Introduction to the Active Living Research Reference List 2007

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E. G. Eakin, M. M. Reeves, S. P. Lawler, B. Oldenburg, C. Del Mar, K. Wilkie, A. Spencer, D. Battistutta and N. Graves. (2007). The Logan Healthy Living Program: A cluster randomized trial of a telephone-delivered physical activity and dietary behavior intervention for primary care patients with type 2 diabetes or hypertension from a socially disadvantaged community - Rationale, design and recruitment. Contemporary Clinical Trials.

BACKGROUND: Physical activity and dietary behavior changes are important to both the primary prevention and secondary management of the majority of our most prevalent chronic conditions (i.e., cardiovascular disease, hypertension, type 2 diabetes, breast and colon cancer). With over 85% of Australian adults visiting a general practitioner each year, the general practice setting has enormous potential to facilitate wide scale delivery of health behaviour interventions. However, there are also many barriers to delivery in such settings, including lack of time, training, resources and remuneration. Thus there is an important need to evaluate other feasible and effective means of delivering evidence-based physical activity and dietary behaviour programs to patients in primary care, including telephone counseling interventions. METHODS: Using a cluster randomized design with practice as the unit of randomization, this study evaluated a telephone-delivered intervention for physical activity and dietary change targeting patients with chronic conditions (type 2 diabetes or hypertension) recruited from primary care practices in a socially disadvantaged community in Queensland, Australia. Ten practices were randomly assigned to the telephone intervention or to usual care, and 434 patients were recruited. Patients in intervention practices received a workbook and 18 calls over 12 months. Assessment at baseline, 4-, 12- and 18-months allows for assessment of initial change and maintenance of primary outcomes (physical activity and dietary behavior change) and secondary outcomes (quality of life, cost-effectiveness, support for health behavior change). CONCLUSIONS: This effectiveness trial adds to the currently limited number of telephone-delivered intervention studies targeting both physical activity and dietary change. It also addresses some of the shortcomings of previous trials by targeting patients from a disadvantaged community, and by including detailed reporting on participant representativeness, intervention implementation and cost-effectiveness, as well as an evaluation of maintenance of health behavior change.

E. G. Eakin, S. S. Bull, K. M. Riley, M. M. Reeves, P. McLaughlin and S. Gutierrez. (2007). Resources for health: a primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions. Health Psychology.

OBJECTIVE: The Resources for Health trial evaluates a social-ecologically based lifestyle (physical activity and diet) intervention targeting low-income, largely Spanish-speaking patients with multiple chronic conditions. DESIGN: A randomized controlled trial was conducted with 200 patients recruited from an urban community health center and assigned to intervention and usual care conditions. Intervention involved 2 face-to-face, self-management support and community linkage sessions with a health educator, 3 follow-up phone calls, and 3 tailored newsletters. MAIN OUTCOME MEASURES: Primary outcomes measured at 6-months were changes in dietary behavior and physical activity. Changes in multilevel support for healthy living were evaluated as a secondary outcome. RESULTS: After adjustment for age, sex, language, and number of chronic conditions, significant intervention effects were observed for dietary behavior and multilevel support for healthy lifestyles but not for physical activity. CONCLUSION: The Resources for Health intervention provides an effective and practical model for improving health behavior among low-income, Spanish-speaking patients with multiple chronic conditions.

C. D. Economos, R. R. Hyatt, J. P. Goldberg, A. Must, E. N. Naumova, J. J. Collins and M. E. Nelson. (2007). A community intervention reduces BMI z-score in children: Shape Up Somerville first year results. Obesity (Silver Spring).

OBJECTIVE: The objective was to test the hypothesis that a community-based environmental change intervention could prevent weight gain in young children (7.6 +/- 1.0 years). RESEARCH METHODS AND PROCEDURES: A non-randomized controlled trial was conducted in three culturally diverse urban cities in Massachusetts. Somerville was the intervention community; two socio-demographically-matched cities were control communities. Children (n = 1178) in grades 1 to 3 attending public elementary schools participated in an intervention designed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before-, during-, after-school, home, and community environments. Many groups and individuals within the community (including children, parents, teachers, school food service providers, city departments, policy makers, healthcare providers, before- and after-school programs, restaurants, and the media) were engaged in the intervention. The main outcome measure was change in BMI z-score. RESULTS: At baseline, 44% (n = 385), 36% (n = 561), and 43% (n = 232) of children were above the 85th percentile for BMI z-score in the intervention and the two control communities, respectively. In the intervention community, BMI z-score decreased by -0.1005 (p = 0.001, 95% confidence interval, -0.1151 to -0.0859) compared with children in the control communities after controlling for baseline covariates. DISCUSSION: A community-based environmental change intervention decreased BMI z-score in children at high risk for obesity. These results are significant given the obesigenic environmental backdrop against which the intervention occurred. This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates.

C. D. Economos and S. Irish-Hauser. (2007). Community interventions: a brief overview and their application to the obesity epidemic. Journal of Law, Medicine & Ethics.

Community-based interventions built on theory and informed by community members produce potent, sustainable change. This intervention model mobilizes inherent community assets and pinpoints specific needs. Advancing community-based research to address obesity will require training of future leaders in this methodology, funding to conduct rigorous trials, and scientific acceptance of this model.

G. Ejlertsson and A. C. Sollerhed. (2007). More physical activity in school-a winning concept. Results from a 3-year intervention in Sweden. European Journal Of Public Health.

A. Eliakim, D. Nemet, Y. Balakirski and Y. Epstein. (2007). The effects of nutritional-physical activity school-based intervention on fatness and fitness in preschool children. Journal Of Pediatric Endocrinology & Metabolism.

Background. Obesity is now the most common chronic pediatric disease. Early health education programs could serve to prevent and treat childhood obesity and its numerous complications. Aim: To examine the effects of a randomized prospective school-based intervention on anthropometric measures, body composition, leisure time habits and fitness in preschool children. Children: Fifty-four preschool children completed a 14-week combined dietary-behavioral-physical activity intervention and were compared to 47 age matched controls (age 5-6 yr). Results: Daily physical activity was significantly greater in the intervention group compared to the controls (6,927 +/- 364 vs 5,489 +/- 284 steps/day, respectively; p < 0.003). Favorable changes were observed in weight (0.35 +/- 0.08 vs 0.9 +/- 0.1 kg, p < 0.0005), BMI percentile (-3.8 +/- 1.3 vs 2.9 +/- 1.5 k g/m(2), p < 0.001), fat percent (by skinfolds, -0.65 +/- 0.3 vs 1.64 +/- 0.3%, p < 0.028) and fitness (endurance time -3.55 +/- 1.85 vs 3.16 +/- 2.05%, p < 0.017) in the intervention versus control groups. Conclusions: A preschool, dietary/physical activity intervention may play a role in health promotion, prevention and treatment of childhood obesity.

J. Emery, C. Crump and M. Hawkins. (2007). Formative evaluation of AARP's Active for Life campaign to improve walking and bicycling environments in two cities. Health Promotion Practice.

AARP conducted a 2.5-year social-marketing campaign to improve physical activity levels among older adults in Richmond, Virginia and Madison, Wisconsin. This article presents formative evaluation findings from the campaign's policy/environmental change component. Evaluation data were abstracted from technical-assistance documentation and telephone interviews. Results include 11 policy and 14 environmental changes attained or in-process by campaign closure. Differences between the cities' results are explained through differences in program implementation (e.g., types of changes planned, formalization of partnerships). Project teams took less time deciding to pursue policy change than environmental change; however, planning the policy activities took longer than planning environmental-change activities. Recommendations for future policy/environmental change interventions focus on the selection of strategies; planning for administrative resources; formalizing partnerships to ensure sustainability of impact; ensuring training and technical assistance; and documenting progress. Similar intervention results may be attainable with a multi-year timeframe, adequate part-time coordination, and committed volunteers.

Y. Gao, S. Griffiths and E. Y. Chan. (2007). Community-based interventions to reduce overweight and obesity in China: a systematic review of the Chinese and English literature. Journal of Public Health (Oxf).

BACKGROUND: Overweight and obesity pose a challenge to public health in China. According to ChineSEefinition, 303 million Chinese are overweight (body mass index, BMI >/= 24 kg m(-2)). Among them, 73 million are clinically obese (BMI >/= 28 kg m(-2)). In line with the global trend, the rate of obesity in China continues to increase, with associated morbidity and mortality. This study was to identify interventions, which are effective in Mainland Chinese society. METHODS: All non-drug-controlled interventions (>/=3 months) in Mainland China, which used anthropometric outcome measures, were selected from three Chinese and nine international electronic databases (before May 2006) and included in this systematic review. RESULTS: A total of 20 studies met the selection criteria and were included in the review. Among them only one was published in an international journal. Most studies combined at least physical activity, dietary intervention and health education. Seventeen studies (85%) reported significant effects in anthropometric measurement outcomes. CONCLUSIONS: Comprehensive interventions with at least physical activity, dietary intervention and health education may be effective in reducing obesity in Chinese children. The role of grandparents as carers in the one-child society is worth considering further. Current evidence of effective interventions for adults is limited. Publication bias in ChineSEatabases should be taken into account.

B. Giles-Corti, M. Knuiman, A. Timperio, K. Van Niel, T. J. Pikora, F. C. Bull, T. Shilton and M. Bulsara. (2008). Evaluation of the implementation of a state government community design policy aimed at increasing local walking: Design issues and baseline results from RESIDE, Perth Western Australia. Preventive Medicine.

OBJECTIVES.: To describe the design and baseline results of an evaluation of the Western Australian government's pedestrian-friendly subdivision design code (Liveable Neighborhood (LN) Guidelines). METHODS.: Baseline results (2003-2005) from a longitudinal study of people (n=1813) moving into new housing developments: 18 Liveable, 11 Hybrid and 45 Conventional (i.e., LDs, HDs and CDs respectively) are presented including usual recreational and transport-related walking undertaken within and outside the neighborhood, and 7-day pedometer steps. RESULTS.: At baseline, more participants walked for recreation and transport within the neighborhood (52.6%; 36.1% respectively), than outside the neighborhood (17.7%; 13.2% respectively). Notably, only 20% of average total duration of walking (128.4 min/week (SD159.8)) was transport related and within the neighborhood. There were few differences between the groups' demographic, psychosocial and perceived neighborhood environmental characteristics, pedometer steps, or the type, amount and location of self-reported walking (p>0.05). However, asked what factors influenced their choice of housing development, more participants moving into LDs reported aspects of their new neighborhood's walkability as important (p<0.05). CONCLUSIONS.: The baseline results underscore the desirability of incorporating behavior and context-specific measures and value of longitudinal designs to enable changes in behavior, attitudes, and urban form to be monitored, while adjusting for baseline residential location preferences.

D. Gillis, M. Brauner and E. Granot. (2007). A community-based behavior modification intervention for childhood obesity. Journal Of Pediatric Endocrinology & Metabolism.

Childhood obesity, caused by reduced physical activity and increased food consumption, has reached epidemic proportions. We hypothesized that a single practitioner could enable a child to reduce BMI by educating towards a healthier lifestyle and then reinforcing the message in a structured manner. In this study, intervention group participants and their parents received a half-hour talk on exercise and diet, repeated after 3 months. They were instructed to fill weekly diaries and were called weekly by telephone. Controls received the initial instruction only. Twenty-seven (14 intervention) obese children were recruited. Anthropometric parameters, fitness and biochemical data were collected before intervention and after 6 months in both groups. Sustained but not statistically significant improvements in attitude, BMI SDS and LDL-cholesterol were noted in the intervention group. These promising results support a need for further work to evaluate the efficacy and applicability of our approach in the population at large.

R. L. Gombosi, R. M. Olasin and J. L. Bittle. (2007). Tioga County Fit for Life: a primary obesity prevention project. Clinical Pediatrics (Phila).

Pediatric obesity, which has reached epidemic proportions in the United States in the past 10 years, translates directly into rising rates of adult obesity. This study assessed the impact of a school, family, community, and industry-based primary intervention project on the rates of overweight and obesity in a rural countywide cohort of children in grades kindergarten through 8. It included classroom education, student/ family wellness booklets, point source healthy menus, occupational health analyses, and community health fairs. A 5-year longitudinal analysis of grade-specific rates of overweight and obesity of the participating children showed that overweight and obesity rates increased for all cohorts. Key elements contribute to increasing rates of pediatric obesity. Inadequate penetration of education/information dissemination and lag time represent 2 explanations for the lack of obesity reduction during the program implementation period. Strategies for successful engagement of multiple groups are essential to effectively reverse the pediatric obesity epidemic.

B. B. Green, A. Cheadle, A. S. Pellegrini and J. R. Harris. (2007). Active for life: a work-based physical activity program. Preventing Chronic Disease.

BACKGROUND: The American Cancer Society's Active for Life is a worksite wellness program that encourages employees to be physically active. This paper reports the experience of implementing Active for Life in a worksite setting and its longer-term impact on physical activity. CONTEXT: The Active for Life intervention was provided to employees at Group Health Cooperative, a nonprofit health care system in the Pacific Northwest with 9800 employees. METHODS: Posters, newsletters, health fairs, and site captains promoted enrollment in Active for Life. Interventions included goal-setting, self-monitoring, incentives, and team competition. Preprogram and postprogram changes in physical activity were assessed at baseline, 10 weeks, and 6 months. CONSEQUENCES: Active for Life was offered to 3624 employees, and 1167 (32%) enrolled; 565 (48%) completed all three surveys. At 10 weeks, all physical activity measures increased significantly. The proportion of employees meeting the guideline of the Centers for Disease and Control and Prevention for physical activity increased from 34% to 48% (P <.01). At the 6-month follow-up, the frequency of exercising enough to work up a sweat (P <.01) remained significantly increased, but other measures of physical activity declined toward baseline. INTERPRETATION: A 10-week worksite program implemented at multiple facilities increased physical activity by the end of the intervention, but these changes were not sustained over time. Future interventions might include extending the length of the program, repeating the program, or adding larger economic incentives over time. Any such alternative models should be carefully evaluated, using a randomized design if possible.

L. Haerens, E. Cerin, L. Maes, G. Cardon, B. Deforche and I. De Bourdeaudhuij. (2007). Explaining the effect of a 1-year intervention promoting physical activity in middle schools: a mediation analysis. Public Health Nutrition.

OBJECTIVE: The aim of the present study was to examine the mediation effects of changes in psychosocial determinants of physical activity (attitude, social support, self-efficacy, perceived benefits and barriers) on changes in physical activity. DESIGN: One-year intervention study with baseline and 1-year post measures of physical activity habits and psychosocial correlates. SETTING: Fifteen middle schools. SUBJECTS: Boys and girls (n = 2840) aged 11-15 years completed the validated questionnaires during class hours. RESULTS: The product-of-coefficients test was used to asses the mediating effects. Self-efficacy for physical activity at school was found to be the only significant mediator of physical activity change. Specifically, self-efficacy for physical activity at school partly mediated the effect of the intervention on total and school-related physical activity change in the intervention group with parental support (P < 0.05). None of the other potential mediators, attitudes, social support, perceived benefits and perceived barriers, seemed to have had a positive effect. Even a suppressor effect was found for attitudes. Given that the effects of self-efficacy and attitudes were of opposite direction, the total mediated/suppressed effects of the intervention were not statistically significant. CONCLUSIONS: Positive changes in total and school-related physical activity in adolescents could be partly explained by increases in self-efficacy for physical activity at school through a physical activity intervention in middle schools with parental support. However, the suppressor effect of attitudes decreased this effect. As this is one of the first true mediation analyses in this age group, further research is needed to replicate the importance of these mediators.

L. Haerens, I. De Bourdeaudhuij, L. Maes, G. Cardon and B. Deforche. (2007). School-based randomized controlled trial of a physical activity intervention among adolescents. The Journal of adolescent health.

PURPOSE: To evaluate the effects of a middle school physical activity intervention, new in combining an environmental and computer tailored component; and to evaluate the effects of parental involvement. METHODS: A clustered randomized controlled design was used. A random sample of 15 schools with 7th and 8th graders was randomly assigned to one of three conditions: (a) intervention with parental support, (b) intervention alone, and (c) control group. The intervention was new in combining environmental strategies with computer-tailored feedback to increase levels of moderate to vigorous physical activity. The intervention was implemented by the school staff. Physical activity was measured through a questionnaire in the total sample and with accelerometers in a sub sample of adolescents. RESULTS: The intervention with parental support led to an increase in self-reported school-related physical activity of, on average, 6.4 minutes per day (p < or =.05, d =.40). Physical activity of light intensity measured with accelerometers decreased with, on average, 36 minutes per day as a result of the intervention with parental support (p < or =.05, d =.54). Physical activity of moderate to vigorous intensity measured with accelerometers significantly increased with on average 4 minutes per day in the intervention group with parental support, while it decreased with almost 7 minutes per day in the control group (p < or =.05, d =.46). CONCLUSIONS: The physical activity intervention, implemented by the school staff, resulted in enhanced physical activity behaviors in both middle school boys and girls. The combination of environmental approaches with computer-tailored interventions seemed promising.

R. J. Haggerty, C. A. Aligne, M. K. Bell and M. A. Limbos. (2007). Pediatrics in the community: the Earn-a-Bike program. Pediatrics in review.

E. Hayes, Silberman, L. (2007). Incorporating Video Games into Physical Education. JOPERD.

Contrary to common belief, several studies have found no relationship between video gaming and obesity or physical inactivity. In fact, video gaming is an untapped resource for enhancing young people's motivation and ability to participate in sports and other movement-based activities. Many popular video games offer sophisticated and engaging simulations of popular sports--such as basketball, soccer, tennis, and football. These simulated experiences may enhance students' motivation, confidence, understanding, and performance in athletic activities if incorporated into the physical education setting.

H. M. Hendy, K. E. Williams, T. S. Camise, S. Alderman, J. Ivy and J. Reed. (2007). Overweight and average-weight children equally responsive to "Kids Choice Program" to increase fruit and vegetable consumption. Appetite.

Secondary analyses were conducted for children participating in the school-based Kids Choice Program [Hendy, H. M., Williams, K., & Camise, T. (2005). "Kids Choice" school lunch program increases children's fruit and vegetable acceptance. Appetite, 45, 250-263.] to examine whether fruit and vegetable consumption and preference ratings by overweight and average-weight children within the original sample were equally responsive to the program. The Kids Choice Program produced increased fruit and vegetable consumption by both overweight and average-weight children that lasted throughout the month-long program, while avoiding "over-justification" drops in later fruit and vegetable preference ratings. We believe that the Kids Choice Program shows promise for encouraging overweight children to improve nutrition and weight management behaviors while in their everyday peer environment.

C. Hill, C. Abraham and D. B. Wright. (2007). Can theory-based messages in combination with cognitive prompts promote exercise in classroom settings? Social Science & Medicine.

A randomised control trial evaluated the effectiveness of a theory-based persuasive leaflet designed to encourage students to undertake at least one additional physical exercise session a week. Participants were 503 secondary school students attending a school in South-East England. The leaflet was written to target potentially modifiable cognitive antecedents of exercise specified by the Theory of Planned Behaviour. It was separately augmented with two cognitive change techniques, resulting in three intervention conditions, leaflet alone; leaflet plus motivational quiz, and leaflet plus implementation intention prompt, as well as a no-leaflet control condition. Cognitions and behaviour were measured immediately before and 3 weeks after intervention. The results showed that all three-leaflet interventions significantly increased reported exercise, intention to exercise and related cognitions, compared to the control condition, but did not differ in their impact. Mediation analysis showed that intervention effects on exercise were partially mediated by intentions and perceived behavioural control.

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