Evaluation of a classroom-based physical activity promoting programme

Do You Want to Increase Physical Activity in Adolescents? A School-Based Physical Activity Program Could Be an Efficient Way

The aim of this study was to assess the effects of a classroom-based physical activity program, using bike desks, on academic and physical performance in adolescents. The Program to Enhance and Develop Active Lessons (PEDAL) was designed for this purpose, expecting an increase in students' physical activity without any decrease in academic performance. This intervention based on pedal or bike desks-stationary bikes that integrate with a desk workspace-was conducted with 55 high- school students who were randomly assigned to two groups: a PEDAL group (n = 28, 14.86 ± 0.65 years old, 46.4% girls) and a control group (n = 27, 15 ± 0.68 years old, 51.9% girls). Throughout the intervention, the PEDAL students pedaled 4 days a week for 10 weeks during their Spanish-language arts lessons. The comparisons between the PEDAL group and the control group, as well as the pre- and post-test results, were statistically analyzed to verify the students' physical activity (i.e., IPAQ-SF, heart rate monitors, polar OH1+), cardiorespiratory capacity (20 m shuttle run test), and academic performance (d2 test of attention and language proficiency test). Regarding the physical aspect, only the PEDAL group showed significant growth in their physical activity levels as compared to the pre-test data (p = 0.001), and they achieved higher results compared with the control group (p = 0.022) and less sedentary time than control students (p = 0.012). Concerning cardiorespiratory fitness, there were no post-test differences between the two groups (p = 0.697), probably because the physical activity performed with the bike desks was light-moderate. As far as academic performance is concerned, no significant post-test effects were discovered in either group on the levels of language competence (p = 0.48), attention (TOT, p = 0.432), and concentration (CON, p = 0.216). In conclusion, adolescents who move while learning, using bike desks, increase their light and moderate physical activity without any detriment to academic performance.

Developing a core outcome set for physical activity interventions in primary schools: a modified-Delphi study

OBJECTIVES

To develop a core outcome set (COS) for physical activity interventions in primary schools.

DESIGN

Modified-Delphi study.

SETTING

The UK and international.

PARTICIPANTS

104 participants from four stakeholder groups (educators, public health professionals, health researchers, parents); 16 children (aged 8-9 years) from 1 London primary school.

INTERVENTIONS

Physical activity interventions.

METHODS

Four-stage process: (1) outcomes extracted from relevant studies identified from an umbrella review and a focus group; (2) list of outcomes produced and domains established; (3) stakeholders completed a two-round Delphi survey by rating (Round 1) and re-rating (Round 2) each outcome on a nine-point Likert Scale from 'not important' to 'critical': a>70% participant threshold identified the outcomes rated 'critical' to measure, and outcomes important to children were identified through a workshop; and (4) a stakeholder meeting to achieve consensus of the outcomes to include in the COS.

RESULTS

In total, 74 studies were extracted from 53 reviews. A list of 50 outcomes was produced and three domains were established: 'physical activity and health' (16 outcomes), 'social and emotional health' (22 outcomes) and 'educational performance' (12 outcomes). 104 participants completed survey Round 1; 65 participants completed both rounds. In total, 13 outcomes met the threshold; children identified 8 outcomes. Fourteen outcomes achieved consensus to produce the COS: five outcomes for physical activity and health (diet (varied and balanced), energy, fitness, intensity of physical activity, sleep (number of hours)); seven outcomes for social and emotional health (anxiety, depression, enjoyment, happiness, self-esteem, stress, well-being); and two outcomes for educational performance (concentration, focus).

CONCLUSIONS

We have developed the first COS for physical activity interventions in primary schools in consultation with those interested in the development and application of an agreed standardised set of outcomes. Future studies including these outcomes will reduce heterogeneity across studies.

TRIAL REGISTRATION NUMBER

Core Outcome Measures in Effectiveness Trials Initiative registration number 1322; Results.

Impacts of School Nutrition Interventions on the Nutritional Status of School-Aged Children in Asia: A Systematic Review and Meta-Analysis

This review aims to describe school nutrition interventions implemented in Asia and quantify their effects on school-aged children’s nutritional status. We searched Web of Science, Embase, Ovid MEDLINE, Global Health, Econlit, APA PsycInfo, and Social Policy and Practice for English articles published from January 2000 to January 2021. We quantified the pooled effects of the interventions on the changes in body mass index (BMI) and body mass index z score (BAZ), overall and by type of intervention. In total, 28 articles were included for this review, of which 20 articles were multi-component interventions. Twenty-seven articles were childhood obesity studies and were included for meta-analysis. Overall, school nutrition interventions reduced school-aged children’s BMI and BAZ. Multi-component interventions reduced the children’s BMI and BAZ, whereas physical activity interventions reduced only BMI and nutrition education did not change BMI or BAZ. Overweight/obesity reduction interventions provided a larger effect than prevention interventions. Parental involvement and a healthy food provision did not strengthen school nutrition interventions, which may be due to an inadequate degree of implementation. These results suggested that school nutrition interventions should employ a holistic multi-component approach and ensure adequate stakeholder engagement as well as implementation to maximise the effects.

Classroom-Based Strategies to Reduce Disparities in Physical Activity Among Children with Asthma

Children with asthma often experience physical activity (PA) induced symptoms 5-15 min following the start of exercise. Classroom PA breaks provide short intermittent bouts of PA and may represent a novel strategy to safely promote PA participation in this clinical population. The purpose of this study was to determine the feasibility of a classroom-based PA intervention, Interrupting Prolonged Sitting with Activity (InPACT), where teachers implement 5 × 4-min moderate-to-vigorous physical activity (MVPA) breaks throughout the school day. Nine classrooms at one elementary-middle school in Detroit, MI (student demographics: 79% Hispanic; 80% on free/reduced lunch; 31% prevalence of asthma and asthma-like symptoms) participated in this 20-week intervention. Asthma status was self-reported via the International Study of Asthma and Allergies in Childhood (ISAAC) Video Questionnaire in conjunction with nurse documentation. PA participation, exercise intensity, and asthmatic symptom occurrence were assessed via direct observation. Students accumulated approximately 17 min of activity per day during PA breaks. Compared to students without asthma, a higher percentage of students with asthma participated in MVPA (asthma: 52.9% ± 1.2%; non-asthma: 46.2% ± 0.8%; p = 0.01), a lower percentage participated in light PA (asthma: 25.9% ± 1.0%; non-asthma: 30.1% ± 0.7%; p = 0.01), and sedentary time during activity breaks (asthma: 21.2% ± 0.9%; non-asthma: 23.8% ± 0.7%; p = 0.02). Out of 294 observations, six instances of asthmatic symptoms (coughing) were observed in students with asthma 5-15 min following the PA break. Symptoms self-resolved within 15-min of the PA break and did not result in sustained exercise-induced bronchoconstriction. Classroom-based interventions that incorporate short intermittent bouts of PA represent safe exercises for children with asthma and may help to reduce PA disparities in this clinical population.

School-Based Physical Activity Intervention: A Qualitative Process Evaluation of a Feasibility Trial in Yangzhou, China

Background: There is an urgent need for children in China to increase their physical activity levels. We first developed a 16-week school-based behavior change intervention based on the Behavior Change Wheel and Theoretical Domains Framework. We then conducted a cluster feasibility non-randomized controlled trial (RCT) among children in Yangzhou, China. Aim: This qualitative process evaluation was embedded within the cluster feasibility non-RCT and aimed to: (1) explore the experiences and perceptions of participants and providers in the intervention and trial; and (2) generate recommendations to inform a future intervention and full-scale cluster RCT. Methods: A qualitative study, using semi-structured interviews with trial participants (n = 20 children: 10 intervention, 10 control), parents (n = 20), and health education providers (n = 2), was conducted in two public schools in Yangzhou, China. Interviews were audio-recorded, transcribed, and translated verbatim from Mandarin to English. Data were analyzed using thematic analysis. Results: Findings believed to reflect experiences and perceptions of participants in the intervention and the trial are presented as eight major themes: (1) perceived high efficacy of the intervention components to help children become more active, (2) appreciation of the intervention features, (3) factors that facilitated or impeded intervention attendance and delivery, (4) positive experiences and feelings gained through the data collection process, (5) satisfaction regarding the organization and implementation of the trial, (6) influences of personal beliefs and emotional responses to the trial, (7) social influences on participatory decision-making, and (8) key barriers to consider regarding the recruitment of participants. Conclusions: The intervention and trial methods were acceptable to children, parents, and health education providers. School-based behavior change intervention was perceived to be a useful approach to increase physical activity in children aged 10–12 years in China. However, there were barriers to intervention delivery and engagement that should be considered when designing a future cluster RCT to assess the intervention efficacy.

School-based behaviour change intervention to increase physical activity levels among children: a feasibility cluster non-randomised controlled trial in Yangzhou, China

OBJECTIVES

Children in China have low levels of physical activity. We developed a school-based behaviour change intervention to increase their physical activity levels. The study aimed to determine the feasibility of undertaking a cluster randomised controlled trial (RCT) in the future. This future cluster RCT will evaluate the effectiveness of the intervention.

DESIGN

Feasibility cluster non-RCT design.

SETTING

Two public schools (one intervention and one control) in Yangzhou, China.

PARTICIPANTS

Children aged 10-12 years and their parents.

INTERVENTION

The 16-week school-based behaviour change intervention to increase physical activity levels consisted of three components (a) health education (physical education), (b) family involvement and (c) school environment support.

OUTCOMES MEASURES

We estimated important parameters that are needed to design the future cluster RCT, such as SD of the primary outcome (ie, 7-day steps in children), intracluster correlation coefficient (ICC), recruitment of child-parent dyads, follow-up of children, completion of and time needed for data collection among children and intervention attendance.

RESULTS

Sixty-four children and their parents participated in the study (32 per study group). The SD of the primary outcome was 34 519 steps. The ICC was 0.03. The recruitment and follow-up rates were 100%. The completion of data collection was 100% (except for the 7-day steps at baseline-one child lost the step log in the intervention group and two children lost their pedometer in the control group). The time needed to complete the self-reported questionnaire by children was around 15 min per study group, and the measurement of their anthropometric parameters took around 40 min per study group. The intervention attendance was 100%.

CONCLUSIONS

Based on the promising recruitment, follow-up, completion of and time needed for data collection and intervention attendance, it would be feasible to undertake the future cluster RCT in China.

TRIAL REGISTRATION NUMBER

ChiCTR1900026865.

The Effects of Bike Desks in Formal Education Classroom-Based Physical Activity: A Systematic Review

A systematic review of the research conducted on classroom-based physical activity using bike desks, a school health prevention strategy. To our knowledge, this is the first systematic review of bike desks effects on formal education students. Articles from two databases, Web of Science and PubMed, were analyzed according to PRISMA. The quality of each study was analyzed. After the exclusion criteria, eight articles were fully assessed based on six criteria: (1) author and year, (2) setting and sample, (3) duration, (4) outcomes measurements, (5) instruments and (6) main results. The results show how the interventions are mainly in secondary education and university, and most of them are quantitative studies of short-term interventions. Physical activity is the most frequently variable assessed, using logs, questionnaires and objective methods such as accelerometry and heart rate monitoring. Based on all the studies, it is feasible to implement bike desks in the classroom during theoretical lessons. The weaknesses are related to small samples and the use of different instruments to measure. In conclusion, this systematic review compiles the current information about bike desks in order to inform teachers and administrators for the implementation of bike desk in their schools. They should consider bike desks’ strengths and weaknesses.

Development of a School-Based Intervention to Increase Physical Activity Levels Among Chinese Children: A Systematic Iterative Process Based on Behavior Change Wheel and Theoretical Domains Framework

Regular physical activity has a range of benefits for children's health, academic achievement, and behavioral development, yet they face barriers to participation. The aim of the study was to systematically develop an intervention for improving Chinese children's physical activity participation, using the Behavior Change Wheel (BCW) and Theoretical Domains Framework (TDF). The BCW and TDF were used to (i) understand the behavior (through literature review), (ii) identify intervention options (through the TDF-intervention function mapping table), (iii) select content and implementation options [through behavior change technique (BCT) taxonomy and literature review], and (iv) finalize the intervention content (through expert consultation, patient and public involvement and engagement, and piloting). A systematic iterative process was followed to design the intervention by following the steps recommended by the BCW. This systematic process identified 10 relevant TDF domains to encourage engagement in physical activity among Chinese children: knowledge, memory, attention and decision processes, social influences, environmental context and resources, beliefs about capabilities, beliefs about consequences, social/professional role and identity, emotions, and physical skills. It resulted in the selection of seven intervention functions (education, persuasion, environmental restricting, modeling, enablement, training, and incentivization) and 21 BCTs in the program, delivered over a period of 16 weeks. The BCW and TDF allowed an in-depth consideration of the physical activity behavior among Chinese children and provided a systematic framework for developing the intervention. A feasibility study is now being undertaken to determine its acceptability and utility.

Adapting the InPACT Intervention to Enhance Implementation Fidelity and Flexibility

Adapting classroom-based physical activity interventions are critical for program feasibility and fidelity in low-resource elementary schools. The purpose of this pilot study was to use Replicating Effective Programs (REP) framework to tailor the Interrupting Prolonged sitting with ACTivity (InPACT) intervention and evaluate its effectiveness on program fidelity in classrooms within a low-resource school. REP was applied to adapt program packaging, teacher training, and technical assistance to disseminate Tailored InPACT, a 20-week intervention where teachers implemented 5 × 4-min activity breaks per day. Tailored InPACT was implemented in nine, 3rd-6th grade classrooms in one low-resource school in Detroit Michigan (80% qualified for free/reduced lunch). Intervention fidelity was measured via daily, weekly, and end-of-study self-report questionnaires and direct observation. Throughout the 20-week intervention period, 3rd-5th grade teachers achieved intervention dose (5 activity breaks per day at an average duration of 4 min 8 s). Sixth grade teachers did not achieve intervention dose as they were only able to implement 2 activity breaks per day at an average duration of 4 min 12 s. These findings suggest 5 × 4-min classroom activity breaks per day is a feasible dose of classroom activity that 3rd-5th grade teachers can implement in low-resource classroom settings. Additional adaptations are needed to maximize fidelity in 6th grade classrooms.

Effect of Comprehensive Interventions Including Nutrition Education and Physical Activity on High Blood Pressure among Children: Evidence from School-Based Cluster Randomized Control Trial in China

Childhood hypertension has increasingly become a public health problem globally. However, limited literature research examined the effect of comprehensive interventions including nutrition education and physical activity on blood pressure among children. A total of 6764 children aged 7–13 years were analyzed based on a multicenter randomized controlled trial for comprehensive interventions in 30 primary schools in China to evaluate the effects on blood pressure, which lasted for two semesters. The standards used for the diagnosis of high blood pressure were the cut-off points based on age and sex for Chinese children. Compared with the control group, the intervention effects were −0.5 mm Hg (95% confidence interval (CI): −1.1, 0; p = 0.064) for diastolic blood pressure and −0.9 mmHg (95% CI: −1.5, −0.3; p = 0.005) for systolic blood pressure. For the incidence of high blood pressure, the changes were −1.4% in the intervention group and 0.4% in the control group (1.8% difference between the two groups, p = 0.015) after trial. The school-based comprehensive interventions appeared to have moderate effects on high blood pressure prevention among children in China.

Elementary Classroom Teachers' Self-Reported Use of Movement Integration Products and Perceived Facilitators and Barriers Related to Product Use

Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers' self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators and barriers. MI product use lasted for 11.2 (Standard Deviation (SD) = 7.5) min/occasion and MI products were used 4.1 (SD = 3.5) times/week on average. Activity Bursts in the Classroom for Fitness, GoNoodle, and Physical Activity Across the Curriculum were most frequently used. Facilitators of and barriers to MI product use were identified within three central areas-logistics, alignment with teaching goals, and student needs and interests. Teachers were receptive to MI products and used them frequently throughout the week. When considering the adoption of MI products, teachers, administrators, and policy makers should consider products that are readily usable, align with teaching goals, and are consistent with student needs and interests.

Understanding Elementary Classroom Teachers' Use of Movement Integration Resources

Movement integration (MI)-infusing physical activity (PA) into normal classroom time during school-is an evidence-based strategy to support public health goals and enhance educational outcomes for elementary children. However, few elementary classroom teachers in the United States appear to be using MI resources. In order to understand teachers' MI resource use, this study's purpose was 3-fold: (a) to examine teachers' perceptions about MI and MI resources, (b) to identify teachers' latent class membership based on their perceptions, and (c) to determine the extent to which teachers' MI preferences, demographics, background, and school context predict class membership. We recruited a national sample of participants (N = 420) who completed an electronic survey including six sections: perceived benefits of MI, perceived barriers to using MI resources, satisfaction with MI resources, perceived importance of different MI resource characteristics, MI resource preferences, and participant demographics, background, and school context. Data analysis consisted of descriptive analyses, exploratory factor analysis, confirmatory factor analysis, latent profile analysis, and multinomial regression analysis. Participants mostly agreed about the benefits of MI and were satisfied with the MI resources they were using but had varying perceptions about the presence of barriers to using MI resources. Participants rated the integration of an MI resource with the academic curriculum, the amount of time required for teacher training, the type of training materials provided, and the timing of the training as the most important characteristics they would consider before adopting a resource. Factor analyses supported single factor solutions for perceived benefits, perceived barriers, and satisfaction, and a three-factor solution for perceived importance of different MI resource characteristics (Curriculum Integration, Training Logistics, and Feasibility). Based on these factors, we identified five latent classes of teachers. Regression results showed that desirable latent class membership depended on certain MI preferences and demographic, background, and school context characteristics. Teacher educators and interventionists should consider teachers' MI perceptions, the nature of MI trainings, teacher characteristics, and school context in efforts to increase teachers' use of MI resources. Further research is needed to explore the intrinsic value of MI for teachers, given MI's education- and public health-related benefits.

Improvements in Physical Activity Levels after the Implementation of an Active-Break-Model-Based Program in a Primary School

The aim of this study was to analyze changes in the physical activity levels in students after implementing an active break (AB)-model-based program during the school day. Forty-four fifth-grade primary school children (24 boys, 20 girls, with a mean age = 10.44 ± 0.45) participated in a 17 week program. After intervention, there was an increase in moderate and vigorous total activity during physical education lessons, non-physical education lessons, and recesses. Intervention programs to encourage physical activity and decrease sedentary time are recommended.

Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis

BACKGROUND

Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity.

METHODS

We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes.

RESULTS

A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively.

CONCLUSIONS

Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.

Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial

Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): -0.49 (-0.85, -0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%-18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI. Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn.

A Systematic Review and Qualitative Synthesis Resulting in a Typology of Elementary Classroom Movement Integration Interventions

Background/Objective

Movement integration (MI) involves infusing physical activity into normal classroom time. A wide range of MI interventions have succeeded in increasing children’s participation in physical activity. However, no previous research has attempted to unpack the various MI intervention approaches. Therefore, this study aimed to systematically review, qualitatively analyze, and develop a typology of MI interventions conducted in primary/elementary school settings.

Subjects/Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify published MI interventions. Irrelevant records were removed first by title, then by abstract, and finally by full texts of articles, resulting in 72 studies being retained for qualitative analysis. A deductive approach, using previous MI research as an a priori analytic framework, alongside inductive techniques were used to analyze the data.

Results

Four types of MI interventions were identified and labeled based on their design: student-driven, teacher-driven, researcher-teacher collaboration, and researcher-driven. Each type was further refined based on the MI strategies (movement breaks, active lessons, other: opening activity, transitions, reward, awareness), the level of intrapersonal and institutional support (training, resources), and the delivery (dose, intensity, type, fidelity). Nearly half of the interventions were researcher-driven, which may undermine the sustainability of MI as a routine practice by teachers in schools. An imbalance is evident on the MI strategies, with transitions, opening and awareness activities, and rewards being limitedly studied. Delivery should be further examined with a strong focus on reporting fidelity.

Conclusions

There are distinct approaches that are most often employed to promote the use of MI and these approaches may often lack a minimum standard for reporting MI intervention details. This typology may be useful to effectively translate the evidence into practice in real-life settings to better understand and study MI interventions.

Class Time Physical Activity Programs for Primary School Aged Children at Specialist Schools: A Systematic Mapping Review

Children with disabilities tend to be less active than typically developing peers and may therefore miss important developmental benefits. Class time physical activity (PA) programs can provide additional PA to children and have shown to contribute to numerous benefits in mainstream classrooms. However, it is unclear whether class time PA opportunities are provided in specialist education settings. This review aimed to identify and map class time PA programs that have been implemented in specialist schools and classes. Nine electronic databases were searched. Grey literature searches were also conducted. Programs were included if they were implemented in a primary/elementary specialist school or class, involved a PA component, were conducted during class time and involved more than one child from the class participating. Included programs were mapped and narratively synthesised according to activity type. Of the 2068 records screened, 34 programs were included. Programs involving dance/drama activities (k = 11) were most common and programs involving stretching activities (k = 2) were least frequently implemented. Twenty-three programs had been evaluated, of which only two were randomised controlled trials. More class time PA opportunities are warranted in specialist education settings. Further research is required to build the evidence base for these programs.

The effect of a curriculum-based physical activity intervention on accelerometer-assessed physical activity in schoolchildren: A non-randomised mixed methods controlled before-and-after study

Classroom-based physical activity (PA) interventions offer the opportunity to increase PA without disrupting the curriculum. We aimed to explore the feasibility and potential effectiveness of a classroom-based intervention on moderate to vigorous PA (MVPA) and total PA. The secondary aim was to assess the acceptability and sustainability of the intervention. In a mixed-methods, non-randomised, exploratory controlled before-and-after study, 152 children (10 ± 0.7 years) were recruited from five schools; two intervention (n = 72) and three control (n = 80) schools. School teachers delivered an 8-week classroom-based intervention, comprising of 10 minutes daily MVPA integrated into the curriculum. The control schools maintained their usual school routine. Mean daily MVPA (min), total PA (mean cpm), physical fitness, and health-related quality of life measurements were taken at baseline, end of intervention, and 4-weeks post-intervention (follow-up). Data were analysed using a constrained baseline longitudinal analysis model accounting for the hierarchical data structure. For the primary outcomes (MVPA and total PA) the posterior mean difference and 95% compatibility interval were derived using a semi-Bayesian approach with an explicit prior. The acceptability and sustainability of the intervention was explored via thematic content analysis of focus group discussions with teachers (n = 5) and children (n = 50). The difference in mean daily MVPA (intervention-control) was 2.8 (-12.5 to 18.0) min/day at 8 weeks and 7.0 (-8.8 to 22.8) min/day at follow-up. For total PA, the differences were -2 (-127 to 124) cpm at 8-weeks and 11 (-121 to 143) cpm at follow-up. The interval estimates indicate that meaningful mean effects (both positive and negative) as well as trivial effects are reasonably compatible with the data and design. The intervention was received positively with continuation reported by the teachers and children. Classroom-based PA could hold promise for increasing average daily MVPA, but a large cluster randomised controlled trial is required.

A Pilot Intervention Using Gamification to Enhance Student Participation in Classroom Activity Breaks

The purpose of this study was to determine the effect of adding game design elements (goal setting, feedback, and external rewards) to an evidence-based physical activity intervention to increase in-class physical activity participation (intensity of activity breaks performed). Nine third- through sixth-grade classrooms (n = 292 students) in one elementary-middle school in Detroit, Michigan (49% female, 95% nonwhite; 80% qualified for free/reduced lunch) participated in this 20-week intervention where teachers implemented 5 × 4 min moderate-to-vigorous activity breaks per day. Gamification of activity breaks occurred during weeks 13-20 of the intervention and included the use of game design elements and classroom goals for activity break intensity. Moderate-to-vigorous physical activity (MVPA) during activity breaks was measured via direct observation. There was a significant effect of intervention with a 27% increase in student MVPA participation during the gamified intervention weeks compared with the standard intervention weeks (p = 0.03). Gamification of activity breaks resulted in 55% (compared with 25% during the standard intervention) of students accumulating approximately 20 min of health-enhancing physical activity per day in their classroom. These findings provide preliminary evidence that gamifying activity breaks may be an important strategy for increasing student participation in classroom activity breaks.

Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis

OBJECTIVE

This review provides the first meta-analysis of the impact of physically active lessons on lesson-time and overall physical activity (PA), as well as health, cognition and educational outcomes.

DESIGN

Systematic review and meta-analysis of controlled studies. Six meta-analyses pooled effects on lesson-time PA, overall PA, in-class educational and overall educational outcomes, cognition and health outcomes. Meta-analyses were conducted using the metafor package in R. Risk of bias was assessed using the Cochrane tool for risk of bias.

DATA SOURCES

PubMed, Embase, PsycINFO, ERIC and Web of Science, grey literature and reference lists were searched in December 2017 and April 2019.

STUDIES ELIGIBILITY CRITERIA

Physically active lessons compared with a control group in a randomised or non-randomised design, within single component interventions in general school populations.

RESULTS

42 studies (39 in preschool or elementary school settings, 27 randomised controlled trials) were eligible to be included in the systematic review and 37 of them were included across the six meta-analyses (n=12 663). Physically active lessons were found to produce large, significant increases in lesson-time PA (d=2.33; 95% CI 1.42 to 3.25: k=16) and small, increases on overall PA (d=0.32; 95% CI 0.18 to 0.46: k=8), large, improvement in lesson-time educational outcomes (d=0.81; 95% CI 0.47 to 1.14: k=7) and a small improvement in overall educational outcomes (d=0.36; 95% CI 0.09 to 0.63: k=25). No effects were seen on cognitive (k=3) or health outcomes (k=3). 25/42 studies had high risk of bias in at least two domains.

CONCLUSION

In elementary and preschool settings, when physically active lessons were added into the curriculum they had positive impact on both physical activity and educational outcomes. These findings support policy initiatives encouraging the incorporation of physically active lessons into teaching in elementary and preschool setting.

TRIAL REGISTRATION NUMBER

CRD42017076933.

Elementary school classroom physical activity breaks: student, teacher, and facilitator perspectives

Current physical activity (PA) guidelines recommend that children accumulate at least 60 min of PA each day, and that adults should collaborate across sectors to increase opportunities for PA. Implementing brief classroom PA breaks (CPABs) is one way to help increase daily PA. The primary purpose of this study was to determine perceptions of a 14-wk CPAB program among elementary school children, in the first through fourth grades ( n = 254), at a suburban elementary school, and their teachers ( n = 18). The CPAB program was implemented by university exercise science students, and student and teacher perceptions were assessed through surveys. The children reported that the CPABs were very fun (86%), provided them with a nice break during the school day (88%), were very good for their health (94%), helped them feel more ready to learn (71%), and learn better (50%). The teachers reported that the students really enjoyed the CPABs (100%), that encouraging students to be physically active was either very important (83%) or important (17%), and that they were either very confident (72%) or confident (28%) that they themselves could lead the CPABs. No teacher reported that the CPABs hindered classroom learning. CPABs appear to be enjoyable to both students and teachers, easy to administer, and supportive of learning. Recommendations for improvements within the present collaboration were minimal and could be easily addressed with firmer entrenchment of the program. This collaboration was beneficial and fun for the vast majority involved, and others are urged to implement similar programs.

Classroom-based physical activity improves children's math achievement - A randomized controlled trial

This RCT investigated the effect on children of integrating physical activity (PA) into math lessons. The primary outcome was math achievement and the secondary outcomes were executive functions, fitness and body mass index. Twelve Danish schools were randomized to either an intervention group or a control group. A total of 505 children with mean age 7.2 ± 0.3 years were enrolled in the study. Change in math achievement was measured by a 45-minute standardized math test, change in executive function by a modified Eriksen flanker task, aerobic fitness by the Andersen intermittent shuttle-run test, and body mass index by standard procedures. PA during the math lessons and total PA (including time spent outside school) were assessed using accelerometry (ActiGraph, GT3X and GT3X+). Children in the intervention group improved their math score by 1.2 (95% CI 0.3; 2.1) more than the control group (p = 0.011) and had a tendency towards a higher change in physical activity level during math lessons of 120,4 counts/min (95% CI -9.0;249.8.2, p = 0.067). However, the intervention did not affect executive functions, fitness or body mass index. Participation in a 9-month PA intervention (from 2012-2013) improved math achievement among elementary school children. If replicated, these findings would suggest that implementation of physical activity in school settings could lead to higher academic achievement.

Physical activity in the classroom to prevent childhood obesity: a pilot study in Santiago, Chile

This paper describes a 4-month pilot study that tested the suitability of a physical activity intervention for first graders (children aged 6 and 7 years) in a public school in Santiago, Chile. Teachers were trained to deliver the programme in the classroom during the school day. Teachers were surveyed to determine if this intervention fit within their curriculum and classroom routines and they reported in a focus group that it was suitable for them. All children actively participated in the programme and positive changes in their attitudes towards physical activity were observed by their teachers. Anthropometrics, blood pressure and hand grip strength were measured in the students. A significant reduction was observed in children with high waist circumference ≥ 90th percentile, and in mean systolic blood pressure. However, statistical power values for those comparisons were rather low. Anthropometry and hand grip strength were not modified. The latter calculations and the lack of a control group are showing the weaknesses of this pilot study and that further research with a larger sample size and an experimental design is strongly needed.

Preventing childhood obesity in Asia: an overview of intervention programmes

The rapid economic growth in Asia in the past few decades has contributed to the global increase in childhood obesity prevalence. Yet, little is known about obesity prevention efforts in this region. This systematic review provides an overview of child obesity prevention programmes in Asia. Searches were performed in six electronic databases. Out of 4,234 studies, 17 were included, among them 11 controlled trials (of which five were randomized). Only one study was published before 2007. Identified studies were predominantly conducted in China and Thailand and targeted primary school children in a school setting. Most studies implemented different programmes, frequently targeting behavioural modification through nutrition/health education lectures and/or physical activity sessions. Programme effects related to obesity outcome measures were mixed. Most substantial effects were found for outcomes such as improved health knowledge and/or favourable lifestyle practices. The relatively small number of relevant publications in Asia highlights the need for scientific evaluations of existing and future programmes. This will help ensure the implementation and dissemination of evidence-based approaches that have been proven to be effective in the Asian context. Targeting preschool settings and applying a comprehensive multisectoral approach may increase the effectiveness and sustainability of childhood obesity prevention programmes.

Feasibility and Effects of Short Activity Breaks for Increasing Preschool-Age Children's Physical Activity Levels

BACKGROUND

We examined the effects of short bouts of structured physical activity (SBS-PA) implemented within the classroom setting as part of designated gross-motor playtime on preschoolers PA.

METHODS

Preschools were randomized to SBS-PA (centers, N = 5; participants, N = 141) or unstructured free playtime (UPA) (centers, N = 5; participants, N = 150). SBS-PA consisted of structured PA implemented in the classroom during the first 10 minutes of gross-motor playtime followed by 20 minutes of free playtime. UPA consisted of 30 minutes of unstructured free playtime. Teachers implemented both conditions for 5 days/week for 6 months. PA was assessed with accelerometers (preschool-day) and direct observation (30-minute sessions). Generalized linear mixed models were used to examine the impact of the intervention.

RESULTS

Regarding the 30-minute sessions, significant group main effects were observed for intervals spent at light (p < .001) and moderate-to-vigorous PA (MVPA, p < .001). Regarding the preschool-day PA, significant group by visit interaction was observed for percent time spent in total preschool-day MVPA (F (2, 254) = 3.54, p = .03). Percent of time spent in MVPA significantly decreased in both groups at 3 months and at 6 months.

CONCLUSION

SBS-PA can be implemented in classroom settings; however, further research is needed to examine its impact on preschoolers PA levels.

Promoting physical activity for children and adolescents in low- and middle-income countries: An umbrella systematic review: A review on promoting physical activity in LMIC

OBJECTIVE

It is unknown how much previous reviews on promoting physical activity (PA) for children and adolescents (aged 6-18years) take into account studies from low- and middle-income countries (LMIC, based on the World Bank definition) and the level of evidence of the effect of PA interventions in this population. This study aims to answer such questions using an umbrella systematic review approach.

METHODS

We searched for peer-reviewed systematic reviews and original studies in eight electronic databases, screening of reference lists and expert contacts. Information in systematic reviews on PA interventions for children and adolescents from LMIC was discussed. Original studies on PA interventions (randomized-controlled trials [RCT], cluster-RCT and non-RCT) with children and adolescents from LMIC were eligible. We assessed the methodological quality in all studies, and the evidence level of effect on PA in intervention studies.

RESULTS

Fifty systematic reviews (nine meta-analyses) and 25 original studies (20 different interventions) met eligibility criteria. Only 3.1% of mentioned studies in previous reviews were from LMIC. Strong and LMIC-specific evidence was found that school-based, multicomponent, and short-term (up to six months) interventions, focused on adolescents primarily (aged 13-18years), can promote PA in children and adolescents from LMIC. Other intervention characteristics had inconclusive evidence due to the low number of studies, low methodological quality, and/or small sample size.

CONCLUSION

A minimal part of PA interventions mentioned in previous reviews are from LMIC. Our LMIC-specific analyses showed priorities of implementation and practical implication that can be used in public policies for PA promotion in LMIC.

Evaluation of a comprehensive intervention with a behavioural modification strategy for childhood obesity prevention: a nonrandomized cluster controlled trial

Background

With regard to the global childhood obesity epidemic, it is imperative that effective lifestyle interventions are devised to combat childhood obesity. This paper describes the development and implementation of a comprehensive (a combination of diet and physical activity (PA)), social cognitive behaviour modification intervention using accelerometry and a dietary diary to tackle child overweight and obesity. The comprehensive intervention effect was evaluated in a comparison with diet only, PA only and a no-treatment control group.

Methods

A pilot study was conducted with a non-randomized cluster design. Four hundred thirty-eight overweight and obese children aged 7–12 years from ten primary schools in Beijing were recruited to receive a one-year intervention. Participants were allocated into one of four groups: the comprehensive intervention group; the PA only group (Happy 10 program); the diet only group (nutrition education program); and a control group. The effects of intervention on adiposity, blood pressure, and biochemical indicators were assessed by examining 2-way interactions (time × intervention) in linear mixed models. Means and 95 % confidence intervals (CI) for the adjusted changes between post-intervention and baseline relative to changes in the control group were calculated and reported as effect sizes.

Results

The percentage of body fat in the comprehensive intervention group showed a significant relative decrease (adjusted change: −1.01 %, 95 % CI: (−1.81, −0.20) %) compared with the PA only, diet only or control groups (P < 0.001). Systolic blood pressure significantly decreased in the comprehensive intervention group (adjusted change: −4.37 mmHg, 95 % CI: (−8.42, −0.33) mmHg), as did diastolic blood pressure (adjusted change: −5.50 mmHg, 95 % CI (−8.81, −2.19) mmHg) (P < 0.05). Compared with the other two intervention groups and the control group, positive adjusted changes in fasting glucose in the comprehensive group were found, although not for the biochemical lipid metabolism indicators. Positive but non-significant adjusted changes in body mass index and waist circumference were observed.

Conclusions

Compared with the diet or PA only intervention groups, the current comprehensive program had superior positive effects on body fat percentage and blood pressure but not on the biochemical lipid metabolism indicators in Chinese overweight and obese children. Future randomized controlled trials and long-term follow-up studies are required to elaborate the findings of the current intervention.

Trial registration

ClinicalTrials.gov identifier: NCT02228434

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2535-2) contains supplementary material, which is available to authorized users.

Integrating movement in academic classrooms: understanding, applying and advancing the knowledge base

In the context of comprehensive and coordinated approaches to school health, academic classrooms have gained attention as a promising setting for increasing physical activity and reducing sedentary time among children. The aims of this paper are to review the rationale and knowledge base related to movement integration in academic classrooms, consider the practical applications of current knowledge to interventions and teacher education, and suggest directions for future research. Specifically, this paper (i) situates movement integration amid policy and research related to children's health and the school as a health-promoting environment; (ii) highlights the benefits of movement integration; (iii) summarizes movement integration programs and interventions; (iv) examines factors associated with classroom teachers' movement integration; (v) offers strategies for translating research to practice and (vi) forwards recommendations for future inquiry related to the effectiveness and sustainability of efforts to integrate movement into classroom routines. This paper provides a comprehensive resource for developing state-of-the-art initiatives to maximize children's movement in academic classrooms as a key strategy for important goals in both education and public health.

Intervention of childhood and adolescents obesity in Shantou city

OBJECTIVES

The purpose of this study was to evaluate the effects of multicomponent school based intervention constituted of diet modification, regular exercise and psychosocial consultation on body status in overweight and obese children and adolescents. And to come up with an appropriate intervention protocol for controlling children and adolescents obesity in Shantou city.

METHODS

Two schools were randomised to intervention group and control group respectively. A total of 41 students enrolled were diagnosed as overweight or obese. Twenty-six students of the intervention group completed the one-year intervention programme consisted of diet modification, regular exercise and psychological consultation except two of them were transferred to another school. The differences of BMI, anthropometric measures, metabolic profile and the scores of questionnaire and the scale were compared to evaluate the effects of the intervention programme.

RESULTS

After one-year intervention, it observed in the intervention group that BMI-Z score, WHR and WHtR had significant improvements, and there was a nonsignificant trend (P=0.053) for a decrease in BMI-P. Fasting plasma glucose, cholesterol (CH) and low-density-lipoprotein cholesterol (LDL-C) levels in the intervention group showed nonsignificant trend for a decrease (PFPG=0.084, PCH=0.057, PLDLC=0.098), compared with a significant increase of triglycerides (TG) and LDL-C levels in the control group (PTG=0.041, PLDL-C=0.038). There were some positive dietary, physical activity, or sedentary behaviour changes found in the students of the intervention group as the scores of the questionnaire got significant improvement (P=0.04).

CONCLUSIONS

Our one-year multicomponent school-based intervention programme did have positive effects to some extents on health state and lifestyle behaviour of overweight and obese children and adolescents, which indicated that it is feasible and important to implement such a school-based intervention programme in Shantou city.

Physically active lessons as physical activity and educational interventions: a systematic review of methods and results

OBJECTIVE

Physically active lessons aim to increase children's physical activity whilst maintaining academic time. This systematic review aimed to investigate the methods used in such interventions and their effects on physical activity and educational outcomes.

METHODS

In March 2014; PubMed, Web of Science, PsycINFO and ERIC electronic databases were searched. Inclusion criteria were: 1. Classroom lessons containing both PA and educational elements; 2. intervention studies featuring a control group or within-subjects baseline measurement period; 3. any age-group; and 4. English language. Studies assessing physically active lessons within complex interventions were excluded. Data were extracted onto a standardised form. Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) tool.

RESULTS

Eleven studies were identified: five examined physical activity outcomes only, three examined educational outcomes only and three examined both physical activity and educational outcomes. All studies found improved physical activity following physically active lessons: either in the whole intervention group or in specific demographics. Educational outcomes either significantly improved or were no different compared to inactive teaching. Studies ranged from low to high risk of bias.

CONCLUSIONS

Encouraging evidence of improved physical activity and educational outcomes following physically active lessons is provided. However, too few studies exist to draw firm conclusions. Future high-quality studies with longer intervention periods are warranted.

Process evaluation design in a cluster randomised controlled childhood obesity prevention trial: the WAVES study

Background

The implementation of a complex intervention is heavily influenced by individual context. Variation in implementation and tailoring of the intervention to the particular context will occur, even in a trial setting. It is recognised that in trials, evaluating the process of implementation of a complex intervention is important, yet process evaluation methods are rarely reported. The WAVES study is a cluster randomised controlled trial to evaluate the effectiveness of an obesity prevention intervention programme targeting children aged 6–7 years, delivered by teachers in primary schools across the West Midlands, UK. The intervention promoted activities encouraging physical activity and healthy eating. This paper presents the methods used to assess implementation of the intervention.

Methods

Previous literature was used to identify the dimensions of intervention process and implementation to be assessed, including adherence, exposure, quality of delivery, participant responsiveness, context, and programme differentiation.

Results

Multiple methods and tools were developed to capture information on all these dimensions. These included observations, logbooks, qualitative evaluation, questionnaires and research team reflection.

Discussion

Data collection posed several challenges, predominantly when relying on teachers to complete paperwork, which they saw as burdensome on top of their teaching responsibilities. However, the use of multiple methods helped to ensure data on each dimension, where possible, was collected using more than one method. This also allowed for triangulation of the findings when several data sources on any one dimension were available.

Conclusions

We have reported a comprehensive approach to the assessment of the implementation and processes of a complex childhood obesity prevention intervention within a cluster randomised controlled trial. These approaches can be transferred and adapted for use in other complex intervention trials.

Trial registration number

ISRCTN97000586

The costs and cost-effectiveness of a school-based comprehensive intervention study on childhood obesity in China

Background

The dramatic rise of overweight and obesity among Chinese children has greatly affected the social economic development. However, no information on the cost-effectiveness of interventions in China is available. The objective of this study is to evaluate the cost and the cost-effectiveness of a comprehensive intervention program for childhood obesity. We hypothesized the integrated intervention which combined nutrition education and physical activity (PA) is more cost-effective than the same intensity of single intervention.

Methods

And Findings: A multi-center randomized controlled trial conducted in six large cities during 2009-2010. A total of 8301 primary school students were categorized into five groups and followed one academic year. Nutrition intervention, PA intervention and their shared common control group were located in Beijing. The combined intervention and its’ control group were located in other 5 cities. In nutrition education group, ‘nutrition and health classes’ were given 6 times for the students, 2 times for the parents and 4 times for the teachers and health workers. "Happy 10" was carried out twice per day in PA group. The comprehensive intervention was a combination of nutrition and PA interventions. BMI and BAZ increment was 0.65 kg/m² (SE 0.09) and 0.01 (SE 0.11) in the combined intervention, respectively, significantly lower than that in its’ control group (0.82±0.09 for BMI, 0.10±0.11 for BAZ). No significant difference were found neither in BMI nor in BAZ change between the PA intervention and its’ control, which is the same case in the nutrition intervention. The single intervention has a relative lower intervention costs compared with the combined intervention. Labor costs in Guangzhou, Shanghai and Jinan was higher compared to other cities. The cost-effectiveness ratio was $120.3 for BMI and $249.3 for BAZ in combined intervention, respectively.

Conclusions

The school-based integrated obesity intervention program was cost-effectiveness for children in urban China.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-PRC-09000402 URL:http://www.chictr.org/cn/

Longitudinal sedentary behavior changes in adolescents in Ho Chi Minh City

BACKGROUND

Sedentary behavior is associated with increased risk of chronic disease and sedentary behavior is increasing among adolescents. Data on changes in sedentary behavior in developing countries are limited.

PURPOSE

To describe 5-year longitudinal changes in nonschool sedentary hours among urban adolescents in Ho Chi Minh City, and to identify correlates with this change.

METHODS

This is a 5-year longitudinal cohort with systematic random sampling of 759 students from 18 junior high schools. All measures were taken annually between 2004 and 2009. Sedentary behavior was assessed by self-report and accelerometry. Generalized linear latent and mixed models were used to analyze the data in 2011.

RESULTS

Between 2004 and 2009, self-reported time spent in nonschool sedentary behavior increased from 498 to 603 minutes/day. In the 5th survey year, boys and girls (aged 16 years) were, respectively, 3.6 times (95% CI=2.3, 6.0) and 3.1 times (95% CI= 1.8, 5.0) more likely to spend ≥2 hours/day on screen time compared with baseline (aged 12 years). Accelerometer data adjusted for wearing time revealed that boys and girls aged 16 years had, respectively, 78 minutes/day (95% CI=48, 104) and 69 minutes/day (95% CI=34, 95) more nonschool sedentary time than those at the first accelerometer assessment (at age 13 years). Girls in the highest socioeconomic quartile spent an additional 90 minutes/day in sedentary behavior compared with girls in the lowest quartile (95% CI=52, 128).

CONCLUSIONS

Nonschool sedentary behavior increased among Vietnamese adolescents with age. The largest increase was in recreational screen time (28%), which would be the most obvious target for preventive health strategies.

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association

BACKGROUND

Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.

METHODS AND RESULTS

For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies.

CONCLUSIONS

This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review

BACKGROUND

The prevalence of childhood obesity is increasing rapidly in low- and middle-income countries, and informed policies to tackle the problem must be defined.

OBJECTIVE

We systematically reviewed the evidence on the effectiveness of school-based interventions targeting dietary behavior and/or physical activity for the primary prevention of obesity in children and adolescents aged 6-18 y in low- and middle-income countries.

DESIGN

We searched the MEDLINE, EMBASE, Web of Science, CENTRAL, ERIC, Cochrane Library, and Centre for Reviews and Dissemination databases for peer-reviewed controlled studies published in English, Spanish, French, German, or Dutch between January 1990 and July 2011. The quality of the included studies was appraised independently by 2 authors who used the Effective Public Health Practice Project tool.

RESULTS

From a total of 7218 unique references, we retained 22 studies. Most of the interventions (82%) had a positive effect on dietary behavior and physical activity behavior (effect size ranged from -0.48 to 1.61). BMI decreased in 8 studies (effect size ranged from -0.7 to 0.0). Effective interventions targeted both diet and physical activity, involved multiple stakeholders, and integrated educational activities into the school curriculum.

CONCLUSIONS

School-based interventions have the potential to improve dietary and physical activity behavior and to prevent unhealthy body weights in low- and middle-income countries. To reach their full potential, interventions should conduct process evaluations to document program implementation. The effect and the pathways through which interventions have this effect need to be better documented through rigorous evaluation studies.

Physically active academic lessons and time on task: the moderating effect of body mass index

Physically active classroom lessons have been found to increase on-task behavior in children. Given that physical activity has been associated with an increased time on task (TOT) and that overweight children take fewer steps than normal weight children do, it was expected that benefits of the physical activity would differentially impact those children of higher weight status.

PURPOSE

To examine the effects of a physically active classroom lesson and body mass index (BMI) category on TOT in a sample of elementary-aged children (N = 97).

METHODS

Behavior was assessed through direct observations before and after a physically active classroom lesson and before and after a traditional inactive classroom lesson. TOT was calculated through momentary time sampling for each student by dividing the number of on-task observations by the total number of observations per student (interrater reliability = 94%).

RESULTS

TOT decreased significantly from before to after the lesson for all BMI categories in the inactive control condition, with no change for the active condition. Post hoc analyses found a significant linear effect for the reduction in TOT with each level of BMI in the inactive condition, with the greatest magnitude of effect for the overweight group.

CONCLUSIONS

Physically active classroom lessons provide a buffer to prevent the steep reduction in TOT experienced after a period of inactivity in all children, especially those who are overweight.

Ten Years of TAKE 10!(®): Integrating physical activity with academic concepts in elementary school classrooms

OBJECTIVE

Current literature supports the link between physical activity (PA) or fitness and a child's ability to achieve academically; however, little structured activity time is incorporated into elementary school classrooms. This paper explores the impact of a classroom-based PA program, TAKE 10!, and health-academic integration through existing state and federal policy and programming.

METHODS

Evidence from journal articles, published abstracts, and reports were examined to summarize the impact of TAKE 10! on student health and other outcomes. This paper reviews 10 years of TAKE 10! studies and makes recommendations for future research.

RESULTS

Teachers are willing and able to implement classroom-based PA integrated with grade-specific lessons (4.2 days/wk). Children participating in the TAKE 10! program experience higher PA levels (13%>), reduced time-off-task (20.5%), and improved reading, math, spelling and composite scores (p<0.01). Furthermore, students achieved moderate energy expenditure levels (6.16 to 6.42 METs) and studies suggest that BMI may be positively impacted (decreases in BMI z score over 2 years [P<0.01]).

CONCLUSION

TAKE 10! demonstrates that integrating movement with academics in elementary school classrooms is feasible, helps students focus on learning, and enables them to realize improved PA levels while also helping schools achieve wellness policies.

Integration of short bouts of physical activity into organizational routine a systematic review of the literature

CONTEXT

Recommended daily physical activity accumulated in short intervals (e.g., <10 minutes) may be more feasible and appealing to the relatively sedentary populace than longer bouts. The purpose of this paper is to present a systematic review of the evidence for the effectiveness of short activity bouts incorporated into organizational routine as part of the regular "conduct of business."

EVIDENCE ACQUISITION

PubMed, MEDLINE, and Google Scholar databases were searched in August 2009 (updated search in February and July 2010) to identify relevant, peer-reviewed journal articles and abstracts on school-, worksite-, and faith-based interventions of short, structurally integrated physical activity breaks.

EVIDENCE SYNTHESIS

The majority of interventions implemented daily physical activity bouts of 10-15 minutes in length. Schools were the most common settings among the 40 published articles included in this review. The rigor of the studies varied by setting, with more than 75% of worksite versus 25% of school studies utilizing RCT designs. Studies focused on a broad range of outcomes, including academic/work performance indicators, mental health outcomes, and clinical disease risk indicators, in addition to physical activity level. Physical activity was the most commonly assessed outcome in school-based studies, with more than half of studies assessing and observing improvements in physical activity outcomes following the intervention. About a quarter of worksite-based studies assessed physical activity, and the majority found a positive effect of the intervention on physical activity levels. About half of studies also observed improvements in other relevant outcomes such as academic and work performance indicators (e.g., academic achievement, cognitive performance, work productivity); psychosocial factors (e.g., stress, mood); and clinical disease risk indicators (e.g., blood pressure, BMI). The average study duration was more than 1 year, and several reported outcomes at 3-6 years.

CONCLUSIONS

Interventions integrating physical activity into organizational routine during everyday life have demonstrated modest but consistent benefits, particularly for physical activity, and these are promising avenues of investigation. The proportionately longer-term outcomes available in these studies compared with individual-level studies suggest that physical activity promotion strategies at the organizational level may be more sustainable.

Report on childhood obesity in China (8): effects and sustainability of physical activity intervention on body composition of Chinese youth

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 randomized 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.

The nutrition-based comprehensive intervention study on childhood obesity in China (NISCOC): a randomised cluster controlled trial

BACKGROUND

Childhood obesity and its related metabolic and psychological abnormalities are becoming serious health problems in China. Effective, feasible and practical interventions should be developed in order to prevent the childhood obesity and its related early onset of clinical cardiovascular diseases. The objective of this paper is to describe the design of a multi-centred random controlled school-based clinical intervention for childhood obesity in China. The secondary objective is to compare the cost-effectiveness of the comprehensive intervention strategy with two other interventions, one only focuses on nutrition education, the other only focuses on physical activity.

METHODS/DESIGN

The study is designed as a multi-centred randomised controlled trial, which included 6 centres located in Beijing, Shanghai, Chongqing, Shandong province, Heilongjiang province and Guangdong province. Both nutrition education (special developed carton style nutrition education handbook) and physical activity intervention (Happy 10 program) will be applied in all intervention schools of 5 cities except Beijing. In Beijing, nutrition education intervention will be applied in 3 schools and physical activity intervention among another 3 schools. A total of 9750 primary students (grade 1 to grade 5, aged 7-13 years) will participate in baseline and intervention measurements, including weight, height, waist circumference, body composition (bioelectrical impendence device), physical fitness, 3 days dietary record, physical activity questionnaire, blood pressure, plasma glucose and plasma lipid profiles. Data concerning investments will be collected in our study, including costs in staff training, intervention materials, teachers and school input and supervising related expenditure.

DISCUSSION

Present study is the first and biggest multi-center comprehensive childhood obesity intervention study in China. Should the study produce comprehensive results, the intervention strategies would justify a national school-based program to prevent childhood obesity in China.

The effect of duration of exercise at the ventilation threshold on subjective appetite and short-term food intake in 9 to 14 year old boys and girls

Background

The effect of exercise on subjective appetite and short-term food intake has received little investigation in children. Despite a lack of reported evaluation of short-duration activity programs, they are currently being implemented in schools as a means to benefit energy balance. The purpose of this study was to determine the effect of duration of exercise at the ventilation threshold (VeT) on subjective appetite and short-term food intake in normal weight boys and girls aged 9 to 14 years.

Methods

On 4 separate mornings and in random order, boys (n = 14) and girls (n = 15) completed 2 rest or 2 exercise treatments for 15 (short-duration; SD) or 45 min (long-duration; LD) at their previously measured VeT, 2 h after a standardized breakfast. Subjective appetite was measured at regular intervals during the study sessions and food intake from a pizza meal was measured 30 min after rest or exercise.

Results

An increase in average appetite, desire to eat, and hunger (p < 0.05) was attenuated by SD exercise, but was further increased (p < 0.05) by LD exercise. However, food intake after SD and LD exercise was similar to after rest in both boys and girls (p = 0.55). The energy cost of SD and LD exercise resulted in a lower net energy balance compared to resting during the study measurement period in boys (SD: Δ = -418 ± 301 kJ; LD: Δ = -928 ± 196 kJ) and in girls (SD: Δ = -297 ± 105 kJ; LD: Δ = -432 ± 115 kJ).

Conclusion

Neither SD nor LD exercise at the VeT increased short-term food intake and SD exercise attenuated increases in appetite. Thus, SD exercise programs in schools may be an effective strategy for maintaining healthier body weights in children.

The meta-volition model: organizational leadership is the key ingredient in getting society moving, literally!

This paper argues that substantive and sustainable population-wide improvements in physical activity can be achieved only through the large scale adoption and implementation of policies and practices that make being active the default choice and remaining inactive difficult. Meta-volition refers to the volition and collective agency of early adopter leaders who implement such changes in their own organizations to drive productivity and health improvements. Leaders, themselves, are motivated by strong incentives to accomplish their organizational missions. The meta-volition model (MVM) specifies a cascade of changes that may be sparked by structural integration of brief activity bouts into organizational routine across sectors and types of organizations. MVM builds upon inter-disciplinary social ecological change models and frameworks such as diffusion of innovations, social learning and social marketing. MVM is dynamic rather than static, integrating biological influences with psychological factors, and socio-cultural influences with organizational processes. The model proposes six levels of dissemination triggered by organizational marketing to early adopter leaders carried out by "sparkplugs," boisterous leaders in population physical activity promotion: initiating (leader-leader), catalyzing (organizational-individual), viral marketing (individual-organizational), accelerating (organizational-organizational), anchoring (organizational-community) and institutionalizing (community-individual). MVM embodies public-private partnership principles, a collective investment in the high cost of achieving and maintaining active lifestyles.