57 cm ; 95 % confidence interval , -1.10 to -0.05 ) . No significant intervention effects were found related to aerobic fitness . CONCLUSIONS The multicomponent Dutch Obesity Intervention in Teenagers program positively influenced several measures of body composition among both girls and boys . Our results indicate that secondary prevocational school curriculum changes may contribute to excessive weight gain prevention among adolescents This special supplement to Ethnicity & Disease presents the background and rationale , methodology , feasibility , and results of 4 separate interventions that were pilot-tested in Phase 1 of the  Girls health Enrichment Multi-site Studies ( GEMS ) research program . The ultimate aim of the interventions was to prevent obesity in African-American girls . Four field centers , a Coordinating Center , and the National Heart , Lung , and Blood Institute were involved in a unique collaboration to generate and share ideas related to recruitment , formative assessment , and the st and ardization of some aspects of data collection while each field center design ed and implemented a different intervention . Outcomes for recruitment , participation , and behavioral change were generally very favorable , particularly for the two field centers that have progressed to test their interventions in full-scale r and omized trials in GEMS Phase 2 . The intervention development and pilot study phase also provided many lessons about the importance of trust , openness , and community acceptability in implementing undertakings of this type . Given the paucity of evidence for effective strategies to prevent obesity overall and in high-risk population s , GEMS is an important step forward in developing well-grounded strategies for improving nutrition , physical activity , and weight status in African-American girls OBJECTIVE To evaluate an intervention aim ed at increasing family physical activity and parent education about diet and activity for kindergarten students and issues related to their children 's BMI . METHODS A r and omized , controlled trial design was used to assess intervention impact in parental report of child diet and physical activity  , and step logs over a 4-week period . RESULTS Participants in the intervention group reported that their children obtained more steps by the end of the program period , were more active , and had consumed fewer sweets than the comparison group . CONCLUSION The proposed intervention for parents and their young children does produce awareness and behavior change African-Americans ( AAs ) are significantly less likely to be physically active than other Americans , and , like all Americans , they consume fewer than the recommended five fruit and vegetable ( F & V ) servings per day . This study , titled Healthy Body/Healthy Spirit , has two primary aims : ( 1 ) to test the effectiveness of a culturally tailored self-help dietary ( focusing on  F & V intake ) and physical activity ( PA ) intervention compared to st and ard health education material s , and ( 2 ) to test the effectiveness of using Motivational Interviewing ( MI ) , delivered by telephone , to modify PA and dietary habits . The study is a r and omized effectiveness trial with three experimental conditions . Group 1 ( comparison ) will receive st and ard ( existing commercial ) nutrition and PA intervention material s , Group 2 ( TX1 ) will receive a culturally tailored self-help nutrition and PA intervention of similar intensity as Group 1 , and Group 3 ( TX2 ) will receive the same intervention as Group 2 , plus four telephone counseling calls based on MI . Participants will be AA adults recruited through local black churches . Despite the extensive use of MI to modify addictive behaviors , this represents one of the first controlled field trials to employ MI to address diet and PA . Secondly , this is one of the first studies to test the effectiveness of a  self-help diet and PA intervention  tailored for an African-American church population The HEALTHY primary prevention trial was design ed and implemented in response to the growing numbers of children and adolescents being diagnosed with type 2 diabetes . The objective was to moderate risk factors for type 2 diabetes . Modifiable risk factors measured were indicators of adiposity and glycemic dysregulation : body mass index ⩾85th percentile , fasting glucose ⩾5.55 mmol l−1 ( 100 mg per 100 ml ) and fasting insulin ⩾180 pmol l−1 ( 30 μU ml−1 ) . A series of pilot studies established the feasibility of performing data collection procedures and tested the development of an intervention consisting of four integrated components : ( 1 ) changes in the quantity and nutritional quality of food and beverage offerings throughout the total school food environment ; ( 2 ) physical education class lesson plans and accompanying equipment to increase both participation and number of minutes spent in moderate-to-vigorous physical activity ; ( 3 ) brief classroom activities and family outreach vehicles to increase knowledge , enhance decision-making skills and support and reinforce youth in accomplishing goals ; and ( 4 ) communications and social marketing strategies to enhance and promote changes through messages , images , events and activities . Expert study staff provided training , assistance , material s and guidance for school faculty and staff to implement the intervention components . A cohort of students were enrolled in sixth grade and followed to end of eighth grade . They attended a health screening data collection at baseline and end of study that involved measurement of height , weight , blood pressure , waist circumference and a fasting blood draw . Height and weight were also collected at the end of the seventh grade . The study was conducted in 42 middle schools , six at each of seven locations across the country , with 21 schools r and omized to receive the intervention and 21 to act as controls ( data collection activities only ) . Middle school was the unit of sample size and power computation , r and omization , intervention and primary analysis BACKGROUND Underst and ing the factors that influence physical activity behavior is important in the design of intervention programs targeted at youth . METHODS A prospect i ve study design was used to identify the predictors of vigorous physical activity ( VPA ) ( > or = 6 METs ) and moderate and vigorous physical activity ( MVPA ) ( > or = 3 METs ) among 202 rural , predominantly African-American children . Selected social-cognitive determinants of physical activity were assessed via question naire in the fifth grade . Participation in VPA and MVPA was assessed via the previous day physical activity recall 1 year later in the sixth grade . RESULTS For girls , participation in community sports , self-efficacy in overcoming barriers , enjoyment of school physical education , race ( white > black ) , and perception of mother 's activity level ( active vs inactive ) were significant predictors of VPA . For  MVPA , participation in community sports and self-efficacy in overcoming barriers were significant predictors . For boys , self-efficacy in overcoming barriers was the only significant predictor of VPA , while beliefs regarding activity outcomes and participation in community sports were significant predictors of MVPA . CONCLUSION Social-cognitive constructs such as physical activity self-efficacy , access to community physical activity outlets , and positive beliefs regarding physical activity outcomes are important predictors of future physical activity behavior among rural , predominantly African-American children BACKGROUND A school-based obesity prevention study ( Medical College of Georgia FitKid Project ) started in the fall of 2003 in 18 elementary schools . Half of the schools were r and omized to an after-school program that included moderate-to-vigorous physical activity , healthy snacks , homework assistance , and academic enrichment .  All third grade rs were invited to enroll . The objective of this study was to assess the cost-effectiveness ( CE ) of the first-year intervention . METHODS St and ard CE analysis methods and a societal perspective were used . Program delivery costs incurred during the first-year intervention and the usual after-school care costs that would occur in the absence of the intervention were estimated ( in 2003 dollars ) . Net intervention costs were calculated by subtracting the usual after-school care costs from the intervention costs . The effectiveness of the intervention was measured as percent body fat ( % BF ) reduction compared with a control condition . The CE was assessed as the net intervention cost divided by the effectiveness of the intervention . RESULTS The intervention costs totaled $ 174,070 , $ 558/student , or $ 956/student who attended > or = 40 % of the intervention sessions . The usual after-school care costs were estimated at $ 639/student . Students who attended > or = 40 % of the intervention reduced % BF by 0.76 % ( 95 % confidence interval : -1.42 to -0.09 ) at an additional cost of $ 317/student . CONCLUSIONS Subjects who attended > or = 40 % of the intervention achieved a significant reduction in % BF at a relatively low cost . School-based obesity prevention programs of this type are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners This article describes the process of setting up a 3-year , school-based after-school physical activity intervention in elementary schools . The primary aim of the study is to determine whether adiposity and fitness will improve in children who are exposed to a fitogenic versus an obesogenic environment . Eighteen schools were r and omized to the  control ( obesogenic ) or intervention ( fitogenic ) group . The study design , program components , and evaluation of the intervention are described in detail . The intervention consists of ( a ) academic enrichment , ( b ) a healthy snack , and ( c ) physical activity in a mastery-oriented environment . Successful implementation would show the feasibility of schools ’ being able to provide a fitogenic environment . Significant differences between the groups would provide evidence that a fitogenic environment after school has positive health benefits . If feasibility and efficacy are demonstrated , implementing an after-school program like this one in elementary schools could play a major role in preventing and reducing childhood obesity Background Effective interventions to prevent overweight and obesity in children are urgently needed especially in inner-city neighbourhoods where prevalence of overweight and inactivity among primary school children is high . A school based intervention was developed aim ing at the reduction of overweight and inactivity in these children by addressing both behavioural and environmental determinants . Methods / design The main components of the intervention ( Lekker Fit ! ) are the re-establishment of a professional physical education teacher ; three ( instead of two ) PE classes per week ; additional sport and play activities outside school hours ; fitness testing ; classroom education on healthy nutrition , active living and healthy lifestyle choices ; and the involvement of parents . The effectiveness of the intervention is evaluated through a cluster r and omized controlled trial in 20 primary schools among grade s 3 through 8 ( 6–12 year olds ) . Primary outcome measures are BMI , waist circumference and fitness . Secondary outcome measures are assessed in a subgroup of grade 6–8 pupils ( 9–12 year olds ) through classroom question naires and constitute of nutrition and physical activity behaviours and behavioural determinants . Multilevel regression analyses are used to study differences in outcomes between children in the intervention schools and in  control schools , taking clustering of children within schools into account . Discussion Hypotheses are that the intervention results in a lower prevalence of children being overweight and an improved mean fitness score , in comparison with a control group where the intervention is not implemented . The results of our study will contribute to the discussion on the role of physical education and physical activity in the school curriculum . Trial registration [ IS RCT N84383524 OBJECTIVE The objective was to test the hypothesis that a community-based environmental change intervention could prevent weight gain  in young children ( 7.6 + /- 1.0 years ) . RESEARCH METHODS AND PROCEDURES A non-r and omized controlled trial was conducted in three culturally diverse urban cities in Massachusetts . Somerville was the intervention community ; two socio-demographically-matched cities were  control communities . Children ( n = 1178 ) in grade s 1 to 3 attending public elementary schools participated in an intervention design ed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before- , during- , after-school , home , and community environments . Many groups and individuals within the community ( including children , parents , teachers , school food service providers , city departments , policy makers , healthcare providers , before- and after-school programs , restaurants , and the media ) were engaged in the intervention . The main outcome measure was change in BMI z-score . RESULTS At baseline , 44 % ( n = 385 ) , 36 % ( n = 561 ) , and 43 % ( n = 232 ) of children were above the 85th percentile for BMI z-score in the intervention and the two control communities , respectively . In the intervention community , BMI z-score decreased by -0.1005 ( p = 0.001 , 95 % confidence interval , -0.1151 to -0.0859 ) compared with children in the control communities after controlling for baseline covariates . DISCUSSION A community-based environmental change intervention decreased BMI z-score  in children at high risk for obesity . These results are significant given the obesigenic environmental backdrop against which the intervention occurred . This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates OBJECTIVE To determine if timing and frequency of interventions affect the outcome of treatment of  obesity in pediatric patients . DESIGN Retrospective chart review ; comparison of subgroups defined by age and frequency of visits . SETTING A nutrition evaluation clinic , an outpatient referred care clinic at a metropolitan hospital . PARTICIPANTS All 93 obese children , aged 1 to 10 years , seen within 1 year and with one or more subsequent visits in the next year . Obesity was defined as greater than 120 % ideal body weight for height age ( IBWH ) . Mean percent IBWH was 171 % ( median , 199 % ; range , 127 % to 251 % ) . INTERVENTIONS ( 1 ) Initial visit . Comprehensive history and physical examination , by physician , registered dietician , and licensed clinical social worker ; design of individualized care plan , including prescribed frequency and size of meals and snacks ; and type , frequency , and duration of exercise . ( 2 ) Subsequent visits ( after 1 month , then with frequency tailored to need ) . Review of progress , adjustment of energy intake and expenditure ; management of biopsychosocial obstacles to needed changes . MEASUREMENTS /MAIN RESULTS Four patient groups were defined by two variables : age ( preschool vs school-age children ) and frequency of visits in 1 year ( two to three vs four or more ) . Groups were compared on change in mean percent IBWH and on mean change in percent IBWH . All groups showed significant change in percent IBWH ( P < or = .040 for school-age children , P < or = .012 for preschool children ) . For all visits , the mean change was more than twice as great for preschool as for school-age children ( 4.7 + /- 5.4 vs 1.9 + /- 4.8 , P = .027 ) . CONCLUSIONS ( 1 ) The most successful treatment of pre-adolescent obesity may be in preschool children with frequent visits . ( 2 ) A r and omized trial is warranted to test this possibility . ( 3 ) Many of the techniques used to treat early obesity can be adapted for prevention and intervention in early obesity during the preschool years , and this is the preferred approach BACKGROUND The rapid increase of obesity and diabetes risk beginning in youth , particularly those from disadvantaged communities , calls for prevention efforts . OBJECTIVE To examine the impact of a curriculum intervention , Choice , Control & Change , on the adoption of the energy balance-related behaviors of decreasing sweetened drinks , packaged snacks , fast food , and leisure screen time , and increasing water , fruits and vegetables , and physical activity , and on potential psychosocial mediators of the behaviors . DESIGN Ten middle schools were r and omly assigned within matched pairs to either intervention or comparison/delayed control conditions  during the 2006 - 2007 school year . SUBJECTS/ SETTING Students were from low-income New York City neighborhoods ; 562 were in the intervention condition , and 574 in the comparison condition . INTERVENTION Students received the 24 Choice , Control & Change lessons that used science inquiry investigations to enhance motivation for action , and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action . MAIN OUTCOME MEASURES Self-report instruments to measure energy balance-related behaviors targeted by the curriculum and potential psychosocial mediators of the behaviors . STATISTICAL ANALYSES Analysis of covariance with group ( intervention/control ) as a fixed factor and pretest as covariate . RESULTS Students in intervention schools compared to the delayed intervention controls reported consumption of considerably fewer sweetened drinks and packaged snacks , smaller sizes of fast food , increased intentional walking for exercise , and decreased leisure screen time , but showed no increases in their intakes of water , fruits , and vegetables . They showed substantial increases in positive outcome expectations about the behaviors , self-efficacy , goal intentions , competence , and autonomy . CONCLUSIONS The Choice , Control & Change curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk , indicating that combining inquiry-based science education and behavioral theory is a promising approach OBJECTIVES ICAPS ( Intervention Centred on Adolescents ' Physical activity and Sedentary behaviour ) is aim ed at preventing excessive weight gain and cardiovascular risk in adolescents by promoting physical activity ( PA ) with an emphasis on recreational and daily-life PA , with a lifelong perspective . DESIGN R and omized study design ed to last for four years . Study cohort constituted of 954 first-level students ( 91 % of eligible pupils ) , aged 11.7 + /- 0.6 y ( mean + /- SD ) from four pairs of schools r and omly selected in eastern France , after sociogeographical stratification . In each pair , intervention status was r and omised at school-level . The program , not limited to school setting s , involves multiple partners with three objectives : 1 ) changing attitudes through debates and access to attractive activities during breaks and after-school hours , 2 ) encouraging social support , 3 ) providing environmental conditions that enable PA . Adapted times and places , open participation , emphasis on fun , meeting with others and absence of competitive aspects are used to reduce usual barriers to PA .  Accessibility and safety are permanent concerns . RESULTS Prevalence of overweight was 23.7 % . High participation rates were attained ( 50 % participated in at least one weekly activity ) . At six-month , the proportion of intervention adolescents  not performing supervised PA out of academic PA  was reduced by half ( 36 % to 17 % vs 42 % to 42 % in controls P < 10 - 4 ) ; the proportion of those spending > 3 h/day in sedentary occupations decreased ( 34 % to 28 % vs 27 % to 36 % ; P < 10 - 4 ) . CONCLUSION These data demonstrate the feasibility of implementing a multilevel PA intervention program in adolescents . Six-month results document increased PA  and decreased sedentary behaviour BACKGROUND Although adolescence is a time when physical activity levels decline , few interventions have targeted high school-aged girls in the school setting . OBJECTIVE To evaluate the effects of a life skills-oriented physical activity intervention for increasing overall physical activity in high school-aged girls . DESIGN R and omized controlled trial . SETTING Baltimore magnet high school . PARTICIPANTS A total of 221 ninth- grade girls , 83.0 % of whom were African American . Intervention Participants were r and omized to an 8-month physical intervention conducted in physical education class or to a st and ard physical education class ( control ) . MAIN OUTCOME MEASURES 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 . RESULTS 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 ) . CONCLUSION 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 Background Given the increase in overweight and obesity prevalence in adolescents in the last decade , effective prevention strategies for these conditions in adolescents are urgently needed . The PRALIMAP ( Promotion de l'ALImentation et de l'Activité Physique ) trial aims to evaluate the effectiveness for these conditions of 3 health promotion strategies -- educational , screening and environmental -- applied singly or in combination in high schools over a 2-year intervention period . Methods PRALIMAP is a stratified 2 × 2 × 2 factorial cluster r and omised controlled trial including 24 state high schools in Lorraine , northeastern France , in 2 waves : 8 schools in 2006 ( wave 1 ) and 16 in 2007 ( wave 2 ) . Students entering the selected high schools in the 4 academic years from 2006 to 2009 are eligible for data collection . Interventional strategies are organized over 2 academic years . The follow-up consists of 3 visits : at the entry of grade 10 ( T0 ) , grade 11 ( T1 ) and grade 12 ( T2 ) . At T0 , 5,458 ( 85.7 % ) adolescents participated . The educational strategy consists of nutritional lessons , working groups and a final party . The screening strategy consists in detecting overweight/obesity and eating disorders in adolescents and proposing , if necessary , an adapted care management program of 7 group educational sessions . The environmental strategy consists in improving dietary and physical activity offerings in high schools and facilities , especially catering . The main outcomes are body size evolution over time , nutritional behaviour and knowledge , health and quality of life . An evaluation process documents how each intervention strategy is implemented in the schools and estimates the dose of the intervention , allowing for a per protocol analysis after the main intention-to-treat analysis . Discussion PRALIMAP aims at improving the prevention and management of overweight and obesity in adolescents by translating current evidence into public health practice . Particular attention is paid to clustering , multiple factorials and long-term duration to address common pitfalls in health promotion trials . The results should inform how best to implement , in a school environment , effective nutrition prevention programs targeting adolescents who are at a point their lives when they develop responsibilities and empowerment for health attitude behaviours . Trial registration This trial is registered at Clinical Trials.gov under NCT00814554 Objective : To analyse the effect of extracurricular physical activities on fat mass accumulation and physical fitness during growth in early pubertal males . Design : Longitudinal study .Subjects : A total of 42 male children ( 9.4±1.4 years , Tanner I – II and 12.7±1.5 years , Tanner III – IV , before and after the 3.3 years follow-up , respectively ) , r and omly sample d from the population of Gran Canaria ( Spain ) , 26 of them physically active ( PA , at least 3 h per week during 3 years ) and 16 non-physically active ( non-PA ) . Measurements : Body composition ( dual-energy X-ray absorptiometry ) , anthropometrics ( body circumferences and skinfolds ) and physical fitness variables ( dynamic and isometric force , anaerobic capacity and maximal aerobic power ) were determined in all subjects . Results : Both groups had comparable body sizes at the start and the end of the study . Body mass index increased with growth more in the PA than in the non-PA group ( P<0.05 ) . However , fat mass accumulation with growth was lower in the PA than in the non-PA ( P<0.05 ) . There was a positive relationship between the increment of total and trunkal fat mass , especially in non-active children ( r 2=0.93 ) . In contrast , there was an inverse relationship between the total lean mass growth and the accumulation of total and regional fat mass ( r=−0.37 to −0.41 , all P<0.05 ) . Physical fitness was maintained in the PA , while it worsened in the non-PA children . Conclusions : Without any dietary intervention , children who regularly participate in at least 3 h per week of sports activities are more protected against total and regional fat mass accumulation . They also increase their total lean and bone mass to a greater extent than children who do not participate in extracurricular sport activities . In addition , PA children maintain their physical fitness during growth , while it deteriorates in the non-PA children The purpose of this study was to determine the effects of a 15-week aerobic activity program on the  total cholesterol ( TC ) and high-density lipoprotein cholesterol ( HDL-C ) levels of 25 high school students , ages 14 - 17 years ( experimental group = 14 , control group = 11 ) . Participants in the activity program exercised 4 days per week in a specially design ed physical education class , while the control group participated in the regular physical education program . Results of the analysis of covariance found significant reductions in TC in the training group ( control group Adj M = 190.2 mg/dl , experimental group Adj M = 173.1 mg/dl , p < .05 ) , but no significant changes in HDL-C ( control group Adj M = 49.8 mg/dl , experimental group Adj M = 50 mg/dl ) . While the exercise program appeared to have a beneficial effect on TC in 12 of 14 participants ( 86 % ) , HDL-C also dropped in 12 of 14 participants ( 86 % ) The POWER PE study was an 8-mo , r and omized , controlled , school-based exercise intervention design ed to apply known principles of effective bone loading to practical opportunities to improve life-long musculoskeletal outcomes . A total of 99 adolescents ( 46 boys and 53 girls ) with a mean age of 13.8 + /- 0.4 yr ( peri- to postpubertal ) volunteered to participate . Intervention subjects performed 10 min of jumping activity in place of regular physical education ( PE ) warm up . Control subjects performed usual PE warm-up activities .  Bone mass ( DXA and QUS ) was assessed at baseline and follow-up along with anthropometry , maturity , muscle power , and estimates of physical activity and dietary calcium . Geometric properties ( such as femoral neck [ FN ] moment of inertia ) were calculated from DXA measures . Boys in the intervention group experienced improvements in calcaneal broadb and ultrasound attenuation ( BUA ) ( + 5.0 % ) and fat mass ( -10.5 % ) , whereas controls did not ( + 1.4 % and -0.8 % , respectively ) . Girls in the intervention group improved FN BMC ( + 13.9 % ) and lumbar spine ( LS ) BMAD ( + 5.2 % ) more than controls ( + 4.9 % and + 1.5 % , respectively ) . Between-group comparisons of change showed intervention effects only for whole body ( WB ) BMC ( + 10.6 % versus + 6.3 % ) for boys . Boys in the intervention group gained more lean tissue mass , trochanter ( TR ) BMC , LS BMC , and WB BMC and lost more fat mass than girls in the intervention group ( p < 0.05 ) . Ten minutes of jumping activity twice a week for 8 mo during adolescence seems to improve bone accrual in a sex-specific manner . Boys increased WB bone mass and BUA , and reduced fat mass , whereas girls improved bone mass at the hip and spine This report describes the proposed intervention and outcome measurement procedures for the Pathways study . Pathways is a multicenter school-based study aim ed at reducing the alanning increase in the prevalence of obesity in American Indian children . It is design ed as a r and omized clinical trial , involving approximately 2,00 third grade children in 40 schools in seven diferent American Indian communities . During a 3-year feasibility phase , which was just completed , the major components of the intervention ( school food service , classroom curriculum , physical education program , and family involvement ) were developed and pilot-tested . The measurement instruments for body composition ; physical activity ; dietary intake ; and knowledge , attitudes , and behavior were also developed and vali date d. Comprehensive process evaluation procedures also were defined . As of this writing , thefull-scale intervention program is being initiated and is scheduled to be completed in the spring of 200 . The primary aim of the Pathways intervention is to reduce average percent body fat in intervention-school children  by at least 3 % compared with control-school children by the end of the 3-year intervention . This goal is to be achieved primarily by an increase in physical activity and a reduction in the perceni of dietary fat intake . The program does not seek to reduce dietary energy intake . Rather , it is based on the assumption that a healthier ; lower-fat diet , combined with an increase in energy expenditure by increased physical activity , will result in fewer excess calories deposited as body fat OBJECTIVES To determine whether a large-scale physical activity intervention could affect body composition in primary school students in Beijing , China . METHODS The study design was one-year cluster r and omized controlled trial of physical activity intervention ( 20 min of daily exercise in the classroom ) with an additional year of follow-up among 4 700 students aged 8 - 11 years at baseline . RESULTS After the one-year intervention , BMI increased by 0.56 kg/m(2 ) ( SD 1.15 ) in the intervention group and by 0.72 kg/m(2 ) ( SD 1.20 ) in the control group , with a mean difference of -0.15 kg/m(2 ) ( 95 % CI : -0.28 to -0.02 ) . BMI z score decreased by -0.05 ( SD 0.44 ) in the intervention group , but increased by 0.01 ( SD 0.46 ) in the control group , with a mean difference of -0.07 ( -0.13 to -0.01 ) . After another year of follow up , compared to the control group , children in the intervention group had significantly lower BMI ( -0.13 , -0.25 to -0.01 ) , BMI z score ( -0.05 , -0.10 to -0.01 ) , fat mass ( -0.27 kg , -0.53 to -0.02 ) and percent body fat ( -0.53 , -1.00 to -0.05 ) . The intervention had a more pronounced effect on weight , height , BMI , BMI z score , and body composition among obese children than among normal weight or overweight children . Compared to the control group , the intervention group had a significantly higher percentage of children who maintained or reduced their BMI z score at year 1 ( P=0.008 ) and year 2 ( P=0.04 ) . CONCLUSIONS These findings suggest that 20 min of daily moderate to vigorous physical activity during the school year is a feasible and effective way to prevent excessive gain of body weight , BMI , and body fatness in primary school students BACKGROUND Physical activity is important for weight control and good health ; however , activity levels decline in the adolescent years , particularly in girls . DESIGN Group r and omized controlled trial . SETTING / PARTICIPANTS 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 . R and om , cross-sectional sample s were drawn within schools : 6th grade rs in 2003 ( n=1721 ) and 8th grade rs in 2005 ( n=3504 ) and 2006 ( n=3502 ) . INTERVENTION 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 . MAIN OUTCOME MEASURES 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 . RESULTS 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 . CONCLUSION A school-based , community-linked intervention modestly improved physical activity in girls OBJECTIVES African-American girls are at increased risk for becoming overweight . Increased physical activity may prevent this . This study examines measurements of girls ' physical activity and associations with : BMI , parent 's reported self-efficacy and support for helping daughters be active , girl 's perceived support from parents for physical activity , parent 's and girl 's perceived neighborhood safety and access to facilities , and family environment . RESEARCH METHODS AND PROCEDURES Fifty-two 8- to 10-year-old African-American girls and their primary caregiver in the Minneapolis/St . Paul area participated in the Girls Health Enrichment Multisite Studies pilot intervention to prevent weight gain by promoting healthy eating and physical activity . Data collected included height , weight , physical activity level , and physical activity-related psychosocial measures from girl and parent . Girls wore an activity monitor for 3 days to assess activity level . Correlations were computed among the average minutes per day of moderate to vigorous activity between 12 pm and 6 pm and BMI and psychosocial measures . RESULTS BMI was inversely correlated with moderate to vigorous activity ( r = -0.35 , p < 0.01 ) , whereas parent 's self-efficacy for supporting daughter to be active was positively correlated with activity ( r = 0.45 , p < 0.001 ) . There was a trend for parent 's reported support of daughter 's activity level to be associated with activity ( r = 0.26 , p < 0.06 ) . Girl 's perception of parent 's support for physical activity , perceived neighborhood safety and access to facilities , and family environment were not associated with girl 's activity levels . DISCUSSION Interventions to increase physical activity among preadolescent African-American girls may benefit from a parental component to encourage support and self-efficacy for daughters ' physical activity To assess whether an enrichment of the coordinative dem and s of physical education ( PE ) during the curricular time may more efficiently improve coordinative abilities than the traditional PE program . One hundred and fifty-two middle school students aged 11 - 12 years were r and omly assigned either to an experimental ( n=77 ) or to a traditional ( n=75 ) PE program lasting 5 months . The experimental intervention was structured in different modules focused on co-ordination abilities . Pre- and post-intervention tests assessed students ' fitness ( 1 mile run/walk , curl-up , flexed arm hang , trunk lift , sit and reach , 30 m run , st and ing long jump , basketball forward throw ) and motor co-ordination abilities ( four field tests of kinesthetic discrimination and response orientation ability ) . After the intervention period , both groups showed a significant increment in most fitness tests . However , only the experimental group showed a significant improvement or a significantly more pronounced improvement than the control group in coordinative performances . The results show that both experimental and traditional PE interventions lead to increase physical fitness levels , but only the experimental one also improves coordinative abilities . Thus , focusing on a multivariate PE approach linking co-ordination and fitness training seems to add quality to students ' experiences without reducing their effectiveness in terms of physical fitness Background and purpose : The lack of effective school-based interventions for preventing obesity in children has caused a call for longer duration of interventions and better reporting on design and evaluation methodology . The purpose of this paper is to present the development of the intervention , the design of the effectiveness study , and the test-retest reliability of the main outcome measures in the HEalth In Adolescents ( HEIA ) study . Methods / design : The HEIA intervention programme was developed based on literature review s , a social ecological framework , and focus groups . The intervention aim ed to increase total physical activity ( PA ) and consumption of fruit and vegetables and to decrease screen time and consumption of sugar-sweetened beverages . The intervention programme consisted of a classroom component , including dietary behaviour lessons , computer tailoring , fruit/vegetable and PA breaks , and posters , and an environmental component including active transport campaigns , equipment , suggestions for easy improvements of schoolyards , inspirational courses for teachers ( all with regards to PA ) , and fact sheets to parents . The effect of the intervention programme is evaluated in a cluster r and omised controlled trial design ( intervention = 12 schools , control = 25 schools ) including process evaluation . Main outcomes include anthropometry , PA , screen time , and consumption of fruit , vegetables , and sugar-sweetened beverages . A 2-week test— retest study was conducted among 114 pupils . Determinants of the behaviours were assessed . Similar data were collected from parents . Children ’s PA was measured objective ly by accelerometers . Conclusions : The HEIA study represents a theoretically informed r and omised trial comprising a comprehensive set of multilevel intervention components with a thorough evaluation using reliable outcome measures . The study will contribute to a better underst and ing of determinants of healthy weight development among young people and how such determinants can be modified All tenth grade rs in four senior high schools ( N = 1447 ) from two school districts participated in a cardiovascular disease risk-reduction trial . Within each district , one school was assigned at r and om to receive a special 20-session risk-reduction intervention and one school served as a control . At a two-month follow-up , risk factor knowledge scores were significantly greater for students in the treatment group . Compared with controls , a higher proportion of those in the treatment group who were not exercising regularly at baseline reported regular exercise at follow-up . Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up , while only 5.6 % of baseline experimental smokers in the treatment group graduated to regular smoking compared with 10.3 % in the control group . Students in the treatment group were more likely to report that they would choose " heart-healthy " snack items . Beneficial treatment effects were observed for resting heart rate , body mass index , triceps skin fold thickness , and subscapular skin fold thickness . The results suggest that it is feasible to provide cardiovascular disease risk-reduction training to a large segment of the population through school-based primary prevention approaches PURPOSE This intervention compares the effectiveness of daily step count targets with time-based prescription for increasing the health-related physical activity of low-active adolescent girls . METHODS We assigned participants ( N = 85 , mean age 15.8 + /- 0.8 yr ) depending on school attended to a control ( CON ) , pedometer ( PED ) , or minutes ( MIN ) group . The intervention groups were involved in a 12-wk physical activity self-monitoring and educative program . The only difference between the intervention groups was that the PED group set daily step count targets whereas the MIN group set daily time-based goals for physical activity involvement . Pre- , mid- , and postintervention changes in physical activity ( 4-d blinded step count and 3-d physical activity recall ) and body mass index ( BMI ) were assessed using a series of 3 ( group assignment ) x 3 ( time ) ANOVA . Where significant interactions were found , separate follow-up simple main effects tests were used . RESULTS At postintervention , only the PED group had significantly increased their total activity as measured by a 4-d step count , when compared with the control ( P = 0.03 , ES = 0.13 ) . The group , time , and interaction effects for 4-d step count were significant , indicating that although both the participants in the PED and the MIN groups significantly increased their step count across the 12-wk intervention ( P = 0.00 - 0.01 ) , the participants in the PED group had a greater increase at the midintervention time point ( P = 0.04 , ES = 0.10 ) . No pre- , mid- , or postintervention changes were reported in any group for BMI ( F = 1.18 , P = 0.32 ) . CONCLUSION The use of pedometers and daily step count targets with low-active adolescent girls may result in short-term ( 6 wk ) enhanced physical activity related outcomes when compared with traditional time-based physical activity prescriptions . However , both interventions appear to result in similar improvements in physical activity when duration of the observation is extended to 12 wk PURPOSE The study evaluated whether targeted changes in factors influencing enjoyment of physical education ( PE ) , physical activity enjoyment , and self-efficacy beliefs about participating in physical activity mediated the effect of the Lifestyle Education for Activity Program ( LEAP ) intervention on participation in physical activity . METHODS High schools ( N=24 ) paired on enrollment size , racial composition , urban or rural location , and class structure were r and omized into control ( N=12 ) or experimental ( N=12 ) groups . Of the 4044 girls enrolled and eligible , 2087 ( 51.6 % ) participated in the measurement component of the study . There were 1038 girls in the control group and 1049 girls in the experimental group . INTERVENTION LEAP was a comprehensive school-based intervention emphasizing changes in instruction and school environment design ed to increase physical activity among black and white adolescent girls . It was organized according to the Coordinated School Health Program and included a PE component with core objectives of promoting enjoyment of PE , physical activity enjoyment , and self-efficacy . RESULTS Latent variable structural equation modeling indicated that : 1 ) the intervention had direct , positive effects on physical activity and factors influencing enjoyment of PE , which subsequently explained the effects of increased physical activity enjoyment and self-efficacy on increased physical activity ; and 2 ) an additional , indirect effect of physical activity enjoyment on physical activity operated by an influence on self-efficacy . CONCLUSIONS Increases in enjoyment partially mediated the positive effect of the LEAP intervention . To our knowledge , we have provided the first experimental evidence from a r and omized controlled trial linking increased enjoyment with increased physical activity among black and white adolescent girls 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 r and omly 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 design ed and implemented based on student preferences , teachers ' expertise and local re sources . 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 BACKGROUND Obesity and mental health disorders are 2 major public health problems in American adolescents , with prevalence even higher in Hispanic teens . Despite the rapidly increasing incidence and adverse health outcomes associated with overweight and mental health problems , very few intervention studies have been conducted with adolescents to improve both their healthy lifestyles and mental health outcomes . Even fewer studies have been conducted with Hispanic youth . The purpose of this study was to evaluate the preliminary efficacy of the COPE ( Creating Opportunities for Personal Empowerment ) Healthy Lifestyles TEEN ( Thinking , Emotions , Exercise , and Nutrition ) program , a manualized educational and cognitive behavioral skills-building program , on Hispanic adolescents ' healthy lifestyle choices as well as mental and physical health outcomes . METHODS A cluster r and omized controlled pilot study was conducted with 19 Hispanic adolescents enrolled in 2 health classes in a southwestern high school . One class received COPE and the other received an attention control program . RESULTS Adolescents in the COPE program increased their healthy lifestyle choices and reported a decrease in depressive and anxiety symptoms from baseline to postintervention follow-up . A subset of 7 overweight adolescents in the COPE program had a decrease in triglycerides and an increase in high-density lipoproteins . In addition , these overweight adolescents reported increases in healthy lifestyle beliefs and nutrition knowledge along with a decrease in depressive symptoms . CONCLUSION The COPE TEEN program is a promising school-based strategy for improving both physical and mental health outcomes in adolescents BACKGROUND This study reports on effectiveness trial outcomes of Health in Motion , a computer tailored multiple behavior intervention for adolescents . METHODS Using school as level of assignment , students ( n=1800 ) from eight high schools in four states ( RI , TN , MA , and NY ) were stratified and r and omly assigned to no treatment or a multi-media intervention for physical activity , fruit and vegetable consumption , and limited TV viewing between 2006 and 2007 . RESULTS Intervention effects on continuous outcomes , on movement to action and maintenance stages , and on stability within action and maintenance stages were evaluated using r and om effects modeling . Effects were most pronounced for fruit and vegetable consumption and for total risks across all time points and for each behavior immediately post intervention . Co-variation of behavior change occurred within the treatment group , where individuals progressing to action or maintenance for one behavior were 1.4 - 4.2 times more likely to make similar progress on another behavior . CONCLUSION Health in Motion is an innovative , multiple behavior obesity prevention intervention relevant for all adolescents that relies solely on interactive technology to deliver tailored feedback . The outcomes of the effectiveness trial demonstrate both an ability to initiate behavior change across multiple energy balance behaviors simultaneously and feasibility for ease of dissemination The purpose of this study was to investigate the effects of two , three times a week , 8‐week training programmes on the aerobic power and anaerobic performance of 30 prepubescent girls , with a mean age of 9.6 y.  Peak oxygen uptake assessed by an incremental discontinuous treadmill test , and peak power in 5 s and mean power over 30 s estimated from a Wingate anaerobic test were used as the criterion measures . Twelve girls trained using a continuous cycle ergometer programme , 11 girls followed  a sprint running programme and the control group consisted of 7 girls .  Both training groups significantly ( p < 0.05 ) increased their peak oxygen uptake and peak power in 5 s. However , the increases reported here are lower than those generally observed in adolescents following training . The control group demonstrated no significant ( p > 0.05 ) change in either variable . No significant ( p > 0.05 ) changes in mean power over 30 s were observed in any group OBJECTIVE African-American girls and women are at high risk of obesity and its associated morbidities . Few studies have tested obesity prevention strategies specifically design ed for African-American girls . This report describes the design and baseline findings of the Stanford GEMS ( Girls health Enrichment Multi-site Studies ) trial to test the effect of a two-year community- and family-based intervention to reduce weight gain in low-income , pre-adolescent African-American girls . DESIGN R and omized controlled trial with measurements scheduled in girls ' homes at baseline , 6 , 12 , 18 and 24 month post-r and omization . SETTING Low-income areas of Oakl and , CA . PARTICIPANTS Eight , nine and ten year old African-American girls and their parents/caregivers . INTERVENTIONS Girls are r and omized to a culturally-tailored after-school dance program and a home/family-based intervention to reduce screen media use versus an information-based community health education Active-Placebo Comparison intervention . Interventions last for 2 years for each participant . MAIN OUTCOME MEASURE Change in body mass index over the two-year study . RESULTS Recruitment and enrollment successfully produced a predominately low-socioeconomic status sample . Two-hundred sixty one ( 261 ) families were r and omized . One girl per family is r and omly chosen for the analysis sample . R and omization produced comparable experimental groups with only a few statistically significant differences . The sample had a mean body mass index ( BMI ) at the 74 th percentile on the 2000 CDC BMI reference , and one-third of the analysis sample had a BMI at the 95th percentile or above . Average fasting total cholesterol and LDL cholesterol were above NCEP thresholds for borderline high classifications . Girls averaged low levels of moderate to vigorous physical activity , more than 3 h per day of screen media use , and diets high in energy from fat . CONCLUSIONS The Stanford GEMS trial is testing the benefits of culturally-tailored after-school dance and screen-time reduction interventions for obesity prevention in low-income , pre-adolescent African-American girls Background Child and adolescent obesity predisposes individuals to an increased risk of morbidity and mortality from a range of lifestyle diseases . Although there is some evidence to suggest that rates of pediatric obesity have leveled off in recent years , this has not been the case among youth from low socioeconomic background s. The purpose of this paper is to report the rationale , study design and baseline findings of a school-based obesity prevention program for low-active adolescent girls from disadvantaged secondary schools . Methods / Design The Nutrition and Enjoyable Activity for Teen Girls ( NEAT Girls ) intervention will be evaluated using a group r and omized controlled trial . NEAT Girls is a 12-month multi-component school-based intervention developed in reference to Social Cognitive Theory and includes enhanced school sport sessions , interactive seminars , nutrition workshops , lunch-time physical activity ( PA ) sessions , PA and nutrition h and books , parent newsletters , pedometers for self-monitoring and text messaging for social support . The following variables were assessed at baseline and will be completed again at 12- and 24-months : adiposity , objective ly measured PA , muscular fitness , time spent in sedentary behaviors , dietary intake , PA and nutrition social-cognitive mediators , physical self-perception and global self-esteem . Statistical analyses will follow intention-to-treat principles and hypothesized mediators of PA and nutrition behavior change will be explored . Discussion NEAT Girls is an innovative intervention targeting low-active girls using evidence -based behavior change strategies and nutrition and PA messages and has the potential to prevent unhealthy weight gain and reduce the decline in physical activity and poor dietary habits associated with low socio-economic status . Few studies have reported the long-term effects of school-based obesity prevention programs and the current study has the potential to make an important contribution to the field . Trial registration Australian New Zeal and Clinical Trials Registry No : In this research study , a quasi-experimental , nonequivalent control group pretest-posttest design was used to assess the impact of the Cardiovascular Health Education Program ( CHEP ) on the cardiovascular health knowledge of grade eight adolescents . A total of 146 adolescents participated in study , with 88 in the experimental group and 58 in the control group . One-hundred two of the adolescents resided in a rural region and 44 resided in an urban region in the province of Newfoundl and and Labrador , Canada . The findings from this study indicate that the CHEP did have a significant positive impact on the cardiovascular health knowledge of the rural adolescents , but it did not have a comparable impact on the cardiovascular health knowledge of the urban adolescents . The findings also indicate that there was no significant difference between rural and urban cardiovascular health knowledge prior to implementing the program . These findings support the need for implementation of the CHEP within this population . This study also shows that nurses can design , implement , and evaluate community-based health promotion programs for targeted population OBJECTIVE To evaluate the impact of a school-based diabetes mellitus prevention program on low-income fourth- grade Mexican American children . DESIGN A r and omized controlled trial with 13 intervention and 14 control schools . SETTING Elementary schools in inner-city neighborhoods in San Antonio , Tex . PARTICIPANTS Eighty percent of participants were Mexican American and 94 % were from economically disadvantaged households . Baseline and follow-up measures were collected from 1419 ( 713 intervention and 706 control ) and 1221 ( 619 intervention and 602 control ) fourth- grade children , respectively . INTERVENTION The Bienestar Health Program consists of a health class and physical education curriculum , a family program , a school cafeteria program , and an after-school health club . The objectives are to decrease dietary saturated fat intake , increase dietary fiber intake , and increase physical activity . MAIN OUTCOME MEASURES The primary end point was fasting capillary glucose level , and the secondary end points were percentage of body fat , physical fitness level , dietary fiber intake , and dietary saturated fat intake . Fasting capillary glucose level , bioelectric impedance , modified Harvard step test , three 24-hour dietary recalls , weight , and height were collected at baseline and 8 months later . RESULTS Children in the intervention arm attended an average of 32 Bienestar sessions . Mean fasting capillary glucose levels decreased in intervention schools and increased in control schools after adjusting for covariates ( -2.24 mg/dL [ 0.12 mmol/L ] ; 95 % confidence interval , -6.53 to 2.05 [ -0.36 to 0.11 mmol/L ] ; P = .03 ) . Fitness scores ( P = .04 ) and dietary fiber intake ( P = .009 ) significantly increased in intervention children and decreased in control children . Percentage of body fat ( P = .56 ) and dietary saturated fat intake ( P = .52 ) did not differ significantly between intervention and control children . CONCLUSION This intervention showed some positive results , but additional research is needed to examine long-term benefits , translation , and cost-effectiveness Using a quasiexperimental design , the authors examine whether fourth- and fifth- grade students exposed to a developmental physical education ( PE ) curriculum , Michigan ’s Exemplary Physical Education Curriculum ( EPEC )  , demonstrated stronger motor skill — specific self-efficacy and perceptions of physical activity competence , physical activity levels , motor skills , and physical fitness than did students exposed to existing PE curricula . The authors conducted a multilevel regression analysis with data from 1,464 students in the fourth and fifth grade s. Data were collected using a student survey , an activity checklist , and motor and fitness assessment s. Compared to students receiving st and ard PE , students exposed to EPEC showed significantly stronger results in motor skills but not fitness outcomes . The authors found significant positive intervention effects on indicators of motor skill self-efficacy and physical activity levels among the fourth- grade cohort . EPEC was more effective than st and ard PE curricula at improving motor skill performance ( fourth- and fifth- grade cohorts ) and at increasing self-reported motor skill-specific self-efficacy and physical activity ( fourth- grade cohort ) OBJECTIVE To examine the effects of a health and nutrition intervention , implemented in primary schools of Crete , on health knowledge , nutrient intakes and physical activity of the intervention population . METHODS The intervention group consisted of 24 schools while the control group consisted of 16 schools . The overall duration of the intervention was six years , while the topics of the intervention primarily focused on children ' dietary habits , physical activity and fitness . RESULTS After the completion of the intervention period , the changes observed in health knowledge , nutrient intakes and physical activity were in favour of the intervention group pupils . CONCLUSION The encouraging findings of the study indicate the potential of the programme in health promotion and disease prevention without involving substantial new school re sources and time The aim of this study was to evaluate the impact of an intervention program on the patterns of physical activity in 8- to 10-year-old Mexican children from lower socioeconomic status . This study performed a r and omized controlled field trial in 498 children aged 8 - 10 years from 10 public schools of low socioeconomic status in Mexico City . Schools were r and omly assigned to intervention ( n = 5 ) or control ( n = 5 ) groups and followed up during 12 months . Physical and sedentary activities were assessed at the beginning of the program and after 6 and 12 months . At the end of follow-up , there was a significant increase in the performance of moderate physical activity ( MPA ) among children in intervention group who had not performed MPA at baseline any day of the week ( 40 % , P = 0.04 ) but not in the control group ( 8 % , P = not significant ) . The intervention group also showed a significant reduction in the proportion of children who spent more than 3 hours a day playing video games ( from 23 to 13 % , P = 0.01 ) , while control group did not show significant changes . Given these findings , we conclude that intervention was able to modify positively physical activity and reduce time spent on such sedentary activities as video games among those at highest risk studied children OBJECTIVE --To examine the effect of physical training on physical fitness and blood pressure in children aged 9 - 11 years . DESIGN -- Prospect i ve r and omised controlled intervention study of a sample of children drawn from a population survey of coronary risk factors in children . SETTING --Odense , Denmark . SUBJECTS--69 children with mean blood pressure greater than or equal to 95th centile ( hypertensive group ) and 68 with mean blood pressure less than 95th centile ( normotensive group ) , r and omly selected from a population of 1369 children . INTERVENTION--67 children were r and omised to receive three extra lessons a week of an ordinary school physical education programme for eight months . MAIN OUTCOME MEASURES --Physical fitness assessed by calculation of maximum oxygen uptake and blood pressure recorded by one unblinded observer . RESULTS --After three months neither blood pressure nor physical fitness had changed significantly . After adjustment for values in weight , height , heart rate , and the variable in question before training physical fitness rose significantly at the end of eight months ' training , by 3.7 mlO2/kg/min ( 95 % confidence interval 2.2 to 5.3 ) in the normotensive training subgroup and by 2.1 mlO2/kg/min ( 0.1 to 4.2 ) in the hypertensive training subgroup compared with that in the controls . Systolic and diastolic blood pressures in the training subgroups fell significantly by 6.5 mm Hg ( 3.2 to 9.9 ) and 4.1 mm Hg ( 1.7 to 6.6 ) respectively in the normotensive group and by 4.9 mm Hg ( 0.7 to 9.2 ) and 3.8 mm Hg ( 0.9 to 6.6 ) respectively in the hypertensive group . CONCLUSIONS --Physical training lowers blood pressure and improves physical fitness in children and might have implication s for an important non-pharmacological approach to primary prevention of essential hypertension The effectiveness of a health and nutrition education programme , in changing certain chronic disease risk factors , was assessed after the 6 years intervention period was completed . The school-based intervention programme was applied to all children registered in the first grade ( age 5.5 - 6.5 years ) in 1992 in two counties of Crete , while the children from a third county served as a control group . In order to assess the effectiveness of the intervention , a variety of biological and behavioural parameters were measured before and following completion of the intervention in a r and omly selected school-based sample of 602 intervention group ( IG ) and 444 control group ( CG ) pupils . At the end of the 6-year period , it was found that biochemical indices generally improved significantly more in the IG compared with the CG ( mean change for IG v. CG was -0.27 v. -0.12 mmol/l for total cholesterol ( TC ) ; -0.07 v. + 0.24 for TC : HDL and -0.13 v. + 0.14 for LDL : HDL ) . Similarly , the changes observed in the anthropometric variables in the two groups were in favour of the IG ( + 3.68 v. + 4.28 kg/m2 for BMI ; + 2.97 v. + 4.47 mm for biceps skinfold ) . Total energy intake and consumption of total fat and saturated fat increased significantly less in the IG compared with the CG ( + 747.7 v. 1534.7 kJ ( + 178.7 v. + 366.8 kcal ) ; + 5.9 v. + 18.8 g and + 0.8 v. + 5.1 g respectively ) , while time devoted to leisure time physical activity and cardiovascular run test performance increased significantly more in the IG ( + 281 v. + 174 min/week and + 2.5 v. + 1.2 stages respectively ) . The findings of the present study underline the importance of such programmes in health promotion and disease prevention . Although the long-term effects of these programmes can only be assessed by tracking this population through to adolescence and adulthood , these programmes seem to have the potential to lead to a healthier lifestyle and thus a reduction in risk factor levels Background The efficacy of pharmacological treatment in controlling  childhood obesity  is controversial . We aim ed to compare the effects of three types of drug regimens and placebo on generalized and abdominal obesity among obese children and adolescents who did not succeed to lose weight 3 months after lifestyle modification ( diet and exercise ) . Methods This triple-masked r and omized clinical trial was conducted among 180 participants aged 10–16 years . They were assigned r and omly to 4 groups of equal number to receive metformin , fluoxetine , a combination of the two drugs , or placebo . The trial lasted for 12 weeks and participants were followed up for an additional 12-week period . Results Overall , 91.1 % ( n=164 ) of the enrolled participants completed the trial . After the 12-week trial , the body mass index decreased significantly in all groups receiving medications [ approximately −1.2 ( 0.2 ) kg/m2 , P<0.05 ] . This decrease was not significant in the placebo group . Waist circumference decreased significantly in the groups receiving metformin [ −2.1 ( 0.4 ) cm , P=0.03 ) ] as well as in the group receiving a combination therapy of metformin and fluoxetine [ −2.5 ( 0.4 ) cm , P=0.01 ) ] . In the 24-week follow-up study , these anthropometric indexes were lower than the baseline in the group that had received a combination therapy of metformin and fluoxetine . No serious drug side-effects were reported . Conclusions A limited period of such treatment may help weight control , and might be used to encourage those children who have been refractory to weight loss for continuing the non-pharmacological programs . Our findings should be confirmed in future studies with a longer follow-up period Objectives : Obesity prevention among children and adolescents is a public health priority ; however , limited school-based intervention trials targeting obesity have been conducted . This article provides an overview of the study design and baseline preliminary findings of our ongoing school-based intervention study . Design : R and omized intervention trial to test a school-based , environmental obesity prevention program in urban low socioeconomic status ( SES ) African-American adolescents . The intervention program was developed based on several behavioral theories and was guided by preliminary findings based on focus group discussion and baseline data . Setting : Four Chicago public schools in the US.Subjects : Over 450 5–7th grade rs and their families and schools were involved . Results : Our baseline data indicate a high prevalence of overweight ( 43 % in boys and 41 % in girls ) and a number of problems in these children 's physical activity and eating patterns . Only 26 % reported spending ⩾20 min engaged in vigorous-moderate exercise  in ⩾5 days over the past 7 days ; 29 % reported spending ⩾5 h each day watching TV , playing video games , or using computer . They also consumed too many fried foods and soft drinks . On average , 55 % consumed fried foods ⩾2 times/day over the past 7 days ; regarding soft drinks , 70 % reported consuming ⩾2 times/day . Conclusion : School-based obesity prevention programs are urgently needed in the target US urban , low SES , minority communities . These data can be used to inform intervention activities Background 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 r and omized controlled field study aim ed 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 . Methods 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 . Results 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↑ minutes , 95 % CI = 5.82–6.18 , p = 0.05 ) , daily after school activity minutes ( mean difference between I and C = 8.95↑ minutes , 95 % CI = 8.69–9.21 , p = 0.04 ) , and daily weekend activity minutes ( mean difference between I and C = 19.00↑ 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↓ minutes , 95 % CI = 11.74–12.48 , p = 0.05 ) and total daily sedentary activity minutes ( mean difference between I and C = 16.99↓ minutes , 95 % CI = 16.49–17.50 , p = 0.04 ) . Conclusion A well design ed 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 Interventions to promote physical activity are important in preventing children from becoming overweight . Many projects have been developed but only a few showed ( moderate ) effects . JUMP-in is a systematic ally developed primary -school-based intervention that focuses on the use of theory , environmental changes , parental influences and cooperation with multi-level parties in intervention development . The effects of JUMP-in were evaluated with a quasi-experimental pre-test/post-test research design . In total , 510 children from Grade s 4 , 5 and 6 of four intervention schools and two control schools in Amsterdam were followed for an intervention period of one school year . Changes in physical activity as well as in the social cognitive determinants were assessed using self-reports . In addition , a process evaluation has been executed . The results show that JUMP-in was effective in influencing physical activity , especially among children from Grade 6 . Children in the control group decreased their level of physical activity considerably , while activity levels in intervention children from Grade 6 remained stable . The intervention effects could not be explained by changes in the measured social cognitive determinants . In contrast , process information illuminated differences in intervention effects between the participating schools . The results from the JUMP-in study show the importance of intervention design s that focus on a theory-based mix of relevant environmental and social cognitive factors Objective : To assess the impact of an active school model on  children ’s physical activity ( PA ) . Design : 16-month cluster r and omised controlled trial . Setting : 10 elementary schools in Greater Vancouver , BC . Participants : 515 children aged 9–11 years . Intervention : Action Schools ! BC ( AS ! BC ) is an active school model that provided schools with training and re sources to increase children ’s PA . Schools implemented AS ! BC with support from either external liaisons ( liaison schools , LS ; four schools ) or internal champions ( champion schools , CS ; three schools ) . Outcomes were compared with usual practice ( UP ) schools ( three schools ) . Main outcome measurements : PA was measured four times during the study using pedometers ( step count , steps/day ) . Results : Boys in the LS group took 1175 more steps per day , on average , than boys in the UP group ( 95 % CI : 97 to 2253 ) . Boys in the CS group also tended to have a higher step count than boys in the UP group ( + 804 steps/day ; 95 % CI : −341 to 1949 ) . There was no difference in girls ’ step counts across groups . Conclusions : The positive effect of the AS ! BC model on boys ’ PA is important in light of the current global trend of decreased PA Objective To assess whether a physical activity intervention reduces body mass index in young children . Design Cluster r and omised controlled single blinded trial over 12 months . Setting Thirty six nurseries in Glasgow , Scotl and . Participants 545 children in their preschool year , mean age 4.2 years ( SD 0.2 ) at baseline . Intervention Enhanced physical activity programme in nursery ( three 30 minute sessions a week over 24 weeks ) plus home based health education aim ed at increasing physical activity through play and reducing sedentary behaviour . Main outcome measure Body mass index , expressed as a st and ard deviation score relative to UK 1990 reference data . Secondary measures were objective ly measured physical activity and sedentary behaviour ; fundamental movement skills ; and evaluation of the process . Results Group allocation had no significant effect on the primary outcome measure at six and 12 months or on measures of physical activity and sedentary behaviour by accelerometry . Children in the intervention group had significantly higher performance in movement skills tests than control children at six month follow-up ( P=0.0027 ; 95 % confidence interval 0.3 to 1.3 ) after adjustment for sex and baseline performance . Conclusions Physical activity can significantly improve motor skills but did not reduce body mass index in young children in this trial . Trial registration Current Controlled Trials IS RCT N36363490 Background The EdAL ( Educació enAlimentació ) study is a long-term , nutrition educational , primary -school-based program design ed to prevent obesity by promoting a healthy lifestyle that includes dietary recommendations and physical activity . The aims are : 1 ) to evaluate the effects of a 3-year school-based life-style improvement program on the prevalence  of obesity in an area of north-west Mediterranean 2 ) To design a health-promotion program to be implemented by health-promoter agents ( university students ) in primary schools . Methods / Design 1 ) The intervention study is a r and omised , controlled , school-based program performed by  university-student health-promoter agents . Initial pupil enrolment was in 2006 and continued for 3 years . We considered two clusters ( design ated as cluster A and cluster B ) as the units for r and omisation . The first cluster involved 24 schools from Reus and the second involved 14 schools from surrounding towns Cambrils , Salou and Vilaseca combined in order to obtain comparable groups . There are very good communications between schools in each town , and to avoid cross influence of the programs result ing from inter-school dialogue , the towns themselves were the unit for r and omisation . Data collected included name , gender , date and place of birth at the start of the program and , subsequently , weight , height , body mass index ( BMI ) and waist circumference every year for 3 years . Question naires on eating and physical activity habits are filled-in by the parents at the start and end of the study and , providing that informed consent is given , the data are analysed on the intention-to-treat basis . The interventions are based on 8 nutritional and physical activity objectives . They are implemented by university students as part of the university curriculum in training health-promoter agents . These 8 objectives are developed in 4 educational activities/year for 3 years ( a total of 12 activities ; 1 h/activity ) performed by the health-promoter agents in primary schools . Control pupils follow their usual activities.2 ) Courses on education and promotion of health , within in the curriculum of medicine and health sciences for university students , are design ed to train health-promoter agents to administer these activities in primary schools . Discussion This controlled school-based intervention will test the possibility of preventing childhood obesity . Trial registration numberIS RCT N : IS RCT The efficacy of specially programmed physical and health education on the motor development of first- grade pupils was analyzed in a sample of 633 children aged 7 years . Pupils have been divided into control group consisting of  140 boys and 137 girls attending st and ard program of physical and health education  , and in  experimental group  consisting of 184 boys and 172 girls attending specially programmed physical and health education .  A battery of 12 motor tests has been used on two occasions separated by nine-month interval . Analysis of time-changes ( by using the model of differences ) pointed to the significantly greater quantitative changes in experimental group compared with control group of children . In boys , the changes are obtained for the tests of aerobic endurance , static strength , flexibility , speed , explosive strength of sprint and throw type , and equilibrium , and in girls , they are for aerobic endurance , static strength , explosive strength of throw and sprint type , flexibility , repetitive strength , speed , and equilibrium BACKGROUND Identification of the behavioural , normative and control beliefs influencing children 's behaviour is an important prerequisite in design ing 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 . METHODS Participants were 646 fifth grade pupils ( 360 girls and 286 boys ) . The intervention group ( IG ) consisted of 321 children in 13 r and omly selected schools while the rest ( n = 325 children ) served as the  control group ( CG ) . Based on the outcome of the TPB question naire , 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 . RESULTS 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 . CONCLUSIONS 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 INTRODUCTION Developing effective exercise programmes for the paediatric population is a strategy for decreasing obesity and is expected to help in eventually limiting obesity-associated long-term health and societal impact . In this study , the effects of a 12-week twice weekly additional exercise training , which comprised a combination of circuit-based resistance training and aerobic exercises , in additional to typical physical education sessions , on aerobic fitness , body composition and serum C-reactive protein ( CRP ) and lipids were analysed in 13- to 14-year-old obese boys contrasted with a control group . MATERIAL S AND METHODS Both the exercise group ( EG , n = 12 ) and control group ( CG , n = 12 ) participated in the typical 2 sessions of 40-minute physical education ( PE ) per week in schools , but only EG participated in additional 2 sessions per week of 45 to 60 minutes per session of exercise training , which comprised a combination of circuit-based resistance training and aerobic exercises maintained at 65 % to 85 % maximum heart rate ( HRmax = 220 - age ) . Body composition was measured using dual energy X-ray absorptiometry ( DEXA ) . Fasting serum CRP and blood lipids were analysed pre- and postexercise programme . Aerobic fitness was measured by an objective laboratory submaximal exercise test , PWC170 ( Predicted Work Capacity at HR 170 bpm ) . RESULTS Exercise training significantly improved lean muscle mass , body mass index , fitness , resting HR , systolic blood pressure and triglycerides in EG . Serum CRP concentrations were elevated at baseline in both groups , but training did not result in a change in CRP levels . In the CG , body weight increased significantly at the end of the 12-week period . CONCLUSION This study supports the value of an additional exercise training programme , beyond the typical twice weekly physical education classes , to produce physiological benefits in the management of obesity in adolescents , including prevention of weight gain Objective To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren . Design Cluster r and omised controlled trial . Setting 28 classes from 15 elementary schools in Switzerl and r and omly 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 . Participants 540 children , of whom 502 consented and presented at baseline . Intervention 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 . Main outcome measures Primary outcome measures included body fat ( sum of four skinfolds ) , aerobic fitness ( shuttle run test ) , physical activity ( accelerometry ) , and quality of life ( question naires ) . 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 ) . Results 498 children completed the baseline and follow-up assessment s ( 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 . Conclusions 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 IS RCT N15360785 BACKGROUND . The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic setting s. Schools are ideal setting s for population -based interventions to address obesity . OBJECTIVE . The purpose of this work was to examine the effects of a multicomponent , School Nutrition Policy Initiative on the prevention of overweight ( 85.0th to 94.9th percentile ) and obesity ( > 95.0th percentile ) among children in grade s 4 through 6 over a 2-year period . METHODS . Participants were 1349 students in grade s 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with ≥50 % of students eligible for free or reduced-price meals .  Schools were matched on school size and type of food service and r and omly assigned to intervention or control . Students were assessed at baseline and again after 2 years . The School Nutrition Policy Initiative included the following components : school self- assessment , nutrition education , nutrition policy , social marketing , and parent outreach . RESULTS . The incidences of overweight and obesity after 2 years were primary outcomes . The prevalence and remission of overweight and obesity , BMI z score , total energy and fat intake , fruit and vegetable consumption , body dissatisfaction , and hours of activity and inactivity were secondary outcomes . The intervention result ed in a 50 % reduction in the incidence of overweight . Significantly fewer children in the intervention schools ( 7.5 % ) than in the control schools ( 14.9 % ) became overweight after 2 years . The prevalence of overweight was lower in the intervention schools . No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years . CONCLUSION . A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grade s 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals BACKGROUND The role of physical activity in preventing obesity during adolescence remains unknown . We examined changes in activity in relation to changes in body-mass index ( BMI ) and adiposity in a cohort of 1152 black and 1135 white girls from the USA , who were followed up prospect ively from ages 9 or 10 to 18 or 19 years . METHODS BMI and sum of skinfold thickness were assessed annually , whereas habitual activity was assessed at years 1 ( baseline ) , 3 , 5 , and 7 - 10 . Each girls ' overall activity status was categorised as active , moderately active , or inactive . Longitudinal regression models examined associations between changes in activity and in overall activity status with changes in BMI and in sum of skinfold thickness . FINDINGS Each decline in activity of 10 metabolic equivalent [MET]-times per week was associated with an increase in BMI of 0.14 kg/m2 ( SE 0.03 ) and in sum of skinfold thickness of 0.62 mm ( 0.17 ) for black girls , and of 0.09 kg/m2 ( 0.02 ) and 0.63 mm ( 0.13 ) for white girls . At ages 18 or 19 years , BMI differences between active and inactive girls were 2.98 kg/m2 ( p<0.0001 ) for black girls and 2.10 kg/m2 ( p<0.0001 ) for white girls . Similar results were apparent for sum of skinfold thickness . For moderately active girls , changes in BMI and sum of skinfold thickness were about midway between those for active and inactive girls . INTERPRETATION Changes in activity levels of US girls during adolescence significantly affected changes in BMI and adiposity . Thus , preventing the steep decline in activity during adolescence is an important method to reduce obesity Background Childhood obesity is multi-factorial and determined to a large extent by dietary habits , physical activity and sedentary behaviours . Previous research has shown that school-based programmes are effective but that their effectiveness can be improved by including a parental component . At present , there is a lack of effective parental support programmes for improvement of diet and physical activity and prevention of obesity in children . Methods / Design This paper describes the rationale and design of a parental support programme to promote healthy dietary habits and physical activity in six-year-old children starting school . The study is performed in close collaboration with the school health care and is design ed as a cluster-r and omised controlled trial with a mixed methods approach . In total , 14 pre-school classes are included from a municipality in Stockholm county where there is large variation in socio-economic status between the families . The school classes are r and omised to intervention ( n = 7 ) and  control ( n = 7 ) groups including a total of 242 children . The intervention is based on social cognitive theory and consists of three main components : 1 ) a health information brochure ; 2 ) two motivational interviewing sessions with the parents ; and 3 ) teacher-led classroom activities with the children . The primary outcomes are physical activity in the children measured objective ly by accelerometry , children 's dietary and physical activity habits measured with a parent-proxy question naire and parents ' self-efficacy measured by a question naire . Secondary outcomes are height , weight and waist circumference in the children . The duration of the intervention is six months and includes baseline , post intervention and six months follow-up measurements . Linear and logistic regression models will be used to analyse differences between intervention and control groups in the outcome variables . Mediator and moderator analysis will be performed . Participants will be interviewed . Discussion The results from this study will show if it is possible to promote a healthy lifestyle and a normal weight development among children from low-income districts with relatively limited efforts involving parents . Hopefully the study will provide new insights to the further development of effective programmes to prevent overweight and obesity in children . Trial registration IS RCT N : IS RCT Background  Physical activity ( PA ) rates decline precipitously during the high school years and are consistently lower among adolescent girls than adolescent boys . Due to cultural barriers , this problem might be exacerbated in female Iranian adolescents . However , little intervention research has been conducted to try to increase PA participation rates with this population . Because PA interventions in schools have the potential to reach many children and adolescents , this study reports on PA intervention research conducted in all-female Iranian high schools . Methods A r and omized controlled trial was conducted to examine the effects of two six-month tailored interventions on potential determinants of  PA and PA behavior .  Students ( N = 161 ) were r and omly allocated to one of three conditions : an intervention based on Pender 's Health Promotion model ( HP ) , an intervention based on an integration of the health promotion model and selected constructs from the Transtheoretical model ( THP ) , and a control group ( CON ) . Measures were administered prior to the intervention , at post-intervention and at a six-month follow-up . Results Repeated measure ANOVAs showed a significant interaction between group and time for perceived benefits , self efficacy , interpersonal norms , social support , behavioral processes , and PA behavior , indicating that both intervention groups significantly improved across the 24-week intervention , whereas the control group did not . Participants in the THP group showed greater use of counter conditioning and stimulus control at post-intervention and at follow-up . While there were no significant differences in PA between the HP and CON groups at follow-up , a significant difference was still found between the THP and the CON group . Conclusion This study provides the first evidence of the effectiveness of a PA intervention based on Pender 's HP model combined with selected aspects of the TTM on potential determinants to increase PA among Iranian high school girls Objective To assess the long term effects of an obesity prevention programme in schools . Design Longitudinal results after a cluster r and omised controlled trial . Setting Schools in southwest Engl and . Participants Of the original sample of 644 children aged 7 - 11 , 511 children were tracked and measurements were obtained from 434 children three years after baseline . Intervention The intervention was conducted over one school year , with four sessions of focused education promoting a healthy diet and discouraging the consumption of carbonated drinks . Main outcome measures Anthropometric measures of height , weight , and waist circumference . Body mass index ( BMI ) converted to z scores ( SD scores ) and to centile values with growth reference curves . Waist circumference was also converted to z scores ( SD scores ) . Results At three years after baseline the age and sex specific BMI z scores ( SD scores ) had increased in the control group by 0.10 ( SD 0.53 ) but decreased in the intervention group by −0.01 ( SD 0.58 ) , with a mean difference of 0.10 ( 95 % confidence interval −0.00 to 0.21 , P=0.06 ) . The prevalence of overweight increased in both the intervention and control group at three years and the significant difference between the groups seen at 12 months was no longer evident . The BMI increased in the control group by 2.14 ( SD 1.64 ) and the intervention group by 1.88 ( SD 1.71 ) , with mean difference of 0.26 ( −0.07 to 0.58 , P= 0.12 ) . The waist circumference increased in both groups after three years with a mean difference of 0.09 ( −0.06 to 0.26 , P=0.25 ) . Conclusions These longitudinal results show that after a simple year long intervention the difference in prevalence of overweight in children seen at 12 months was not sustained at three years Background Medically treated injuries have been shown to increase with increasing body mass index ( BMI ) . Information is lacking on the frequency and type of injuries and illnesses among overweight and obese adults who engage in regular physical activities as part of weight loss or weight gain prevention programs . Methods Sedentary adults with BMI s between 25 and 40 kg/m2 ( n = 397 ) enrolled in one of two r and omized clinical trials that emphasized exercise as part of a weight loss or weight gain prevention program . Interventions differed by duration of the exercise goal ( 150 , 200 , or 300 minutes/week or control group ) . Walking was prescribed as the primary mode of exercise . At six month intervals , participants were asked , " During the past six months , did you have any injury or illness that affected your ability to exercise ? " Longitudinal models were used to assess the effects of exercise and BMI on the pattern of injuries/illnesses attributed to exercise over time ; censored linear regression was used to identify predictors of time to first injury/illness attributed to exercise . Results During the 18-month study , 46 % reported at least one injury/illness , and 32 % reported at least one injury that was attributed to exercise .  Lower-body musculoskeletal injuries ( 21 % ) were the most commonly reported injury followed by cold/flu/respiratory infections ( 18 % ) and back pain/injury ( 10 % ) . Knee injuries comprised one-third of the lower-body musculoskeletal injuries . Only 7 % of the injuries were attributed to exercise alone , and 59 % of the injuries did not involve exercise . BMI ( p ≤ 0.01 ) but not exercise ( p ≥ 0.41 ) was significantly associated with time to first injury and injuries over time . Participants with higher BMI s were injured earlier or had increased odds of injury over time than participants with lower BMI s. Due to the linear dose-response relationship between BMI and injury/illness , any weight loss and reduction in BMI was associated with a decrease risk of injury/illness and delay in time to injury/illness . Conclusions Overweight and obese adults who were prescribed exercise as part of weight loss or weight gain prevention intervention were not at increased risk of injury compared to overweight adults r and omized not to participate in prescribed exercise . Since onset of injury/illness and pattern of injuries over time in overweight and obese individuals were attributed to BMI , weight reduction may be an avenue to reduce the risk of injury/illness in sedentary and previously sedentary overweight and obese adults . Trial Registration Clinical trials.gov NCT00177502 and PURPOSE This study evaluated the effects of a classroom-based physical activity program on  children 's in-school physical activity levels  and on-task behavior during academic instruction . METHODS Physical activity of 243 students was assessed during school hours . Intervention-group students ( N = 135 ) received a classroom-based program ( i.e. , Energizers ) . The control group ( N = 108 ) did not receive Energizers .  On-task behavior during academic instruction time was observed for 62 third- grade ( N = 37 ) and fourth- grade students ( N = 25 ) before and after Energizers activities . An independent groups t-test compared in-school physical activity levels between intervention and control classes . A multiple-baseline across-classrooms design was used to evaluate the effectiveness of the Energizers on on-task behavior . Additionally , a two-way ( time [ pre- vs postobservation ] x period [ baseline vs intervention ] ) repeated- measures analysis of variance compared on-task behavior between observation periods . Magnitudes of mean differences were evaluated with Cohen 's delta ( ES ) . RESULTS Students in the intervention group took significantly ( P < 0.05 ) more in-school steps ( 5587 + /- 1633 ) than control-group students ( 4805 + /- 1543 ) , and the size of this difference was moderate ( ES = 0.49 ) . The intervention was effective in improving on-task behavior ; after the Energizers were systematic ally implemented , on-task behavior systematic ally improved . The improvement in on-task behavior of 8 % between the pre-Energizers and post-Energizers observations was statistically significant ( P < 0.017 ) , and the difference was moderate ( ES = 0.60 ) . Likewise , the least on-task students improved on-task behavior by 20 % after Energizers activities . This improvement was statistically significant ( P < 0.001 ) and meaningful ( ES = 2.20 ) . CONCLUSION A classroom-based physical activity program was effective for increasing daily in-school physical activity and improving on-task behavior during academic instruction Cardiovascular disease begins early in life but might be prevented or delayed by primary prevention programs design ed for children and adolescents .  Regular physical activity is an important part of primary prevention programs , and school physical education programs have potential for the promotion of regular physical activity . Cardiovascular disease is the major cause of death among Hispanics and African Americans in the United States . Low levels of fitness and increased body mass index are common in African American and Hispanic adolescents . Increased physical activity and the adoption of healthy eating habits would increase fitness and reduce body mass index among these adolescents . The purpose of the study was to undertake a small-scale controlled trial to determine if Dance for Health , an intervention program design ed to provide an enjoyable aerobic program for African American and Hispanic adolescents , has a significant effect on improving aerobic capacity , helping students maintain or decrease weight , and on improving attitudes toward physical activity and physical fitness . In the first year of the program ( 1990 - 91 ) , approximately 110 boys and girls ages 10 - 13 years participated in an aerobic dance pilot program three times per week for 12 weeks . Dance for Health was revised and continued in the 1992 - 93 school year with seventh grade students and an added culturally sensitive health curriculum . Forty-three students were r and omized to Dance for  Health and 38 to  usual physical activity . Those in the intervention class received a health education curriculum twice a week and a dance oriented physical education class three times a week . The usual physical activity consisted mostly of playground activities . Students in the intervention had a significantly greater lowering in body mass index and resting heart rate than students in regular physical activity We report the design , rationale , and statistical procedures used in Pathways , a r and omized , school-based intervention for the primary prevention of obesity in American Indian children . The intervention , which is now being implemented in 7 American Indian communities around the country , includes a health-promotion curriculum , a physical education program , a school meal program , and a family involvement component .  Forty-one schools serving American Indian children were r and omly assigned to be either intervention or control groups . The intervention will begin in the third grade and continue through the end of the fifth grade . Efficacy of intervention will be assessed by differences in mean percentage body fat , calculated by a prediction equation , between intervention and control schools at the end of the fifth grade . Power computations indicate that the study has power to detect a mean difference of 2.8 % in body fat . Data analysis will use intention-to-treat concepts and the mixed linear model . The study will be completed in 2000 Objective . To determine the immediate effects of two types of elementary school-based interventions on children with multiple cardiovascular disease ( CVD ) risk factors . Design . R and omized , controlled field trial . Setting . Conducted in 18 r and omly selected elementary schools across North Carolina . Study Participants . Four hundred twenty-two children age 9 ± 0.8 years with at least two risk factors at baseline : low aerobic power and either high serum cholesterol or obesity . Intervention . Both 8-week interventions consisted of a knowledge and attitude program and an adaptation of physical education . The classroom-based intervention was given by regular teachers to all children in the 3rd and 4th grade s. The risk-based intervention was given in small groups only to children with identified risk factors . Children in the control group received usual teaching and physical education . Outcome Measures . The primary outcome measure was cholesterol ; additional measures were blood pressure , body mass index , body fat , eating and activity habits , and health knowledge . Results . Both interventions produced large reductions in cholesterol ( −10.1 mg/dL and −11.7 mg/dL ) compared with a small drop ( −2.3 mg/dL ) in the controls . There was a trend for systolic blood pressure to increase less in both intervention groups than in the controls . Both intervention groups had a small reduction in body fat and higher health knowledge than the control group . Conclusions . Both brief interventions can improve the CVD risk profile of children with multiple risk factors . The classroom-based approach was easier to implement and used fewer re sources . This population approach should be considered as one means of early primary prevention of CVD The preschool years offer an opportunity to interrupt the trajectory toward obesity in black children . The Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial was a group-r and omized controlled trial assessing the feasibility and effectiveness of a teacher-delivered weight control intervention for black preschool children . The 618 participating children were enrolled in 18 schools administered by the Chicago Public Schools . Children enrolled in the nine schools r and omized to the intervention group received a 14-week weight control intervention delivered by their classroom teachers . Children in the nine control schools received a general health intervention .  Height and weight , physical activity , screen time , and diet data were collected at baseline and postintervention . At postintervention , children in the intervention schools engaged in more moderate-to-vigorous physical activity ( MVPA ) than children in the control schools ( difference between adjusted group means = 7.46 min/day , P = 0.02 ) . Also , children in the intervention group had less total screen time ( -27.8 min/day , P = 0.05 ) . There were no significant differences in BMI , BMI Z score , or dietary intake . It is feasible to adapt an obesity prevention program to be taught by classroom teachers . The intervention showed positive influences on physical activity and screen time , but not on diet . Measuring diet and physical activity in preschool children remains a challenge , and interventions delivered by classroom teachers require both intensive initial training and ongoing individualized supervision Abstract : School‐based cardiovascular risk‐reduction programs have the potential to influence lifelong habits intrinsic to good health . Following earlier Australian Body owner 's Manual ( BOM ) intervention trials , we examined the effects of two interventions on physiological indicators of risk of cardiovascular disease and on health knowledge : the BOM ; and the BOM plus healthy life style programs for teachers and school‐canteen interventions ( BOM+ ) over two school years in socially disadvantaged primary schools . Each school was allocated to either a control condition or to one of two intervention conditions . In contrast to the findings of the earlier South Australian trials , there were no statistically‐significant changes in aerobic fitness , body fatness or HDL cholesterol ; there were significant reductions in diastolic blood pressure , total cholesterol and triglyceride concentration for those in the BOM+ schools . There were significant increases in health and nutrition knowledge for the BOM+ schools , and in health knowledge for the BOM schools Physical activity during childhood is advocated as one strategy for enhancing peak bone mass ( bone mineral content [ BMC ] ) as a means to reduce osteoporosis-related fractures . Thus , we investigated the effects of high-intensity jumping on hip and lumbar spine bone mass in children . Eighty-nine prepubescent children between the ages of 5.9 and 9.8 years were r and omized into a  jumping  ( n = 25 boys and n = 20 girls ) or  control group  ( n = 26 boys and n = 18 girls ) . Both groups participated in the 7-month exercise intervention during the school day three times per week . The jumping group performed 100 , two-footed jumps off 61-cm boxes each session , while the control group performed nonimpact stretching exercises .  BMC ( g ) , bone area ( BA ; cm2 ) , and bone mineral density ( BMD ; g/cm2 ) of the left proximal femoral neck and lumbar spine ( L1-L4 ) were assessed by dual-energy X-ray absorptiometry ( DXA ; Hologic QDR/4500-A ) . Peak ground reaction forces were calculated across 100 , two-footed jumps from a 61-cm box . In addition , anthropometric characteristics ( height , weight , and body fat ) , physical activity , and dietary calcium intake were assessed . At baseline there were no differences between groups for anthropometric characteristics , dietary calcium intake , or bone variables . After 7 months , jumpers and controls had similar increases in height , weight , and body fat . Using repeated measures analysis of covariance ( ANCOVA ; covariates , initial age and bone values , and changes in height and weight ) for BMC , the primary outcome variable , jumpers had significantly greater 7-month changes at the femoral neck and lumbar spine than controls ( 4.5 % and 3.1 % , respectively ) . In repeated measures ANCOVA of secondary outcomes ( BMD and BA ) , BMD at the lumbar spine was significantly greater in jumpers than in controls ( 2.0 % ) and approached statistical significance at the femoral neck ( 1.4 % ; p = 0.085 ) . For BA , jumpers had significantly greater increases at the femoral neck area than controls ( 2.9 % ) but were not different at the spine . Our data indicate that jumping at ground reaction forces of eight times body weight is a safe , effective , and simple method of improving bone mass at the hip and spine in children . This program could be easily incorporated into physical education classes Abstract Complex training , a combination of resistance training and plyometrics is growing in popularity , despite limited support for its efficacy . In pre- and early pubertal children , the study of complex training has been limited , and to our knowledge an examination of its effect on anaerobic performance characteristics of the upper and lower body has not been undertaken . Furthermore , the effect of detraining after complex training requires clarification . The physical characteristics ( mean±s ) of the 54 male participants in the present study were as follows : age 12.3 ± 0.3 years , height 1.57 ± 0.07 m , body mass 50.3 ± 11.0 kg . Participants were r and omly assigned to an experimental ( n = 33 ) or control group ( n = 21 ) . The training , which was performed three times a week for 12 weeks , included a combination of dynamic constant external resistance and plyometrics . After training , participants completed 12 weeks of detraining . At baseline , after training and after detraining , peak and mean anaerobic power , dynamic strength and athletic performance were assessed . Twenty-six participants completed the training and none reported any training-related injury . Complex training was associated with small increases ( ≤5.5 % ) in peak and mean power during training , followed by decreases of a similar magnitude ( ≤ −5.9 % ) during detraining ( P < 0.05 ) . No changes or minor , progressive increases ( ≤1.5 % ) were evident in the control group ( P > 0.05 ) . In the experimental group , dynamic strength was increased by 24.3 – 71.4 % ( dependent on muscle group ; P < 0.01 ) , whereas growth-related changes in the control group varied from 0 to 4.4 % ( P > 0.05 ) . For 40-m sprint running , basketball chest pass and vertical jump test performance , the experimental group saw a small improvement ( ≤4.0 % ) after training followed by a decline ( ≤ −4.4 % ) towards baseline during detraining ( P < 0.05 ) , whereas the control group experienced no change ( P > 0.05 ) . In conclusion , in pre- and early pubertal boys , upper and lower body complex training is a time-effective and safe training modality that confers small improvements in anaerobic power and jumping , throwing and sprinting performance , and marked improvements in dynamic strength . However , after detraining , the benefits of complex training are lost at similar rates to other training modalities OBJECTIVE Examine the effect of the  California Children 's Power Play ! Campaign 's School Idea & Re source Kits for fourth/fifth grade s on the psychosocial determinants of fruit and vegetable ( FV ) intake and  physical activity ( PA ) . METHODS R and omized , controlled trial ( n = 31 low-re source public schools ; 1,154 children ) .  Ten grade -specific , 50-minute nutrition and PA lessons over an 8-week period . Pre/post surveys measuring knowledge , outcome expectations , and self-efficacy ( SE ) were analyzed using analysis of covariance , controlling for baseline values ; chi-square comparing positive/negative changes , adjusted for cluster design effects . RESULTS Intervention children made significant gains for FV knowledge ( 4 items , P < .05 to P < .001 ) ; positive outcome expectations ( fifth grade only , P < .001 ) ; asking/shopping and eating SE ( P = .04 and P < .001 ) ; PA knowledge ( 2 items , P < .01 to P < .001 ) ; outcome expectations ( P < .05 ) ; and support seeking SE ( P = .04 ) ; but not SE to overcome barriers . CONCLUSIONS AND IMPLICATION S The Power Play ! Campaign 's School Idea & Re source Kits improved the determinants of FV intake and PA BACKGROUND We examined the effects of a multicomponent , school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes . METHODS Using a cluster design , we r and omly assigned 42 schools to either a multicomponent school-based intervention ( 21 schools ) or assessment only ( control , 21 schools ) . A total of 4603 students participated ( mean [ + /- SD ] age , 11.3 [ + /- 0.6 years ; 54.2 % Hispanic and 18.0 % black ; 52.7 % girls ) . At the beginning of 6th grade and the end of 8th grade , students underwent measurements of  body-mass index ( BMI ) , waist circumference , and fasting glucose and insulin levels .  RESULTS There was a decrease in the primary outcome --the combined prevalence of overweight and obesity -- in both the intervention and control schools , with no significant difference between the school groups . The intervention schools had greater reductions in the secondary outcomes of BMI z score , percentage of students with waist circumference at or above the 90th percentile , fasting insulin levels ( P=0.04 for all comparisons ) , and prevalence of obesity ( P=0.05 ) . Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline . Less than 3 % of the students who were screened had an adverse event ; the proportions were nearly equivalent in the intervention and control schools . CONCLUSIONS Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools . However , the intervention did result in significantly greater reductions in various indexes of adiposity . These changes may reduce the risk of childhood-onset type 2 diabetes . ( Funded by the National Institutes of Health and the American Diabetes Association ; Clinical Trials.gov number , NCT00458029 . OBJECTIVE To test the impact of an enhanced physical education programme upon the growth and development of static and dynamic lung volumes of primary schoolchildren . EXPERIMENTAL DESIGN Quasi-experimental three factor design ( treatment x gender x urban vs rural environment ) with students evaluated over each of 6 years of primary school . SETTING Entire classes from State schools in urban and rural environment . PARTICIPANTS All willing students aged 7 - 12 years in selected classes ; initially 546 students , with 4 % drop-out rate per year . INTERVENTION Five hours of additional physical education per week , taught by specialist . MEASURES Body dimension ( height , body mass ) , aerobic power ( treadmill to exhaustion ) , forced vital capacity ( FVC ) , one second forced expiratory volume ( FEV1.0 ) . RESULTS Small but statistically significant influences of treatment , gender ( M > F ) and environment ( rural > urban ) which could not be explained by body size . Both FVC and FEV1.0 conform closely to cubic functions of height in metres : Boys FVC = 0.93 (H)3 , FEV1.0 = 0.79 (H)3 . Girls FVC + /- 0.85 (H)3 , FEV1.0 = 0.76 (H)3 . CONCLUSIONS A regular physical education programme can enhance lung volumes in primary school students . Norms should allow for gender differences , and reflect the potential attainment of students receiving adequate physical training and living in an area of low air pollution The purpose of this study was to describe changes in physical activity and determinants in youngsters treated for obesity .  Self-reported physical activity and determinants were assessed at start , during and after an intervention in 24 obese patients ( mean age 13.5+/-2.1 years ) .  Participation in activities of moderate to high intensity  increased during treatment , but 6-months after treatment this decreased again to pre-treatment levels .  Participation in activities of low intensity and television watching  decreased during treatment and increased following treatment . Very little change was found in perceived benefits , barriers or self-efficacy scores . Modelling of siblings decreased after treatment , whereas there was no evolution in modelling of parents . Social support by family members increased during treatment , but decreased following treatment . We can conclude that the intervention was successful in activating obese youngsters to move at the desirable exercise intensity and frequency ; however , maintenance of the exercise habit after treatment was not successful PURPOSE : To test the effects of an osteoporosis prevention program given to high school students DESIGN : R and omized , multisite field study . SAMPLE : The final sample for analysis was composed of 693 teens from 18 schools . FINDINGS : The average knowledge difference score of the OPTIONS group was 8.4 percentage points higher than that of the control group . Some of the analysis suggested that girls gained more from the intervention than did boys . Students from all types of schools , responded equivalently to the intervention . Health beliefs about barriers to preventive action were not influenced by the intervention . DISCUSSION : This intervention increased students ' knowledge about how to build healthy bones ; however , the real challenge lies in building on that knowledge gain to influence behaviors . The modest gain in knowledge also suggests that educational interventions of this type should be tested with younger children , who might be more receptive Regular physical activity has both short- and long-term health benefits in adults . No study has investigated childhood determinants of adult physical activity patterns , however . In a nonconcurrent prospect i ve study , the physical activity levels of 453 young men , 23 to 25 years of age , were compared with their physical fitness test scores as children ( 10 to 11 years of age and 15 to 18 years of age ) . The physically active adults had significantly better childhood physical fitness test scores than did the inactive adults . In 224 children , 2 years of fitness test results were available . The risk of physical inactivity in young adulthood was linearly related to the number of low scores on the 548.6-m ( 600-yd ) run and sit-ups tests as children ( P less than .001 ) . In stepwise multivariate discriminant analysis , the childhood 548.6-m run score was the best discriminator between currently physically active and inactive adults . Reported parental encouragement of exercise , level of education , participation in organized sports after high school , and reported spousal encouragement of exercise  also contributed significantly to the discriminant function . These results demonstrate that physical fitness testing in boys facilitates the identification of those at increased risk of becoming physically inactive young adults BACKGROUND We evaluated the effectiveness of a school-based intervention on the promotion of physical activity among high school students in Brazil : the Saude na Boa project . METHODS A school-based , r and omized trial was carried out in 2 Brazilian cities : Recife ( northeast ) and Florianopolis ( south ) . Ten schools in each city were matched by size and location , and r and omized into intervention or control groups . The intervention included environmental/organizational changes , physical activity education , and personnel training and engagement .  Students age 15 to 24 years were evaluated at baseline and 9 months later ( end of school year ) . RESULTS Although similar at baseline , after the intervention , the control group reported significantly fewer d/wk accumulating 60 minutes+ moderate-to-vigorous physical activity ( MVPA ) in comparison with the intervention group ( 2.6 versus 3.3 , P<.001 ) . The prevalence of inactivity ( 0 days per week ) rose in the control and decreased in the intervention group . The odds ratio for engaging at least once per week in physical activity associated with the intervention was 1.83 ( 95 % CI=1.24 - 2.71 ) in the unadjusted analysis and 1.88 ( 95 % CI=1.27 - 2.79 ) after controlling for gender . CONCLUSION The Saude na Boa intervention was effective at reducing the prevalence of physical inactivity . The possibility of exp and ing the intervention to other locations should be considered BACKGROUND Substantial differences exist in how and where physical education ( PE ) is conducted in elementary schools throughout the United States . Few effectiveness studies of large-scale interventions to improve PE have been reported . DESIGN Multicenter r and omized trial . SETTING / PARTICIPANTS The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) was implemented in PE classes in 96 schools ( 56 intervention , 40 control ) in four study centers : California , Louisiana , Minnesota , and Texas . INTERVENTION The 2.5-year PE intervention consisted of professional development sessions , curricula , and follow-up consultations . MAIN OUTCOME MEASURES Intervention effects on student physical activity and lesson context in PE were examined by  teacher type  ( PE specialists and classroom teachers ) and lesson location ( indoors and outdoors ) . RESULTS Differential effects by teacher type and lesson location were evidence d for both physical activity and lesson context . Observations of 2016 lessons showed that intervention schools provided more moderate-to-vigorous physical activity ( p=0.002 ) and vigorous physical activity ( p=0.02 ) than controls . Classroom teachers  improved physical activity relatively more than PE specialists , but PE specialists still provided longer lessons and more physical activity .  Classroom teachers  increased lesson length ( p=0.02 ) and time for physical fitness ( p=0.03 ) . CONCLUSIONS The intervention improved PE of both specialists ' and classroom teachers ' lessons . States and districts should ensure that the most qualified staff teaches PE . Interventions need to be tailored to meet local needs and conditions , including teacher type and location of lessons OBJECTIVE 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 . DESIGN The ACT program was a r and omized 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 r and omization . 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 . MAIN OUTCOME MEASURE The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention . RESULTS 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 . CONCLUSIONS 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 BACKGROUND Physical Activity Across the Curriculum ( PAAC ) was a three-year cluster r and omized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children . METHODS Twenty-four elementary schools were cluster r and omized to the Physical Activity Across the Curriculum intervention or served as control .  All children in grade s two and three were followed to grade s 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 . RESULTS 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 . CONCLUSIONS 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 OBJECTIVE To evaluate the impact of a school-based interdisciplinary health behavior intervention on  diet  and  physical activity  among children in grade s 4 and 5 . DESIGN A quasiexperimental field trial with 6 intervention and 8 matched control schools . Outcomes were assessed longitudinally using preintervention ( fall 1995 ) and follow-up ( spring 1997 ) student survey food frequency and activity measures and follow-up 24-hour recall measures of diet and activity . Change was also assessed using yearly repeated cross-sectional surveys of all grade 5 students from 1995 through 1997 . PARTICIPANTS Longitudinal data were collected from 479 students initially in grade 4 in Baltimore , Md , public schools ; 91 % were African American . Repeated 24-hour recall measures in 1997 were collected for a r and om sub sample of 336 students . Cross-sectional survey data were collected from all grade 5 students in 1995,1996 , and 1997 ( n = 2103 ) . INTERVENTION The Eat Well and Keep Moving Program was taught by classroom teachers over 2 years in math , science , language arts , and social studies classes . Material s provided links to school food services and families and provided training and wellness programs for teachers and other staff members . Intervention material s focused on decreasing consumption of foods high in total and saturated fat and increasing fruit and vegetable intake , as well as reducing television viewing and increasing physical activity . MAIN OUTCOME MEASURES Dietary intake and physical activity measured via repeated 24-hour recall were primary end points , with additional food frequency and activity measures . RESULTS The 24-hour recall measures indicated that , after controlling for baseline covariates , the percentages of total energy from fat and saturated fat were reduced among students in intervention compared with control schools ( -1.4 % ; 95 % confidence interval [ CI ] , -2.8 to -0.04 ; P = .04 and -0.60 % ; 95 % CI , -1.2 to -0.01 ; P = .05 ) . There was an increase in fruit and vegetable intake ( 0.36 servings/4184 kJ ; 95 % CI , 0.10 - 0.62 ; P=.01 ) , in vitamin C intake ( 8.8 mg/4184 kJ ; 95 % CI , 2.0 - 16 ; P=.01 ) , and in fiber consumption ( 0.7 g/4184 kJ ; 95 % CI , 0.0 - 1.4 ; P=.05 ) . Television viewing was marginally reduced ( -0.55 h/d ; 95 % CI , -1.04 to 0.04 ; P=.06 ) . Analysis of longitudinal and repeated cross-sectional food frequency data indicated similar significant decreases in the percentages of total energy from fat and saturated fat . CONCLUSION Evaluation of the Eat Well and Keep Moving Program indicates effectiveness in improving dietary intake of students and reducing television viewing OBJECTIVE To evaluate whether a child-centered physical activity program , combined with a parent-centered dietary program , was more efficacious than each treatment alone , in preventing unhealthy weight-gain  in overweight children . STUDY DESIGN An assessor-blinded r and omized controlled trial involving 165 overweight/obese 5.5- to 9.9- year-old children . Participants were r and omly assigned to 1 of 3 interventions : a parent-centered dietary program ( Diet ) ; a child-centered physical activity program ( Activity ) ; or a combination of both ( Diet+Activity ) . All groups received 10 weekly face-to-face sessions followed by 3 monthly relapse-prevention phone calls . Analysis was by intention-to-treat . The primary outcome was change in body mass index z-score at 6 and 12 months ( n=114 and 106 , respectively ) . RESULTS Body mass index z-scores were reduced at 12-months in all groups , with the Diet ( mean [ 95 % confidence interval ] ) ( -0.39 [ -0.51 to 0.27 ] ) and Diet + Activity ( -0.32 , [ -0.36 , -0.23 ] ) groups showing a greater reduction than the Activity group ( -0.17 [ -0.28 , -0.06 ] ) ( P=.02 ) . Changes in other outcomes ( waist circumference and metabolic profile ) were not statistically significant among groups . CONCLUSION Relative body weight decreased at 6 months and was sustained at 12 months through treatment with a child-centered physical activity program , a parent-centered dietary program , or both . The greatest effect was achieved when a parent-centered dietary component was included OBJECTIVE 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 . RESEARCH METHODS AND PROCEDURES The sample consisted of 1013 students in fourth and fifth grade s from 69 classes in four states .  Intervention and comparison classes were r and omly selected at each school . Intervention teachers participated in workshops on the intervention and received program material s.  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 . RESULTS 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 . DISCUSSION 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 The aims of this study were to document time-related ( morning versus afternoon ) effects of physical activities ( gymnastics ) on a set of physiological and psychological variables in school children , including diurnal changes . For the study , 61 boys and 69 girls , 6 to 11 years of age , volunteered . They were considered healthy according to routine clinical criteria . They were synchronized with diurnal activity from around 07:00 to 21:00 and nocturnal rest , time of year being taken into account . Tests were performed at school during 4 weeks of 4.5 days of school at fixed clock hours : 09:00 , 11:00 , 14:00 , and 16:00 . Gym time was r and omized with regard to week order and season . Four different classes ( 39 boys and 38 girls ) were involved in psychophysiological tests , and two different classes ( 22 boys and 31 girls ) collected saliva sample s for morning free cortisol determination . Both t-test and three-factor analysis of variance ( ANOVA ) were used for statistical analyses . Better performances were obtained in June than in mid-winter with reference to letter cancellation and r and om number addition tests . As a group phenomenon , morning ( 09:00 to 10:00 ) versus afternoon ( 14:00 to 15:00 ) gym was not an influential condition with regard to sleep duration , oral temperature , self-rated fatigue and drowsiness , letter cancellation , addition tests , or salivary cortisol . However , gym-time-related differences were observed in classes of younger subjects ( e.g. , 6 - 7 years ) with regard to self-rated fatigue and the letter cancellation test . Such variability among subgroups suggests that interindividual differences are likely to exist in younger children with regard to manipulation of environmental factors . In addition , gym itself ( without gym time consideration ) may be an influential factor with regard to diurnal patterns of some variables ( e.g. , the letter cancellation test ) The HEALTHY primary prevention trial was design ed to reduce risk factors for type 2 diabetes in middle school students . Middle schools at seven centers across the United States participated in the 3-year study . Half of them were r and omized to receive a multi-component intervention . The intervention integrated nutrition , physical education ( PE ) and behavior changes with a communications strategy of promotional and educational material s and activities . The PE intervention component was developed over a series of pilot studies to maximize student participation and the time ( in minutes ) spent in moderate-to-vigorous physical activity ( MVPA ) , while meeting state-m and ated PE guidelines . The goal of the PE intervention component was to achieve ⩾150 min of MVPA in PE classes every 10 school days with the expectation that it would provide a direct effect on adiposity and insulin resistance , subsequently reducing the risk of type 2 diabetes in youth . The PE intervention component curriculum used st and ard lesson plans to provide a comprehensive approach to middle school PE . Equipment and PE teacher assistants were provided for each school . An expert in PE at each center trained the PE teachers and assistants , monitored delivery of the intervention and provided ongoing feedback and guidance Fear of negative evaluation ( FNE ) is regarded as being the core feature of social anxiety . The present study examined how FNE is associated with  physical activity ( PA ) , body mass index ( BMI ) and perceived physical health ( PPH )  in children . Data were collected in a sample of 502 primary school children in first and fifth grade s taking part in a r and omized-controlled trial ( " Kinder-Sportstudie KISS " ) aim ed at increasing PA and health . PA was assessed by accelerometry over 7 days , PPH by the Child Health Question naire and FNE by the  Social Anxiety Scale for Children -- Revised . BMI z-scores were calculated based on Swiss norms . Cross-sectional analyses indicated that children high in FNE exercised less , reported lower levels of PPH and had higher BMI z-scores ( P<0.01 ) . Using mixed linear models , the school-based PA intervention did not manage to reduce FNE scores . Overweight children demonstrated a greater increase in FNE ( P<0.05 ) indicating that enhanced weight may be a risk factor for FNE . In conclusion , the associations among high FNE , low PA and increased BMI should be considered when promoting an active lifestyle in children Velez , A , Golem , DL , and Are nt , SM . The impact of a 12-week resistance training program on strength , body composition , and self-concept of Hispanic adolescents . J Strength Cond Res 24(4 ) : 1065 - 1073 , 2010-Current evidence suggests that a resistance training program may be physically and psychologically beneficial for adolescents . The purpose of this study was to examine the effects of a structured resistance training program on strength , body composition , and self-concept in normal and overweight Hispanic adolescents . Male and female participants ( n = 28 ; 16.1 ± 0.2 y ; 164.5 ± 1.4 cm ; 63.3 ± 2.5 kg ; 20.0 ± 1.7 % body fat [ BF ] ) were recruited from a predominantly Hispanic high school . Prior to the 12-week program , strength , body composition , and self-concept were assessed . Subjects were r and omly assigned to a control group ( CON ; n = 15 ) or to a resistance training group ( RT ; n = 13 ) that participated in supervised strength training 3 days/week . All measures were repeated at the end of the 12-week program . RT had significantly greater strength increases for bench press ( p < 0.001 ) , seated row ( p = 0.002 ) , shoulder press ( p < 0.001 ) , and squats ( p = 0.002 ) . RT had significant reductions in % BF ( p = 0.001 ) , whereas CON had slightly increased % BF . RT had an increase in condition/stamina competence ( p = 0.008 ) , attractive body adequacy ( p = 0.017 ) , and global self-worth ( p = 0.013 ) from pretest to posttest , whereas no change was observed for CON . In conclusion , resistance training result ed in significant physiological and psychological improvements in Hispanic adolescents compared to typical school-based activities . These findings indicate that resistance training can be incorporated into the activities of Hispanic adolescents to promote improved health and fitness OBJECTIVE To evaluate the effects of a 2-year middle school  physical activity and healthy food intervention , including an environmental and computer-tailored component on  BMI and BMI z-score in boys and girls . RESEARCH METHODS AND PROCEDURES A r and om sample of 15 schools with seventh and eighth grade rs was r and omly assigned to three conditions : an intervention with parental support group , an intervention-alone group , and a control group . Weight and height were measured at the beginning and end of each school year to assess BMI and BMI z-score . A physical activity and healthy food program was implemented over 2 school years . RESULTS In girls , BMI and BMI z-score increased significantly less in the intervention with parental support group compared with the control group ( p < 0.05 ) or the intervention-alone group ( p = 0.05 ) . In boys , no significant positive intervention effects were found . DISCUSSION This was the first study evaluating the effectiveness of an intervention combining environmental changes with personal computer-tailored feedback on BMI and BMI z-score  in middle school children . After 2 school years , BMI and BMI z-score changed in a more positive direction in girls as a result of the intervention with parental support OBJECTIVE The Girls health Enrichment Multisite Studies ( GEMS ) Fun , Food , and Fitness Project ( FFFP ) was design ed to prevent obesity among 8-year-old African-American girls . DESIGN Twelve-week , two-arm parallel group r and omized controlled pilot study . SETTING Summer day camp and homes in Houston , Texas . PARTICIPANTS Thirty-five girls and their parents or caregivers were r and omly assigned to treatment ( N=19 ) or control groups ( N=16 ) . INTERVENTION Girls in the intervention group attended a special 4-week summer day camp , followed by a special 8-week home Internet intervention for the girls and their parents . Control group girls attended a different 4-week summer day camp , followed by a monthly home Internet intervention , neither of which components included the GEMS-FFFP enhancements . MAIN OUTCOME MEASURES Body mass index ( BMI ) , consumption of fruit , 100 % fruit juice , and vegetables ( FJV ) , physical activity . RESULTS After adjusting for baseline BMI , there were no significant differences in BMI between treatment and control group girls , either at the end of the 4-week summer day camp , or after the full 12-week intervention . By the end of the summer camp , the subgroup of treatment group girls heavier at baseline exhibited a trend ( P<.08 ) toward lower BMI , compared to their heavier counterparts in the control group . Overall results at the end of the 12-week program demonstrated substantial , although not significant , differences between treatment and control groups in the hypothesized directions . On average , less than half the treatment sample logged onto the Website , which limited intervention dose . CONCLUSIONS Summer day camp appears to offer promise for initiating health behavior change . Effective methods must be developed and tested to enhance log-on rates among healthy children and their parents before Internet programs can achieve their potential BACKGROUND A cross-cultural , r and omized study was proposed to observe the effects of a school-based intervention design ed to promote physical activity and healthy eating among high school students in 2 cities from different regions in Brazil : Recife and Florianopolis . The objective of this article is to describe the methodology and subjects enrolled in the project . METHODS Ten schools from each region were matched and r and omized into intervention and control conditions . A question naire and anthropometry were used to collect data in the first and last month of the 2006 school year . The sample ( n=2155 at baseline ; 55.7 % females ; 49.1 % in the experimental group ) included students 15 to 24 years , attending nighttime classes . The intervention focused on simple environmental/organizational changes , diet and physical activity education , and personnel training . RESULTS The central aspects of the intervention have been implemented in all 10 intervention schools . Problems during the intervention included teachers ' strikes in both sites and lack of involvement of the canteen owners in schools . CONCLUSIONS The Saude na Boa study provides evidence that public high schools in Brazil represent an important environment for health promotion . Its design and simple measurements increase the chances of it being sustained and disseminated to similar schools in Brazil BACKGROUND Atherosclerosis develops from early childhood ; physical activity could positively affect this process . This study 's aim was to assess the associations of objective ly measured physical activity with clustering of cardiovascular disease risk factors in children and derive guidelines on the basis of this analysis . METHODS We did a cross-sectional study of 1732 r and omly selected 9-year-old and 15-year-old school children from Denmark , Estonia , and Portugal . Risk factors included in the composite risk factor score ( mean of Z scores ) were systolic blood pressure , triglyceride , total cholesterol/HDL ratio , insulin resistance , sum of four skinfolds , and aerobic fitness . Individuals with a risk score above 1 SD of the composite variable were defined as being at risk . Physical activity was assessed by accelerometry . FINDINGS Odds ratios for having clustered risk for ascending quintiles of  physical activity  ( counts per min ; cpm ) were 3.29 ( 95 % CI 1.96 - 5.52 ) , 3.13 ( 1.87 - 5.25 ) , 2.51 ( 1.47 - 4.26 ) , and 2.03 ( 1.18 - 3.50 ) , respectively , compared with the most active quintile . The first to the third quintile of physical activity had a raised risk in all analyses . The mean time spent above 2000 cpm in the fourth quintile was 116 min per day in 9-year-old and 88 min per day in 15-year-old children . INTERPRETATION  Physical activity  levels should be higher than the current international guidelines of at least 1 h per day of physical activity of at least moderate intensity to prevent clustering of cardiovascular disease risk factors The effects of a 2-year health-related school physical education program on st and ardized academic achievement scores was assessed in 759 children who completed Metropolitan Achievement Tests before and after the program . Schools were r and omly assigned to condition : ( a ) Specialists taught the Sports , Play , and Active Recreation for Kids curriculum ; ( b ) classroom teachers were trained to implement the curriculum ; and ( c ) controls continued their usual programs . The Trained Teacher condition was superior to Control on Language , Reading , and Basic Battery . The Specialist condition was superior to Control on Reading , but inferior on Language . Despite devoting twice as many minutes per week to physical education as Controls , the health-related physical education program did not interfere with academic achievement .  Health-related physical education may have favorable effects on students ' academic achievement The primary purpose of this study was to test the efficacy of a brief , multi-health behavior intervention integrating physical activity and alcohol use prevention messages for high school-aged adolescents . A total of 604 participants , 335 9th and 269 11th grade students from a suburban high school in northeast Florida participated in this study . A r and omized control trial was conducted with participants r and omly assigned within grade levels to receive either a brief consultation and prescription with a mailed reinforcing follow-up flyer ( Project SPORT ) or a minimal intervention control consisting of a wellness brochure provided in school and a pamphlet about teen health and fitness mailed to the home . Differences between intervention groups were evaluated with a series of MANCOVA tests . Project SPORT participants demonstrated significant positive effects at 3-months postintervention for alcohol consumption , alcohol initiation behaviors , alcohol use risk and protective factors , drug use behaviors , and exercise habits , and at 12-months for alcohol use risk and protective factors , cigarette use , and cigarette initiation ( p 's < 0.05 ) . A post hoc analysis examining interactions between past 30-day use of marijuana and /or cigarettes by treatment group indicates significant positive effects for drug using adolescents who received Project SPORT on alcohol consumption , drug use behaviors , and drug use initiation at 3-months , and for drug use behaviors and exercise habits at 12-months ( p 's < 0.05 ) . A brief , 12-min one-on-one consultation integrating alcohol avoidance messages within those promoting fitness and other positive health behaviors holds promise for influencing adolescent alcohol and cigarette use and other health behaviors at posttreatment and 1 year later . Long-term sustained effects for cigarette and marijuana use , and both vigorous and moderate physical activity , were found among adolescents using marijuana and /or cigarettes prior to intervention OBJECTIVE To evaluate the effects of an elementary school-based physical education exercise intervention program on bone mineral accrual in prepubertal and early pubertal girls . STUDY DESIGN A total of 14 schools were r and omly assigned to control ( C ) and intervention ( I ) groups . Girls in the I group completed a 10-minute , 3 times per week circuit of varied jumping activities over 7 months . We measured total body , lumbar spine , proximal femur , femoral neck , and trochanteric bone mineral content and areal bone mineral density and estimated femoral neck volumetric bone mineral density at baseline and final measurement in 87 girls in the I group and 90 girls in the C group . Girls were between 8.7 and 11.7 years at baseline . Tanner stage 1 girls were considered prepubertal ; Tanner stages 2 and 3 girls were considered early pubertal . We used analysis of covariance ( adjusting for baseline bone values , change in size , age , and maturity ) to compare 7-month change in bone mineral content , areal bone mineral density , and volumetric bone mineral density between C and I groups within prepubertal and early pubertal girls . RESULTS There was no difference in 7-month change in bone parameters between prepubertal I and C groups . Early pubertal girls in the I group gained 1.5 % to 3.1 % more bone at the femoral neck and lumbar spine than early pubertal girls in the C group ( P < .05 ) ; gain at other sites did not differ . CONCLUSIONS In girls , early puberty may be a particularly opportune time during growth for simple exercise interventions to have a positive effect on bone health Process evaluation complements outcome evaluation by providing data to describe how a program was implemented , how well the activities delivered fit the original design , to whom services were delivered , the extent to which the target population was reached , and factors external to the program that may compete with the program effects . The process evaluation system used in the Child and Adolescent Trial for Cardiovascular Health ( CATCH ) is presented in this paper . The conceptual model underlying the CATCH process evaluation system is described , and process measures and data collection protocol s are review ed . Functions of process evaluation data in the trial include : ( 1 ) describing the implementation of the program , ( 2 ) quality control and monitoring , and ( 3 ) explaining program effects . The importance of incorporating process evaluation into final outcome analyses and assessment s of program impact is emphasized This study examined the feasibility of implementing an innovative theater-based after-school program , ' Ready . Set . ACTION ! ' , to reach ethnically diverse and low-income children and their parents with obesity prevention messages . The study population included 96 children and 61 parents . Children were in fourth to sixth grade and 41 % were overweight at baseline .  Program impact was evaluated with a pre/post-r and omized controlled study design , but a major focus was placed on the process evaluation conducted in the intervention schools . Intervention children and parents reported high program satisfaction and that they had made changes or intended to make positive changes in their behaviors due to program participation . However , few meaningful differences between the intervention and control conditions were found at follow-up . Thus , the combined process and impact evaluation results suggest that the intervention was effective in leading to increased awareness of the need for behavioral change , but was not powerful enough on its own to lead to behavioral change . From this feasibility study , we concluded that Ready . Set . ACTION ! offers promise as a creative intervention strategy . The next research step may be to incorporate theater-based programs into more comprehensive school-based interventions , with both educational and environmental components , and evaluate program impact BACKGROUND Over the years schools have reduced physical education and recess time in favor of more academic instruction . Due to the drastic rise in obesity levels among children , some states have begun to m and ate minimum amounts of physical activity ( PA ) that school children receive , causing schools to find alternative methods for increasing PA levels . Physical Activity Across the Curriculum ( PAAC ) is a 3-year r and omized clinical trial incorporating moderate-intensity PA in elementary schools to reduce childhood obesity . This paper describes the rational , design , and methods of the PAAC intervention study . METHODS Twenty-two elementary schools were r and omized to either a control or intervention condition . In schools r and omized to the intervention condition ( PAAC ) , regular classroom teachers were taught how to incorporate PA into st and ard academic lessons . Teachers were asked to accumulate 90 - 100 min/week of PAAC each week through out the 3-year study period . Schools r and omized to the control group did not alter their teaching methods . Direct observation of PA levels in the classroom was collected weekly . Height and weight was measured twice a year to calculate BMI . RESULTS Two years of the intervention have been completed and only one school has left the study . The remaining 21 schools are participating in the final intervention year . CONCLUSIONS The results from the PAAC intervention may provide schools with an alternative method to increase PA levels in children and reduce childhood obesity OBJECTIVE A r and omized controlled pilot study to test the hypothesis that increasing preschool children 's  outdoor free play time increases their daily physical activity levels . METHODS Physical activity was assessed by accelerometers for four consecutive school days in thirty-two Latino children ( 3.6+/-0.5 years ) attending a preschool for low-income families . After two days of baseline physical activity assessment , participants were r and omly assigned to an intervention ( RECESS ; n = 17 ) or control ( CON ; n = 15 ) group . The RECESS group received two additional 30-minute periods of outdoor free play time per day for two days . The CON group followed their normal classroom schedule . Between group differences in physical activity variables were tested with a Wilcoxon rank-sum test . RESULTS There were no statistically significant differences between groups in changes from baseline in average total daily ( CON , 48.2+/-114.5 ; RECESS , 58.2+/-74.6 ) and during school day ( CON , 64.6+/-181.9 ; RECESS , 59.7+/-79.1 ) counts per minute , or total daily ( CON , 0.4+/-1.3 ; RECESS , 0.3+/-0.8 ) and during school day ( CON , 0.6+/-2.1 ; RECESS , 0.5+/-0.8 ) percent of time spent in moderate to vigorous physical activity . CONCLUSIONS Substantially increasing preschoolers '  outdoor free play time did not increase their physical activity levels PURPOSE 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 . METHODS A r and omized 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 r and omized to intervention or control conditions for the 6-month study period . Objective ly 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 . RESULTS 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 . CONCLUSION 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 OBJECTIVES We sought to assess the effects of a school-based intervention program on cardiovascular disease risk factors in urban girls . METHODS We compared heart health knowledge , health behaviors , cardiovascular risk factors , and physical fitness among a group of 442 multiethnic teenaged girls ( 310 experimental participants vs 132 control participants ) . Testing was conducted before and after a 12-week program of vigorous exercises integrated with lectures and discussion s on diet , exercise , stress , and smoking . RESULTS Significant differences in body fat , systolic and diastolic blood pressure , heart health knowledge , and whether breakfast was eaten were observed between experimental participants and control participants . CONCLUSIONS An integrated program of exercise and heart health-related lectures and discussion s had a beneficial effect on health knowledge , health behaviors , and onset of risk factors for coronary artery disease among urban girls OBJECTIVE This paper describes the development of an after-school obesity-prevention program for African-American girls , and presents findings from a 12-week pilot trial conducted by the University of Minnesota . This study was part of the GEMS project , created to test interventions design ed to reduce excess weight gain in African-American girls . DESIGN Two-arm parallel group , r and omized controlled trial . Measures were taken at baseline and at 12 weeks follow up . SETTING An after-school community program . PARTICIPANTS Fifty-four African-American girls , 8- to 10-years of age , and their parents/caregivers . INTERVENTION The after-school intervention was conducted twice a week for 12 weeks , and focused on increasing physical activity and healthy eating .  A family component was also included . Girls in the control group received a program over 12 weeks unrelated to nutrition and physical activity . OUTCOMES Measures included height and weight ( body mass index ) , percent body fat ( DEXA ) , physical activity , assessed using a CSA accelerometer and self-report , two 24-hour dietary recalls , and psycho-social and demographic variables . Parental data included demographic and psycho-social characteristics , and dietary measures . Additionally , process evaluation data on the intervention were collected . RESULTS Recruitment goals were met . After adjustment for baseline level , follow-up BMI did not differ between the treatment groups , an expected finding , given that this was a pilot study . At 12 weeks follow up , differences between the intervention and control groups were in the hypothesized direction of change for most variables , among both the girls and their parents . Process evaluation results demonstrated that the program was well attended , and well received , by girls and parents . CONCLUSIONS An after-school obesity prevention program for low-income African-American girls is a promising model for future efforts This study compared the physical and psychological effects of running to those of the normal physical education program of activities among 154 fourth , fifth , and sixth grade rs who were r and omly assigned to conditions within a true experimental design . The running program consisted of three 30-min sessions per week for 12 weeks in lieu of attendance in regular physical education classes . Findings showed that although boys tended to run faster than girls overall and that older children run faster than younger children , running-program participants performed better on an 800-m run , had lower pulse rates , and performed better on a test of creativity than did regular physical education participants . Running boys had less body fat , and running girls had more creative involvement in class . No differences were found on 50-m dash performance or perceptual skill . On total behavior , girls were more self-controlled than boys , and self-concept tended to become less positive with increased grade level .  Running performance  for 800 m persisted for 5 months among boys in the treatment , but not among girls . Running was judged effective for enhancing the cardiorespiratory health and creativity of school children OBJECTIVE The aim of this study was to evaluate the efficacy and feasibility of the Physical Activity Leaders ( PALs ) program . PALs is an obesity prevention program for low-active adolescent boys from disadvantaged schools . METHODS The study was conducted in the Hunter Region , New South Wales ( NSW ) , Australia from June to December 2009 . Four disadvantaged secondary schools were r and omized to treatment conditions for the 6-month study period . Participants were 100 adolescent boys [ mean ( SD ) age=14.3(0.6 ) years ; BMI = 22.1 kg/m(-2 ) ( 4.6 ) ; BMI z-score=0.6 ( 1.2 ) ] . The primary outcome was change in BMI and secondary outcomes were body fat ( bioelectrical impedance analysis ) , waist circumference , muscular fitness ( leg dynamometer , 90º push-up test and 7-stage sit-up test ) , physical activity ( 5-days of pedometry ) and selected dietary behaviors . RESULTS Significant group-by-time interaction effects were found for BMI ( mean difference=-0.8 kg/m(-2 ) , p<0.001 , d = 0.7 ) , BMI z-score ( mean difference=-0.2 , p<0.001 , d=0.7 ) , and body fat ( mean difference=-1.8 % , p<0.05 , d=0.5 ) , but not for waist circumference , muscular fitness or physical activity . Participants in the intervention group reduced their consumption of sugar-containing beverages . CONCLUSIONS The PALs program was a feasible and efficacious approach to induce healthy weight loss in adolescent boys from disadvantaged secondary schools The relative effectiveness of a structured physical fitness program was compared with that of the customary organized activities for fifth grade students . The level of fitness was compared at the beginning and end of the nine-month academic year as well as after the three-month summer recess during which time no structured program was offered . The experimental group showed significant improvement over the control group in flexibility , strength and endurance during the school year ; part of that improvement was maintained over the summer months ; the physical fitness program had a positive influence on the general activity level of the students and was adopted by nine of the other 10 classrooms in the experimental school Type 2 diabetes is increasing among youth , with minority youth at highest risk . This preliminary study tested the feasibility of a school-based program to prevent  type 2 diabetes in youth at risk . Forty-one participants ( age 12.6 + /- 1.1 years ; 63 % female , 51 % African American , 44 % Hispanic , and 5 % Caucasian ) were r and omly assigned to one of two groups . Both the experimental and control groups received nutrition education and exercise training . The experimental group also received coping skills training . Data collected included body mass index ( BMI ) , insulin resistance , dietary intake ( 24-Hour Food Recall ) , self-efficacy ( Health Behavior Question naire ) , activity ( Revised Godin-Shepard Activity Survey ) , and parents ' health promoting behaviors ( Health Promoting Lifestyle Profile III ) . At baseline  BMI ranged from 27 to 53 ( M = 36.2 + /- 6.0 ) , and 95 % ( n = 39 ) demonstrated insulin resistance or pre-diabetes  on an oral glucose tolerance test . After 12 months , the experimental group showed trends in improved usual food choices ( p = .1 ) and increased dietary knowledge ( p = .3 ) . They also demonstrated lower glucose ( p = .07 ) and insulin levels ( p = .2 ) . Experimental group parents demonstrated improved health responsibility ( p = .03 ) , healthier nutrition choices ( p = .05 ) , improved stress management skills ( p = .05 ) , increased activity ( p = .2 ) , and increased spirituality ( p = .2 ) . Data suggest a school-based program tailored to multiethnic youth may prove successful in helping these youth increase activity , improve nutrition status , and stabilize glucose and insulin metabolism , and also may be effective in changing parent health behavior Objective : Early menarche is a risk factor for breast cancer . Since body composition influences age at menarche we decided to estimate the effects of a school-based intervention for the prevention of obesity on the initiation of menses in young girls . Methods : Ten schools were r and omized to a modified curriculum or no curricular changes for 2 school-years . Data of 508 pre-menarcheal girls at baseline ( age range : 10–13 years ) were analyzed . Results : Girls attending an intervention school experienced menarche less frequently than girls attending control schools during the intervention period ( intervention schools = 54 % , control schools = 59 % ; RR = 0.76 ; 95 % CI [ 0.66 , 0.87 ] ) . Attending an intervention school was also associated with lower increase in BMI ( −0.3 kg/m2 ; p = 0.003 ) , lower gains in triceps skinfold thickness ( −1.5 mm ; p = 0.007 ) , decreased television viewing ( −0.6 h/day ; p<0.0001 ) and increased physical activity ( 3.1 MET-h/week ; p = 0.032 ) . Including these changes as predictors of menarche incidence attenuated the intervention effect ( RR = 0.94 ; 95 % CI [ 0.80 , 1.10 ] ) . Conclusions : The intervention delayed menarche in this group of girls . The delay was produced by increased physical activity , reduced television viewing and changes in BMI and fat distribution . These findings may have implication s for the primary prevention of breast cancer The primary responsibility for engaging children in opportunities to be physically active and learn physical skills rests with school physical education . This study evaluated the effects of a combined health-related curriculum and inservice program on the quantity and quality of  elementary school  physical education lessons . Seven schools ( N = 28 fourth- grade classes ) in one district were r and omly assigned to one of three conditions : 10 classes were taught in their usual manner by classroom teachers ( Control [ CO ] ) ; 10 classes were taught by trained classroom teachers ( TT ) who received inservice training and follow-up consultations ; and  8 classes were taught by physical education specialists ( PES ) hired by the research project .  Student activity level , curriculum context , and teacher behavior were directly observed and coded during a sample of 112 lessons over an 8-month period . Results indicated significant differences in both the frequency and mean length of classes ( PES , 26.7 min ; TT , 23.4 min ; CO , 18.9 min ) . Additionally , the curriculum and inservice program equipped trained classroom teachers to provide significantly better classes than were provided by controls in terms of student activity engagement , lesson context , and active instructional behavior , though their classes did not match the quality of those taught by the physical education specialists . This study is unique in its use of direct observation of lessons to assess a curriculum and inservice intervention This article reports the development and exploratory testing of a school-based intervention programme design ed 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 r and omly assigned to an  intervention or control group ( N = 291 ) . Primary outcome was ‘ moderate to vigorous physical activity ’ ( International Physical Activity Question naire ) 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 result ed 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 . Implication s for theory and for future research are discussed A quasi-experimental , longitudinal study was conducted to test the effectiveness over a 1-year period of a cardiovascular risk reduction program for school-age children . The effectiveness of the program was measured with the children 's knowledge of physiology of the heart and cardiovascular risk factors , their health habits , and their physical measurements .  Ninety-eight children between the ages of 9 and 12 years participated in the study . The experimental group received a series of five 40-minute sessions on physiology of the heart , smoking , hypertension , diet , and physical activity .  Short-term effectiveness of the program was found for the children 's knowledge of physiology of the heart and smoking . Long-term effectiveness was found for running activity This project tests the effectiveness of a family-based health behavior change intervention in two ethnic groups . The aim is to help family members initiate and maintain dietary and physical activity behaviors believed to be linked to risk factors for cardiovascular disease . This paper describes the project and the baseline results . Twelve San Diego elementary schools were r and omly assigned to intervention or control conditions .  Hispanic and Anglo families with a fifth or sixth grade child were recruited to participate in a two-year study . The intervention emphasizes enjoyable experiences design ed to transmit knowledge and skills required for long-term changes in diet and physical activity habits . Groups of families met at schools for 12 weekly sessions and six maintenance sessions distributed throughout the following nine months . Outcome behavioral and physiologic measures will be collected at baseline , three months , 12 months , and 24 months . Differences between Anglo and Mexican-American subjects justify targeted activities specific to these groups OBJECTIVE To evaluate the effects of a comprehensive physical activity ( PA ) promotion programme in elementary schools on children 's total PA levels , leisure-time PA , physical fitness and psychosocial correlates of PA . DESIGN A pre-test-post-test design over two school years . SETTING AND SUBJECTS Sixteen elementary schools ( 764 children , mean age : 11.2 + /- 0.7 years ) were r and omly assigned to the intervention condition ( n = 8) and the control condition ( n = 8) . The intervention included a health-related physical education programme , an extracurricular PA promotion programme and classroom-based PA education lessons . In the total sample , leisure-time PA , psychosocial correlates of PA and physical fitness were measured using a PA question naire and the Eurofit test battery . In a sub- sample , total PA levels were measured using an accelerometer . RESULTS According to accelerometer data , children 's moderate PA and moderate-to-vigorous PA ( MVPA ) levels decreased less in the intervention schools than in the control schools ( P < 0.01 ) . The average time spent on MVPA decreased by 9 min per day in the intervention schools compared with 33 min per day in the control schools . Children in the intervention schools reported significantly more moderate PA in leisure time than the controls ( P < 0.05 ) . No overall improvement of physical fitness and no effects on the psychosocial correlates of PA were found . CONCLUSIONS The comprehensive PA promotion programme was successful in preventing a decline in children 's  total activity levels . Furthermore , the intervention increased children 's PA engagement in leisure time . Therefore , implementation needs to be encouraged BACKGROUND Obesity and poor physical fitness constitute a health problem affecting an increasing number of children . Causes include a pervasive " toxic " environment that facilitates increased caloric intake and reduced physical activity . An effective strategy for prevention and treatment of childhood obesity likely includes a collaborative effort in the school setting . OBJECTIVE To determine whether a school-based fitness program can improve body composition , cardiovascular fitness level , and insulin sensitivity in overweight children . DESIGN Fifty overweight middle school children with a body mass index ( BMI ) above the 95th percentile for age were r and omized to lifestyle-focused , fitness-oriented gym classes ( treatment group ) or st and ard gym classes ( control group ) for 9 months . Children underwent evaluation of  fasting insulin and glucose levels , body composition by means of  dual energy absorptiometry , and maximum oxygen consumption ( V0(2)max ) treadmill testing  at baseline ( before the school year ) and at end of the school year . SETTING S Rural middle school and an academic children 's hospital . MAIN OUTCOME MEASURES Baseline test results for cardiovascular fitness , body composition , and fasting insulin and glucose levels . RESULTS At baseline , there were no differences between groups before intervention ( values for age , 12 + /- 0.5 years [ all results , mean + /- SD ] ; BMI [ calculated as weight in kilograms divided by the square of height in meters ] , 31.0 + /- 3.7 ; percentage of body fat , 36.5 % + /- 4.6 % ; lean body mass , 41.4 + /- 8.6 kg ; and V0(2)max , 31.5 + /- 5.1 mL/kg per minute ) . Compared with the control group , the treatment group demonstrated a significantly greater loss of body fat ( loss , -4.1 % + /- 3.4 % vs -1.9 % + /- 2.3 % ; P = .04 ) , greater increase in cardiovascular fitness ( V0(2)max , 2.7 + /- 2.6 vs 0.4 + /- 3.3 mL/kg per minute ; P<.001 ) , and greater improvement in fasting insulin level ( insulin level , -5.1 + /- 5.2 vs 3.0 + /- 14.3 microIU/mL [ -35.4 + /- 36.1 vs 20.8 + /- 99.3 pmol/L ] ; P = .02 ) . CONCLUSIONS Children enrolled in fitness-oriented gym classes showed greater loss of body fat , increase in cardiovascular fitness , and improvement in fasting insulin levels than control subjects . The modification to the school physical education curriculum demonstrates that small but consistent changes in the amount of physical activity has beneficial effects on body composition , fitness , and insulin levels in children . Partnering with school districts should be a part of a public health approach to improving the health of overweight children Objectives : To examine the effects of a simple and inexpensive physical activity intervention on change in bone mass and structure in school aged children . Methods : Fifty one children ( n = 23 boys and 28 girls ; mean age 10.1 years ) participated in “ Bounce at the Bell ” which consisted of 10 counter-movement jumps 3 × per day ( total ∼3 min/day ) . Controls were 71 matched children who followed usual school practice . We assessed dietary calcium , physical activity , physical performance , and anthropometry in September and after 8 months of intervention ( June ) . We measured bone mineral content ( BMC ) and bone area at the lumbar spine , total body , and proximal femur . Proximal femur scans were also analysed for bone geometry and structural strength using the hip structural analysis program . Lean and fat mass ( g ) were also calculated . Results : Groups were similar at baseline and did not differ in weight , height , total body , lumbar spine , proximal femur , or femoral neck BMC . Control children had a greater increase in adjusted total body BMC ( 1.4 % ) . Intervention children gained significantly more BMC at the total proximal femur ( 2 % ) and the intertrochanteric region ( 27 % ) . Change in bone structural parameters did not differ between groups . Conclusions : This novel , easily implemented exercise program , took only a few minutes each day and enhanced bone mass at the weight bearing proximal femur in early pubertal children . A large , r and omised study of boys and girls should be undertaken powered to test the effectiveness of Bounce at the Bell in children at different stages of maturity , and in boys and girls independently The  Child and Adolescent Trial for Cardiovascular Health  ( CATCH ) was the largest school-based field trial ever sponsored by the National Institutes of Health . The trial demonstrated positive changes in the school food service and physical education program , as well as in students ' cardiovascular health behaviors . Because the CATCH intervention programs were implemented in 56 schools ( in four states ) that were typical of schools throughout the United States , their reception by schools and degree of implementation provide evidence about their feasibility for schools nationally . Extensive process evaluation data were collected from students , teachers , school food service personnel , and physical education specialists throughout the three school years of the CATCH intervention . Four of the CATCH programs — school food service , physical education , classroom curricula , and home programs — were assessed over the three school years . The process data provide information on participation , dose , fidelity , and compatibility of the CATCH programs in the intervention schools for these programs . High levels of participation , dose , fidelity , and compatibility were observed for the four programs during the 3 school years . CATCH emerges as a model of a feasible multilevel health promotion program to improve eating and exercise behaviors for elementary schools in the United States A five-year intervention study of the effectiveness of the " Know Your Body " program in reducing coronary heart disease risk factors among black students in the District of Columbia , who were in grade s 4 - 6 at baseline , was begun in 1983 . Nine schools were stratified on socioeconomic status and r and omly assigned to control and intervention groups . The " Know Your Body " curriculum focuses on nutrition , fitness , and the prevention of cigarette smoking . At baseline , 1,234 students were eligible for the screening in which the following target risk factors were measured : systolic and diastolic blood pressures , ponderosity index , triceps skinfold thickness , postexercise pulse recovery rate , serum total and high density lipoprotein ( HDL ) cholesterol , and serum thiocyanate . After two years of intervention , results indicated that the program may have had a favorable impact on the following risk factors : systolic and diastolic pressures , HDL cholesterol , ratio of total to HDL cholesterol , fitness ( postexercise pulse recovery rate ) , and smoking . Significant net changes in the favorable direction also were found for health knowledge and attitude toward smoking . Blood pressure reduction was associated with decreased ponderosity and improved fitness , and increased HDL cholesterol was associated with decreased ponderosity . These results are consistent with other evaluations of the " Know Your Body " program , suggesting that the program may be effective in reducing chronic disease risk in diverse school population A center-based program was design ed and implemented to promote aerobic physical activity among healthy Black-American families with children in the fifth through seventh grade s. Ninety-four Black-American families were actively recruited and r and omly as signed to an experimental or control group . Families in the experimental group were encouraged to participate in a program with the following features : one education and two fitness sessions per week for 14 weeks ; educational sessions that included individual counseling , small group education , aerobic activity , and snack components ; located in a convenient building cherished by the community ; aerobic activity sessions in a fitness center outfitted and staffed according to modern characteristics ; a variety of incentives including free transportation and babysitting and reminders to promote attendance . Per cent participation was low , with about 20 % participating in the desired fitness center sessions by the end of the program . As a result of low participation , no differences were detected beween experimental and control groups on indicators of cardiovascular fitness . In postprogram interviews , conflicts with work and school events were the most commonly reported reasons for nonattendance . We concluded that because of difficulties in at tendance , center-based programs appear to have limited value as the sole modality for intervention in public health programs for promoting physical activity among healthy Background : High-intensity progressive resistance training ( PRT ) improves adiposity and metabolic risk in adults , but has not been investigated in children within a r and omized controlled trial ( RCT ) . Objective : We hypothesized that high-intensity PRT ( 8 weeks , twice a week ) would decrease central adiposity in children , as assessed via waist circumference . Methods Design / Setting / Participants : Concealed r and omization stratified by age and gender was used to allocate rural New Zeal and school students to the wait-list control or PRT group . Intervention : Participants were prescribed two sets ( eight repetitions per set ) of 11 exercises targeting all the major muscle groups at high intensity . Primary Outcome : Waist circumference ; secondary outcomes included whole body fat , muscular fitness ( one repetition maximum ) , cardiorespiratory fitness ( peak oxygen consumption during a treadmill test ) , lipids , insulin sensitivity and fasting glucose . Results : Of the 78 children ( 32 girls and 46 boys ; mean age 12.2(1.3 ) years ) , 51 % were either overweight ( 33 % ) or obese ( 18 % ) . High-intensity PRT significantly improved waist circumference ( mean change PRT −0.8 ( 2.2 ) cm vs + 0.5 ( 1.7 ) cm control ; F=7.59 , P=0.008 ) , fat mass ( mean change PRT + 0.2 ( 1.4 ) kg vs + 1.0 ( 1.2 ) kg control ; F=6.00 , P=0.017 ) , percent body fat ( mean change PRT –0.3 (1.8)% vs + 1.2 (2.1)% control ; F=9.04 , P=0.004 ) , body mass index ( mean change PRT −0.01 ( 0.8 ) kg m−2 vs + 0.4 ( 0.7 ) kg m−2 control ; F=6.02 , P=0.017 ) , upper body strength ( mean change PRT+11.6(6.1 ) kg vs + 2.9(3.7 ) kg control ; F=48.6 , P<0.001 ) and lower body strength ( mean change PRT + 42.9(26.6 ) kg vs + 28.5(26.6 ) kg control ; F=4.72 , P=0.034 ) compared to the control group . Waist circumference decreased the most in those with the greatest baseline relative strength ( r=−0.257 , P=0.036 ) , and greatest relative ( r=−0.400 , P=0.001 ) and absolute ( r=0.340 , P=0.006 ) strength gains during the intervention . Conclusion : Isolated high-intensity PRT significantly improves central and whole body adiposity in association with muscle strength in normal-weight and overweight children . The clinical relevance and sustainability of these changes in adiposity should be addressed in future long-term studies OBJECTIVE To assess the effect of lifestyle intervention over 2 years on changes in weight , coronary heart disease ( CHD ) risk factors , and incidence of diabetes in overweight individuals with a parental history of diabetes . RESEARCH DESIGN AND METHODS Participants ( n = 154 ) , who were 30–100 % over ideal body weight , had one or both parents with diabetes , and were currently nondiabetic , were r and omly assigned to 2-year treatments focused on diet ( decreasing calories and fat intake ) , exercise ( goal of 1,500 kcal/week of moderate activity ) , or the combination of diet plus exercise or to a no-treatment control group . Subjects were reassessed at 6 months , 1 year , and 2 years . RESULTS At 6 months , the groups differed significantly on measures of eating , exercise , and fitness ; weight losses in the diet and diet-plus-exercise groups were significantly > in the exercise and control conditions . Weight losses were associated with positive changes in CHD risk factors . After 6 months , there was gradual deterioration of behavioral and physiological changes , so that at 2 years , almost no between-group differences were maintained . Differences between groups in risk of developing diabetes were of borderline significance ( P = 0.08 ) . Strongest predictors were impaired glucose tolerance at baseline , which was positively related to risk of developing diabetes , and weight loss from baseline to 2 years , which was negatively related ; in all treatment groups , a modest weight loss of 4.5 kg reduced the risk of type 2 diabetes by ∼ 30 % compared with no weight loss . CONCLUSIONS Although initially successful , the interventions studied here were not effective in producing long-term changes in behavior , weight , or physiological parameters . However , weight loss from 0 to 2 years reduced the risk of developing type 2 diabetes . Since modest weight loss significantly reduced risk of type 2 diabetes , further research is needed to determine how best to increase the percentage of subjects achieving at least a modest weight loss The purpose of this study was to investigate the effect of Self-testing activities on the development of fundamental movement skills in first- grade children in Greece . Two groups of children were tested . The Control group ( n = 23 children ) received the regular 12-wk . physical education school program and the Experimental group ( n = 22 children ) received a 12-wk . skill-oriented program with an increasing allotment of self-testing activities . The Test of Gross Motor Development was used to assess fundamental movement skills , while the content areas of physical education courses were estimated with an assessment protocol , based on the interval recording system called the Academic Learning Time-Physical Education . A 2 × 2 repeated measures analysis of variance with group as the between factor and testing time ( pretest vs posttest ) as the repeated- measures factor was performed to assess differences between the two groups . A significant interaction of group with testing time was found for the Test of Gross Motor Development total score , with the Experimental group scoring higher then the Control group . A significant main effect was also found for test but not for group . This study provides evidence supporting the notion that a balanced allotment of the self-testing and game activities beyond the usual curriculum increases the fundamental motor-skill development of children . Also , it stresses the necessity for content and performance st and ards for the fundamental motor skills in educational programs . Finally , it seems that the Test of Gross Motor Development is a useful tool for the assessment of children  's fundamental movement skills Studies of the health effects of a daily physical activity programme have been carried out in 10-year-old school children in Adelaide , South Australia . In the first phase ( 1978 ) observations on endurance fitness , four skin folds , blood pressure and blood lipids were made before and after a r and omized trial over a period of 14 weeks . Comparisons were made on over 500 children drawn from classes in seven Primary schools involved in an endurance fitness programme ( 1 1/4 hours per day ) , a skill programme and the previous physical education programme ( controls ) .  The fitness group experienced significant gains in physical work capacity ( PWC ) and showed significant decreases in body fat compared to the other two groups . No significant differences were observed in plasma cholesterol , triglycerides and HDL cholesterol . Subsequently in the second phase ( 1980 ) observations were made on a group of 216 10-year-old children who had already experienced two years of the physical activity programme adopted after phase one . Comparison with the observations in the 10-year-old children in 1978 made prior to the intervention revealed significantly smaller skin folds and greater PWC , with lower blood pressure reaching statistical significance for diastolic pressure in boys . The findings suggest beneficial effects on health of daily physical activity programmes within existing primary school curricula . There was no evidence of any loss of academic performance as measured by arithmetic and reading tests in spite of 45 - 60 minutes ' loss of formal teaching time each day A five-year intervention study of the feasibility and effectiveness of a program aim ed at the primary prevention of chronic disease was initiated in 1980 among children in 22 elementary schools in the Bronx , New York . Schools r and omly were assigned either to the intervention program or to a control group . The intervention program consists of a curriculum focusing on nutrition , physical fitness , and cigarette smoking prevention . The study population at baseline comprised 2,283 fourth- grade rs . Subjects were eligible at baseline and at one-year follow-up for participation in a medical examination in which the following target risk factors were measured : systolic and diastolic blood pressures , plasma total and high-density lipoprotein ( HDL ) cholesterol , serum thiocyanate , ponderosity index , triceps skinfold thickness , and postexercise pulse recovery rate . After one year of intervention , systolic pressure increased less in the intervention group than among controls . Diastolic pressure decreased in both groups , but more in the intervention subjects than in controls . Total cholesterol decreased in the intervention group while increasing among controls . Significant net changes in the favorable direction also were observed for total cholesterol/HDL cholesterol ratio and for thiocyanate . These observations indicate that it is feasible to implement a school-based program aim ed at the primary prevention of chronic disease . The intervention program appears to have had a favorable effect on several target risk factors . Although the effects were relatively small , intervention programs in schools may prove to be effective in lowering chronic disease risk OBJECTIVE To assess the feasibility , acceptability , and potential efficacy of a school-based obesity prevention program among adolescent boys with sub-optimal cardiorespiratory fitness . METHODS In 2007 , a 6-month , 2-arm parallel group , r and omized 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 r and omly 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 , objective ly measured physical activity and small screen recreation time . RESULTS 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 ) . CONCLUSIONS This study verified the feasibility , acceptability and potential efficacy of a multifaceted school-based intervention to prevent unhealthy weight gain among adolescent boys BACKGROUND As overweight continues to rise among children , schools seek effective and sensitive ways to engage parents in promoting healthy weight . OBJECTIVE To evaluate a school-based health report card on the family awareness of and concern about the child weight status , plans for weight control , and preventive behaviors . DESIGN Quasi-experimental field trial with a personalized weight and fitness health report card intervention ( PI ) , a general-information intervention ( GI ) , and a control group ( CG ) . Outcomes were assessed using a postintervention telephone survey , including process and outcome measures . PARTICIPANTS The intervention included 1396 ethnically diverse students at 4 elementary schools in an urban area . Telephone surveys were completed by 399 families from an evaluation sample of 793 . Intervention Families were r and omly assigned to the PI , GI , or CG and mailed intervention material s. The CG was mailed GI material s after the survey . MAIN OUTCOME MEASURES Parent awareness of child weight status , concerns , weight-control plans , and preventive behaviors . Group effects were significantly different by the child 's weight status , so results were stratified . RESULTS Among overweight students , intervention parents were more likely to know their child 's weight status ( PI , 44 % ; GI , 41 % ; CG , 23 % ) ( P = .02 ) . The PI parents planned medical help ( PI , 25 % ; GI , 7 % ; CG , 9 % ) ( P = .004 ) , dieting activities ( PI , 19 % ; GI and CG , < 5 cases ) ( P = .02 ) and physical activities ( PI , 42 % ; GI , 27 % ; CG , 13 % ) ( P<.001 ) for their overweight children . No group effect on concern or preventive behaviors was detected . Most parents of overweight children who read material s requested annual weight and health information on their child ( PI , 91 % ; GI , 67 % ) . CONCLUSIONS Among overweight children , the PI was associated with increased parental awareness of their child 's weight status . Although parents wanted PI for their children , more research is needed to test this approach on children 's self-esteem and plans for weight control UNLABELLED This 16-month r and omized , controlled school-based study compared change in tibial bone strength between 281 boys and girls participating in a daily program of physical activity ( Action Schools ! BC ) and 129 same-sex controls . The simple , pragmatic intervention increased distal tibia bone strength in prepubertal boys ; it had no effect in early pubertal boys or pre or early pubertal girls . INTRODUCTION Numerous school-based exercise interventions have proven effective for enhancing BMC , but none have used pQCT to evaluate the effects of increased loading on bone strength during growth . Thus , our aim was to determine whether a daily program of physical activity , Action Schools ! BC ( AS ! BC ) would improve tibial bone strength in boys and girls who were pre- ( Tanner stage 1 ) or early pubertal ( Tanner stage 2 or 3 ) at baseline . MATERIAL S AND METHODS Ten schools were r and omized to intervention ( INT , 7 schools ) or control ( CON , 3 schools ) . The bone-loading component of AS ! BC included a daily jumping program ( Bounce at the Bell ) plus 15 minutes/day of classroom physical activity in addition to regular physical education . We used pQCT to compare 16-month change in bone strength index ( BSI , mg2/mm4 ) at the distal tibia ( 8 % site ) and polar strength strain index ( SSIp , mm3 ) at the tibial midshaft ( 50 % site ) in 281 boys and girls participating in AS ! BC and 129 same-sex controls . We used a linear mixed effects model to analyze our data . RESULTS Children were 10.2+/-0.6 years at baseline . Intervention boys tended to have a greater increase in BSI ( + 774.6 mg2/mm4 ; 95 % CI : 672.7 , 876.4 ) than CON boys ( + 650.9 mg2/mm4 ; 95 % CI : 496.4 , 805.4 ) , but the difference was only significant in prepubertal boys ( p=0.03 for group x maturity interaction ) . Intervention boys also tended to have a greater increase in SSIp ( + 198.6 mm3 ; 95 % CI : 182.9 , 214.3 ) than CON boys ( + 177.1 mm3 ; 95 % CI : 153.5 , 200.7 ) . Change in BSI and SSIp was similar between CON and INT girls . CONCLUSIONS Our findings suggest that a simple , pragmatic program of daily activity enhances bone strength at the distal tibia in prepubertal boys . The precise exercise prescription needed to elicit a similar response in more mature boys or in girls might be best addressed in a dose-response trial BACKGROUND Previous research suggests motivation , enjoyment , and self-efficacy may be important psychosocial factors for underst and ing physical activity ( PA ) in youth . While previous studies have shown mixed results , emerging evidence indicates relationships between psychosocial factors and PA may be stronger in boys than girls . This study exp and s on previous research by examining the effects of motivation , enjoyment and self-efficacy on PA in underserved adolescent ( low income , ethnic minorities ) boys and girls . Based on previous literature , it was hypothesized the effects of motivation , enjoyment and self-efficacy on  moderate-to-vigorous PA ( MVPA )  would be stronger in boys than in girls . METHODS Baseline cross-sectional data were obtained from a r and omized , school-based trial ( Active by Choice Today ;  ACT ) in underserved 6th grade rs ( N=771 girls , 651 boys ) . Intrapersonal variables for PA were assessed via self-report and confirmatory factor analyses were conducted for each predictor .  MVPA  was assessed with 7-day accelerometry estimates . RESULTS Multivariate regression analyses stratified by sex demonstrated a significant positive main effect of self-efficacy and motivation on MVPA for girls . Boys also showed a positive trend for the effect of motivation on MVPA . CONCLUSIONS The results from this study suggest motivation and self-efficacy should be better integrated to facilitate the development of more effective interventions for increasing PA in underserved adolescents BACKGROUND Physical inactivity is a risk behavior for cardiovascular and other diseases . Schools can promote public health objectives by increasing physical activity among youth . METHODS The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) was a multicenter , r and omized trial to test the effectiveness of a cardiovascular health promotion program in 96 public schools in four states . A major component of CATCH was an innovative , health-related physical education ( P+ ) program . For 2.5 years , r and omly assigned schools received a st and ardized PE intervention , including curriculum , staff development , and follow-up . RESULTS Systematic analysis of 2,096 PE lessons indicated students engaged in more moderate-to-vigorous physical activity ( MVPA ) in intervention than in control schools ( P = 0.002 ) . MVPA during lessons in intervention schools increased from 37.4 % at baseline to 51.9 % , thereby meeting the established Year 2000 objective of 50 % . Intervention children reported 12 more min of daily vigorous physical activity ( P = 0.003 ) and ran 18.6 yards more than control children on a 9-min run test of fitness ( P = 0.21 ) . CONCLUSIONS The implementation of a st and ardized curriculum and staff development program increased children 's  MVPA in existing school PE classes in four geographic and ethnically diverse communities . CATCH PE provides a tested model for improving physical education in American schools OBJECTIVE To evaluate the feasibility and effectiveness of a 3-month minimal physical activity ( PA ) intervention  in adolescents . METHODS A r and omised controlled trial , including five secondary schools ( n=87 ) . In the 3-month intervention ( Amsterdam , The Netherl and s , 2005 ) adolescents were provided with a PAM accelerometer , coupled to a web-based tailored PA advice ( PAM COACH ) . Measurements ( i.e. , PA , determinants of PA , aerobic fitness and anthropometrics ) took place at baseline and at 3- and 8-month follow-up . RESULTS Sixty-five percent of the participants in the intervention group reported to have worn the PAM  frequently and 56 % of the PAM users uploaded their PAM scores to the PAM COACH at least once . We found significant differences between groups in favour of the intervention group in moderate intensity PA ( MPA ) for girls after 3 months ( 411 min/week ; 95 % CI : 1 ; 824 ; P=0.04 ) and in sedentary time for boys after 8 months ( -1801 min/week ; 95 % CI : -3545 ; -57 ; P=0.04 ) . CONCLUSIONS Although the process evaluation suggests that a substantial proportion of the participants did not regularly wear the PAM and did not upload information to the PAM COACH website , our findings suggest promising intervention effects on MPA among girls and sedentary time among boys PURPOSE The purpose of this study was twofold : 1 ) to evaluate the effectiveness of a school-based physical activity intervention , Action Schools ! BC ( AS ! BC ) , for maintaining academic performance in a multiethnic group of elementary children , and 2 ) to determine whether boys and girls ' academic performance changed similarly after participation in AS ! BC . METHODS This was a 16-month cluster r and omized controlled trial . Ten schools were r and omized to intervention ( INT ) or usual practice ( UP ) . One INT school administered the wrong final test , and one UP school grade d their own test , so both were excluded . Thus , eight schools ( six INT , two UP ) were included in the final analysis . Children ( 143 boys , 144 girls ) in grade s 4 and 5 were recruited for the study . We used the Canadian Achievement Test ( CAT-3 ) to evaluate academic performance ( TotScore ) . Weekly teacher activity logs determined amounts of physical activity delivered by teachers to students . Physical activity was determined with the Physical Activity Question naire for Children ( PAQ-C ) . Independent t-tests compared descriptive variables between groups and between boys and girls . We used a mixed linear model to evaluate differences in TotScore at follow-up between groups and between girls and boys . RESULTS Physical activity delivered by teachers to children in INT schools was increased by 47 min x wk(-1 ) ( 139 + /- 62 vs 92 + /- 45 , P < 0.001 ) . Participants attending UP schools had significantly higher baseline TotScores than those attending INT schools . Despite this , there was no significant difference in TotScore between groups at follow-up and between boys and girls at baseline and follow-up . CONCLUSION The AS ! BC model is an attractive and feasible intervention to increase physical activity for students while maintaining levels of academic performance BACKGROUND Pathways was the first multicenter American-Indian school-based study to test the effectiveness of an obesity prevention program promoting healthy eating and physical activity . METHODS Pathways employed a nested cohort design in which 41 schools were r and omized to intervention or control conditions and students within these schools were followed as a cohort ( 1,704 third grade rs at baseline ) . The study 's primary endpoint was percent body fat . Secondary endpoints were levels of fat in school lunches ; time spent in physical activity ; and knowledge , attitudes , and behaviors regarding diet and exercise . Quality control ( QC ) included design of data management systems which provided st and ardization and quality assurance of data collection and processing . Data QC procedures at study centers included manuals of operation , training and certification , and monitoring of performance . Process evaluation was conducted to monitor dose and fidelity of the interventions . Registration and tracking systems were used for students and schools . RESULTS No difference in mean percent body fat at fifth grade was found between the intervention and control schools . Percent of calories from fat and saturated fat in school lunches was significantly reduced in the intervention schools as was total energy intake from 24-hour recalls . Significant increases in self-reported physical activity levels and knowledge of healthy behaviors were found for the intervention school students . CONCLUSIONS The Pathways study results provide evidence demonstrating the role schools can play in public health promotion . Its study design and QC systems and procedures provide useful models for other similar school based multi- or single-site studies Overweight and obesity has doubled among children in Australia . There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain . The aims of this paper are to describe a r and omized controlled trial ( ' Switch-Play ' ) developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation . Children from three government primary schools were r and omized by class to one of four conditions : a  behavioural modification group ( BM ; n = 69 ) ; a fundamental motor skills group ( FMS ; n = 73 ) ; a  combined BM and FMS group ( n = 90 ) ; or a control ( usual classroom lessons ) group ( n = 61 ) . Children in the BM group participated in 19 sessions that encouraged them to reduce screen-based behaviours , and identified physical activity alternatives . The FMS group participated in 19 lessons that focused on mastery of six skills : run , throw , dodge , strike , vertical jump and kick . The combined group participated in all the BM and FMS activities . The intervention specialist teacher reported that the children showed high enjoyment and engagement ( 88 % lessons attended ) in most aspects of the programme . At-home tasks were completed by 57 - 62 % of the children , and 92 % completed the in-class tasks . Two-thirds of the children in the BM group participated in the behavioural contracting to switch off the TV . Most of the children reported high enjoyment of the programmes , and only a small proportion ( 7 - 17 % ) reported difficulties in switching off their nominated TV shows . More than half the children reported reducing their TV viewing ; however , less than half reported increasing their physical activity . It was found that most aspects of the intervention arms of the programme were successfully delivered to the majority of children participating in ' Switch-Play ' ; that the programmes were delivered as intended ; and that the programmes were favourably evaluated by participating children and their parents A six-year intervention study of the feasibility and effectiveness of a program aim ed at the primary prevention of coronary heart disease ( CHD ) has been initiated among children in six school districts in Westchester County , New York . Schools r and omly were assigned either to the intervention program or to a control group . The intervention program consists of a curriculum focusing on nutrition , physical fitness , and cigarette smoking prevention . The study population at baseline comprised 1,822 fourth- grade rs . This paper presents the findings at baseline and at one-year follow-up for the following target risk factors : systolic and diastolic blood pressure , plasma total and high-density lipoprotein ( HDL ) cholesterol , serum thiocyanate , ponderosity index , triceps skinfold thickness , and postexercise pulse recovery rate . After one year of intervention , the program was found to be acceptable to school administrators , teachers , parents , and children . Small net changes in the favorable direction were observed for diastolic blood pressure and thiocyanate . Intervention programs in schools may , after sufficient duration , prove to be effective in lowering CHD risk PURPOSE The objective of this investigation was to examine the mechanisms of physical activity and dietary behavior change in the Program X intervention . METHODS Program X involved a clustered r and omized controlled design with six schools ( N=124 participants , mean age=14.1+/-0.8 years ) r and omized to intervention  or control conditions  for the 6-month study period .  Physical activity and fruit and vegetable consumption  were assessed using  pedometers and question naires , respectively . The theoretical framework of the intervention was assessed using structural equation modeling , mediation , and moderation analyses . RESULTS The model explained 56 % of the variance in physical activity at 6-months , but did not represent a good fit to the data , chi(2)=87.43 , df=19 , p < .001 . The model explaining fruit and vegetable consumption explained 31 % of the variance and provided a good fit to the data , chi(2)=12.40 , df=10 , p=.259 . None of the variables satisfied the criteria for mediation or moderation in the physical activity model , but gender moderated the effects of intervention on fruit and vegetable consumption . CONCLUSIONS None of the hypothesized mediators were responsible for behavior change in the Program X intervention . Future studies should address the limitations of existing psychosocial scales and continue to explore the mechanisms of behavior change using model testing , mediation , and moderation analyses BACKGROUND Poor nutrition and inactivity are widespread and contribute to the epidemic problem of childhood obesity . This study examined the effectiveness of a school-based pilot program to improve nutrition and activity in elementary ( ES ) and high school ( HS ) students . METHODS The Improving Meals and Physical Activity in Children and Teens ( IMPACT ) school-based curriculum used a train-the-trainer model to improve activity and nutrition . Nine students were recruited from one rural North Carolina high school and trained in the IMPACT curriculum and leadership skills . Four 4th grade classes at a neighboring elementary school were r and omized to receive the IMPACT curriculum delivered by the  HS students over 12 weeks ( two classrooms , 38 students ) versus the st and ard curriculum ( two classrooms , 37 students ) . Pre- and post-intervention surveys were used to assess program effectiveness . RESULTS ES students in the intervention classes reported increased fruit and vegetable intake ( + 0.85 servings/day compared with controls ; p < 0.05 ) and improved knowledge of the food group in which to eat the most servings ( p < 0.01 ) . ES students who participated in the IMPACT curriculum also reported increased intake of calcium-rich foods and grains , though these results were not statistically significant . Similar though nonsignificant improvements in diet behaviors were reported by the HS students who assisted in delivering the 4th grade curriculum . LIMITATIONS Study limitations include small sample size , risk of cross-contamination , and short program duration . CONCLUSIONS ES students who participated in the IMPACT curriculum reported improved dietary behaviors and knowledge . School-based curricula such as IMPACT may help improve nutrition among ES students BACKGROUND Many female adolescents participate in insufficient physical activity to maintain cardiovascular fitness and promote optimal bone growth . This study evaluates the impact of a school-based intervention on fitness , activity , and bone among adolescent females . METHODS Subjects were assigned to an  intervention ( n = 63 ) or comparison ( n = 59 ) group , and underwent assessment s of  cardiovascular fitness ( VO2peak )  , physical activity , body composition , bone mineral density ( BMD ) , bone mineral content ( BMC ) , and serum markers of bone turnover  at baseline and at the end of each of two school semesters . RESULTS The intervention increased physical activity , VO2peak , and BMC for the thoracic spine ( P values < 0.05 ) . Bone turnover markers were not affected . In longitudinal analyses of the combined groups , improvements in cardiovascular fitness predicted increased bone formation ( P < 0.01 ) and bone resorption ( P < 0.05 ) . CONCLUSION A school-based intervention for adolescent females effectively increased physical activity , cardiovascular fitness , and thoracic spine BMC Coronary heart disease continues to be a leading cause of death in adults . Because many risk factors for heart disease make their first appearance in childhood , early intervention is an attractive strategy for this disease . A convenience sample of 58 third grade children participated in a year-long , quasi-experimental study to compare a school-based educational program , HeartPower ! , to the st and ard health education curriculum . Variables examined included knowledge , hypercholesterolemia , obesity , sedentary lifestyle , hypertension , exposure to cigarette smoke , and parental participation . The students who participated in the HeartPower ! Program showed improvement ( p < 0.05 ) in their knowledge of healthy lifestyles . Modest improvements in hypertension and exposure to tobacco smoke were observed . These results indicate that focused instruction on important health issues may be preferable to a broad approach CONTEXT Risk factors for type 2 diabetes mellitus ( T2DM ) include obesity , family history , dyslipidemia , a proinflammatory state , impaired insulin secretory capacity , and insulin resistance . OBJECTIVE The aim of this study was to examine the effects of a 3- to 4-month school-based intervention consisting of health , nutrition , and exercise classes plus an aerobic exercise program on diabetes risk . DESIGN This study was a r and omized before/after controlled trial . METHODS Seventy-three eighth- grade students in a predominantly Hispanic New York City public school were divided into a control group ( studied twice without receiving the intervention ) and an experimental group ( studied before and after the intervention ) . OUTCOME MEASURES We measured body fatness ( bioelectrical impedance ) , insulin sensitivity , beta-cell function ( insulin release in response to an iv glucose load corrected for insulin sensitivity ) , lipid profiles , and circulating concentrations of IL-6 , C-reactive protein , adiponectin , and TNF-alpha . RESULTS Participation in the intervention was associated with significant reductions in body fatness , insulin resistance , and circulating concentrations of C-reactive protein and IL-6 , irrespective of somatotype on enrollment . CONCLUSION Short-term school-based health , nutrition , and exercise intervention is beneficial to all students and affects multiple diabetes risk factors PURPOSE To compare the effectiveness of a Web-based physical activity ( PA ) intervention with identical content delivered in a printed workbook among a sample of adolescent girls . METHODS Participants consisted of 319 girls with home Internet access enrolled in four middle schools within one school district . A r and omized trial design was used to compare changes in PA self-efficacy and intentions after two weeks of exposure to either a Web- or print-based intervention delivered to their home . Self-reported physical activity was assessed as a secondary outcome . Analysis of covariance was conducted to determine changes between the intervention groups while controlling for baseline levels of PA constructs . RESULTS Both Web and print groups had significant changes in physical activity self-efficacy ( Web : t[155 ] = 2.58 , p = .01 ; print : t[156 ] = 3.11 , p = .002 ) and intentions ( Web : t[157 ] = 2.27 , p = .02 ; print : t[159 ] = 6.32 , p < or = .001 ) . The print group demonstrated significantly greater increases in intentions compared with the Web group ( F [ 1,315 ] = 13.53 , p < or = .001 ) . Self-reported physical activity increased significantly in the print group only ( t[159 ] = 3.21 , p = .002 ) . CONCLUSIONS It can not be assumed that new media technologies are superior to traditional media such as print for health communication to adolescents . These results suggest that a printed workbook was more effective than an identical website for increasing physical activity intentions and behavior among a sample of middle school girls Abstract Objectives : To implement a school based health promotion programme aim ed at reducing risk factors for obesity and to evaluate the implementation process and its effect on the school . Design : Data from 10 schools participating in a group r and omised controlled crossover trial were pooled and analysed . Setting : 10 primary schools in Leeds . Participants : 634 children ( 350 boys and 284 girls ) aged 7 - 11 years . Main outcome measures : Response rates to question naires , 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 . Results : 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 question naire 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 , re sources , and support . Intervention children showed a higher score for knowledge , attitudes , and self reported behaviour for healthy eating and physical activity . Conclusion : This programme was successfully implemented and produced changes at school level that tackled risk factors for obesity . What is already known on this topic Prevention of obesity is an increasingly important aspect of health promotion Few trials have investigated school based primary prevention programmes directed at obesity What this study adds The programme was successful in producing school level changes to tackle risk factors for obesity High levels of participation indicated support from schools , staff , parents , and pupils Positive changes were seen in school meals , tuck shops , and playground The aim of this study was to analyse the effects of a high-intensity aerobic training program on different components of physical fitness in adolescents aged 11 to 16 years . The subjects were divided into a  high intensity ( HI ) group ( 243 girls and 260 boys ) and a control ( C ) group ( 21 girls and 27 boys ) . HI and C completed a weekly 3 hour physical education ( PE ) session . Before and after a 10-week period , the two groups performed the European physical fitness test battery ( EUROFIT ) . During these 10 weeks HI spent one hour out of three at a specific PE session . These specific sessions consisted of short intermittent exercises ( 10 seconds ) at 100 to 120 % of maximal aerobic speed . They showed a significant influence on st and ing broad jump ( 2.9 % , P<0.05 , F=4.85 ) , 20 meter shuttle run ( 3.8 % , p0.001 , F=23.21 ) and on the maximal distance covered over 7 min ( 7.6 % , P < 0.001 , F= 14.48 ) . For C there was no improvement in EUROFIT performances . It was concluded that training at high intensity improves not only children 's aerobic fitness but also performance of st and ing broad jump . Well-monitored , adequate intensive training is necessary for a more desirable functional development BACKGROUND A growing awareness of health promotion and positive lifestyle change , coupled with the knowledge that cardiovascular risk has its origins in childhood , has led to the development of health promotion programs in the elementary school . While most school-based programs target specific behaviors or enlist singular intervention modalities , the Heart Smart cardiovascular school health promotion targeted the total school environment with a multidisciplinary approach to prompt the school 's varied institutions to implement changes in curriculum , school lunch , and physical education . METHODS Components of the Heart Smart environmental intervention included : ( a ) a school lunch program providing cardiovascular healthful food choices , reduced in fat by 30 % and in sodium and sugar by 50 % ; ( b ) a physical education program promoting personal fitness and aerobic conditioning ; and ( c ) cardiovascular risk factor screening , measuring fasting lipids and lipoproteins , anthropometrics , and blood pressure .  Changes in cardiovascular risk factor status , school lunch selection s , and exercise performance were compared . RESULTS Screening participants showed greater improvement in health knowledge than non participants . School lunch choices were successfully altered , and children whose lunch choices were cardiovascular healthful evidence d the greatest cholesterol reduction . Improvements in run/walk performance were related in predicted directions to the overall cardiovascular risk profile . Increases in high-density lipoprotein cholesterol were observed at intervention schools . CONCLUSION Observations indicate a relationship between behavior change and physiologic changes achieved in a total school health promotion to reduce cardiovascular risk BACKGROUND 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 . METHODS Twenty-four high schools paired on enrollment size , racial composition , urban , suburban , or rural location , and class structure were r and omized 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 . RESULTS 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 . CONCLUSIONS To our knowledge , this study provides the first evidence from a r and omized 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 design ed to increase physical activity among girls Rates of chronic diseases are high among Black South Africans but few studies have tested cognitive-behavioural health-promotion interventions to reduce this problem . We tested the efficacy of such an intervention among adolescents in a cluster-r and omised controlled trial . We r and omly selected 9 of 17 matched pairs of schools and r and omised one school in each pair to the cognitive-behavioural health-promotion intervention design ed to encourage health-related behaviours and the other to a human immunodeficiency virus (HIV)/sexually transmitted disease ( STD ) risk-reduction intervention that served as the control . Interventions were based on social cognitive theory , the theory of planned behaviour and qualitative data from the target population . Data collectors , blind to participants ’ intervention , administered confidential assessment s at baseline and 3 , 6 and 12 months post-intervention . Primary outcomes were fruit and vegetable consumption and physical activity .  Participants were 1057 grade 6 learners ( mean age = 12.4 years ) , with 96.7 % retained at 12-month follow-up . Generalised estimating equations revealed that averaged over the follow-ups , a greater percentage of health-promotion intervention participants than HIV/STD control participants met 5-a-Day fruit and vegetable and physical activity guidelines . The intervention also increased health-promotion knowledge , attitude and intention , but did not decrease substance use or substance-use attitude and intention . The findings suggest that theory based and context ually appropriate interventions may increase health behaviours among young adolescents in sub-Saharan Africa Objectives : To determine whether a  school obesity prevention project developed in the United States can be adapted for use in Engl and . Methods : A pilot cluster r and omised controlled trial and interviews with teachers were carried out in 19 primary schools in South West Engl and . Participants included 679 children in year 5 ( age 9–10 ) . Baseline and follow-up assessment s were completed for 323 children ( screen viewing ) and 472 children ( body mass index ) .  Sixteen lessons on healthy eating , physical activity and reducing TV viewing were taught over 5 months by teachers . Main outcome measures were hours of screen activities , body mass index , mode of transport to school and teachers ’ views of the intervention . Results : Children from intervention schools spent less time on screen-viewing activities after the intervention but these differences were imprecisely estimated : mean difference in minutes spent on screen viewing at the end of the intervention ( intervention schools minus control schools ) adjusted for baseline levels and clustering within schools was −11.6 ( 95 % CI −42.7 to 19.4 ) for a week day and was −15.4 ( 95 % CI −57.5 to 26.8 ) for a Saturday . There was no difference in mean body mass index or the odds of obesity . Conclusions : It is feasible to transfer this US school-based intervention to UK schools , and it may be effective in reducing the time children spend on screen-based activities . The study has provided information for a full-scale trial , which would require 50 schools ( ∼1250 pupils ) to detect effects on screen viewing and body mass index over 2 years of follow-up Childhood overweight has increased significantly in the past 20 years , with the highest rates noted among Mexican Americans . Schools are an optimal setting for intervention efforts ; however , few programs have demonstrated actual decreases in weight . This study evaluated an intensive school-based program design ed to result in weight reduction for overweight Mexican American children . A total of 71 children ( 32 males , 48 % ) between the ages of 10 and 14 at or above the 85th percentile for body mass index ( BMI ) were r and omized into a six-month intensive intervention ( II ) or self-help ( SH ) condition . Results revealed that children in the II condition significantly reduced their st and ardized BMI ( z BMI ) when compared with the children in the self-help condition ( F(2,62)=6.58 , p=0.003 ) . The change in z BMI was significantly different at both 3 and 6 months ( F(1,63)=5.74 , p=0.019 , F(1,63)=12.61 , p=0.001 , respectively ) with II participants showing greater decreases in weight . The 3-month change in z BMI for the II participants was a decrease of 0.07 compared with a decrease of 0.01 for SH participants . The 6-month change in z BMI was a decrease of 0.11 for II and an increase of 0.03 for SH . Overall , the results are promising , suggesting that an intensive school-based intervention may be an effective means for promoting weight loss in overweight Mexican American children PURPOSE To evaluate the impact of a unique school-based program of exercise , health education , and behavior modification on health knowledge , health behaviors , coronary risk factors , and cardiovascular fitness in minority adolescents . METHODS A total of 346 students from an inner-city public high school participated in health promotion intervention or regular physical education volleyball classes . Subjects were African-American ( 47 % ) , Asian-American ( 9 % ) , Hispanic ( 21 % ) , white ( 3 % ) , and other ( 19 % ) . The health promotion curriculum consisted of 11 weeks of daily circuit training exercise and health lecture- discussion s. RESULTS The groups were similar in age , height , weight , ethnicity , and socioeconomic status . Following intervention both boys ( P < .001 ) and girls ( P < .006 ) significantly improved health knowledge test scores . Significant benefits for girls included improved dietary habits ( P < .05 ) , reduced cholesterol ( P < .004 ) , and higher estimated V(O2)max ( P < .0001 ) . There were no other significant changes in boys . CONCLUSIONS The results suggest that a school-based health promotion program of exercise and health lecture- discussion is beneficial for multiethnic , inner-city adolescents , especially females Childhood obesity may be lessened by parent-focused interventions . A pilot parent-directed trial with 46 parents of overweight and obese elementary school students was conducted at two ethnically diverse public schools in Framingham , Massachusetts . Parents were r and omly assigned to either the Material s Group , which received mailed educational material s , or the Material s plus Personal Encounters Group , which received educational material s through interactions with community health workers ( CHWs ) . Parents completed baseline and post-intervention surveys ; children ’s body mass index ( BMI ) percentiles were measured at baseline and post-intervention . There were no differences in the reduction of children ’s BMI between groups . However , the mean BMI percentile for all children dropped from 94.1 to 90.6 ( p = .005 ) , while there was no change in BMI among a nonr and omized contemporaneous control group . Findings are limited by the lack of a true control group and small sample size . Results from this school nurse and CHW outreach program to parents are encouraging The purpose of this analytical review was to estimate the direct and indirect economic costs of  physical inactivity and obesity in Canada in 2001 . The relative risks of diseases associated with physical inactivity and obesity were determined from a meta- analysis of existing prospect i ve studies and applied to the health care costs of these diseases in Canada . Estimates were derived for both the direct health care expenditures and the indirect costs , which included the value of economic output lost because of illness , injury-related work disability , or premature death . The economic burden of physical inactivity was $ 5.3 billion ( $ 1.6 billion in direct costs and $ 3.7 billion in indirect costs ) while the cost associated with obesity was $ 4.3 billion ( $ 1.6 billion of direct costs and $ 2.7 billion of indirect costs ) . The total economic costs of physical inactivity and obesity represented 2.6 % and 2.2 % , respectively , of the total health care costs in Canada . The results underscore the importance of public health efforts aim ed at combating the current epidemics of physical inactivity and obesity in Canada HEALTHY was a multi-center primary prevention trial design ed to reduce risk factors for type 2 diabetes in adolescents . Seven centers each recruited six middle schools that were r and omized to either intervention or control . The HEALTHY intervention integrated multiple components in nutrition , physical education , behavior change and communications and promotion . The conceptual rationale as well as the design and development of the behavior intervention component are described . Pilot study data informed the development of the behavior intervention component . Principles of social learning and health-related behavior change were incorporated . One element of the behavior intervention component was a sequence of peer-led , teacher-facilitated learning activities known as FLASH ( Fun Learning Activities for Student Health ) . Five FLASH modules were implemented over five semesters of the HEALTHY study , with the first module delivered in the second semester of the sixth grade and the last module in the second semester of the eighth grade . Each module contained sessions that were design ed to be delivered on a weekly basis to foster self-awareness , knowledge , decision-making skills and peer involvement for health behavior change . FLASH behavioral practice incorporated individual and group self-monitoring challenges for eating and activity . Another element of the behavior intervention component was the family outreach strategy for extending changes in physical activity and healthy eating beyond the school day and for supporting the student 's lifestyle change choices . Family outreach strategies included the delivery of newsletters and supplemental packages with material s to promote healthy behavior in the home environment during school summer and winter holiday breaks . In conclusion , the HEALTHY behavior intervention component , when integrated with total school food and physical education environmental changes enhanced by communications and promotional campaigns , is a feasible and acceptable mechanism for delivering age-appropriate social learning for healthy eating and physical activity among an ethnically diverse group of middle school students across the United States BACKGROUND The aim of this study was to determine whether the number of participants with multiple coronary heart disease ( CHD ) risk factors exceeded the number expected from a r and om distribution . METHODS A cross-sectional study of 1020 r and omly selected boys and girls , 9 and 15 years old , was conducted . Risk factors were total cholesterol , HDL-cholesterol , triglyceride , serum insulin , and blood pressure . Physical fitness was assessed from a maximal cycle test and body fat from the sum of four skinfolds . Risk factors selected in the analysis were those related to the metabolic syndrome . RESULTS More participants than expected had four or five CHD risk factors . Four risk factors were found in 3.03 ( 95 % confidence interval ( CI ) : 2.24 - 4.10 ) times as many participants as expected from a r and om distribution and five risk factors were found in 8.70 ( 95 % CI : 4.35 - 17.4 ) times as many participants as expected . Fifty ( 5.4 % ) had four or five risk factors and in these individuals physical fitness was 1.2 st and ard deviation ( SD ) lower and body mass index ( BMI ) 1.6 SD higher than mean values for the population . CONCLUSION Clustering of risk factors for the metabolic syndrome was found in children and adolescents . Low levels of physical fitness and raised BMI in these individuals indicate that lifestyle factors such as physical activity and diet may influence the development of these unhealthy risk profiles BACKGROUND Childhood obesity has become a health problem in urban areas in China . Intervention to reduce childhood obesity should be of high priority . School-based intervention programmes are needed to deal with the growing prevalence of childhood obesity in China . METHODS Five primary schools were selected r and omly for this study in the Beijing urban area in China ; two were allocated to the intervention group and three to the control group . A total of 2425 children ( 1029 children in intervention schools and 1396 children in control schools ) took part in the study for 3 years . In the intervention group , children and their parents were involved in a programme of nutrition education and physical activity . Control school students followed their usual health and physical education curriculum with no extra intervention . RESULTS After the 3-year intervention , the prevalence of overweight and obesity were significantly lower in the intervention schools than in the control schools ( overweight : 9.8 % vs. 14.4 % , P < 0.01 ; obesity : 7.9 % vs. 13.3 % , P < 0.01 ) . The prevalence of overweight and obesity decreased by 26.3 % and 32.5 % in intervention schools respectively after intervention . The prevalence of overweight and obesity increased in control schools . There was also significant difference in body mass index between intervention and control schools ( 18.2 + /- 2.6 vs. 20.3 + /- 3.4 , P < 0.01 ) after intervention . More non-obese children became obese in the control schools ( 7.0 % ) than in the intervention schools ( 2.4 % ) at end line ( P < 0.01 ) . Among the children who were obese at baseline , 49.2 % remained obese at end line in intervention schools while 61.9 % remained obese in control schools ( P < 0.01 ) . CONCLUSIONS Our study showed that an intervention programme could be feasible in schools in Beijing , China . The prevalence of overweight and obesity was reduced in schoolchildren in Beijing through an intervention focused on nutrition education and physical activity . Overweight and obesity children as well as normal weight children and their parents should be involved in such an intervention programme PURPOSE School physical education ( PE ) is highly recommended as a means of promoting physical activity , and r and omized studies of health-related PE interventions in middle schools have not been reported . We developed , implemented , and assessed an intervention to increase physical activity  during middle-school PE classes . METHODS Twenty-four middle schools ( approximately 25,000 students , 45 % nonwhite ) in Southern California participated in a r and omized trial . Schools were assigned to intervention ( N = 12 ) or control ( N = 12 ) conditions , and school was the unit of analysis . A major component of the intervention was a 2-yr PE program , which consisted of curricular material s , staff development , and on-site follow-up . Control schools continued usual programs . Student activity and lesson context were observed in 1849 PE lessons using a vali date d instrument during baseline and intervention years 1 and 2 . RESULTS The intervention significantly ( P = 0.02 ) improved student moderate to vigorous physical activity ( MVPA ) in PE , by approximately 3 min per lesson . Effects were cumulative ; by year 2 intervention schools increased MVPA by 18 % . Effect sizes were greater for boys ( d = 0.98 ; large ) than girls ( d = 0.68 ; medium ) . CONCLUSIONS A st and ardized program increased MVPA in middle schools without requiring an increase in frequency or duration of PE lessons . Program components were well received by teachers and have the potential for generalization to other schools . Additional strategies may be needed for girls This article assessed the effects of a video , “ Dynamotion , ” on children 's  knowledge , self-efficacy , and attitude about physical activity and heart health . A quasi-experimental design was used ; 12 classrooms ( grade s K-2 ) were assigned to intervention ( N = 116 ) or comparison ( N = 92 ) groups . Students completed a 9-item pre- and posttest ; only the intervention group was exposed to the video , during which qualitative assessment s were made . Repeated measures analyses were used to detect changes . Overall , the intervention group had greater gains in knowledge and self-efficacy than did the comparison group ( p < 0.001 ) , and they seemed to enjoy the video . The results suggest that exposure to a short , interactive , educational video may promote health among young children OBJECTIVE Childhood obesity is increasingly being recognized as a major public health problem in the Caribbean . The objective of the present study was to evaluate the effectiveness of a short-term , school-based , multi-component education intervention on improving the knowledge , attitudes and behaviour of primary -school children towards better dietary and activity habits . DESIGN The study was a r and omized , controlled , school-based nutrition education and physical activity intervention . Participating schools were r and omly assigned to the intervention ( IVG ) and non-intervention ( NIVG ) groups . SETTING All primary schools in Sangre Gr and e , north-east Trinidad . SUBJECTS Five hundred and seventy-nine pupils in their sixth year of primary -school education were enrolled from twelve schools in Sangre Gr and e , north-east Trinidad . RESULTS Approximately 23 % of participants had BMI > or= 85th percentile of the Centers for Disease Control and Prevention age- and gender-specific cut-off values . In multivariate regression equations controlling for age , gender , BMI and baseline value , intervention was associated with lower intake levels of fried foods , snack foods high in fat , sugar and salt ( HFSS ) and sodas ( P < 0.05 ) . In similar analyses , intervention was associated with higher knowledge scores ( P < 0.01 ) . Intervention was not significantly associated with physical activity and Children 's Eating Attitude Test-26 ( ChEAT26 ) scores after controlling for age , gender , BMI and the relevant baseline values . CONCLUSIONS The intervention was associated with lower intake levels of fried foods , HFSS foods , sodas and higher knowledge scores independent of age , gender , BMI , ethnicity and the appropriate baseline value . Finally , the intervention was not associated with changes in physical activity behaviours in multivariate analyses OBJECTIVES Atherosclerosis is a disease that begins in childhood ; endothelial dysfunction is its earliest detectable manifestation , and primary prevention strategies are likely to be most effective if instituted early . The aim of this study was to characterize the impact of obesity on vascular function in young children and to determine whether an exercise program improves abnormalities in vascular function . STUDY DESIGN The influence of 8 weeks of exercise training was examined in 14 obese subjects , 8.9 + /- 0.4 years of age , with the use of a r and omized crossover protocol . Conduit vessel endothelial function was assessed by means of high-resolution ultrasound and flow-mediated dilation of the brachial artery ( FMD ) . RESULTS Exercise training did not change subcutaneous fat mass , body weight , or body mass index . FMD in the obese group was significantly impaired relative to matched control subjects at entry ( 6.00 % + /- 0.69 % to 12.32 % + /- 3.14 % , P < .0001 ) . FMD significantly improved with exercise training ( 7.35 % + /- 0.99 % , P < .05 ) in the obese group . CONCLUSIONS Conduit vessel FMD , a vali date d surrogate measure of early atherosclerosis , was impaired in obese children but improved as a result of exercise training . This study supports the value of an exercise program in the treatment of obese children in a primary prevention setting PURPOSE To evaluate the effects of a  middle school physical activity intervention , new in combining an environmental and computer tailored component ; and to evaluate the effects of parental involvement . METHODS A clustered r and omized controlled design was used . A r and om sample of 15 schools with 7th and 8th grade rs was r and omly assigned to one of three conditions : ( a ) intervention with parental support , ( b ) intervention alone , and ( c ) control group . The intervention was new in combining environmental strategies with computer-tailored feedback to increase levels of moderate to vigorous physical activity .  The intervention was implemented by the school staff . Physical activity was measured through a question naire in the total sample and with accelerometers in a sub sample of adolescents . RESULTS The intervention with parental support led to an increase in self-reported school-related physical activity of , on average , 6.4 minutes per day ( p < or = .05 , d = .40 ) . Physical activity of light intensity measured with accelerometers decreased with , on average , 36 minutes per day as a result of the intervention with parental support ( p < or = .05 , d = .54 ) . Physical activity of moderate to vigorous intensity measured with accelerometers significantly increased with on average 4 minutes per day in the intervention group with parental support , while it decreased with almost 7 minutes per day in the control group ( p < or = .05 , d = .46 ) . CONCLUSIONS The physical activity intervention , implemented by the school staff , result ed in enhanced physical activity behaviors in both middle school boys and girls . The combination of environmental approaches with computer-tailored interventions seemed promising We examined the effects of a 7-month jumping intervention ( 10 minutes , 3 times per week ) on bone mineral gain in prepubertal Asian and white boys ( 10.3+/-0.6 years , 36.0+/-9.2 kg ) at 14 schools r and omized to control ( n = 60 ) and intervention ( n = 61 ) groups . Intervention and control groups had similar mean baseline and change in height , weight , lean mass and fat mass , baseline areal bone mineral density ( aBMD ; g/cm2 ) , bone mineral content ( BMC ; g ; dual-energy X-ray absorptiometry [ DXA ] , QDR 4500W ) , and similar average physical activity and calcium intakes . Over 7 months , the intervention group gained more total body ( TB ) BMC ( 1.6%,p < 0.01 ) and proximal femur ( PF ) aBMD ( 1 % , p < 0.05 ) than the control group after adjusting for age , baseline weight , change in height , and loaded physical activity . We also investigated the 41 Asian and 50 white boys ( 10.2+/-0.6 years and 31.9+/-4.4 kg ) who were below the 75th percentile ( 19.4 kg/m2 ) of the cohort mean for baseline body mass index ( BMI ) . Boys in the intervention group gained significantly more TB and lumbar spine ( LS ) BMC , PF aBMD , and trochanteric ( TR ) aBMD ( + approximately2 % ) than boys in the control group ( adjusted for baseline weight , final Tanner stage , change in height , and loaded physical activity ) . Bone changes were similar between Asians and whites . Finally , we compared the boys in the  control group ( n = 16 ) and the boys in the intervention group ( n = 14 ) whose baseline BMI fell in the highest quartile ( 10.5+/-0.6 years and 49.1+/-8.2 kg ) . Seven-month bone changes ( adjusted as aforementioned ) were similar in the control and intervention groups . In summary , jumping exercise augmented bone mineral accrual at several regions equally in prepubertal Asian and white boys of average or low BMI , and intervention effects on bone mineral were undetectable in high BMI prepubertal boys The relation between blood pressure and habitual physical activity during leisure time was investigated in a r and om sample of 272 sixth grade schoolchildren ( mean age , 11.3 years ) who entered secondary school in 1983 in Marano di Napoli , a suburb of Naples , Italy .  Blood pressure , pulse rate , and anthropometry were measured with st and ardized techniques . Physical activity was evaluated by a question naire outlining four levels of physical activity during leisure time . The study provided evidence that a low level of physical activity during leisure time in 11-year-old children is associated with higher systolic blood pressure independent of sex , age , and adiposity . These findings may be relevant to programs of primary prevention of arterial hypertension in early life BACKGROUND PE2GO is a self-contained physical education ( PE ) program that provides classroom teachers with the tools they need to lead developmentally appropriate PE lessons . The purpose of this study was to evaluate the PE2GO pilot programs in 6 school districts across the United States . METHODS We used paper and pencil surveys at pre intervention ( n = 114 ) and mid intervention ( n = 94 ) and an electronic survey at post intervention ( n = 65 ) . In addition an electronic survey was sent to administrators at preintervention ( n = 18 ) ; focus groups were conducted with teachers at mid intervention for a broader perspective . The study took place September 2004 through May 2005 . RESULTS Results indicate that teachers were satisfied with the PE2GO program and the perceived effects it had on their students .  Teachers reported that students increased their time engaged in physical activity ( 128.7 - 181.1 minutes per week pre-to-post intervention ) . Administrator support was important ( ie , associated with improvement ) , but not always present . CONCLUSION In conclusion , the PE2GO program holds promise for the concept of providing in-class physical activity opportunities for students 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 r and omly 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 assessment s 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 setting s. 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 It has been suggested that the low level of effectiveness of youth interventions is due to a lack of knowledge regarding the mechanisms responsible for behaviour change . The identification of behaviour mediators is necessary for the progression of physical activity research , as it allows research ers to determine which components of an intervention are responsible for mediating behaviour change . The purpose of this study was to identify mediators of behaviour change in a physical activity intervention for senior school students . Participants ( n=78 ) were r and omly allocated to control or intervention conditions for a period of 10 weeks .  Moderate-to-vigorous physical activity ( MVPA )  and potential mediators were assessed at baseline and post-intervention ( 10 weeks ) . Hypothesized mediators were derived from B and ura 's Social Cognitive Theory and included : peer support , exercise self-efficacy and outcome expectancy . Mediation was assessed using the product-of-coefficients test described by MacKinnon and colleagues , based on the criteria for mediation identified by Baron and Kenny . While none of the variables satisfied all four criteria for mediation among males or females , self-efficacy was able to satisfy the first three criteria among females in the study . Exercise self-efficacy may be a mediator of physical activity behaviour in adolescent girls The purpose of this paper is to describe the process evaluation model for the classroom curricula of the Child and Adolescent Trial for Cardiovascular Health ( CATCH ) Project . The process evaluation plan specifically targets how much each curriculum was implemented , to what degree it was implemented as design ed , and the barriers to implementation . Additionally , the rationale for each of the process evaluation measures and the instrument development process are presented . Data result ing from these measures will be essential in order to answer questions regarding the internal validity of the main outcomes of the project . Specific examples and sample results are provided from the CATCH third- grade classroom curriculum , which was implemented the first year of CATCH . A discussion also is presented of how the findings from a sample of these measures were used to gain additional insight on the salient features of the curriculum , and how those features may be related to student outcomes A high-impact exercise and a lifestyle intervention were implemented over a 9-week period ; changes in bone and body composition were compared to controls . Sixty-one children volunteered from three r and omly selected schools . Each school was r and omly assigned to either a structured exercise ( STEX ) intervention , a lifestyle intervention ( PASS ) or control ( CONT ) .  Bone mineral content ( BMC ) and density ( BMD ) of total body , femoral neck and lumbar spine were measured as well as fat and lean mass at baseline and post-intervention by dual-energy X-ray absorptiometry . The STEX intervention result ed in an additional mean increase in total body BMC of 63.3 g ( p = 0.019 ) and an additional increase of 0.011 g . cm ( -2 ) ( p = 0.018 ) for BMD over increases observed by controls . Bone mineral increases observed for the PASS intervention were not significant compared to the control group ( p > 0.05 ) . Neither intervention produced significant increases in bone mineral at femoral neck or lumbar spine sites ( p > 0.05 ) compared with the controls . No significant changes were found in fat mass index ( p > 0.05 ) , lean mass index ( p > 0.05 ) or percent body fat ( p = 0.09 ) in any groups . Structured impact exercise promoted significant and clinical ly relevant increases in bone measures , without significant changes to body composition . A larger , definitive r and omised trial is needed to confirm the present results Physical Fitness Index ( PFI ) , of fifty Residential ( Sainik ) School children ( Mean + /- SD , 13.18 + /- 0.48 yrs ) and forty four Non-Residential school children ( Mean + /- SD , 13.15 + /- 0.66 yrs ) of Bijapur , Karnataka , was assessed by Harvard Step Test . Their height ( cm ) , weight ( kg ) , chest circumference ( cm ) , and mid arm circumference ( cm ) were recorded as physical anthropometry . Body Mass Index ( BMI ) was also calculated ( kg/m2 ) . Results indicated that Non-Residential School children had poor physical anthropometry and showed a less PFI score ( Mean + /- SD , 60.56 + /- 13.49 ) , as compared to Residential ( Sainik ) School children ( Mean + /- SD , 85.7 + /- 16.91 ) . Regular physical activity with uniform diet and better physical composition attributed higher physical fitness in the children of Residential ( Sainik ) school in comparison to their sedentary Non-Residential counter part OBJECTIVE To evaluate acceptability , feasibility and effectiveness of computer-tailored physical activity education among adolescents . METHODS Two classes of 7th grade rs from 10 r and omly selected schools were assigned to the intervention ( computer-tailored intervention , n=139 ) or control ( no-intervention , n=142 ) condition . Question naires were completed 1 week before and 3 months after the intervention . The computer-tailored intervention was completed during classes . RESULTS Students had few problems with the diagnostic questions and with the use of a computer . About half of the students evaluated the advice as interesting and easy to underst and and about 40 % as personally relevant , easy to use and credible . Half of students evaluated the advice as too long and only 33 % reported to have used the advice . The computer-tailored intervention was effective for increasing school related physical activity levels with on average 25 min per week ( F=3.4 , P < or = .05 ) , but not for increasing total physical activity or leisure time physical activity . CONCLUSIONS A 1-h computer-tailored intervention offered during class-time has the potential to increase school related physical activity . PRACTICE IMPLICATION S Although favourable effects of large scale implementation may be expected , some adaptations that might increase effectiveness should be investigated in the future The rising tide of obesity erodes the health of youths and many times results in adult obesity . The purpose of this investigation was to examine the effectiveness of an eight-session health promotion/transtheoretical model Internet/video-delivered intervention to increase physical activity and reduce dietary fat  among low-income , culturally diverse , seventh- grade students . Those who completed more than half the sessions increased exercise , t ( 103 ) = -1.99 , p = .05 , and decreased the percentage of dietary fat , t ( 87 ) = 2.73 , p = .008 . Responses to the intervention by stage of change , race , and income are examined The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) is an elementary school cardiovascular health education field trial in progress in San Diego , California , New Orleans , Louisiana , Minneapolis , Minnesota , and Austin , Texas . Because a significant part of a child 's health behaviors are shaped within the home , CATCH is evaluating whether the effects of the school-based program are enhanced by the inclusion of a home-based program . A 7 x 7 x 10 r and omized design with 7 school-only and 7 school-plus-family intervention schools , along with 10 control schools is implemented at each site . The CATCH family intervention is implemented during Grade s 3 through 5 and consists of home-based curricula and Family Fun Nights focusing on healthier eating and increased physical activity during Grade s 3 and 4 , along with a smoking prevention curriculum in Grade 5 . CATCH is examining the effectiveness of family ( household ) involvement through changes in students ' dietary intake of fat and sodium . This paper describes the process evaluation methods used to document the extent of participation in the family program . Data reported for the third- grade Family Fun Nights held in the 28 family schools across all sites reflected an  average student participation rate of 67 % . The average family member to student ratio was approximately 2:1 . Participation by all third- grade teachers and the majority of physical education specialists was observed BACKGROUND The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) was the first multicenter school-based research study to employ the fundamentals of clinical trials including the st and ardized protocol and Manuals of Operation , a steering committee for study governance , a distributed data system , an extensive quality control system , and a Data and Safety Monitoring Board . METHOD CATCH tested the effectiveness of changes in school lunches , physical education , smoking policy , curricula , and family activities . Ninety-six elementary schools in four states were r and omized to intervention or control conditions . The baseline cohort comprised 5 , 106 ethnically diverse third grade rs followed through fifth grade . RESULTS The percentages of calories from fat and saturated fat were reduced significantly more in the intervention school lunches than among the controls . Significant increases in moderate to vigorous activity levels in existing physical education classes were made as well . Changes in self-reported dietary , physical activity , and psychosocial measures were significant . There were no significant differences in the physiological measures . Measurement error was generally low for all physiologic measures except skinfolds , indicating a high level of reliability . Across all sites , the coefficients of variation for lipids , height , and weight were less than 3 % , whereas for skinfolds , they were considerably higher , ranging from 6 to 8 % . Intraclass correlations for lipid studies were also uniformly high at 0.99 . Interobserver agreement scores for SOFIT were greater than 90 % for 9 of the 11 activities observed . Data entry error rates were low with less than five errors per 1,000 fields for all forms . CONCLUSIONS The CATCH results provided more scientific evidence on the importance of schools in the population approach to health promotion . Many of the strategies used in this complex multicenter trial in the areas of design and analysis , measurement , training , data management , and quality control protocol s might be appropriate for adoption in other studies Obese children 8 - 12 years old from 61 families were r and omized to treatment groups that targeted increased exercise , decreased sedentary behaviors , or both ( combined group ) to test the influence of reinforcing children to be more active or less sedentary on child weight change . Significant decreases in percentage overweight were observed after 4 months between the sedentary and the exercise groups ( -19.9 vs. -13.2 ) . At 1 year , the sedentary group had a greater decrease in percentage overweight than did the combined and the exercise groups ( -18.7 vs. -10.3 and -8.7 ) and greater decrease in percentage of body fat ( -4.7 vs. -1.3 ) . All groups improved fitness during treatment and follow-up . Children in the sedentary group increased their liking for high-intensity activity and reported lower caloric intake than did children in the exercise group . These results support the goal of reducing time spent in sedentary activities to improve weight loss Project Energize is a  through-school nutrition and activity programme that is being evaluated in a 2-year , cluster-r and omised , longitudinal study . The present paper describes the background of the programme and study , the programme development and delivery , the study methodology including r and omisation , measurement and analysis tools and techniques , and the mix of the study population . The programme is being delivered to sixty-two primary schools with sixty-two control schools , each limb containing about 11,000 students . The children in the evaluation cohort are 5 or 10 years old at enrolment ; the r and omisation protocol has achieved post-consent enrolment of 3,000 evaluation participants , who are comparable by age , sex and school decile . End-point measures include body composition and associated physical characteristics , fitness , home and school environment and practice In this study , methods of decreasing highly preferred sedentary behaviors were compared and the consequent effects on activity choice were examined . Following free choice of sedentary and physical activities , 34 obese children either were positively reinforced for decreases in high-preference sedentary activity , were punished for high-preference sedentary activity , had access to high-preference sedentary activity restricted , or had no contingencies on activity ( control group ) . Children r and omized to reinforcement and punishment were more physically active on intervention days than the control group . Liking for targeted sedentary activity decreased in the reinforcement group , but increased in the restriction and control groups . Results suggest that reinforcing decreases in high-preference sedentary activity can increase physical activity and decrease liking for targeted sedentary activities OBJECTIVES This study evaluated a health-related physical education program for fourth- and fifth- grade students design ed to increase physical activity during physical education classes and outside of school . METHODS Seven schools were assigned to three conditions in a quasi-experimental design . Health-related physical education was taught by physical education specialists or trained classroom teachers . Students from these classes were compared with those in control classes . Analyses were conducted on 955 students with complete data . RESULTS Students spent more minutes per week being physically active in specialist-led ( 40 min ) and teacher-led ( 33 min ) physical education classes than in control classes ( 18 min ; P < .001 ) . After 2 years , girls in the specialist-led condition were superior to girls in the control condition on abdominal strength and endurance ( P < .001 ) and cardiorespiratory endurance ( P < .001 ) . There were no effects on physical activity outside of school . CONCLUSIONS A health-related physical education curriculum can provide students with substantially more physical activity during physical education classes . Improved physical education classes can potentially benefit 97 % of elementary school students This study evaluated a physical activity intervention for children that comprised peer-modelling , pedometer step goals and tangible rewards . A version of the intervention without the reward component was also tested . Participants ( n = 386 ) were from three primary schools , which were r and omly assigned to one of three conditions : ( i ) full intervention , where children received “ Fit ‘ n ’ Fun Dude ” peer-modelling material s and were given daily pedometer goals to receive rewards , ( ii ) no-rewards intervention , where children received peer-modelling material s and pedometer goals but rewards were not used and ( iii ) control , where children wore pedometers with no further intervention .  Physical activity was measured at baseline , intervention and at the end of a 14-week ‘ taper ’ phase . During the intervention , the full intervention school showed the largest increase in physical activity relative to baseline ( + 2456 steps per day , p < 0.001 ) . There was a smaller increase in the no-rewards school ( + 1033 steps per day , p < 0.03 ) , and no significant change in the control . At the end of the taper phase , physical activity in the no-rewards school continued to increase ( + 2030 steps per day , p < 0.001 ) but had returned to baseline in the full intervention school . The intervention that used only peer-modelling and pedometer goals produced better effects over time BACKGROUND The Child and Adolescent Trial for Cardiovascular Health is a school-based study design ed to test the effectiveness of dietary , physical activity , and educational interventions for reducing cardiovascular disease risk and teaching healthful behaviors to children . METHODS As part of a pilot phase in 1989 , lipid , lipoprotein , and anthropometric measures were taken in black ( n = 90 ) , Hispanic ( n = 68 ) , and white ( n = 265 ) 8- to 10-year-old schoolchildren in California , Louisiana , Minnesota , and Texas . RESULTS There were no significant differences in mean lipoprotein cholesterol values between fasting and nonfasting children . Therefore data from fasting and nonfasting children were pooled . Males and females within the same ethnic groups had similar mean levels of total cholesterol , low-density lipoprotein cholesterol , and very low-density lipoprotein cholesterol . However , levels of high-density lipoprotein cholesterol were higher among white and black males than among females from the same ethnic groups . Black males had higher total cholesterol than white males and higher high-density lipoprotein cholesterol than white males and Hispanic males . Similarly , black females had higher high-density lipoprotein cholesterol than white and Hispanic females . In all children combined high-density lipoprotein cholesterol was inversely correlated and low-density lipoprotein cholesterol was positively correlated with subscapular and tricep skinfold thickness , weight , and body mass index . There were significant differences in mean lipoprotein cholesterol levels between geographic sites . Total cholesterol , low-density lipoprotein cholesterol , and high-density lipoprotein cholesterol were highest in children from California followed by children from Texas , Minnesota , and Louisiana . CONCLUSION Our results suggest that body fatness total cholesterol , low-density lipoprotein cholesterol , and high-density lipoprotein cholesterol differ in children by gender , ethnicity , and geographic location PURPOSE To describe longitudinal changes in  leisure-time sedentary behavior  among girls , during early to mid-adolescence . METHODS A 2.5-year prospect i ve cohort study , comprising 5 data collection s , 6 months apart , between 2000 and 2002 . Girls aged 12 - 15 years ( n = 200 ) from 8 high schools located in Sydney , Australia , self-reported the usual time spent each week in a comprehensive range of sedentary behaviors . RESULTS Retention rate for the study was 82 % . Girls aged 12.8 years spent approximately 45 % of their discretionary time in sedentary behavior , which increased to 63 % at age 14.9 years .  Watching TV , videos , and playing video games ( small screen recreation ; SSR ) was the most popular sedentary pastime , accounting for 33 % of time spent in sedentariness , followed by homework and reading ( 25 % ) . Sedentary behavior increased 1.4 and 3.3 hours on week and weekend days , respectively . On weekdays , increased time was spent on hobbies ( 27 min/day ) and on weekend days , increased time was spent sitting around talking with friends ( 60 min/day ) , computer use ( 37 min/day ) , and television viewing ( 34 min/day ) . CONCLUSIONS Among girls , the transition between early and mid-adolescence was accompanied by a significant increase in leisure-time sedentary behavior . Interventions to reduce sedentariness among adolescent girls are best to focus on weekend behaviors . Studies seeking to examine the association between inactivity and the development of chronic health problems need to examine a diverse range of activities that comprehensively measure sedentariness . This information will provide a better underst and ing of inactivity patterns among adolescent girls The effects of regular aerobic exercise on blood concentrations on high‐density lipoprotein cholesterol and prostacyclin were studied in 18 healthy sedentary boys who exercised on a bicycle ergometer for 1 h , four times per week , for 2 months at 75 % of their physical working capacity . The results were compared with those of 10 control boys who did not participate in any specific program . The exercise group revealed a significantly higher mean high‐density lipoprotein cholesterol and 6‐keto‐PGF1a concentration at the end of the training program ( p < 0:005 and p < 0:001 , respectively ) . These results suggest that regular aerobic exercise has beneficial effects upon the high‐density lipoprotein cholesterol and 6‐keto‐PGF1a in healthy young boys and may be beneficial in the long term , by preventing atherosclerosis of coronary artery disease in adulthood The purpose of this study was to determine the feasibility , acceptability , and potential efficacy of a school-based physical activity program delivered during school sport time among adolescent girls from low income predominately linguistically diverse background s in New South Wales , Australia . Using a 3-month , 2-arm , parallel-group pilot RCT design , 38 adolescent girls ( Year 11 ) were recruited to participate in the program and r and omised into intervention ( n=17 ) or control groups ( n=21 ) . The intervention program aim ed to increase physical activity by improving enjoyment , physical self-perception and perceived competence . Baseline and follow-up ( 12 weeks ) assessment s included enjoyment of physical activity , physical self-perception , and objective ly measured physical activity during school sport sessions . Process data were collected through observations of lessons , attendance records , and interviews with participants and staff . Recruitment ( 63 % ) and retention ( 68 % ) goals were less than anticipated but similar to other studies . Participation was higher for the intervention ( 72 % ) than the control ( 60 % ) group and the intervention group reported high levels of satisfaction with the program . At follow-up , girls in the intervention group , compared with the control group , showed greater improvement in their enjoyment of physical activity during school sport ( adjusted mean difference=3.8 , 95 % Confidence Interval [ CI ] -2.4 , 10.1 ; Cohen 's d=0.42 st and ard deviation units ) and body image ( adjusted difference mean=1.0 , 95 % CI -0.4 , 2.3 ; d=0.50 ) . There was a smaller decline in participation in physical activity during school sport ( adjusted mean=13.6 , 95 % CI -21.8 , 48.9 ; d=0.24 ) . This study highlights major barriers confronting adolescent girls ' participation in school sport . Some of these include teacher attitudes and support , activities and programming , purpose and distinction , and student input . Negotiating these barriers and overcoming them in a school setting appears feasible with support from the entire school community BACKGROUND : Childhood obesity is an important , potentially modifiable risk factor for a range of concurrent and later morbidities . Despite concerns about recent increases in children 's body mass index ( BMI ) , supporting data in Australia ( as elsewhere ) are scant . OBJECTIVE : To seek anthropometric evidence of a recent secular increase in BMI in primary school children in Victoria , Australia . DESIGN : Data from two cross-sectional population -based surveys  of primary school children ( the Victorian sub sample of the 1985 Australian Health and Fitness Survey and the 1997 Health of Young Victorians Study ) were compared . Similar stratified r and om sampling and st and ardized measurement methods were employed in the two studies . Subjects were all children aged 7–12 y with complete height and weight data .  Body mass index ( BMI ( weight/height2 ) ) was used as the index of relative adiposity . Non-parametric and parametric methods were used to examine the pattern and magnitude of change in BMI over the 12 y interval . RESULTS : Data for 1421 children ( 50 % male , 68 % response ) from the 1985 survey and 2277 children ( 51 % male , 75 % response ) from the 1997 survey were analysed . At all ages , mean height and median weight were greater in 1997 than 1985 for both boys and girls . Median BMI was significantly higher in the 1997 sample for all but 12 y-old girls and for boys aged 7 , 8 and 10 y ( Mann – Whitney U test ) . The magnitude of the overall increase in BMI was estimated using analysis of covariance for log-transformed BMI adjusted for exact age , which indicated an increase of 1.03 kg/m2 for boys and 1.04 kg/m2 for girls ( both P<0.001 ) . Plots of BMI against BMI percentile clearly showed a pattern of higher BMI at any given percentile , especially at the upper percentiles , for all ages and both genders . CONCLUSIONS : Primary school children in Victoria have become more obese over the last decade . Increases in BMI are most marked at the heavier end of the distribution . Lesser increases in median and mean BMI ( confirmed by both parametric and non-parametric statistical models ) may also have major public health implication The effectiveness of a family-based cardiovascular disease risk reduction intervention was evaluated in two ethnic groups . Participants were 206 healthy , volunteer low-to-middle-income Mexican-American and non-Hispanic white ( Anglo-American ) families ( 623 individuals ) , each with a fifth or a sixth- grade child . Families were recruited through elementary schools . Half of the families were r and omized to a year-long educational intervention design ed to decrease the whole family 's intake of high salt , high fat foods , and to increase their regular physical activity . Eighty-nine percent of the enrolled families were measured at the 24-month follow-up . Both Mexican- and Anglo-American families in the experimental groups gained significantly more knowledge of the skills required to change dietary and exercise habits than did those in the control groups . Experimental families in both ethnic groups reported improved eating habits on a food frequency index . Anglo families reported lower total fat and sodium intake . There were no significant group differences in reported physical activity or in tested cardiovascular fitness levels . Significant differences for Anglo-American experimental vs. control adult subjects were found for LDL cholesterol . Significant intervention-control differences ranging from 2.2 to 3.4 mmHg systolic and /or diastolic blood pressure were found in all subgroups . Direct observation of diet and physical activity behaviors in a structured environment suggested generalization of behavior changes . There was evidence that behavior change persisted one year beyond the completion of the intervention program . It is concluded that involvement of families utilizing school based re sources is feasible and effective . Future studies should focus on the most cost-effective methods of family involvement , and the potential for additive effects when family strategies are combined with other school health education programs The prevalence of childhood overweight has increased significantly , with the highest rates noted among Mexican Americans . Many negative health outcomes are associated with overweight ; thus , there is a need for effective weight-loss interventions tailored to this group . This study evaluated 24-month outcomes of a r and omized , controlled trial involving an intensive lifestyle-based weight maintenance program targeting overweight Mexican-American children at a charter school in Houston , Texas . A total of 60 children ( 33 males , 55 % ) between the ages of 10 and 14 at or > 85th percentile for BMI were recruited . Participants were r and omized to an instructor-led intervention ( ILI ) or a self-help ( SH ) program , both aim ed at modifying eating and physical activity behaviors using behavior modification strategies . Changes in participants ' st and ardized BMI ( z BMI ) were assessed at baseline , 1 , and 2 years . Tricep skinfold , total cholesterol , triglycerides , high-density lipoprotein cholesterol , and calculated low-density lipoprotein were assessed at baseline and 1 year . ILI participants showed significantly greater decreases in z BMI at 1 and 2 years ( F = 26.8 , P < 0.001 , F = 4.1 , P < 0.05 , respectively ) compared to SH controls . ILI participants showed greater improvements in body composition , as measured by tricep skinfold ( F = 9.75 , P < 0.01 ) . Children in the ILI condition experienced benefits with respect to total cholesterol ( F = 7.19 , P < 0.05 ) and triglycerides ( F = 4.35 , P < 0.05 ) compared to children in the SH condition . Overall , the school-based intervention result ed in improved weight and clinical outcomes in overweight Mexican-American children , and z BMI was maintained over 2 years Based on self-determination theory , the present study developed and evaluated the utility a school-based intervention to change pupils ’ physical activity intentions and self-reported leisure-time physical activity behaviour . The study evaluated utility of the intervention to promote physical activity participation over a 5-week interval of time . A cluster r and omised design targeting 215 pupils from 10 schools with schools as the unit of r and omisation was adopted ( Male = 106 , Female = 109 , Age = 14.84 , SD = 0.48 ) . Results indicated that pupils who were taught  by autonomy-supportive teachers reported stronger intentions to exercise during leisure time and participated more frequently in leisure-time physical activities than pupils in the control condition . Autonomous motivation and intentions mediated the effects of the intervention on self-reported physical activity behaviour . It is concluded that self-determination theory provides a useful framework for the development of school-based interventions that ultimately affect leisure-time physical activity participation BACKGROUND Physical education ( PE ) lessons are an ideal setting to improve child fundamental movement skills ( FMSs ) and increase physical activity ( PA ) for optimal health . Despite this , few studies have assessed the potential to do both simultaneously . The " Move It Groove It " primary school intervention in New South Wales , Australia , had this opportunity . METHODS A whole school approach to implementation included establishment of school project teams , a teacher " buddy " system , project Web site , teacher training workshops , and small grants for equipment . The quasi-experimental evaluation involved 1,045 year 3 and 4 children ( aged 7 to 10 years ) in nine intervention and nine control rural primary schools ( 53 % boys/47 % girls ) . It utilised pre- and postobservational surveys of ( 1 ) mastery or near mastery levels for each of eight FMSs , ( 2 ) proportion of PE lesson time spent in moderate to vigorous PA ( MVPA ) and vigorous PA ( VPA ) , and ( 3 ) teacher- and lesson-related context ual covariates . Data were analysed by hierarchical logistic multiple regression . RESULTS For FMSs , overall mastery or near mastery level at baseline was 47 % ranging from 22.7 % for the overarm throw among girls to 75.4 % for the static balance among boys . The intervention delivered substantial improvements in every FMS for both genders ranging from 7.2 % to 25.7 % ( 13 of 16 comparisons were significant ) . For PA level , mean MVPA at baseline was 34.7 % . Baseline MVPA for boys was 38.7 % and for girls was 33.2 % . The intervention was associated with a nonsignificant 4.5 % increase in MVPA and a significant 3.0 % increase in VPA . This translates to a gain of < 1 minute of MVPA per average 21-minute lesson . CONCLUSIONS This is the first study to show that by modifying existing PE lessons , significant improvements in FMS mastery can be gained without adversely affecting children 's MVPA and VPA . To increase PA levels , we recommend increasing the number of PE lessons per week PURPOSE To study the effect of exercise volume on pre- and early-pubertal children 's lipid-lipoprotein profile .  METHODS Thirty-four children ( 15 girls ) completed 12 wk of exercise training , preceded by a 12-wk control period . Sixteen ( 7 girls and 9 boys ) expended an additional 422 + /- 5 kJ.kg BM ( LOW , 100 kcal.kg ) , whereas 18 ( 8 girls and 10 boys ) expended an additional 586 + /- 7 kJ.g ( MOD , 140 kcal.kg ) as a result of the training program . They all exercised on three nonconsecutive days per week at 80 + /- 1 % HRpeak . Exercise duration was individualized to match energy expenditure targets . Plasma TG , TC , and HDL-C were measured precontrol , pretraining , and posttraining . LDL-C , TC/HDL-C , and LDL-C/HDL-C were also calculated . RESULTS Group mean lipid-lipoprotein concentrations did not change as a result of training energy expenditure in either of the groups ( P > 0.05 ) . Dietary composition , habitual physical activity , and body composition were also relatively stable over the intervention period ( P > 0.05 ) . In the LOW , but not the MOD group , peak VO2 ( mL.kg.min ) tended to increase over the intervention period ( P = 0.07 ) . Pearson 's product moment correlation analyses indicated that pretraining concentrations of TG , TC , LDL-C , TC/HDL-C , and LDL-C/HDL-C were all related to the small changes seen in the lipid-lipoprotein profile ( P < 0.01 ) . CONCLUSION Additional energy expenditure of 422 or 586 kJ.kg , as a direct result of aerobic exercise training over a 12-wk period , did not cause significant alterations in the lipid-lipoprotein profile  in pre- and early-pubertal children . This may indicate that the exercise volume was insufficient , the lipoprotein profiles of the majority of children in this study were classified as " desirable , " or more likely a combination of these factors PURPOSE Interventions to improve physical activity ( PA )  might be successful when treatments are matched to the requirements of the recipients , in particular to their stage of change . This intervention study examines PA in Chinese high school students whose stage of change at the beginning of the study was identified . METHODS Two minimal interventions ( 1 hour ) were provided : re source communication and strategic planning . We assumed that preintenders would benefit in terms of PA frequency mainly from re source communication , and intenders would benefit from planning . Adolescents were assigned to an experimental and a control group . Moreover , they were divided according to stage ( preintender , intender , actor ) . In the experimental group , each stage group received interventions . The data were analyzed with repeated measures analyses of variance ( N = 534 ) . Stage groups and treatment ( re source communication , planning , and controls ) were chosen as between-subjects factors .  PA frequency was the dependent variable measured at two points in time 4 weeks apart ( pre-post measures ) . RESULTS Preintenders in the re source communication condition improved their activity levels , whereas intenders increased their PA not only in the planning but also in re source communication conditions . Actors maintained their activity independently of the treatment they received , which was in line with the hypotheses . CONCLUSIONS Matching PA interventions for adolescents to at least two stages of change might be a promising approach . Those who are not motivated to exercise benefit from re source -based messages , whereas those who have behavioral intentions benefit from planning BACKGROUND Television viewing has been associated with increased violence in play and higher rates of obesity . Although there are interventions to reduce television viewing by school-aged children , there are none for younger children . OBJECTIVE To develop and evaluate an intervention to reduce television viewing by preschool children . DESIGN R and omized controlled trial conducted in 16 preschool and /or day care centers in rural upstate New York . PATIENTS Children aged 2.6 through 5.5 years . INTERVENTION Children attending intervention centers received a 7-session program design ed to reduce television viewing as part of a health promotion curriculum , whereas children attending the control centers received a safety and injury prevention program . OUTCOME MEASUREMENTS Change in parent-reported child television/video viewing and measured growth variables . RESULTS Before the intervention , the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos , respectively . Afterward , children in the intervention group decreased their television/video viewing 3.1 h/wk , whereas children in the control group increased their viewing by 1.6 h/wk , for an adjusted difference between the groups of -4.7 h/wk ( 95 % confidence interval , -8.4 to -1.0 h/wk ; P = .02 ) . The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33 % to 18 % among the intervention group , compared with an increase of 41 % to 47 % among the control group , for a difference of -21.5 % ( 95 % confidence interval , -42.5 % to -0.5 % ; P = .046 ) . There were no statistically significant differences in children 's growth between groups . CONCLUSIONS This study is the first to show that a preschool-based intervention can lead to reductions in  young children 's television/video viewing . Further research is needed to determine the long-term effects associated with reductions in young children 's television viewing OBJECTIVE . We design ed and tested a novel health promotion program for elementary schools that was based on peer teaching from older to younger schoolchildren ( “ Healthy Buddies ” ) . SUBJECTS AND METHODS . This prospect i ve pilot study compared the effect of our program ( 2–3 hours/week , 21 weeks ) in 2 Canadian elementary schools ( intervention : n = 232 children , the whole school implementing the program ; control : n = 151 ) . Older students ( 4th through 7th grade ) were given direct instruction from 1 intervention teacher and were paired with  younger students ( kindergarten through 3rd grade ) for the whole school year . Students in 4th through 7th grade then acted as teachers for their younger “ buddies . ” All lessons included 3 components of healthy living : nutrition , physical activity , and healthy body image . The students first learned how to be positive buddies and learned the 3 components of a healthy life . Thereafter , they learned how to overcome challenges to living a healthy life . Outcome measures ( intervention and control schools at the beginning and end of the school year ) included vali date d question naires that assessed healthy-living knowledge , behavior and attitude , a 9-minute fitness run , self-competence , body satisfaction , disordered eating symptoms , and anthropometry ( BMI , blood pressure , and heart rate ) . RESULTS . Compared with control students , both older and younger intervention students showed an increase in healthy-living knowledge , behavior , and attitude scores and a smaller increase in systolic blood pressure . BMI and weight increased less in the intervention students in 4th through 7th grade and height more in the intervention students in kindergarten through 3rd grade . CONCLUSIONS . Our student-led curriculum improved knowledge not only in older schoolchildren but also in their younger buddies . It also decreased weight velocity in the older students . Student-led teaching may be an efficient , easy-to-implement way of promoting a healthy lifestyle from kindergarten to 7th grade INTERVENTION The 2 schools were matched on sociodemographic and scholastic variables . One school ( 106 eligible children ) was allocated to implement an intervention to reduce media use  by limiting access to television sets , budgeting watching or playing time , and more selective use or play . Eighteen lessons ( 30 to 50 minutes each ) were incorporated into the st and ard curriculum and taught by regular classroom teachers who received special training . The second school ( 121 eligible children ) received the usual curriculum ( control group ) OBJECTIVE Obesity prevalence among Chilean children is 19.4 % . The present study aim ed to assess the effectiveness of a school-based obesity prevention programme . DESIGN Non-r and omized controlled study . The intervention included activities in nutrition and physical activity , fully applied the first year and partially in the second one . Primary outcomes were BMI Z-score ( BMI Z ) and obesity prevalence ; secondary outcomes were waist circumference and triceps skinfold thickness . Time effects were assessed by changes in BMI -related variables by gender and period ( ANOVA and Tukey test ) , while intervention effects were determined by comparing changes in ( i ) obesity prevalence by gender and period ( PROC GENMOD ) and ( ii ) BMI Z according gender , age and period ( PROC MIXED ) . SETTING Primary schools in the Chilean cities of Casablanca ( intervention group ) and Quillota ( control group ) . SUBJECTS One thous and seven hundred and fifty-nine children from three schools ( intervention group ) and 671 from one school ( control group ) . RESULTS Over the two years , obesity prevalence and BMI Z declined significantly in the intervention group ; from 17.0 % to 12.3 % and 14.1 % to 10.3 % in boys and girls , respectively , and from 0.62 to 0.53 and 0.64 to 0.58 , respectively . In the control group , obesity remained stable at about 21 % and 15 % , while BMI Z increased significantly in the second year . BMI Z declined in both genders and all age categories in the intervention group during the first year ( significant only in younger boys ) . No changes occurred during the summer , while during the second year , BMI Z increased in boys and girls from both groups ( significant only in the younger control boys ) . Obesity declined significantly only in boys during the first year . CONCLUSION Effectiveness was greater in the first school year and more evident in younger boys The purpose of this study was to examine the effect of  parental involvement in a  school-based program about exercise and nutrition .  One fifth grade and one sixth grade class were r and omly assigned to each of the three different treatment conditions , a  school- and -home condition ( n = 45 ) , a  school-only condition  ( n = 43 ) , and a control condition  ( n = 44 ) . In the school- and -home condition , the children 's parents were also asked to participate in nutritional and exercise activities at home as a family " home team . " A multivariate analysis of variance on change scores was completed on the following variables : height , weight , skinfold , sit- and -reach , sit-ups , mile run , exercise knowledge , saturated fat , cholesterol , percent calories from fat , percent calories from carbohydrates , and nutrition knowledge . There was a significant difference among groups . The school- and -home and school-only groups showed significantly greater improvement than the control group but were not significantly different from each other . Univariate analyses on posttest scores indicated that the school- and -home children scored significantly higher than the control group on sit- and -reach flexibility and nutrition knowledge . The results indicate that including the family was primarily effective in facilitating children 's improvements in flexibility and nutrition knowledge rather than in diet and exercise behaviors BACKGROUND School-based study recruitment efforts are both time consuming and challenging . This paper highlights the recruitment strategies employed by the national , multisite Trial of Activity for Adolescent Girls  ( TAAG ) , a study design ed to measure the effectiveness of an intervention to reduce the decline of physical activity levels among middle school-aged girls . TAAG provided a unique opportunity to recruit large cohorts of r and omly sample d girls within 36 diverse middle schools across the United States . METHODS Key elements of the formative planning , coordination , and design of TAAG 's recruitment efforts included flexibility , tailoring , and the use of incentives . Various barriers , including a natural disaster , political tension , and district regulations , were encountered throughout the recruitment process , but coordinated strategies and frequent communication between the 6 TAAG sites were helpful in tailoring the recruitment process at the 36 intervention and control schools . RESULTS Progressively refined recruitment strategies and specific attention to the target audience of middle school girls result ed in overall study recruitment rates of 80 % , 85 % , and 89 % , for the baseline , posttest , and follow-up period , respectively . DISCUSSION The steady increase in recruitment rates over time is attributed to an emphasis on successful strategies and a willingness to modify less successful methods . Open and consistent communication , an increasingly coordinated recruitment strategy , interactive recruitment presentations , and participant incentives result ed in an effective recruitment campaign BACKGROUND The benefits of childhood physical activity include fitness , weight control , and exercise habits that may carry over into adulthood . School physical education is the primary program responsible for training the nation 's youth to be physically active and national objectives call for students to be engaged in moderate-to-vigorous physical activity at least 50 % of class time . The purpose of this study was to determine through systematic observation in a regional sample of elementary and middle schools the amount of moderate-to-vigorous physical activity students obtain during physical education classes . METHODS Twenty elementary schools and 7 middle schools were r and omly sample d from the 355 elementary schools and 117 middle schools in the 20 school districts in Harris County , Texas . In addition , 9 elementary and 6 middle schools that were identified as having excellent physical education programs were sample d purposively to provide a comparison . Seven systematic observations of student 's physical activity were conducted during physical education in each school . RESULTS The average moderate-to-vigorous physical activity in the r and omly selected elementary schools was 8.6 % , significantly less ( P < 0.05 ) than for the r and omly selected middle schools ( 16.1 % ) or for the comparison elementary schools ( 20.6 % ) and middle schools ( 24.0 % ) . CONCLUSIONS The average amount of  physical activity  observed in this regional sample of schools was less than the estimated national average of 27 % and far less than the national recommendation calling for a minimum of 50 % UNLABELLED BACKGROUND . There are strong theoretical reasons for including a family component with a school-based intervention aim ed at eating , activity , and smoking behaviors , but the empirical findings to date are limited and show mixed results . The overall CATCH family intervention added only knowledge and attitudinal effects , but no additional behavioral outcomes . This study provides a dose analysis of the family component of the CATCH study by assessing the effect of the level of adult participation . METHOD This secondary analysis included students who attended a CATCH family intervention school during all 3 years of the study . The extent of the adult-child interaction , the key aspect of the CATCH family intervention , was measured by the number of activity packets that an adult household member completed with the child . Multiple regression analysis was used to assess the association of adult participation with the child 's knowledge , attitudes , and behaviors related to diet and physical activity . RESULTS Statistically significant results suggested that dose effects were found for knowledge and attitudes related to diet and physical activity . These effects were more pronounced for minority and male students . CONCLUSIONS These results suggest that dose response of a family intervention has been shown in the acquisition of positive knowledge and attitudes toward health habit changes . The methodology of dose response can be applied to other health promotion projects The ' active school ' model offers promise for promoting school-based physical activity ( PA ) ; however , few intervention trials have evaluated its effectiveness . Thus , our purpose was to : ( 1 ) describe Action Schools ! BC ( AS ! BC ) and its implementation ( fidelity and feasibility ) and ( 2 ) evaluate the impact of AS ! BC on school provision of PA . Ten elementary schools were r and omly assigned to one of the three conditions : Usual Practice  ( UP , three schools ) ,  Liaison  ( LS , four schools ) or Champion ( CS , three schools ) . Teachers in LS and CS schools received AS ! BC training and re sources but differed on the level of facilitation provided . UP schools continued with regular PA . Delivery of PA during the 11-month intervention was assessed with weekly Activity Logs and intervention fidelity and feasibility were assessed using Action Plans , workshop evaluations , teacher surveys and focus groups with administrators , teachers , parents and students . Physical activity delivered was significantly greater in LS ( + 67.4 min/week ; 95 % CI : 18.7 - 116.1 ) and CS ( + 55.2 min/week ; 95 % CI : 26.4 - 83.9 ) schools than UP schools . Analysis of Action Plans and Activity Logs showed fidelity to the model and moderate levels of compliance ( 75 % ) . Teachers were highly satisfied with training and support . Benefits of AS ! BC included positive changes in the children and school climate , including provision of re sources , improved communication and program flexibility . These results support the use of the ' active school ' model to positively alter the school environment . The AS ! BC model was effective , providing more opportunities for " more children to be more active more often " and as such has the potential to provide health benefits to elementary school children The purpose of this study was to assess whether the magnitude of change in aerobic power was different in boys ( mean age 10.25 + /- 0.50 y ) who followed a high-intensity interval training protocol  , compared to those who followed a moderate-intensity continuous training protocol . Boys were assigned to either a control group ( n = 15 ) , a continuous training group ( n = 10 ) , or an interval training group ( n = 10 ) . They completed peak oxygen uptake tests at baseline and following an 8-week training period . The control group continued with normal activity habits , whilst the continuous training group followed a 20-minute steady-state cycle protocol at 80 - 85 % of the maximal heart rate , and the interval training group completed 30-s sprints on a cycle ergometer , interspersed with active rest periods . The two training protocol s were design ed to incur similar cardiovascular work over the 20 minutes of each training session . Significant increases ( p < 0.05 ) in peak oxygen uptake were noted for both the interval and continuous training groups . The interval training group showed marked pre- to post-increases in both peak oxygen pulse , oxygen pulse at the ventilatory threshold , and ventilatory threshold that were not apparent in the continuous group boys . It would appear that a high-intensity interval protocol confers a different training effect in comparison to continuous steady-state training in boys . Possible mechanisms that underpin these adaptations may include increased blood volume and a concomitant adjustment in stroke volume OBJECTIVE 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 . DESIGN A r and omized , controlled field trial at four sites with 56 intervention and 40 control elementary schools . Outcomes were assessed using prer and omization measures ( fall 1991 ) and follow-up measures ( spring 1994 ) . PARTICIPANTS A total of 5106 initially third- grade students from ethnically diverse background s in public schools located in California , Louisiana , Minnesota , and Texas . INTERVENTION 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 . MAIN OUTCOME MEASURES 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 . RESULTS 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 . CONCLUSION 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 OBJECTIVE To test the efficacy of a health plan-based lifestyle intervention to increase bone mineral density  in adolescent girls . DESIGN Two-year r and omized , controlled trial . SETTING Large health maintenance organization . PARTICIPANTS Girls 14 to 16 years old with body mass index below the national median .  Intervention Behavioral intervention ( bimonthly group meetings , quarterly coaching telephone calls , and weekly self-monitoring ) design ed to improve diet and increase physical activity . MAIN OUTCOME MEASURES Total bone mineral density was measured by dual-energy x-ray absorptiometry . Behavioral outcomes included intake of calcium , vitamin D , soda , and fruits and vegetables ; high-impact and strength-training physical activity ; measures of strength and fitness ; and biomarkers ( osteocalcin and naltrexone ) . RESULTS Compared with control subjects , girls in the intervention group had significantly higher bone mineral density in the spine and trochanter regions during the first study year , which was maintained during the second study year . The naltrexone biomarker demonstrated a greater relative decrease in the intervention group compared with the control group , with nonsignificant changes in osteocalcin consistent with more bone building in the intervention group . Participants in the intervention group reported significantly greater consumption of calcium in both study years , vitamin D in the first year , and fruits and vegetables in both years . We found no effect on soda consumption or target exercise rates . CONCLUSIONS A comprehensive health care-based lifestyle intervention can effectively improve dietary intake and increase bone mineral gains in adolescent girls . To our knowledge , this study is the first to significantly improve bone mass in adolescent girls in a non-school-based intervention . Trial Registration Clinical Trials.gov Identifier : NCT00067600 PURPOSE The study was done to investigate the effects of an exercise program on body composition , cardiopulmonary function and physical fitness in obese children . METHODS Thirty nine children in grade s 4 , 5 , and 6 in elementary school were employed : experimental group(20 ) and control group(19 ) . The subjects in the experimental group participated in an exercise program for 8 weeks , thirty five minutes per session , four times per week . This data was analyzed by ANCOVA and paired t-test . RESULT The Height(F=2.615 , p=0.027 ) of the experimental group was significantly different from the control group . Also , in the experimental group , there were significant differences of height(t=4.79 , p=0.000 ) , cardiac rate(t=-6.461 , p=0.000 ) , body mass index(t=-2.13 p=0.046 ) , muscle strength(t=3.48 , p=0.003 ) , and muscle endurance(t=3.20 , p=0.005 ) . Otherwise , in the control group , there were significant differences of weight(t=2.27 , p=0.036 ) , waist-hip ratio(t=3.16 , p=0.005 ) , and muscle endurance(t=-2.38 , p=0.030 ) . CONCLUSION Jumping rope improved the body composition , cardiopulmonary function , and physical fitness for obese children Abstract The purpose of this study was to evaluate the impact of an extra-curricular school sport programme to promote physical activity among adolescents . One hundred and sixteen students ( mean age 14.2 years , s = 0.5 ) were assigned to an intervention ( n = 50 ) or comparison group ( n = 66 ) . The 8-week intervention involved structured exercise activities and information sessions . Four days of pedometer monitoring and time spent in non-organized physical activity and sedentary behaviours were measured at baseline and post-test . At baseline , participants were classified using steps per day as low-active ( girls < 11,000 , boys < 13,000 ) or active ( girls ≥ 11,000 , boys ≥ 13,000 ) and the effects of the intervention were assessed using these subgroups . Adolescents in the intervention group classified as low-active at baseline increased their step counts across the 8-week intervention ( baseline : 7716 steps/day , s = 1751 ; post-test : 10,301 steps/day , s = 4410 ; P < 0.05 ) and accumulated significantly more steps ( P < 0.05 ) than their peers in the comparison group ( baseline : 8414 steps/day , s = 2460 ; post-test : 8248 steps/day , s = 3674 ; P = 0.879 ) . The results of the present study provide further evidence that physical activity monitoring using pedometers is an effective strategy for increasing activity among low-active adolescents BACKGROUND Of the few exercise intervention studies focusing on pediatric population s , none have confined the intervention to the scheduled physical education curriculum . OBJECTIVE To examine the effect of an 8-month school-based jumping program on the change in areal bone mineral density ( aBMD ) , in grams per square centimeter , of healthy third- and fourth- grade children . STUDY DESIGN Ten elementary schools were r and omized to exercise ( n = 63 ) and control groups ( n = 81 ) . Exercise groups did 10 tuck jumps 3 times weekly and incorporated jumping , hopping , and skipping into twice weekly physical education classes . Control groups did regular physical education classes . At baseline and after 8 months of intervention , we measured aBMD and lean and fat mass by dual-energy x-ray absorptiometry ( Hologic QDR-4500 ) . Calcium intake , physical activity , and maturity were estimated by question naire . RESULTS The exercise group showed significantly greater change in femoral trochanteric aBMD ( 4.4 % vs 3.2 % ; P < .05 ) . There were no group differences at other sites . Results were similar after controlling for covariates ( baseline aBMD change in height , change in lean , calcium , physical activity , sex , and ethnicity ) in hierarchical regression . CONCLUSIONS An easily implemented school-based jumping intervention augments aBMD at the trochanteric region in the prepubertal and early pubertal skeleton BACKGROUND No national policy for health education in schools exists to date in Greece . The first attempt to apply a school-based health education intervention program was launched in 1992 on all 4,171 pupils registered in the first grade in two counties of Crete . The 1,510 pupils registered in a third county served as controls . METHODS The school-based intervention and the seminars organized for parents were primarily aim ed at improving children 's diet , fitness , and physical activity . Pupils in the first grade in a representative sample of 40 schools were examined prior to the intervention program on a variety of health knowledge , dietary , physical activity , fitness , anthropometric , and biochemical indices . The same measurements were taken after 3 years of the program on 288 intervention group and 183 control group pupils . RESULTS Positive serum lipid level changes occurred to a greater extent in the intervention group than the control group . BMI increased less in the intervention group than for controls . The increase in health knowledge and physical activity and fitness levels occurred to a higher extent in the intervention group compared to controls . CONCLUSIONS The short-term changes observed in the present study are markedly encouraging and indicate great potential for progressive improvement . Continuation and expansion of such a program may prove to be beneficial in initiating long-term changes OBJECTIVE To test a classroom-based intervention to reduce cardiovascular disease risk factors in elementary school children . STUDY DESIGN This was a r and omized , controlled field trial in 12 schools across North Carolina , stratified by geographic region and urban/rural setting . Subjects were 1274 third and fourth grade rs ( 48 % boys ) .  The intervention , taught by regular classroom and physical education teachers , provided all children an 8-week exercise program and 8 weeks of classes on nutrition and smoking . Data were analyzed at the school level with survey regression models and at the individual level with multivariate analysis of variance and analysis of covariance models ; 95 % confidence intervals were computed . RESULTS Children in the intervention group had significantly greater knowledge ( 7.9 % more correct ) and a significant increase in self-reported physical activity than children in the control group . Trends for the intervention group were a reduction in total cholesterol level ( -5.27 mg/dl ) , an increase in aerobic power , a reduction in body fat , and smaller rise in diastolic blood pressure than control children . CONCLUSIONS This classroom-based , public health approach improved children 's cardiovascular disease risk profiles ; it is practical and fairly easy to incorporate into the school day . All children directly receive the potential benefits of the intervention without a risk of labeling . This program can improve health knowledge , habits , and health outcomes of young children at a time when health habits are being formed BACKGROUND Cardiovascular risk factors and related behaviors begin during youth . METHODS As part of the Child and Adolescent Trial for Cardiovascular Health , 4,019 children from four states and representing multiple ethnic groups were measured for selected risk factors both at baseline and after 2(1/2 ) years of intervention . Common protocol s were used for both examinations at the four sites . RESULTS Overall , changes in obesity , blood pressure , and serum lipids in the intervention group , compared with the control group , were not statistically significant . Total cholesterol , the primary physiologic outcome measure , decreased by 1.3 mg/dl over time in the intervention group and by 0.9 mg/dl ( P > 0.05 ) in the control group . Different risk factor patterns for boys and girls and among three ethnic groups were noted . CONCLUSIONS Although the school-based program effected significant institutional changes in food service and physical education class and although the children made significant changes in eating and physical activity behaviors , these did not translate to significant changes in risk factors at these ages . These behavioral changes , however , if sustained into adulthood , have the potential to influence cardiovascular risk reduction The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) is a multicenter trial design ed to test the effectiveness of school and family-based cardiovascular health promotion for preadolescents .  CATCH interventions target multiple cardiovascular health behaviors such as dietary intake of fat and sodium , physical activity , and tobacco use . Evaluation includes physiological , psychosocial , behavioral , and process measures . An important aspect of the process evaluation is the assessment of environmental factors and " secular events " in both intervention and control schools that may affect outcomes independently of the CATCH interventions . With such information , CATCH investigators are able to isolate the impact of the CATCH intervention from competing ( non-CATCH ) factors as well as " track " proximal ( i.e. , immediate and short term ) changes related to the intervention that may in turn lead to " distal " ( long-term ) behavior change . The School Health Question naire , the major process evaluation tool for monitoring secular and environmental changes in the schools , is described in detail , and data describing tobacco-related environmental factors and secular events are presented BACKGROUND Prevention of childhood obesity is a public health priority . Parents influence a child 's weight by modeling healthy behaviors , controlling food availability and activity opportunities , and appropriate feeding practice s. Thus interventions should target education and behavioral change in the parent , and positive , mutually reinforcing behaviors within the family . METHODS This paper presents the design , rationale and baseline characteristics of Kids and Adults Now ! - Defeat Obesity ( KAN-DO ) , a r and omized controlled behavioral intervention trial targeting weight maintenance in children of healthy weight , and weight reduction in overweight children . 400 children aged 2 - 5 and their overweight or obese mothers in the Triangle and Triad regions of North Carolina are r and omized equally to control or the KAN-DO intervention , consisting of mailed family kits encouraging healthy lifestyle change . Eight ( monthly ) kits are supported by motivational counseling calls and a single group session . Mothers are targeted during a hypothesized " teachable moment " for health behavior change ( the birth of a new baby ) , and intervention content addresses : parenting skills ( ( e.g. , emotional regulation , authoritative parenting ) , healthy eating , and physical activity . RESULTS The 400 mother-child dyads r and omized to trial are 75 % white and 22 % black ; 19 % have a household income of $ 30,000 or below . At baseline , 15 % of children are overweight ( 85th-95th percentile for body mass index ) and 9 % are obese ( ≥ 95th percentile ) . CONCLUSION This intervention addresses childhood obesity prevention by using a family-based , synergistic approach , targeting at-risk children and their mothers during key transitional periods , and enhancing maternal self-regulation and responsive parenting as a foundation for health behavior change The Healthy Youth Places ( HYP ) intervention targeted increased fruit and vegetable consumption ( FV ) and physical activity ( PA ) through building the environmental change skills and efficacy of adults and youth .  HYP included group training for adult school site leaders , environmental change skill curriculum , and youth-led FV and PA environment change teams . Sixteen schools were r and omized to either implement the HYP program or not . Participants ( N = 1,582 ) were assessed on FV and PA  and hypothesized HYP program mediators ( e.g. , proxy efficacy ) at the end of sixth grade ( baseline ) , seventh grade ( Postintervention Year 1 ) , and eighth grade ( Postintervention Year 2 ) . After intervention , HYP schools did not change in FV but did significantly change in PA compared to control schools . Proxy efficacy to influence school PA environments mediated the program effects . Building the skills and efficacy of adults and youth to lead school environmental change may be an effective method to promote youth PA OBJECTIVES We previously reported significant gains in hip and spine bone mass after 7 months of high-impact training in 89 prepubertal children . Our aim in this investigation was to evaluate the bone response to 7 months of " detraining " in this cohort of children . STUDY DESIGN Seventy-four boys and girls ( n = 37 jumpers , n = 37 controls ) from the original cohort completed follow-up testing .  Bone mineral content ( BMC ; g ) and bone area ( BA ; cm(2 ) ) of the left proximal femoral neck and lumbar spine ( L(1 - 4 ) ) were assessed by dual-energy x-ray absorptiometry . In addition , anthropometric characteristics , Tanner staging , physical activity , and average dietary calcium intake were assessed . RESULTS Over 14 months , jumpers maintained 4 % greater femoral neck BMC and 4 % greater femoral neck BA ( P < .05 and P < .01 , respectively ) than controls . Group differences did not persist at the lumbar spine . CONCLUSION Gains in both BMC and BA at the femoral neck from high-impact jumping were retained after an equivalent period of detraining . We conclude that this simple exercise may be useful in promoting bone growth at the hip and , thus , enhance peak bone mass The present study tested the effect of a school-based physical activity ( PA ) program on quality of life ( QoL ) in 540 elementary school children . First and fifth grade rs were r and omly assigned to a PA program or a no-PA control condition during one academic year . QoL was assessed by the Child Health Question naire at baseline and postintervention . Based on mixed linear model analyses , physical QoL in first grade rs and physical and psychosocial QoL in fifth grade rs were not affected by the intervention . In first grade rs , the PA intervention had a positive impact on psychosocial QoL ( effect size [ d ] , 0.32 ; p < .05 ) . Sub population analyses revealed that this effect was caused by an effect in urban ( effect size [ d ] , 0.38 ; p < .05 ) and overweight first grade rs ( effect size [ d ] , 0.45 ; p < .05 ) . In conclusion , a school-based PA intervention had little effect on QoL in elementary school children Objectives : To evaluate the effectiveness of an intervention to prevent excess weight gain , reduce time spent in screen behaviours , promote participation in and enjoyment of physical activity ( PA ) , and improve fundamental movement skills among children . Participants : In 2002 , 311 children ( 78 % response ; 49 % boys ) , average age 10 years 8 months , were recruited from three government schools in low socioeconomic areas of Melbourne , Australia . Design : Group-r and omized controlled trial . Children were r and omized by class to one of the four conditions : a behavioural modification group ( BM ; n=66 ) ; a fundamental movement skills group ( FMS ; n=74 ) ; a combined BM/FMS group ( BM/FMS ; n=93 ) ; and a control ( usual curriculum ) group ( n=62 ) . Data were collected at baseline , post intervention , 6- and 12-month follow-up periods . Results :  BMI data were available for 295 children at baseline and 268 at 12-month follow-up . After adjusting for food intake and PA , there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls ( −1.88 kg m−2 , P<0.01 ) , which was maintained at 6- and 12-month follow-up periods ( −1.53 kg m−2 , P<0.05 ) . Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention ( adjusted odds ratio (AOR)=0.36 , P<0.05 ) ; also maintained at 12-month follow-up ( AOR=0.38 , P<0.05 ) . Compared with controls , FMS group children recorded higher levels and greater enjoyment of PA ; and BM children recorded higher levels of PA and TV viewing across all four time points . Gender moderated the intervention effects for participation in and enjoyment of PA , and fundamental movement skills . Conclusion : This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA . Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required This exploratory trial evaluates the effect of a structured exercise ( STEX ) or lifestyle intervention ( PASS ) program upon  cardiovascular ( CV ) disease risk factors in children . Sixty-one schoolchildren were r and omly assigned by school to an intervention or control ( CON ) condition . The effect of the STEX ( compared with CON ) was a mean benefit of -0.018 mm for average maximum carotid intimamedia thickness . The PASS intervention did not result in clinical ly important effects , and no other substantial changes were observed . Relatively high probability of clinical ly beneficial effects of the STEX intervention suggests that a larger , definitive r and omized trial with longer follow-up is warranted BACKGROUND 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 . METHODS Six schools were equally r and omized 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 . RESULTS 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 . CONCLUSIONS New Moves was well received and fills a needed niche within school physical education programs . An exp and ed intervention and evaluation is needed to enhance and assess long-term program effectiveness BACKGROUND Childhood obesity has become a growing public health issue in Taiwan . Obese children have risk factors for type 2 diabetes and cardiovascular disease . In this prospect i ve study , we investigated the effect of a twelve-week heart health education and physical activity program on body weight and risk factors for type 2 diabetes and cardiovascular disease . METHODS Subjects were 120 obese fifth grade rs ( 65 boys and 55 girls , aged 10 - 13 years ( mean 10.6 yrs ) , body mass index ( BMI ) at the 95th percentile or more ) and were r and omly assigned to an intervention group ( n=60 ) or control group ( n=60 ) . The intervention group received a twelve-week heart health education and physical activity program , while the control group did not . In both groups , a series of examinations were done at baseline and post-test , including height , weight , BMI , body fat , blood pressure ( BP ) , physical fitness ( 800-meter running test ) , heart health knowledge , and serum biochemistry . Differences for baseline and post-test data were compared between both groups . RESULTS Mean changes in the intervention group versus control group were significant for weight ( P = 0.024 ) , BMI ( P = 0.047 ) , percentage body fat ( P = 0.008 ) , physical fitness ( 800-meter running test ) ( P = 0.025 ) , heart health knowledge ( P = 0.006 ) , total cholesterol ( P = 0.027 ) , triglycerides ( P = 0.018 ) , high-density lipoprotein cholesterol ( HDL-C ) ( P = 0.009 ) , low-density lipoprotein cholesterol ( LDL-C ) ( P = 0.041 ) , sugar ( P = 0.035 ) , insulin ( P = 0.007 ) , and insulin resistance ( HOMA-IR ) ( P = 0.028 ) . At post-test , weight , BMI , body fat , total cholesterol , triglycerides , LDL-C , sugar , insulin and HOMA-IR had decreased , but HDL-C had increased in the intervention group . CONCLUSIONS A classroom-based weight-control intervention provides educational programs to promote cardiovascular health in children . This intervention is simple , practical , and beneficial for elementary school children OBJECTIVES American female adolescents are at high risk of a physically inactive lifestyle that likely leads to health problems later in life . We hypothesized that a brief program of endurance exercise training in female adolescents would result in increased energy expenditure and quantifiable structural and functional adaptations . STUDY DESIGN Forty-four high school girls ( aged 15 to 17 years , none were elite athletes ) enrolled in a 5-day per week anatomy class for 5 weeks and were r and omly assigned to control ( n = 22 ) and training groups . All subjects participated in a 2-hour daily teaching program . During the remaining time ( 2 hours ) , the training group members underwent endurance-type training and control group subjects participated in a computer workshop . The intervention was assessed by ( 1 ) comparison of total energy expenditure between groups with the doubly labeled water technique , ( 2 ) determination of changes in thigh muscle volume by magnetic resonance imaging , and ( 3 ) determination of changes in maximal oxygen uptake by use of respiratory gas exchange responses . RESULTS Total energy expenditure was significantly greater ( 15.3 % ) in the training group compared with the control subjects ( p < 0.003 ) . Five weeks of training led to a 4.3 % + /- 1 % increase in thigh muscle volume ( p < 0.0002 ) and a 12.1 % + /- 3.7 % increase in maximal oxygen uptake ( p < 0.004 ) ; there were no changes in the control group . The training effect was most pronounced in the least fit subjects . CONCLUSIONS Exercise training programs for female adolescents can be successfully integrated into a high school summer curriculum . Quantifiable , substantial structural and functional responses occur with relatively short periods of training . Approximately 60 % of the training response was related to factors independent of muscle size per se . These data may serve to better design physical activity programs for female adolescents OBJECTIVE The aim of this study was to evaluate the efficacy and feasibility of two school-based RT programs to improve muscular fitness and body composition in adolescents . METHODS The study was conducted in Australia from July 2008 to June 2009 . Participants [ n=108 , mean age (SD)=15.0 ( 0.7 ) years ] were r and omized to free weights ( n=37 ) or elastic tubing ( n=41 ) RT groups and a control group was recruited ( n=30 ) . Participants in the RT groups completed 2 sets of 10 - 12 repetitions on 10 exercises for 8 weeks . Waist circumference , body composition ( bioelectrical impedance analysis ) and muscular strength ( bench press and leg press ) were assessed at baseline and posttest . RESULTS Boys ( p<0.001 ) and girls ( p<0.01 ) in both RT groups improved their body composition over the study period . Boys in both RT groups significantly improved both upper and lower body strength and their improvements were significantly greater than changes observed in the control group . Girls in the free weights groups achieved larger improvements in lower body strength compared to the control group ( p<0.05 ) . CONCLUSIONS Free weights and elastic tubing RT are feasible and effective strategies for improving aspects of health-related fitness in adolescents BACKGROUND The Child and Adolescent Trial for Cardiovascular Health is a multisite study of a school-based intervention to reduce or prevent the development of risk factors for cardiovascular disease . The purpose of this paper is to present the evaluation results of the 3-year intervention , focusing upon the psychosocial variables conceptualized as determinants of dietary and physical activity behaviors . METHODS A total of 96 schools across four study sites ( California , Louisiana , Minnesota , and Texas ) were r and omized to two treatment conditions : intervention and control . Pre- and post measurements on the health behavior question naire were collected from over 6,000 students . The data analyses utilized a nested design approach in which schools served as the primary unit of analysis . Repeated- measures multivariate analyses were applied to investigate effect sizes for each determinant and to explore theoretical relationships among the determinants over time . RESULTS The findings indicated sustained significant effects in improved knowledge , intentions , self-efficacy , usual behavior , and perceived social reinforcement for healthy food choices ( P < 0.0001 for these five variables ) after 3 years . Intermittent effects were observed for perceived support and self-efficacy for physical activity . No gender by determinant interaction effects were observed , and girls reported significantly greater perceived reinforcement for healthy eating than did boys . CONCLUSION The CATCH program was effective in changing the psychosocial variables likely to influence a reduction in behavior for cardiovascular disease . The study is significant in that it demonstrates the viability and effectiveness of a sustained multifaceted intervention in a preadolescent population . The results point to a need for greater underst and ing of adolescent developmental issues and the role of community environment ( particularly social support ) in creating effective curricula OBJECTIVE To evaluate the 4-year outcome of a school-based health promotion on weight status as part of the Kiel Obesity Prevention Study ( KOPS ) . RESEARCH METHODS AND PROCEDURES Within a cluster- sample d quasi-r and omized controlled trial , 1764 children at 6 and 10 years of age were assessed between 1996 and 2005 in 32 primary schools in Kiel , North Germany .  Six nutrition units followed by 20-minute running games were performed within the first year at school . Prevalence , incidence , and remission of overweight were main outcome measures . RESULTS The 4-year change in BMI was + 11.6 % , with increases in prevalence of overweight and obesity from 5.2 % to 11.1 % and 3.9 % to 5.1 % , respectively . Cumulative 4-year incidence of overweight and obesity was 9.2 % and 3.1 % , respectively . Intervention had no effect on mean BMI . The effect on prevalence was significant in children from families with high socioeconomic status [ odds ratio ( OR ) , 0.35 ; 95 % confidence interval ( CI ) , 0.14 to 0.91 ] and marginally significant in children of normal-weight mothers ( OR , 0.57 ; 95 % CI , 0.33 to 1.00 ) . Cumulative 4-year incidence of overweight was lower only in intervention children from families with high socioeconomic status ( OR , 0.26 ; 95 % CI , 0.07 to 0.87 ) . Remission of overweight was most pronounced in children of normal-weight mothers ( OR , 5.43 ; 95 % CI , 1.28 to 23.01 ) . Prevalence of underweight was unchanged . The intervention had minor but favorable effects on lifestyle . DISCUSSION A school-based health promotion has sustainable effects on remission and incidence of overweight ; it was most pronounced in children of normal-weight mothers and children from families with high socioeconomic status . There was no effect on obesity . The data argue in favor of additional measures of prevention Physical inactivity and lack of nutritious diets increase children ’s risk of obesity , especially children from low-income and ethnic minority groups . To address this risk , the school-based TAKE 10 ! program was implemented to increase the physical activity and improve the nutrition of K-6th grade students in one public urban school serving a predominantly low-income , Hispanic population . In this study the research ers ( a ) evaluated the program outcomes using the physical activity and nutrition question naires provided with the TAKE 10 ! curriculum material , teacher surveys , observations , and interview data ; ( b ) evaluated the question naires provided with the TAKE 10 ! curriculum material and provided suggestions for modification ; and ( c ) described the experience of a positive partnership among school , university , and community agencies implementing the TAKE 10 ! curriculum . Based on the findings , recommendations are offered for successful physical activity and nutrition health promotion programs for these children Purpose . To determine whether the amount of television ( TV ) watched by participants enrolled in a physical activity intervention  mediates or moderates program effectiveness . Design . Nine-month , controlled , school-based physical activity intervention . Setting . Public high school . Participants . One hundred twenty-two sedentary adolescent females ( mean + st and ard deviation age = 15.04 + 0.79 years ) . Intervention . Supervised in-class exercise , health education , and internet-based self-monitoring . Measures .  Physical activity  by  3-day physical activity recall ; TV viewing  by  self-reports ; cardiovascular fitness  by cycle ergometer . Analysis . T-tests were conducted to examine between-group differences . Linear regression equations tested the mediating or moderating role of TV watching relative to the intervention . Results . TV viewing moderated the intervention 's effect on vigorous activity ; the intervention significantly predicted change in physical activity among high ( β = −.45 ; p < .001 ) , but not among low ( p > .05 ) , TV watchers . TV viewing did not mediate the intervention effect . Conclusions . Consistent with displacement theory , adolescents who watched more TV prior to the intervention showed postintervention increases in vigorous physical activity and concomitant decreases in TV viewing , whereas those who watched less TV showed no change in physical activity or TV viewing After-school programs can be implemented by school nurses to facilitate healthy lifestyle choices in children with the goal of decreasing obesity .  Kids Living Fit ™ (KLF ) , an after-school program design ed by community hospital nurses , was implemented in elementary schools and focused on best lifestyle choices regarding foods consumed and activities chosen for children in grade s 2 through 5 . Study measures included comparison of body mass index ( BMI ) percentiles for age and gender and waist circumference between two self-selected groups composing a total sample size of 185 participants : the KLF intervention group ( n = 80 ) and the no-intervention/ contrast group ( n = 105 ) . The 12-week intervention included a weekly fitness program and monthly dietitian presentations . Participants  completed food and activity diaries and wore pedometers . In pairwise comparisons , the KLF group had a significant decrease in BMI percentile between baseline and follow-up ( −2.3 % ) compared with the contrast group . The KLF group also demonstrated a smaller increase in waist circumference than the contrast group Future Fit was developed to provide a low cost , heart health education and fitness program that could be incorporated readily into existing after-school programs with minimal teacher training and nominal expenditures for equipment and supplies . Participants in the 12-week demonstration project were 55 third and fourth grade students enrolled in after-school programs at four sites , r and omly assigned to experimental and control conditions . Results indicated significant knowledge gains and changes in knowledge , attitude , and behavior at home . These outcomes suggest health and fitness programming in the after-school setting can be an effective complement to the education provided within the school setting OBJECTIVE The Wise Mind pilot study compared the efficacy of an environmental approach for prevention of inappropriate weight gain  in children with an active control condition that used an environmental approach for modifying expectancies related to the use of alcohol , tobacco , and drugs . RESEARCH METHODS AND PROCEDURES A total of 670 second to sixth grade students from four schools were enrolled in the study . The study spanned 2 academic years , and 586 students were available for evaluation at the end of the study . Two schools were r and omly assigned to each treatment arm . The environmental approach for weight gain prevention focused on modification of eating habits and physical activity , and the active control group focused on modification of expectancies related to substance use . RESULTS Using an intention to treat design , the study found no differences in weight gain prevention between the two interventions . The weight gain prevention program was associated with reduction of total caloric intake , reduction of dietary fat intake , reduction of protein intake , and increased physical activity in comparison with the active control group and relative to baseline . These changes in food intake were attributed to changes in food selection s that result ed from modification of school cafeteria menus and food preparation . DISCUSSION The Wise Mind school-based weight gain prevention program induced behavioral changes in healthy eating and physical activity but did not induce significant changes in body weight in comparison with the control arm . Recommendations for future research are provided OBJECTIVES This study evaluated the effects of aerobic exercise physical education on blood pressure in high-risk , predominantly African-American , adolescent girls . METHODS Ninth- grade girls ( n = 99 ) with blood pressure above the 67th percentile were r and omized to 1 semester of aerobic exercise classes or st and ard physical education classes . RESULT The study was completed by 88 girls . At posttest , only members of the aerobic exercise group increased their estimated cardiorespiratory fitness . The aerobic exercise group had a greater decrease in systolic blood pressure than the st and ard physical education group ( P < .03 ) . CONCLUSIONS Aerobic exercise physical education is a feasible and effective health promotion strategy for high-risk adolescent girls OBJECTIVES To assess the impact of a culturally proficient dietary/physical activity intervention on changes in body mass index ( BMI ) ( kg/m 2 ) . STUDY DESIGN R and omized controlled trial ( Hip-Hop to Health Jr. ) conducted between September 1999 and June 2002 in 12 Head Start preschool programs in Chicago , Illinois . RESULTS Intervention children had significantly smaller increases in BMI compared with control children at 1-year follow-up , 0.06 vs 0.59 kg/m 2 ; difference -0.53 kg/m 2 ( 95 % CI -0.91 to -0.14 ) , P = .01 ; and at 2-year follow-up , 0.54 vs 1.08 kg/m 2 ; difference -0.54 kg/m 2 ( 95 % CI -0.98 to -0.10 ) , P = .02 , with adjustment for baseline age and BMI . The only significant difference between intervention and control children in food intake/physical activity was the Year 1 difference in percent of calories from saturated fat , 11.6 % vs 12.8 % ( P = .002 ) . CONCLUSIONS Hip-Hop to Health Jr. was effective in reducing subsequent increases in BMI in preschool children . This represents a promising approach to prevention of overweight among minority children in the preschool years The Trial of Activity for Adolescent Girls ( TAAG ) is a r and omized , multicenter field trial in middle schools that aims to reduce the decline of physical activity in adolescent girls . To inform the development of the TAAG intervention , two phases of formative research are conducted to gain information on school structure and environment and on the conduct of physical education classes . Principals and design ated staff at 64 eligible middle schools were interviewed using the School Survey during Phase 1 . The following year(Phase 2 ) , physical education department heads of the 36 schools selected into TAAG were interviewed . Responses were examined to design a st and ardized , multicomponent physical activity intervention for six regions of the United States . This article describes the contribution of formative research to the development of the physical education intervention component and summarizes the alignment of current school policies and practice s with national and state st and ards OBJECTIVE The objective was to evaluate quality of life ( QOL ) in at-risk-for-overweight and overweight Mexican-American children after participating in 6 months of intensive weight management or self-help . RESEARCH METHODS AND PROCEDURES Eighty sixth- and seventh- grade at-risk-for-overweight ( BMI > or=85th to < 95th percentile ) and overweight ( BMI > or=95th percentile ) Mexican-American children were r and omly assigned to either intensive instructor-led intervention ( ILI ) or self-help ( SH ) . The ILI condition included daily participation for 12 weeks in a school-based program comprised of nutrition education , physical activity , and behavior modification , followed by ongoing monthly maintenance .  QOL was assessed at baseline and 6 months via child self-report PedsQL . QOL outcomes were compared across treatment groups , and the impact of change in z BMI on change in QOL was evaluated . RESULTS Children in the ILI condition not only achieved significantly greater weight loss ( z BMI , -0.13 + /- 0.14 ; p < 0.001 ) but also significantly greater physical QOL improvements than those in the SH condition at 6 months ( p < 0.05 ) . Furthermore , physical QOL increases were associated with z BMI reduction ( p < 0.05 ) . However , neither psychosocial nor total QOL was significantly impacted by intervention or z BMI change . DISCUSSION These findings show that even modest decreases in z BMI after weight management result in improved physical QOL in Mexican-American children . These results illustrate the clear need to include evaluation of QOL in the process of identifying effective weight management programs OBJECTIVES 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 . METHODS A group-r and omized 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 design ed to change the instructional program and the school environment to increase support for physical activity among girls . RESULTS 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 . CONCLUSIONS A comprehensive school-based intervention can increase regular participation in vigorous physical activity among high-school girls We conducted a study of the effectiveness of an educational intervention design ed to modify risk factors associated with coronary heart disease among 3388 children in 37 schools in two demographically dissimilar areas ( the Bronx and Westchester County ) in and around New York City . Schools within each area were r and omly assigned to either intervention or nonintervention groups . In schools targeted for intervention , children in the fourth through eighth grade s were taught a teacher-delivered curriculum focusing on diet , physical activity , and cigarette smoking .  Risk-factor levels were measured in all schools at base line and at four follow-up points . A total of 1769 of the children qualified for analysis of the intervention effect . After five years , the net mean change in plasma levels of total cholesterol was -1.7 mg per deciliter per year ( -0.04 mmol per liter ) ( 95 percent confidence interval , -2.7 to -0.7 mg per deciliter [ -0.07 to -0.02 mmol per liter ] ) in the Westchester County schools , or -8.5 mg per deciliter ( -0.22 mmol per liter ) ( 5.1 percent ) over a period of five years . In the schools in the Bronx , the net mean change was -1.0 mg per deciliter per year ( -0.03 mmol per liter ) ( 95 percent confidence interval , -2.3 to + 0.3 mg per deciliter [ -0.06 to + 0.01 mmol per -2.3 to + 0.3 mg per deciliter [ -0.06 to + 0.01 mmol per liter ] ) , or -5.0 mg per deciliter ( -0.13 mmol per liter ) ( 2.9 percent ) over a period of five years . Favorable trends in dietary intake and health knowledge were also observed , whereas the other targeted risk factors were not significantly altered . If these findings can be replicated , this will suggest that educational programs to modify coronary risk factors are feasible and may have a favorable ( albeit small ) effect on blood levels of cholesterol in children This study examined the efficacy of a school-based exercise and nutrition program with a parent component . Third- grade children ( N = 238 ) from six elementary schools participated in the study , with three schools r and omly assigned to a program group and the other three schools to a control group . The program group received a health-related fitness school-based program and a home program that required parents and children to complete activities and earn points for nutrition and exercise activities . The control group received their traditional physical education and nutrition education program . Univariate analysis of variance on pre- and posttest scores were completed on the following variables : height , weight , body mass index , skinfold , blood cholesterol , mile run , exercise and nutrition knowledge , calories , protein , carbohydrates , total fat , saturated fat , dietary cholesterol , fiber , sodium , percentage of calories from carbohydrates , and percentage of calories from fat . At pretest , the treatment and control groups did not significantly differ on the measures using schools as the unit of analysis . Girls scored significantly higher than boys on skinfold and pretest knowledge . At posttest , the treatment group scored significantly higher than the control group on exercise and nutrition knowledge and significantly lower than the control group on total fat intake , using schools as the unit of analysis . There was no improvement in physiological measures , including blood cholesterol . The study demonstrated that schools can adjust curriculum to meet some health needs of students and achieve modest changes in exercise and nutrition knowledge and diet . The family component of the program provided a practical approach to improving physical activity and nutrition behaviors for elementary school teachers who teach many participants in a crowded curriculum INTRODUCTION There has been a paucity of theory-based interventions to improve health outcomes in overweight adolescents . Therefore , two intervention studies were conducted to : ( a ) determine the feasibility of implementing the Creating Opportunities for Personal Empowerment ( COPE ) Healthy Lifestyles Thinking , Emotions , Exercise , and Nutrition ( TEEN ) program with overweight adolescents ; ( b ) obtain feedback that could be used to refine the program ; and ( c ) examine the preliminary efficacy of the COPE program on the adolescents ' weight and body mass index ( BMI ) . METHOD Phase I and Phase II clinical trials were conducted with 23 overweight teens . The Phase 1 trial used a pre-experimental design with one group of 11 urban adolescents . The Phase 2 trial was conducted with 12 suburban teens using a r and omized controlled pilot study . COPE teens received a 15-session cognitive-behavioral skills building program that included physical activity , while the control group received an attention control program .  Weight change and BMI were the key outcomes . RESULTS COPE teens experienced a significantly greater reduction in weight and BMI than did teens in the control group , who gained weight over time . Although the COPE program was well received by all of the teens , retention of subjects across time and parent involvement in the program were challenges in the urban high school . DISCUSSION These studies provide preliminary data to indicate that the implementation of COPE is feasible and may lead to a reduction in weight and BMI in overweight teens . Implementing COPE within the context of the school day may be more successful in sustaining adolescent involvement in the program versus using an after-school format Our aim was to assess BMC of the hip over 8 yr in prepubertal children who participated in a 7-mo jumping intervention compared with controls who participated in a stretching program of equal duration .  We hypothesized that jumpers would gain more BMC than control subjects . The data reported come from two cohorts of children who participated in separate , but identical , r and omized , controlled , school-based impact exercise interventions and reflect those subjects who agreed to long-term follow-up ( N = 57 ; jumpers = 33 , controls = 24 ; 47 % of the original participants ) .  BMC was assessed by DXA at baseline , 7 and 19 mo after intervention , and annually thereafter for 5 yr ( eight visits over 8 yr ) . Multilevel r and om effects models were constructed and used to predict change in BMC from baseline at each measurement occasion . After 7 mo , those children that completed high-impact jumping exercises had 3.6 % more BMC at the hip than control subjects whom completed nonimpact stretching activities ( p < 0.05 ) and 1.4 % more BMC at the hip after nearly 8 yr ( BMC adjusted for change in age , height , weight , and physical activity ; p < 0.05 ) . This provides the first evidence of a sustained effect on total hip BMC from short-term high-impact exercise undertaken in early childhood . If the benefits are sustained into young adulthood , effectively increasing peak bone mass , fracture risk in the later years could be reduced BACKGROUND During recess , children can be active on a daily basis , making it an important school environmental factor for the promotion of health-related physical activity . The aim of the present study was to investigate the effects of providing game equipment on children 's physical activity levels  during morning recess and lunch break in elementary schools . METHODS Seven elementary schools were r and omly assigned to the  intervention group ( four schools ) , including 122 children ( 75 boys , 47 girls , mean age : 10.8 + /- 0.6 years ) , and to the control group ( three schools ) , including 113 children ( 46 boys , 67 girls , mean age : 10.9 + /- 0.7 years ) .  Children 's activity levels were measured before and three months after providing game equipment , using MTI accelerometers . RESULTS During lunch break , children 's moderate and vigorous physical activity significantly increased in the intervention group ( moderate : from 38 to 50 % , vigorous : from 10 to 11 % ) , while it decreased in the control group ( moderate : from 44 to 39 % , vigorous : from 11 to 5 % ) . At morning recess , providing game equipment was effective in increasing children 's moderate physical activity ( from 41 to 45 % ) , while it decreased in the control group ( from 41 to 34 % ) . CONCLUSION Providing game equipment during recess periods was found to be effective in increasing  children 's physical activity levels . This finding suggests that promoting physical activity through game equipment provision during recess periods can contribute to reach the daily activity levels recommended for good health Research ers assessed the possible moderating effects of school organizational characteristics ( school climate , school health , and job satisfaction ) on outcomes of a  teacher health behavior change program . Thirty-two public schools were matched and r and omly assigned either to treatment or control conditions .  Organizational , dietary , and physiologic data were collected from third to fifth grade teachers over three years . Treatment schools received a  teacher wellness program for two years . Psychometrics of most organizational scales achieved acceptable levels of reliability . Mixed model analyses were conducted to test for moderating effects . Treatment schools with high organizational climate and health scores reported higher fruit and juice and vegetable consumption at Year 2 compared with intervention schools with low scores . Treatment schools with high job satisfaction scores reported higher fruit and juice and lower-fat food consumption at Year 3 compared with intervention schools with low scores . These measures may be used as a tool to assess the environment in which school health promotion programs are presented . Future interventions may need to be tailored to the organizational characteristics of schools Project SPARK evaluates multiple effects of a health-related physical education ( PE ) program for elementary school students . Seven schools were r and omly 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 grade s. Data are available from one cohort of 550 children who were measured in the fall and spring of both grade s.  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 . BMI s 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 The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) is a multisite intervention research study that builds on significant progress made in school health education research in the 1980s . The study has three phases : Phase I deals with study design , intervention , and measurement development , Phase II involves the main trial in 96 schools in four states , and Phase III focuses on analysis . The intervention program targets third-fifth grade students and focuses on multiple cardiovascular health behaviors  , including  eating habits , physical activity  , and  cigarette smoking . Classroom curricula , school environmental change , and family involvement programs are developed for each grade level and behavioral focus . This paper describes Phase II of CATCH with a rationale for cardiovascular health promotion with youth . The process of change that appears to be necessary for school-based health promotion and that will be tested in CATCH are presented as a framework to guide these efforts This investigation ascertained effects of exposing high school students to classroom health-related fitness instruction involving a curriculum focused on the relationship of exercise to cardiorespiratory fitness , body composition , flexibility , strength ( particularly as it relates to abdominal and lower-back muscoskeletal function ) , and muscular endurance . The curriculum included lectures , labs , and readings as part of the physical education course work . Ninety ninth and 10th grade students were assigned r and omly to one of three physical education classes , which met daily for one , 12-week semester . Each class received the same skill-related instruction ; however , the two experimental classes , in lieu of skill activities , were exposed to classroom instruction and readings dealing with health fitness topics on a one or two day per week basis . The third class of students , the control group , was engaged strictly in skill activities daily . Students exposed to health-related fitness classroom instruction displayed significantly more positive attitudes toward physical activity and a better underst and ing of health-related fitness than students who did not receive such information Background : The decline in physical activity levels of young children seems to be combined with a high prevalence of obesity and overweight and a reduction in the participation in organized sport . With the ever-increasing interest in exploring the relationship between physical activity and obesity amongst children , it is important to provide a more precise estimate of both physical activity and body fatness . A significant proportion of previous research on this topic has relied on self-report methods to assess physical activity and body mass index as a proxy for actual body fatness . There is a need to investigate the relationships between physical activity and fatness in children using objective methods . Aim : This study was conducted in order to explore the relationship between  physical activity patterns and percentage body fat amongst a group of primary school children . Subjects and methods : Forty-seven primary school children ( boys , n = 23 ; girls , n = 24 ) participated in this study . They were r and omly selected from children in years 5 and 6 ( 9–11 year olds ) of four schools drawn from the same catchment area in the city of Birmingham , UK . The frequency , intensity and duration of physical activity were determined using continuous heart rate monitoring from 8:30 am to 8:30 pm over three separate days ( two weekdays and one weekend day ) . Percentage body fat was assessed using air displacement plethysmography . Results : Results indicated that 52 % of children did not achieve a single 15-min bout of sustained moderate physical activity over the three days of monitoring . Independent t-tests revealed that girls were significantly fatter ( t44 = −3.126 , p = 0.003 ) than boys . There was no significant difference ( t45 = 0.225 , p > 0.05 ) between boys and girls in accumulated time spent with heart rates above the moderate physical activity threshold . Pearson 's product moment correlation coefficients revealed no significant ( r = −0.017 , p > 0.05 ) relationship between per cent body fat and average daily time spent in moderate and vigorous activity . Conclusion : Despite the prediction to the contrary , there was no evidence of a significant relationship between percentage body fat of children and time spent in moderate and vigorous activity . Additionally , while there were no significant gender differences in physical activity patterns , children were more physically active during weekdays than weekends 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 r and om sample of 15 schools with seventh and eight grade rs was r and omly 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 question naires 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 question naires . 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 The present study was design ed to develop an innovative motivational intervention ( based on Self-Determination Theory and Social Cognitive Theory ) to increase physical activity ( PA ) in underserved adolescents . Sixty-four adolescents ( 35 females , 29 males ; 50 % minority ; 65 % on reduced lunch program ; ages 11 - 13 yr ) participated in either an 8-week motivational intervention after-school ( n = 32 ) or a typical after-school program ( n = 32 ) . The conceptual framework for the intervention targeted the social environment ( perceived autonomy , perceived social support , participation , fun ) , cognitive mediators ( perceived choice , self-efficacy , and relatedness/belongingness ) , and motivational orientation ( intrinsic motivation , commitment , positive self-concept ) . Formative evaluation data was collected by staff through daily forms throughout the 8-week program and through observational data completed by independent objective observers during 2 weeks of the program . The major themes that were identified addressed theoretical concepts regarding the intervention and logistical issues in delivering the intervention . The data revealed information regarding the importance of the cognitive appropriateness of the PA  and  motivational activities , the environmental climate for promoting nurturing relationships , developing specific strategies for increasing intrinsic rather than extrinsic reinforcement , and developing methods for preventing social " cliques " and gender conflicts to maintain an appropriate level of support in the social climate . Themes for training staff included focusing on team building , leadership , and nurturing . This formative evaluation is being used to formalize a r and omized trial to test the effects of a student-centered motivational intervention on increasing PA in underserved 6th grade rs HEALTHY was a 3-year middle school-based primary prevention trial to reduce modifiable risk factors for type 2 diabetes in youth . The study was conducted at seven centers across the country . This paper describes the recruitment and retention activities employed in the study . Schools and students were the focus of recruitment and retention . Each center was responsible for the recruitment of six schools ; eligibility was based on ability to enroll a sufficient number of predominately minority and lower socioeconomic status students . Study staff met with district superintendents and school principals to verify the eligibility of schools , and to ascertain how appropriate the school would be for conducting the trial . Sixth grade students were recruited employing a variety of techniques ; students and their parents did not know whether their school was r and omized to the intervention or control arm . This cohort was followed through sixth , seventh and eighth grade s. In the eighth grade , an additional sample of students who were not originally enrolled in the study was recruited in a similar manner to participate in data collection to allow for cross-sectional and dose-response secondary analyses . Parents signed informed consent forms and children signed informed assent forms , as per the needs of the local Institutional Review Board . Parents received a letter describing the results of the health screening for their children after data collection in sixth and eighth grade s. Retention of schools and students was critical for the success of the study and was encouraged through the use of financial incentives and other strategies . To a large extent , student withdrawal due to out-migration ( transfer and geographical relocation ) was beyond the ability of the study to control . A multi-level approach that proactively addressed school and parent concerns was crucial for the success of recruitment and retention in the HEALTHY study BACKGROUND The mainstream r and omized clinical trial is not always feasible in a school setting . There might be practical and ethical issues that make dividing school classes into an intervention and a control group impossible or undesirable , and there is a need to explore the validity of alternative design s and analyses . METHODS An alternative to a r and omized clinical trial in a physical performance experiment at a school is introduced and evaluated . The before-intervention data are utilized as control data for the intervention data in addition to adjust for pre-intervention differences . The strict class year structure of school data makes this possible . In a rural school in inl and Norway , all school children joined the project of walking in a rugged terrain outside school for 20 min every school day during one school year . Measurements of low back static endurance , hamstrings flexibility , st and ing balance and cardiovascular fitness were made before and after the intervention . As intervention and ' aging ' were confounded , the special use of the pre-intervention data , ' age-adjusted ' , is proposed to solve this issue . A comparison with having an independent control group is performed . RESULTS The alternative analysing method is judged to yield valid results without having an independent control group . The age-adjusted analyses showed 11 % increase in low back static endurance , 8 % increase in hamstrings flexibility , 69 % increase in balance and 6 - 13 % increase in cardiovascular fitness . The effects were largest among those children who had the lowest performances before the intervention . CONCLUSION The introduced statistical methods display that , in a school population , evaluations from an experiment can be made without an independent control group . A 20-min walk during school time for 1 year seemed to improve physical performance BACKGROUND Weight-related problems are prevalent in adolescent girls . PURPOSE To evaluate New Moves , a school-based program aim ed at preventing weight-related problems in adolescent girls . DESIGN School-based group-r and omized controlled design . SETTING / PARTICIPANTS 356 girls ( mean age=15.8±1.2 years ) from six intervention and six control high schools . More than 75 % of the girls were racial/ethnic minorities and 46 % were overweight or obese . Data were collected in 2007 - 2009 and analyzed in 2009 - 2010 . INTERVENTION An all-girls physical education class , supplemented with nutrition and self-empowerment components , individual sessions using motivational interviewing , lunch meetings , and parent outreach . MAIN OUTCOME MEASURES Percentage body fat , BMI , physical activity , sedentary activity , dietary intake , eating patterns , unhealthy weight control behaviors , and body/self-image . RESULTS New Moves did not lead to significant changes in the girls ' percentage body fat or BMI but improvements were seen for sedentary activity , eating patterns , unhealthy weight control behaviors , and body/self-image . For example , in comparison to control girls , at 9-month follow-up , intervention girls decreased their sedentary behaviors by approximately one 30-minute block a day ( p=0.050 ) ; girls increased their portion control behaviors ( p=0.014 ) ; the percentage of girls using unhealthy weight control behaviors decreased by 13.7 % ( p=0.021 ) ; and improvements were seen in body image ( p=0.045 ) and self-worth ( p=0.031 ) . Additionally , intervention girls reported more support by friends , teachers , and families for healthy eating and physical activity . CONCLUSIONS New Moves provides a model for addressing the broad spectrum of weight-related problems among adolescent girls . Further work is needed to enhance the effectiveness of interventions to improve weight status of youth OBJECTIVE 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 . METHODS We undertook a cluster-r and omized 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 r and omly 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 ) . RESULTS 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 . CONCLUSION 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 re source the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis OBJECTIVE To investigate the differences in effects of a computer tailored physical activity advice as compared to generic information in adolescents . METHODS Students ( mean age , 14.6+/-1.2 ) out of 90 classes from six different Flemish schools were r and omly 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 Question naire ( IPAQ ) . RESULTS 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 ) . CONCLUSIONS 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
target: There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures .
  Specifically positive effects were observed for duration of physical activity , television viewing , VO2 max , and blood cholesterol .
  Generally , school-based interventions had little effect on physical activity rates , systolic and diastolic blood pressure , BMI , and pulse rate .
  At a minimum , a combination of printed educational material s and changes to the school curriculum that promote physical activity result ed in positive effects .
  Few changes in outcomes were observed in this up date with the exception of blood cholesterol and physical activity rates .
  For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions .
  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 .
background: BACKGROUND The World Health Organization ( WHO ) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese .
  In addition , WHO estimates that physical inactivity causes 10 % to 16 % of cases each of breast cancer , colon , and rectal cancers as well as type 2 diabetes , and 22 % of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades .
  OBJECTIVES The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents .