Introduction to the Active Living Research Reference List 2007

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H. S. Brown, A. Perez, Y. P. Li, D. M. Hoelscher, S. H. Kelder and R. Rivera. (2007). The cost-effectiveness of a school-based overweight program. International Journal Of Behavioral Nutrition And Physical Activity.

Background: This study assesses the net benefit and the cost-effectiveness of the Coordinated Approach to Child Health (CATCH) intervention program, using parameter estimates from the El Paso trial. There were two standard economic measures used. First, from a societal perspective on costs, cost-effectiveness ratios (CER) were estimated, revealing the intervention costs per quality-adjusted life years (QALYs) saved. QALY weights were estimated using National Health Interview Survey (NHIS) data. Second, the net benefit (NB) of CATCH was estimated, which compared the present value of averted future costs with the cost of the CATCH intervention. Using National Health and Nutrition Examination Survey I (NHANES) and NHANES follow-up data, we predicted the number of adult obesity cases avoided for ages 40-64 with a lifetime obesity progression model. Results: The results show that CATCH is cost-effective and net beneficial. The CER was US$900 (US$903 using Hispanic parameters) and the NB was US$68,125 (US$43,239 using Hispanic parameters), all in 2004 dollars. This is much lower than the benchmark for CER of US$30,000 and higher than the NB of US$0. Both were robust to sensitivity analyses. Conclusion: Childhood school-based programs such as CATCH are beneficial investments. Both NB and CER declined when Hispanic parameters were included, primarily due to the lower wages earned by Hispanics. However, both NB and CER for Hispanics were well within standard cost-effectiveness and net benefit thresholds.

T. Bungum, Meacham, M., Truax, N. (2007). The Effects of Signage and the Physical Environment on Stair Usage. Journal of Physical Activity and Health.

BACKGROUND: Physical activity (PA) is a health behavior that most Americans do not participate in at recommended levels. METHODS: We sought to increase PA by use of motivational signs in selected buildings. Because physical environments are known to influence PA, the relationship of building characteristics and stair usage was also assessed. One pre- and two post-intervention observations were conducted. RESULTS: The proportion of those using the stairs increased from baseline to the second data collection, (2 = 39.31, p < 0.01) and baseline to a final data collection (2 = 10.1, p < 0.01). Built environment factors, including steps to the next higher floor and the number of floors in the building were consistent predictors of stair use. With signs positioned, the visibility of the stairs while standing in front of elevators became a significant predictor of stair usage. CONCLUSIONS: Motivational signs and characteristics of built environments are associated with increased stair usage.

C. L. Bush, S. Pittman, S. McKay, T. Ortiz, W. W. Wong and W. J. Klish. (2007). Park-based obesity intervention program for inner-city minority children. Journal Of Pediatrics.

Objective To assess an intervention strategy-a 6-week obesity intervention program, Project KidFIT, at 3 Houston, Texas park centers-to address the obesity epidemic in minority children. Study design Project FidFIT is a physical fitness and nutrition education program aimed at promoting the benefits of physical activity and improving nutrition knowledge in overweight (body mass index [BMI] >= 95th percentile) minority children. Results A total of 120 minority children (77 boys and 43 girls, mean age, 10.1 years) were enrolled in the program. Approximately 71% of these children were at risk of overweight (BMI >= 85th percentile), and 54% were overweight. Decreases in body weight (0.3 +/- 0.2 kg [mean +/- standard error]) and BMI -(0.1 +/- 0.1 kg/m(2)) were detected in the overweight children, whereas increases in body weight (0.4 +/- 0.1 kg) and BMI (0.2 - 0.1 kg/m(2)) were observed in the children with normal body weight (BMI < 85th percentile but > 5th percentile). Significant improvements (P <.05) in flexibility, muscular endurance, and muscular strength were detected in all children, regardless of weight status. Conclusions The findings suggest that the city park-based KidFIT program might be effective at promoting stabilization for body weight and BMI and improving physical activity performance and nutrition knowledge in overweight minority children.

A. L. Carrel, R. R. Clark, S. Peterson, J. Eickhoff and D. B. Allen. (2007). School-based fitness changes are lost during the summer vacation. Archives Of Pediatrics & Adolescent Medicine.

Objective: To determine the changes in percentage of body fat, cardiovascular fitness, and insulin levels during the 3-month summer break in overweight children enrolled in a school-based fitness program. Study Design: Overweight middle-school children were randomized to a lifestyle-focused physical education class (treatment) or standard physical education class (control) for 1 school year (9 months; previously reported). This analysis reports changes during the 3-month summer break in children who participated in the fitness intervention group and who remained at this school the following year and repeated a fitness class. At the beginning and end of the school year, children underwent evaluation of (1) fasting levels of insulin and glucose, (2) body composition by means of dual x-ray absorptiometry, and (3) maximum oxygen consumption as determined by treadmill use. Setting: Rural middle school and an academic children's hospital. Participants: Overweight middle-school children. Intervention: School-based fitness curriculum, followed by summer break, and an additional year of school-based fitness intervention. Main Outcome Measures: Cardiovascular fitness test results (maximum oxygen consumption), body composition, and fasting insulin levels. Results: Improvements seen during the 9-month school-year intervention in cardiovascular fitness, fasting insulin levels, and body composition were lost during the 3-month summer break. During this summer break, mean +/- SD fitness level decreased (maximum oxygen consumption, -3.2 +/- 1.9 mL/kg per minute; P =.007), fasting insulin level increased (+44 +/- 69 pmol/L [+6.1 +/- 9.7 mIU/ mL]; P =.056), and percentage of body fat increased (+1.3%+/- 1.3%; P =.02) to levels that were similar to those seen before the school intervention. Conclusion: In obese middle-school children, school-based fitness interventions are an important vehicle for health promotion, but without sustained intervention, these benefits may be lost during the extended summer break.

K. Casazza and M. Ciccazzo. (2007). The method of delivery of nutrition and physical activity information may play a role in eliciting behavior changes in adolescents. Eating Behaviors.

OBJECTIVES: Motivating adolescents to adopt proper nutrition and physical activity behaviors is important in this nation's fight to prevent obesity and chronic diseases. This study was conducted to determine which health education delivery method would elicit a greater behavior change. METHOD: The intervention was conducted in three schools (control, computer-based, and traditional education). RESULTS: Students who received the computer-based intervention showed increased knowledge (p<0.001), physical activity (p=0.001), self-efficacy (p<0.001), and social support (p<0.001), and decreased meals skipped (p<0.001). CONCLUSION: The computer-based group showed more positive behavior changes. However, future programs may be enhanced by including group discussion and individual feedback.

M. Chase, Vealey, R., Galli, N., Evers, J., Klug, J., Reichert, K. (2007). What's in it for me? An intervention to increase physical activity among adolescents in physical education. JOPERD.

Adolescents typically become less physically active as they progress through high school. This inactivity has led to some adolescents becoming unhealthy, overweight, and unmotivated to participate in physical activity. The purpose of this article is to present two interventions aimed at motivating physical education students to be more physcially active. These interventions provide adolescents with information about how to maintain physical activity and find it more meaninful.

N. Chaudhary and N. Kreiger. (2007). Nutrition and physical activity interventions for low-income populations. Canadian Journal of Dietetic Practice & Research.

A systematic review was conducted of community-based nutrition and physical activity strategies for chronic disease prevention targeting low-income populations. A computer search of the relevant published literature from 1996 to 2004 was done using Medline, EMBASE, ERIC, CINAHL, PubMed, and HealthSTAR databases. The primary objective was to develop an inventory of intervention strategies. The interventions ranged in approach from traditional group sessions taught by allied health professionals, peer-led workshops, one-on-one counselling print material, and home-based telephone and mail interventions to multimedia strategies and experiential activities such as food demonstrations and group exercise. The results suggest that nutrition and physical activity interventions aimed at low-income audiences tend to be delivered in an interactive visual format, to be culturally appropriate, to be administered in accessible primary care settings, and to provide incentives.

K. K. Clarke, J. Freeland-Graves, D. M. Klohe-Lehman, T. J. Milani, H. J. Nuss and S. Laffrey. (2007). Promotion of physical activity in low-income mothers using pedometers. Journal of the American Dietetic Association.

OBJECTIVE: This study tested the effectiveness of a pedometer program for increasing physical activity levels and reducing body weight in overweight and obese mothers of young children. DESIGN: Participants' motivational readiness to exercise, exercise self-efficacy, pedometer steps, pedometer kilocalories, and anthropometrics were evaluated at week 0 and week 8; anthropometrics were reassessed at week 24. Healthful-weight mothers provided comparison data at baseline. SUBJECTS/SETTING: A convenience sample of 93 intervention women (body mass index [calculated as kg/m(2)] >or=25) and 31 comparison women (body mass index <25) were recruited from public health clinics, community centers, and churches. Eligibility criteria included Hispanic, African-American, or white ethnicity and low income (<200% of the federal poverty index). INTERVENTION: An 8-week physical activity and dietary program was conducted. MAIN OUTCOME MEASURES: Motivational readiness to exercise, exercise self-efficacy, pedometer steps, and weight loss. STATISTICAL ANALYSES PERFORMED: Independent sample t tests, chi(2) tests, paired t tests, Wilcoxon signed-ranks tests, repeated measures analysis of variance, and Pearson and Spearman correlations. RESULTS: Mothers enhanced their motivational readiness to exercise, exercise self-efficacy, pedometer steps, and pedometer kilocalories. Reductions in body weight, percent body fat, and waist circumference also were observed. Significant correlations were found between exercise self-efficacy and exercise readiness (r=0.28, P<0.01), pedometer steps (r=0.30, P<0.01), and pedometer kilocalories (r=0.28, P<0.05). CONCLUSIONS: This intervention successfully increased the physical activity levels and promoted weight loss in low-income mothers. Public health clinics may wish to incorporate elements of this intervention into their programs to improve the physical fitness of recipients.

C. Cooper. (2007). Successfully changing individual travel behavior - Applying community-based social marketing to travel choice. Transportation Research Record.

This paper demonstrates that community-based social marketing techniques can be successfully used to affect people's transportation awareness and behavior, as deployed in Washington State's King County Metro Transit's In Motion program. The In Motion approach focuses on neighborhood-based outreach instead of a more typical employer-based trip reduction program. In addition, In Motion addresses the potential to change any trip from drive alone to an alternative mode instead of focusing exclusively on commute trips. In Motion provides neighborhood residents with incentives to try driving less, raises individual awareness of alternative travel options, and helps break the automatic reflex to drive for all trips. The program was designed to be easily adapted to other neighborhoods with minor modifications in message and materials. The program has been completed in four neighborhoods. Program participants in each neighborhood report increased transit ridership and use of other non-single-occupant vehicle modes, such as carpooling, biking, and walking. The pre- and postparticipant reported mode shares for each In Motion program indicate a 24% to > 50% decrease in driving alone and a 20% to almost 50% increase in transit use. These self-reported numbers are supported by bus stop counts and analysis of overall transit ridership. The In Motion program has had promising results in urban and suburban neighborhoods and has been positively received by residents and businesses. King County Metro Transit continues to expand the program to new geographic areas in King County and to explore innovative approaches to establish partnerships and leverage funding for expanded applications.

S. N. Culos-Reed, P. K. Doyle-Baker, D. Paskevich, J. A. Devonish and R. A. Reimer. (2007). Evaluation of a community-based weight control program. Physiology & Behavior.

Overweight and obesity result from a complex interaction of behavioral, environmental, and genetic factors. The present study reports on the efficacy of a community-based weight control program in 31 overweight and obese adults. TrymGym (R) is a multi-dimensional lifestyle behavior change program for improving both diet and physical activity (PA) related behavior with education and cognitive behavioral training. The program was evaluated using nutritional, physiological, and physical activity-related psychological factors before and after the 12 week program. Paired sample t-tests were conducted to identify significant changes. Body weight (BW) and diastolic blood pressure decreased by 3.6 and 6.4% respectively in completers of the study. Waist and hip circumferences decreased by 4.1 and 5.7% respectively. Caloric intake decreased from 1994 146 at baseline to 1768 +/- 144 in completers of the study. There was also a significant 5.2% decrease in the percentage of calories derived from fat and a 4% increase in percent of calories from protein. Although intake of vitamin C was increased at the end of the study, intake of several other micronutrients at baseline did not meet Dietary Reference Intake recommendations and were further compromised at week 12. Despite a trend toward increased participation in leisure-time and strenuous PA there was a decrease in behavioral intention to participate in future PA. Overall, this community-based weight control program was effective in fostering a significant improvement in BW, anthropometric measurements, participation in PA, and nutritional intake. (C) 2007 Elsevier Inc. All rights reserved.

S. Danielzik, S. Pust and M. J. Muller. (2007). School-based interventions to prevent overweight and obesity in prepubertal children: process and 4-years outcome evaluation of the Kiel Obesity Prevention Study (KOPS). Acta Paediatrica.

Aim: To evaluate the feasibility and 4-year outcome of school-based health promotion on overweight among 6-10-year-old children. Methods: Four-year follow-up data of 344 children participating in health promotion (I) as part of the Kiel Obesity Prevention Study (KOPS) at age 6 years, compared with 4-year changes in 1420 non-intervention children (NI). Nutritional knowledge was assessed before and 3 months after intervention in 1996 and 2004. Outcome was characterized compared to reference values for (i) BMI, (ii) triceps skinfold (TSF) and (iii) waist circumference (WC). Results: Process evaluation showed an increase in knowledge after intervention. However, the prevalence of children with good nutritional knowledge before intervention doubled from 1996 to 2004 but similar intervention-induced increases in knowledge (+50%) were observed. When compared with NI I increased remission of overweight with no significant effect on incidence. The effect was most pronounced in girls. The effect was affected by definition of overweight: when compared with parameters of fat mass (TSF and WC), BMI was showing a stronger effect (remission in girls (Delta I - NI): BMI: +13.4%, TSF: +18.7%, WC: +20.7%). Conclusions: School-based health promotion has sustainable effects on nutritional knowledge and remission of overweight being most pronounced in girls. The effect of intervention was most pronounced using TSF and WC as criteria of overweight.

K. A. De Cocker, I. M. De Bourdeaudhuij, W. J. Brown and G. M. Cardon. (2007). Effects of "10,000 steps Ghent": a whole-community intervention. American Journal of Public Health.

BACKGROUND: Currently there is a great deal of interest in multistrategy community-based approaches to changing physical activity or health behaviors. The aim of this article is to describe the effectiveness of the physical activity promotion project "10,000 Steps Ghent" after 1 year of intervention. METHODS: A multistrategy community-based intervention was implemented in 2005 with follow-up measurements in 2006 to promote physical activity to adults. A local media campaign, environmental approaches, the sale and loan of pedometers, and several local physical activity projects were concurrently implemented. In 2005, 872 randomly selected subjects (aged 25 to 75), from the intervention community Ghent and 810 from a comparison community, participated in the baseline measurements. Of these, 660 intervention subjects and 634 comparison subjects completed the follow-up measurements in 2006. Statistical analyses were performed in 2006. RESULTS: After one year there was an increase of 8% in the number of people reaching the "10,000 steps" standard in Ghent, compared with no increase in the comparison community. Average daily steps increased by 896 (95% CI=599-1192) in the intervention community, but there was no increase in the comparison community (mean change -135 [95% CI= -432 to 162]) (F time x community=22.8, p<0.001). Results are supported by self-reported International Physical Activity Questionnaire (IPAQ) data. CONCLUSIONS: The "10,000 steps/day" message reached the Ghent population and the project succeeded in increasing pedometer-determined physical activity levels in Ghent, after 1 year of intervention.

J. de Jong, K. A. Lemmink, A. C. King, M. Huisman and M. Stevens. (2007). Twelve-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65. Patient Education Counseling.

OBJECTIVE: To determine the effects on energy expenditure, health and fitness outcomes after 12 months of GALM. METHODS: Subjects from matched neighbourhoods were assigned to an intervention (IG) (n=79) or a waiting-list control group (CG) (n=102). During the 12 months the IG attended two series of 15 moderately intensive GALM sessions once a week and the CG attended one series after a 6-month waiting-list period. RESULTS: Significant time effects were found for energy expenditure for recreational sports activities (EE(RECSPORT)), other leisure-time physical activity (EE(LTPA)) and total physical activity (EE(TOTAL)). EE(RECSPORT) increased over 12 months for both groups while the significant time x group interaction for EE(LTPA) revealed that the CG continuously increased over 12 months and the IG improved in the first 6 months but decreased from 6 to 12 months. Further significant time effects were found for performance-based fitness but no group effects. CONCLUSION: Participation in GALM improved EE(RECSPORT) after 12 months, which was reflected in increases in performance-based fitness. The increase in EE(LTPA) seemed to be a short-term effect (6 months), which may explain the lack of improvement in other health indicators. PRACTICE IMPLICATIONS: To further increase EE(LTPA), more attention should be paid to behavioural skill-building during the GALM program.

K. D. Dubose, M. S. Mayo, C. A. Gibson, J. L. Green, J. O. Hill, D. J. Jacobsen, B. K. Smith, D. K. Sullivan, R. A. Washburn and J. E. Donnelly. (2008). Physical activity across the curriculum (PAAC): Rationale and design. Contemporary Clinical Trials.

BACKGROUND: Over the years schools have reduced physical education and recess time in favor of more academic instruction. Due to the drastic rise in obesity levels among children, some states have begun to mandate minimum amounts of physical activity (PA) that school children receive, causing schools to find alternative methods for increasing PA levels. Physical Activity Across the Curriculum (PAAC) is a 3-year randomized clinical trial incorporating moderate-intensity PA in elementary schools to reduce childhood obesity. This paper describes the rational, design, and methods of the PAAC intervention study. METHODS: Twenty-two elementary schools were randomized to either a control or intervention condition. In schools randomized to the intervention condition (PAAC), regular classroom teachers were taught how to incorporate PA into standard academic lessons. Teachers were asked to accumulate 90-100 min/week of PAAC each week through out the 3-year study period. Schools randomized to the control group did not alter their teaching methods. Direct observation of PA levels in the classroom was collected weekly. Height and weight was measured twice a year to calculate BMI. RESULTS: Two years of the intervention have been completed and only one school has left the study. The remaining 21 schools are participating in the final intervention year. CONCLUSIONS: The results from the PAAC intervention may provide schools with an alternative method to increase PA levels in children and reduce childhood obesity.

E. G. Eakin, K. Mummery, M. M. Reeves, S. P. Lawler, G. Schofield, A. J. Marshall and W. J. Brown. (2007). Correlates of pedometer use: Results from a community-based physical activity intervention trial (10,000 Steps Rockhampton). International Journal Of Behavioral Nutrition And Physical Activity.

Background: Pedometers have become common place in physical activity promotion, yet little information exists on who is using them. The multi-strategy, community-based 10,000 Steps Rockhampton physical activity intervention trial provided an opportunity to examine correlates of pedometer use at the population level. Methods: Pedometer use was promoted across all intervention strategies including: local media, pedometer loan schemes through general practice, other health professionals and libraries, direct mail posted to dog owners, walking trail signage, and workplace competitions. Data on pedometer use were collected during the 2-year follow-up telephone interviews from random population samples in Rockhampton, Australia, and a matched comparison community (Mackay). Logistic regression analyses were used to determine the independent influence of interpersonal characteristics and program exposure variables on pedometer use. Results: Data from 2478 participants indicated that 18.1% of Rockhampton and 5.6% of Mackay participants used a pedometer in the previous 18-months. Rockhampton pedometer users (n = 222) were more likely to be female (OR = 1.59, 95% CI: 1.11, 2.23), aged 45 or older (OR = 1.69, 95% CI: 1.16, 2.46) and to have higher levels of education (university degree OR = 4.23, 95% CI: 1.86, 9.6). Respondents with a BMI > 30 were more likely to report using a pedometer (OR = 1.68, 95% CI: 1.11, 2.54) than those in the healthy weight range. Compared with those in full-time paid work, respondents in 'home duties' were significantly less likely to report pedometer use (OR = 0.18, 95% CI: 0.06, 0.53). Exposure to individual program components, in particular seeing 10,000 Steps street signage and walking trails or visiting the website, was also significantly associated with greater pedometer use. Conclusion: Pedometer use varies between population subgroups, and alternate strategies need to be investigated to engage men, people with lower levels of education and those in full-time 'home duties', when using pedometers in community-based physical activity promotion initiatives.

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