Introduction to the Active Living Research Reference List 2007


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D. Hollar, T. L. Hollar and A. S. Agatston. (2007). School-based early prevention interventions decrease body mass index percentiles during school year, but children experience increase in percentiles during summer. Circulation.
D. Hollar, T. L. Hollar and A. S. Agatston. (2007). School-based early prevention interventions improve body mass index percentiles: Preliminary results of the HOPS study. Circulation.

P. J. Horne, C. A. Hardman, C. F. Lowe and A. V. Rowlands. (2007). Increasing children's physical activity: a peer modelling, rewards and pedometer-based intervention. European Journal Of Clinical Nutrition.

Background/Objectives:To evaluate a peer modelling, rewards and pedometer-feedback intervention designed to increase children's physical activity and which uses the same behaviour-change principles underlying the Food Dude Healthy Eating Programme.Subjects/Methods:The study was conducted in two primary schools in Wales. Participants were 47 children (21 boys, 26 girls) from the experimental school and 53 children (29 boys, 24 girls) from a matched control school, aged 9-11 years. Children in the experimental school took part in the intervention; over 8 days they were introduced to fictional role models (the Fit n' Fun Dudes) via visual and audio intervention materials and received small rewards when their daily pedometer step counts increased by 1500 steps per day relative to their baselines. Pedometer measures were taken from children in both schools at baseline, intervention (baseline 2 for the control school) and 12-week follow-up.Results:Among experimental girls, steps per day were significantly higher during the intervention (14 686+/-2540) and at follow-up (13 737+/-3288) compared to baseline (10 864+/-2481, P<0.001) and control girls (P<0.005). Experimental boys showed significantly higher daily steps during the intervention compared to baseline (16 237+/-4204 cf. 13 452+/-3258, P<0.001) and control boys (P<0.005). There were no significant differences between activity levels of experimental and control boys at follow-up.Conclusions:The intervention resulted in substantial increases in children's physical activity, which was well maintained over a 12-week period in girls.European Journal of Clinical Nutrition advance online publication, 19 September 2007; doi:10.1038/sj.ejcn.1602915.

A. R. Hughes, R. McLaughlin, J. McKay, K. Lafferty, T. McKay and N. Mutrie. (2007). The B'Active programme for overweight primary school children in Glasgow: determining the prevalence of overweight and obesity and piloting an activity intervention. British Journal of Nutrition.

The aim of this study was to determine the prevalence of overweight and obesity in primary school children in Glasgow and to evaluate a pilot activity programme for overweight and obese children. BMI was measured in 1548 children. Overweight, obesity and severe obesity were defined as BMI > or =85th, 95th and 98th centile, respectively. Overweight and obese children were then invited to participate in a 10-week school-based activity programme. The programme was evaluated by recording weekly attendance, intensity (using the Children's Effort Rating Scale) and enjoyment (scale 1-10). Focus groups were used to explore the experiences and views of the children, teachers, coaches and parents. Of the 1548 children, 31.4% were overweight, 19.1% were obese and 12.4% were severely obese; 38% of those invited attended the activity programme. Weekly programme attendance was 83% (range 56-99%). Mean enjoyment rating (scale 1-10) was 8 for boys and 9 for girls. The intensity of activity sessions were rated 'very easy' by boys and 'just feeling a strain' by girls. Common themes emerging from the focus groups related to perceived positive and negative aspects of the programme (fun, concerns about stigmatising children); physical and psychological outcomes (fitter, more confident); and future recommendations (involve parents). In summary, the prevalence of overweight and obesity was high. The activity programme was successful in terms of attendance and enjoyment, and overall views of the initiative were positive and there was compelling support for its continuation.

M. E. Huhman, L. D. Potter, J. C. Duke, D. R. Judkins, C. D. Heitzler and F. L. Wong. (2007). Evaluation of a national physical activity intervention for children: VERB campaign, 2002-2004. American Journal of Preventive Medicine.

BACKGROUND: Amid concern for the consequences of physical inactivity among children, the Centers for Disease Control and Prevention started a campaign using commercial marketing methods to promote physical activity to children. DESIGN: Longitudinal study using a telephone survey to assess physical activity behaviors and attitudes at baseline and for 2 years of follow-up. Relationships of campaign awareness to behavioral and psychosocial effects were analyzed with use of propensity scoring. PARTICIPANTS: Nationally representative cohort of 2257 parent-child dyads. INTERVENTION: Marketing campaign (VERB) directed to all U.S. children aged 9 to 13 years. Components included general market and ethnic-specific advertisements on television and radio, in print, and through promotions in communities, schools, and on the Internet. Advertising ran nationally at consistent levels from June 2002 through June 2004. MAIN OUTCOME MEASURES: Psychosocial measures and self-reports of free-time and organized physical activity during nonschool hours in the week before the interview and on the day before the interview. RESULTS: After 2 years, a dose-response effect was detected in the study population. The more children who reported seeing VERB messages, the more physical activity they reported and the more positive their attitudes were about the benefits of being physically active. Children aware of VERB reported engaging in significantly more physical activity than children unaware of VERB. These results were considerably stronger than the effects after Year 1, which were only for physical activity among subpopulations. CONCLUSIONS: The VERB campaign continued to positively influence children's attitudes about physical activity and their physical activity behaviors and expanded the effects to more children. With adequate and sustained investment, health marketing shows promise to affect the attitudes and behavior of children.

A. J. Isaacs, J. A. Critchley, S. S. Tai, K. Buckingham, D. Westley, S. D. R. Harridge, C. Smith and J. M. Gottlieb. (2007). Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only. Health Technology Assessment.

Objectives: To evaluate and compare the effectiveness and cost-effectiveness of a leisure centre-based exercise programme, an instructor-led walking programme and advice-only in patients referred for exercise by their GPs. Design: A single-centre, parallel-group, randomised controlled trial, consisting of three arms, with the primary comparison at 6 months. Setting: Assessments were carried out at Copthall Leisure Centre in Barnet, an outer London borough, and exercise programmes conducted there and at three other leisure centres and a variety of locations suitable for supervised walking throughout the borough. Participants: Participants were aged between 40 and 74 years, not currently physically active and with at least one cardiovascular risk factor. Interventions: The 943 patients who agreed to participate in the trial were assessed in cohorts and randomised to one of the following three arms: a 10-week programme of supervised exercise classes, two to three times a week in a local leisure centre; a 10-week instructor-led walking programme, two to three times a week; an advice-only control group who received tailored advice and information on physical activity including information on local exercise facilities. After 6 months the control group were rerandomised to one of the other trial arms. Assessments took place before randomisation, at 10 weeks (in a random 50% subsample of participants), 6 months and 1 year in the leisure centre and walking arms. The control participants were similarly assessed up to 6 months and then reassessed at the same intervals as those initially randomised to the leisure centre and walking groups. Main outcome measures: The primary outcome measures were changes in self-reported exercise behaviour, blood pressure, total cholesterol and lipid subfractions. Secondary outcomes included changes in anthropometry, cardiorespiratory fitness, flexibility, strength and power, self-reported lifestyle behaviour, general and psychological health status, quality of life and health service usage. The costs of providing and making use of the service were quantified for economic evaluation. Results: There was a net increase in the proportion of participants achieving at least 150 minutes per week of at least moderate activity in the sport/leisure and walking categories in all three study groups: at 6 months, the net increases were 13.8% in the leisure centre group, 11.1% in the walking group and 7.5% in the advice-only group. There were significant reductions in systolic and diastolic blood pressure in all groups at each assessment point compared with baseline. There were also significant and sustained improvements in cardiorespiratory fitness and leg extensor power, and small reductions in total and low-density lipoprotein cholesterol in all groups, but there were no consistent differences between the groups for any parameter over time. All three groups showed improvement in anxiety and mental well-being scores 6 months after the beginning of the trial. Leisure centre and walking groups maintained this improvement at 1 year. There were no differences between groups. Costs to the participants amounted to pound 100 for the leisure centre scheme and pound 84 for the walking scheme, while provider costs were pound 186 and pound 92, respectively. Changes in overall Short Form 36 scores were small and advice only appeared the most cost-effective intervention. Conclusions: The results of this trial suggest that referral for tailored advice, supported by written materials, including details of locally available facilities, supplemented by detailed assessments may be effective in increasing physical activity. The inclusion of supervised exercise classes or walks as a formal component of the scheme may not be more effective than the provision of information about their availability. On cost-effectiveness grounds, assessment and advice alone from an exercise specialist may be appropriate to initiate action in the first instance. Subsidised schemes may be best concentrated on patients at higher absolute risk, or with specific conditions for which particular programmes may be beneficial. Walking appears to be as effective as leisure centre classes and is cheaper. Efforts should be directed towards maintenance of increased activity, with proven measures such as telephone support. Further research should include an updated meta-analysis of published exercise interventions using the standardised mean difference approach.
M. Jallo. (2007). Childhood obesity. A community approach. International Journal Of Obesity.
J. James, P. Thomas and D. Kerr. (2007). Preventing childhood obesity: two year follow-up results from the Christchurch obesity prevention programme in schools (CHOPPS). British Medical Journal.

Objective To assess the long term effects of an obesity prevention programme in schools. Design Longitudinal results after a cluster randomised controlled trial. Setting Schools in southwest England. Participants Of the original sample of 644 children aged 7-11, 511 children were tracked and measurements were obtained from 434 children three years after baseline. Intervention The intervention was conducted over one school year, with four sessions of focused education promoting a healthy diet and discouraging the consumption of carbonated drinks. Main outcome measures Anthropometric measures of height, weight, and waist circumference. Body mass index (BMI) converted to z score (SD scores) and to centile values with growth reference curves. Waist circumference was also converted to z scores (SD scores). Results At three years after baseline the age and sex specific BMI z scores (SD scores) had increased in the control group by 0.10 (SD 0.53) but decreased in the intervention group by -0.01 (SD 0.58), with a mean difference of 0.10 (95% confidence interval -0.00 to 0.21, P=0.06). The prevalence of overweight increased in both the intervention and control group at three years and the significant difference between the groups seen at 12 months was no longer evident. The BMI increased in the control group by 2.14 (SD 1.64) and the intervention group by 1.88 (SD 1.71), with mean difference of 0.26 (-0.07 to 0.58, P=0.12). The waist circumference increased in both groups after three years with a mean difference of 0.09 (-0.06 to 0.26, P=0.25). Conclusions These longitudinal results show that after a simple year tong intervention the difference in prevalence of overweight in children seen at 12 months was not sustained at three years.

J. Jiang, X. Xia, T. Greiner, G. Wu, G. Lian and U. Rosenqvist. (2007). The effects of a 3-year obesity intervention in schoolchildren in Beijing. Child Care Health Development.

BACKGROUND: Childhood obesity has become a health problem in urban areas in China. Intervention to reduce childhood obesity should be of high priority. School-based intervention programmes are needed to deal with the growing prevalence of childhood obesity in China. METHODS: Five primary schools were selected randomly for this study in the Beijing urban area in China; two were allocated to the intervention group and three to the control group. A total of 2425 children (1029 children in intervention schools and 1396 children in control schools) took part in the study for 3 years. In the intervention group, children and their parents were involved in a programme of nutrition education and physical activity. Control school students followed their usual health and physical education curriculum with no extra intervention. RESULTS: After the 3-year intervention, the prevalence of overweight and obesity were significantly lower in the intervention schools than in the control schools (overweight: 9.8% vs. 14.4%, P < 0.01; obesity: 7.9% vs. 13.3%, P < 0.01). The prevalence of overweight and obesity decreased by 26.3% and 32.5% in intervention schools respectively after intervention. The prevalence of overweight and obesity increased in control schools. There was also significant difference in body mass index between intervention and control schools (18.2 +/- 2.6 vs. 20.3 +/- 3.4, P < 0.01) after intervention. More non-obese children became obese in the control schools (7.0%) than in the intervention schools (2.4%) at end line (P < 0.01). Among the children who were obese at baseline, 49.2% remained obese at end line in intervention schools while 61.9% remained obese in control schools (P < 0.01). CONCLUSIONS: Our study showed that an intervention programme could be feasible in schools in Beijing, China. The prevalence of overweight and obesity was reduced in schoolchildren in Beijing through an intervention focused on nutrition education and physical activity. Overweight and obesity children as well as normal weight children and their parents should be involved in such an intervention programme.

C. A. Johnston, C. Tyler, G. Fullerton, W. S. Poston, C. K. Haddock, B. McFarlin, R. S. Reeves and J. P. Foreyt. (2007). Results of an intensive school-based weight loss program with overweight Mexican American children. International Journal of Pediatric Obesity.

Childhood overweight has increased significantly in the past 20 years, with the highest rates noted among Mexican Americans. Schools are an optimal setting for intervention efforts; however, few programs have demonstrated actual decreases in weight. This study evaluated an intensive school-based program designed to result in weight reduction for overweight Mexican American children. A total of 71 children (32 males, 48%) between the ages of 10 and 14 at or above the 85th percentile for body mass index (BMI) were randomized into a six-month intensive intervention (II) or self-help (SH) condition. Results revealed that children in the II condition significantly reduced their standardized BMI (zBMI) when compared with the children in the self-help condition (F(2,62)=6.58, p=0.003). The change in zBMI was significantly different at both 3 and 6 months (F(1,63)=5.74, p=0.019, F(1,63)=12.61, p=0.001, respectively) with II participants showing greater decreases in weight. The 3-month change in zBMI for the II participants was a decrease of 0.07 compared with a decrease of 0.01 for SH participants. The 6-month change in zBMI was a decrease of 0.11 for II and an increase of 0.03 for SH. Overall, the results are promising, suggesting that an intensive school-based intervention may be an effective means for promoting weight loss in overweight Mexican American children.

C. A. Johnston, C. Tyler, S. Carvalho, A. El-Mubasher, W. C. Poston, C. K. Haddock, R. Reeves and J. P. Foreyt. (2007). Weight management for Mexican American adolescents: School-based program. Faseb Journal.

R. A. Jones, A. D. Okely, C. E. Collins, P. J. Morgan, J. R. Steele, J. M. Warren, L. A. Baur, D. P. Cliff, T. Burrows and J. Cleary. (2007). The HIKCUPS trial: a multi-site randomized controlled trial of a combined physical activity skill-development and dietary modification program in overweight and obese children. Bmc Public Health.

Background: Childhood obesity is one of the most pressing health issues of our time. Key health organizations have recommended research be conducted on the effectiveness of well-designed interventions to combat childhood obesity that can be translated into a variety of settings. This paper describes the design and methods used in the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) trial, an ongoing multi-site randomized controlled trial, in overweight/obese children comparing the efficacy of three interventions: 1) a parent-centered dietary modification program; 2) a child-centered physical activity skill-development program; and 3) a program combining both 1 and 2 above. Methods/Design: Each intervention consists of three components: i) 10-weekly face-to-face group sessions; ii) a weekly homework component, completed between each face-to-face session and iii) three telephone calls at monthly intervals following completion of the 10-week program. Details of the programs' methodological aspects of recruitment, randomization and statistical analyses are described here a priori. Discussion: Importantly this paper describes how HIKCUPS addresses some of the short falls in the current literature pertaining to the efficacy of child obesity interventions. The HIKCUPS trial is funded by the National Medical Research Council, Australia.

E. B. Jones. (2007). Preventing weight bias in workplace lifestyle intervention programs. Archives Of Internal Medicine.
N. S. Joo, J. Y. Kim, S. H. Choi, S. B. Park, M. H. Kong, T. Y. Lee and B. T. Kim. (2007). The effect on weight control by community-based, anti-obesity health education program. International Journal Of Obesity.
C. M. Kelly, E. A. Baker, R. C. Brownson and M. Schootman. (2007). Translating research into practice: using concept mapping to determine locally relevant intervention strategies to increase physical activity. Evaluation Program Planning.

PURPOSE: To translate intervention strategies to increase physical activity interventions recommended by the Community Guide for higher and lower income African-American adults living in an urban, Midwestern community. METHOD: Structured interviews were conducted with a stratified random sample of African-American men and women from high- and low-income groups. Data were analyzed using concept mapping, a six-step process that incorporates qualitative and quantitative analysis. RESULTS: The results suggest differences among men and women, high and low income, in the conceptualization of factors associated with physical activity behavior. The different conceptualizations suggest different intervention strategies and action steps may be necessary for subgroups of a population. CONCLUSION: Concept mapping is a participatory method that community members and health practitioners can use to develop locally defined intervention strategies. From the strategies and action steps identified, evidence-based interventions can be developed in light of the optimal characteristics necessary within a community.

R. A. Kennedy, C. A. G. Boreham, M. H. Murphy, I. S. Young and N. Mutrie. (2007). Evaluating the effects of a low volume stairclimbing programme on measures of health-related fitness in sedentary office workers. Journal Of Sports Science And Medicine.

Despite its obvious advantages, few studies have examined health outcomes of regular stariclimbing. In this study, we investigated the training effects of eight weeks of stairclimbing on recognised measures of health-related fitness in an occupational setting. Forty-five public sector employees (22 male, 23 female) aged 42.3 +/- 9.0 years were randomly assigned to control (n = 16) or stairclimbing (n = 29) groups. Stairclimbing training began with 1 bout 5d.wk(-1) in week 1, increasing by one climb per day every two weeks until week 5, where a maintenance level of 3 climbs per day was reached. Participants climbed on staircases located within an 8 storey office block, consisting of 145 steps. The prescribed exercise intensity involved climbing the 8 flights of stairs at a rate of 75 steps.min(-1). All participants agreed not to change their diet or lifestyle over the experimental period. Relative to controls, the stairclimbing group showed a significant increase of 9.4% in predicted VO2max (p < 0.05). No significant changes in blood pressure, blood lipid concentrations or body composition were noted. These findings provide evidence that stairclimbing can enhance an important component of health-related fitness, namely cardiovascular fitness. Given that such improvement resulted from less than 30 minutes per week of moderate exercise, stairclimbing in the workplace should be promoted as a health-enhancing physical activity.

J. R. Kicklighter, D. M. Whitley, S. J. Kelley, S. M. Shipskie, J. L. Taube and R. C. Berry. (2007). Grandparents raising grandchildren: a response to a nutrition and physical activity intervention. Journal of the American Dietetic Association.

This pilot study explored the impact of an educational program on nutrition and physical activity knowledge of urban African-American grandparents raising their grandchildren. The program was integrated into a community-based intervention, Project Healthy Grandparents, and was implemented during the first 15 minutes of 10 grandparent support groups and parenting classes. Subjects included 22 grandparents who attended at least six sessions and completed pre- and posttests of nutrition and physical activity knowledge. Participants' posttest scores were significantly higher than their pretest scores (P<0.05), indicating an increase in knowledge. Eighteen grandparents provided insights about diet and physical activity and barriers to lifestyle changes during an audiotaped focus group. Based on analysis of the focus group's discussion, three major influences on healthful eating and physical activity emerged, including financial considerations, presence of grandchildren in the home, and preference for traditional cultural foods. Themes from the focus group were consistent with responses on the nutrition and physical activity knowledge test. Satisfaction with the program was very high and no specific recommendations for improvements were made. Results can guide future nutrition interventions for this target group and potentially contribute to grandparents' improved health and ability to care for their grandchildren.

A. L. Kossert, T. M. Loughead and K. J. Munroe-Chandler. (2007). Promoting physical activity in the natural environment through prompted stairway use. Journal Of Sport & Exercise Psychology.
M. La Londe, R. Snow, K. Spencer, C. Graffagnino, J. M. Falko and T. Caulin-Glaser. (2007). Impact of participation level in a community weight loss program on determinants and prevalence of metabolic syndrome. Circulation.

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