title: Increasing active travel to school: are we on the right track? A cluster randomised controlled trial from Sydney, Australia. Impact of pedometer use and self-regulation strategies on junior high school physical education students daily step counts. Children, parents and pets exercising together (CPET): exploratory randomised controlled trial How active are our children? Findings from the Millennium Cohort Study Pilot evaluation of a walking school bus program in a low-income, urban community Effects of a controlled pedometer-intervention trial for low-active adolescent girls. Accumulating brisk walking for fitness, cardiovascular risk, and psychological health. Defining accelerometer thresholds for activity intensities in adolescent girls. Effects of a 15-week accumulated brisk walking programme on the body composition of primary school children The effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents. Longitudinal Changes in Active Transportation to School in Canadian Youth Aged 6 Through 16 Years The Walking School Bus and Children's Physical Activity: A Pilot Cluster Randomized Controlled Trial Changes in physical activity from walking to school. Children's physical activity levels during school recess: a quasi-experimental intervention study
abstract: 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 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 Levels of physical activity ( PA ) in UK children are much lower than recommended and novel approaches to its promotion are needed . The Children , Parents and Pets Exercising Together ( CPET ) study is the first exploratory r and omised controlled trial ( RCT ) to develop and evaluate an intervention aim ed at dog-based PA promotion in families . CPET aim ed to assess the feasibility , acceptability and potential efficacy of a theory-driven , family-based , dog walking intervention for 9–11 year olds . Methods Twenty-eight families were allocated r and omly to either receive a 10-week dog based PA intervention or to a control group . Families in the intervention group were motivated and supported to increase the frequency , intensity and duration of dog walking using a number of behaviour change techniques . Parents in the intervention group were asked to complete a short study exit question naire . In addition , focus groups with parents and children in the intervention group , and with key stakeholders were undertaken . The primary outcome measure was 10 week change in total volume of PA using the mean accelerometer count per minute ( cpm ) . Intervention and control groups were compared using analysis of covariance . Analysis was performed on an intention to treat basis . Results Twenty five families were retained at follow up ( 89 % ) and 97 % of all outcome data were collected at baseline and follow up . Thirteen of 14 ( 93 % ) intervention group parents available at follow up completed the study exit question naire and noted that study outcome measures were acceptable . There was a mean difference in child total volume of PA of 27 cpm ( 95 % CI -70 , 123 ) and -3 cpm ( 95 % CI -60 , 54 ) for intervention and control group children , respectively . This was not statistically significant . Approximately 21 % of dog walking time for parents and 39 % of dog walking time for children was moderate-vigorous PA . Conclusions The acceptability of the CPET intervention and outcome measures was high . Using pet dogs as the agent of lifestyle change in PA interventions in children and their parents is both feasible and acceptable , but did not result in a significant increase in child PA in this exploratory trial . Trial registration IS RCT Objective To describe levels of physical activity , sedentary time and adherence to Chief Medical Officers ( CMO ) physical activity guidelines among primary school-aged children across the UK using objective accelerometer-based measurements . Design Nationally representative prospect i ve cohort study . Setting Children born across the UK , between 2000 and 2002 . Participants 6497 7-year-old to 8-year-old singleton children for whom reliable accelerometer data were available for at least 10 h a day for at least 2 days . Main outcome measures Physical activity in counts per minute ( cpm ) ; time spent in sedentary and moderate-to-vigorous intensity physical activity ( MVPA ) ; proportion of children meeting CMO guidelines ( ≥60 min/day MVPA ) ; average daily steps . Explanatory measures Gender , ethnicity , maternal current/most recent occupation , lone parenthood status , number of children in the household and country/region of residence . Results The median daily physical activity level was 595 cpm ( IQR 507 , 697 ) . Children spent a median of 60 min ( IQR 47–76 ) in MVPA/day and were sedentary for a median of 6.4 h/day ( IQR 6–7 ) . Only 51 % met CMO guidelines , with girls ( 38 % ) less active than boys ( 63 % ) . Children took an average of 10 229 ( 95 % CI ( 8777 to 11 775 ) ) steps each day . Children of Indian ethnicity were significantly less active overall than all other ethnic groups . Children of Bangladeshi origin and those living in Northern Irel and were least likely to meet CMO guidelines . Conclusions Only half of 7-year-old children in the UK achieve recommended levels of physical activity , with significant gender , ethnic and geographic variations . Longitudinal studies are needed to better underst and the relevance of these (in)activity patterns for long-term health and well-being . In the meantime population -wide efforts to boost physical activity among young people are needed which are likely to require a broad range of policy interventions Background To evaluate the impact of a walking school bus ( WSB ) program on student transport in a low-income , urban neighborhood . Methods The design was a controlled , quasi-experimental trial with consecutive cross-sectional assessment s. The setting was three urban , socioeconomically disadvantaged , public elementary schools ( 1 intervention vs. 2 controls ) in Seattle , Washington , USA . Participants were ethnically diverse students in kindergarten-5th grade ( aged 5–11 years ) . The intervention was a WSB program consisting of a part-time WSB coordinator and parent volunteers . Students ' method of transportation to school was assessed by a classroom survey at baseline and one-year follow-up . The Pearson Chi-squared test compared students transported to school at the intervention versus control schools at each time point . Due to multiple testing , we calculated adjusted p-values using the Ryan-Holm stepdown Bonferroni procedure . McNemar 's test was used to examine the change from baseline to 12-month follow-up for walking versus all other forms of school transport at the intervention or control schools . Results At baseline , the proportions of students ( n = 653 ) walking to the intervention ( 20 % + /- 2 % ) or control schools ( 15 % + /- 2 % ) did not differ ( p = 0.39 ) . At 12-month follow up , higher proportions of students ( n = 643 , p = 0.001 ) ) walked to the intervention ( 25 % + /- 2 % ) versus the control schools ( 7 % + /- 1 % ) . No significant changes were noted in the proportion of students riding in a car or taking the school bus at baseline or 12-month follow up ( all p > 0.05 ) . Comparing baseline to 12-month follow up , the numbers of students who walked to the intervention school increased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . In contrast , the numbers of students who walked to the control schools decreased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . Conclusion A WSB program is a promising intervention among urban , low-income elementary school students that may promote favorable changes toward active transport to school . Trial Registration Clinical Trials.gov 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 To compare the effects of different patterns of regular brisk walking on fitness , risk factors for cardiovascular disease , and psychological well-being in previously sedentary adults . METHODS Twenty-one subjects ( 14 women ) , aged 44.5 + /- 6.1 yr ( mean + /- SD ) were r and omly assigned to two different , 6-wk programs of brisk walking in a cross-over design , with an interval of 2 wk . One program comprised one 30-min walk per day , 5 d.wk(-1 ) ( long bout ) and the other three 10-min walks per day , also 5 d.wk(-1 ) ( short bouts ) . All walking was at 70 - 80 % of predicted maximal heart rate . Maximal oxygen uptake ( (.)VO(2max ) ) , body composition , resting arterial blood pressure , fasting plasma lipoprotein variables , and psychological parameters were assessed before and after each program . RESULTS Overall , subjects completed 88.2 + /- 1.1 % and 91.3 + /- 4.1 % of prescribed total walking time in the short- and long-bout programs , respectively . Both programs increased plasma concentrations of high-density lipoprotein cholesterol , and decreased concentrations of triacylglycerol and total cholesterol ( all < 0.05 ) . There were no changes in body mass , but the sum of four skinfolds , waist circumference , and hip circumference were decreased after both walking programs ( all P<0.05 ) . Predicted (.)VO(2max ) increased with both programs ( P<0.05 ) , but this increase was greater with the program based on short bouts ( P<0.05 ) . Both walking patterns result ed in similar decreases in tension/anxiety ( P<0.05 ) . CONCLUSION These findings suggest that three short bouts ( 10 min ) of brisk walking accumulated throughout the day are at least as effective as one continuous bout of equal total duration in reducing cardiovascular risk and improving aspects of mood in previously sedentary individuals PURPOSE To derive a regression equation that estimates metabolic equivalent ( MET ) from accelerometer counts , and to define thresholds of accelerometer counts that can be used to delineate sedentary , light , moderate , and vigorous activity in adolescent girls . METHODS Seventy-four healthy 8th grade girls , age 13 - 14 yr , were recruited from urban areas of Baltimore , MD , Minneapolis/St . Paul , MN , and Columbia , SC , to participate in the study .  Accelerometer and oxygen consumption (.-)VO(2 ) ) data for 10 activities that varied in intensity from sedentary ( e.g. , TV watching ) to vigorous ( e.g. , running ) were collected . While performing these activities , the girls wore two accelerometers , a heart rate monitor and a Cosmed K4b2 portable metabolic unit for measurement of (.-)VO(2 ) . A r and om-coefficients model was used to estimate the relationship between accelerometer counts and (.-)VO(2 ) . Activity thresholds were defined by minimizing the false positive and false negative classifications . RESULTS The activities provided a wide range in (.-)VO(2 ) ( 3 - 36 mL x kg x min ) with a correspondingly wide range in accelerometer counts ( 1- 3928 counts x 30 s ) . The regression line for MET score versus counts was MET = 2.01 + /- 0.00171 ( counts x 30 s ) ( mixed model R = 0.84 , SEE = 1.36 ) . A threshold of 1500 counts x 30 s defined the lower end of the moderate intensity ( approximately 4.6 METs ) range of physical activity . That cutpoint distinguished between slow and brisk walking , and gave the lowest number of false positive and false negative classifications . The threshold ranges for sedentary , light , moderate , and vigorous physical activity were found to be 0 - 50 , 51- 1499 , 1500 - 2600 , and > 2600 counts x 30 s , respectively . CONCLUSION The developed equation and these activity thresholds can be used for prediction of MET score from accelerometer counts and participation in various intensities of physical activity in adolescent girls Abstract The purpose of this study was to establish whether an accumulated brisk walking programme , performed during the school day , is effective in changing body composition in primary school children aged 5–11 years . Altogether , 152 participants ( 79 boys and 73 girls ) took part in this repeated- measures intervention study , divided into groups of walkers and controls . The walkers took part in the intervention during school time , which involved brisk walking around the school grounds for 15 min in the morning and afternoon , at least three times a week for 15 weeks . This represented an additional 90 min of moderate physical activity per week . The controls undertook their usual school day activities . Pre- and post-intervention anthropometric and body composition measures were taken . Body fat ( −1.95 ± 2.6 % ) and fat mass ( −0.49 ± 1.0 kg ) were significantly reduced in the walkers after the intervention , whereas the controls showed no significant changes in these measures . Our results show that regular accumulated bouts of brisk walking during the school day can positively affect body composition in primary school children AIM To study the effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents . BACKGROUND The beneficial effects of regular physical activity on health in youths are well-documented . However , adolescence is found to be the age of greatest decline in physical activity participation . Physical activity participation among girls was generally less frequent and less intense than boys . Therefore , there is a strong need for effective interventions that can help promote physical activity in this population . DESIGN An experimental design . METHODS Two classes of female junior college students ( mean age = 16 ) were r and omly sample d from a total of four classes and , of those , one each was r and omly assigned to either the intervention ( n = 46 ) or the control group ( n = 48 ) . Self-efficacy was used as a core theoretical foundation of the intervention design , and pedometers were provided to the students in the intervention group . Distances between each domestic scenic spot were illustrated graphically in a walking log for students to mark the extent of their walking or running . Students in the control group participated in a usual physical education programme . The primary outcome was a change in the number of aerobic steps . The secondary outcomes were changes in cardiopulmonary endurance and exercise self-efficacy . RESULTS At 12-week follow-up , the mean change in aerobic steps was 371 steps and 108 steps in the intervention and control group , respectively . The difference in mean change between the two groups was 467 steps . Effects of the intervention on changes of cardiopulmonary endurance and perceived exercise self-efficacy scores were not found . CONCLUSIONS Among adolescent girls , a 12-week intervention design ed on the theoretical foundation of self-efficacy theory and provision of pedometers was found to have an effect on increasing their physical activity . The intervention , using graphs of domestic scenic spots to represent the distance of walking or running as monitored by pedometers , might enhance motivation regarding physical activity . RELEVANCE TO CLINICAL PRACTICE It is important for health professionals , including school health nurses , involved in the care of adolescent health , to design and provide a physical activity intervention combining self-efficacy theory and provision of pedometer to promote physical activity BACKGROUND : Concern has been raised regarding the increased prevalence of physical inactivity among children .  Active transportation , such as walking and cycling to school , is an opportunity for children to be physically active . OBJECTIVE : To identify the sociodemographic predictors of  active transportation to schools across time among school-aged children participating in the Canadian National Longitudinal Survey of Children and Youth ( NLSCY ) . METHODS : The sample included 7690 school-aged children attending public schools who were drawn from cycle 2 ( 1996 and 1997 ) of the Canadian NLSCY . Data were collected through interviews with the person most knowledgeable about the child . Parents were asked how their child usually gets to school . Responses were dichotomized into active ( walking or bicycling ) or inactive ( school bus , public transit , is driven , or multiple ) modes . Using 3 waves of data from the Canadian NLSCY ( 1996–2001 ) , we estimated the effect of sociodemographic factors on the likelihood  of active transportation to school across time using r and om-effects models . RESULTS : Longitudinal analyses indicated that as children aged , the likelihood of using active transportation to school increased , peaked at the age of 10 years , and then decreased . Urban setting s ( odds ratio [ OR ] : 3.66 [ 95 % confidence interval ( CI ) : 3.23–4.15 ] ) , households with inadequate income ( OR : 1.21 [ 95 % CI : 1.06–1.38 ] ) , living with 1 parent ( OR : 1.46 [ 95 % CI : 1.29–1.65 ] ) , and having an older sibling living at home ( OR : 1.14 [ 95 % CI : 1.04–1.25 ] ) were significant predictors of  active transportation to school at baseline and carried through across time . CONCLUSIONS : Underst and ing the factors that influence  active transportation  may support its adoption by children , which in turn may contribute to meeting physical activity guidelines OBJECTIVE : To evaluate the impact of a “ walking school bus ” program on  children 's rates of active commuting to school and physical activity . METHODS : We conducted a pilot cluster r and omized controlled trial among 4th- grade rs from 8 schools in Houston , Texas ( N = 149 ) . R and om allocation to treatment or control conditions was at the school level . Study staff walked with children to and from school up to 5 days/week . Outcomes were measured the week before ( time 1 ) and during weeks 4 and 5 of the intervention ( time 2 ) . The main outcome was the weekly rate of active commuting , and a secondary outcome was moderate-to-vigorous physical activity . Covariates included sociodemographics , distance from home to school , neighborhood safety , child BMI z score , parent self-efficacy/ outcome expectations , and child self-efficacy for active commuting . A mixed-model repeated measures regression accounted for clustering by school , and stepwise procedures with backward elimination of nonsignificant covariates were used to identify significant predictors . RESULTS : Intervention children increased active commuting ( mean ± SD ) from 23.8 % ± 9.2 % ( time 1 ) to 54 % ± 9.2 % ( time 2 ) , whereas control subjects decreased from 40.2 % ± 8.9 % ( time 1 ) to 32.6 % ± 8.9 % ( time 2 ) ( P < .0001 ) . Intervention children increased their minutes of daily moderate-to-vigorous physical activity from 46.6 ± 4.5 ( time 1 ) to 48.8 ± 4.5 ( time 2 ) , whereas control children decreased from 46.1 ± 4.3 ( time 1 ) to 41.3 ± 4.3 ( time 2 ) ( P = .029 ) . CONCLUSIONS : The program improved children 's active commuting to school and daily moderate-to-vigorous physical activity Active commuting to school ( e.g. walking or bicycling ) has been suggested as a strategy to increase  children ’s physical activity 1 , 2 and a number of walk-to-school websites now exist . 3–5 Several observational studies have found positive associations between walking to school and physical activity 6–9 but they are unable to determine the causal direction . Adult-chaperoned walks to school ( i.e. , walking school bus1 , 5 ) have been evaluated 10–12 but no research was found that assessed objective ly measured changes in physical activity from walking to school . Walk-to-school programs can be a component of comprehensive school health plans , have particular relevance for school nurse/health staff and physical education faculty and can be adapted to suit the schools ’ physical and social environment . Therefore , we completed a small , short-term pilot and feasibility r and omized control trial to 1 ) test the feasibility of the walking school bus as an intervention strategy and 2 ) to identify any changes in physical activity from walking to school . A r and omized controlled trial design was used with all participants completing one week of baseline automobile commuting . Students were then r and omized , for the second week , to either a control group that continued to be driven to school or an intervention group that participated in the walking school bus .  Families were recruited from one elementary school ( Menlo Park , CA ) . Eighteen families responded and met the inclusion criteria : 1 ) student in 3rd–5th grade and 2 ) currently being driven to school at least four days/week . Six families declined to participate , due to time constraints ( n=4 ) , shared custody ( n=1 ) , and general concern ( n=1 ) . Therefore , 12 students were r and omized to a control ( CON  , n=6 ) or intervention ( WALK  , n=6 ) group . All students completed the study protocol as design ed . One student in the WALK group was excluded from analysis due to activity monitor malfunction , leaving five WALK and six CON students in the analysis sample . This study was approved by the Stanford University Administrative Panel on Human Subjects in Medical Research . This study was conducted during March and April of 2005 . The ActiGraph  physical activity monitor was used to measure physical activity . 13–15 One-minute data collection time intervals ( epochs ) were used for this study . An elastic belt with an attached monitor was fit to each student on the first day of the study ( always a weekend ) . Students were instructed to wear the monitor at all times for 14 consecutive days except when swimming , bathing , or sleeping . All students were instructed to maintain their normal activities during the baseline week . On the fifth day , families were notified of their group r and omization and , for the WALK group , the planned route and schedule . The morning commute for the CON group was not altered . A walking school bus , led by one study personnel , followed the safest route to school based on the location of the students ’ homes relative to each other and the school . Students walked at their normal pace but were encouraged to stay together as a group . A wagon , pulled by the study personnel , was used to transport backpacks and instruments . If a student lived more than 1.6 Km from the school , the parent/guardian dropped the student off at one of the other student ’s homes ( 1.1 Km from school ) and he/she walked the remainder of the trip . Raw accelerometer data were reduced to summary variables using a custom software program . 9 For analysis , accelerometer data were summarized for the total week and weekdays . Each weekday was also divided into four time blocks ; before- , during- , and after-school and evening . Average monitor counts·min−1 and the average percent of time spent in moderate-tovigorous physical activity ( % MVPA ) were calculated for each student using age-specific count cutoffs 16 and change scores ( intervention – baseline ) calculated . Between group comparisons used non-parametric Wilcoxon Rank Sum tests with a two-tailed alpha=0.05 . CON ( n=6 ) and WALK ( n=5 ) students were ( mean±SD ) 9.5±1.02 and 9.7±0.90 years old . The CON group had four boys ( all Caucasian ) and two girls ( 1 Caucasian , 1 Chinese ) . The WALK group had two boys and three girls ( all Caucasian ) . On average , CON and WALK students lived 1.3±0.68 and 0.9±0.46 Km from school . The time required to walk to school for the WALK students ranged from 10–36 minutes and was proportional to the distance traveled 0.4–1.1 Km ( mean , 0.8 Km ) ( Spearman r=0.95 ) . Compared to students in the CON group , WALK students significantly increased their counts·min-1 and % MVPA ( p≤0.02 ) before school ( Table 1 ) . This difference was even more pronounced when only looking at the General Commute Time ( GCT ) , defined as the 45 minutes before school ( p<0.01 ) . While there was no change for the CON group ( 12 min of MVPA ) , the WALK group added , on average , 14 minutes of MVPA during the GCT ( between group p=0.05 ) . No significant differences were detected for the other weekday periods . No significant between group differences were detected ( all p≥0.40 ) for the change in counts·min−1 or % MVPA averaged over all useable days or weekdays . Table 1 Average counts·min-1 and percent of time spent in MVPA by group by weekday time blocks , all days , and weekdays To our knowledge , this is the first experimental study to investigate the effect of walking to school on physical activity . The walking school bus did prove feasible in this small sample . Compared to students that were driven to school , those that walked to school increased their MVPA during the GCT by 14 minutes per day . Qualitative data collected at the end of the intervention indicated that the walking school bus was well liked . Parents noted that it was a , “ less stressful start to the day ” and another mentioned , “ She can do it ! And she enjoys walking . She even wanted to walk home ” . Students indicated that they enjoyed walking with others and one student noted that he , “ Did n't feel as tired in the morning compared to when I am driven to school ” . Two students indicated they did not like getting up earlier and none of the students liked the “ loud , embarrassing wagon ” . Five of the six students in the WALK group said they would continue to walk to school . In this experimental study we found no significant group differences for total daily or weekday physical activity or percent of time spent in MVPA . This was likely due to insufficient power to detect such differences , given the high variability of physical activity behavior and measurement error . The 14 minute increase in MVPA during the general commute time for the WALK students represents approximately 25 % of the recommended 60-minutes of MVPA per day . The promising results of this small experimental study justify larger walk to school experiments to examine whether walk to school interventions can impact total daily physical activity and MVPA , as well as other health and behavior outcomes . Additional community level benefits include less car congestion and emissions and improved neighborhood safety via more frequent social interactions with neighbors and greater community cohesion . Since walking to school will likely take longer than being driven , the morning routine may change to accommo date this . The child may need to get up earlier , potentially reducing the amount of time for sleeping and eating breakfast . Therefore , quality and quantity of sleep , consumption of breakfast and overall dietary behavior of students that walk to school should be considered . Lastly , such school- and community-based efforts should seek to engage school personnel and parent and community volunteers as walking school bus chaperones.17 The experiences from such programs can be incorporated into physical education and science curriculums as experiential learning opportunities ( e.g. , walkability audits ; car , bike , and pedestrian counts ; step or distance goals for active commuting , etc … ) Background Recess provides a daily opportunity for children to engage in moderate-to-vigorous ( MVPA ) and vigorous physical activity ( VPA ) . Limited research has investigated the effects of recess-based interventions on physical activity using large sample sizes whilst investigating variables that may influence the intervention effect . The aim of the study was to investigate the short-term effects of a playground markings and physical structures intervention on recess physical activity .  A secondary aim was to investigate the effects of covariates on the intervention . Methods 150 boys and 147 girls were r and omly selected from 26 elementary schools to wear uni-axial accelerometers that quantified physical activity every 5 seconds during recess . Fifteen schools located in deprived areas in one large urban city in Engl and received funding through a national initiative to re design the playground environment . Eleven schools served as matched socioeconomic controls . Data were collected at baseline and 6-weeks following playground intervention .  Recess MVPA and VPA levels adjusted for pupil- and school-level covariates ( baseline physical activity , age , gender , recess length , body mass index ) were analysed using multilevel analyses . Results Positive but non-significant intervention effects were found for MVPA and VPA when confounding variables were added to the model . Gender was a significant predictor of recess physical activity , with boys engaging in more MVPA and VPA than girls . Significant interactions for MVPA revealed that the intervention effect was stronger for younger elementary aged school children compared to older children , and the intervention effect increased as daily recess duration increased . Conclusion The playground re design intervention result ed in small but non-significant increases in children 's  recess physical activity when school and pupil level variables were added to the analyses . Changing the playground environment produced a stronger intervention effect for younger children , and longer daily recess duration enabled children to engage in more MVPA following the intervention . This study concludes that the process of increasing recess physical activity is complex when school and pupil-level covariates are considered , though they should be taken into account when investigating the effects of playground intervention studies on children 's physical activity during recess
target: Commonly employed behaviour change techniques within successful interventions included goals and planning , feedback and monitoring , social support and repetition and substitution .
  Conclusions Walking interventions , particularly those conducted in the school environment , have the potential to increase PA in children and adolescents .
  Conclusions on which interventions most effectively increased walking behaviours in this population were hindered by the limited number of identified interventions and the short duration of interventions evaluated .
background: Background  Physical activity ( PA ) levels decline as children move into adolescence , with this decline more notable in girls .
  As a consequence , many young people are failing to meet current PA guidelines .
  Walking has been a cornerstone of PA promotion in adults and may provide an effective means of increasing PA levels among younger people .
  Objective Our objective was to conduct a systematic review of interventions aim ed at promoting increased levels of walking  among children and adolescents .