Introduction to the Active Living Research Reference List 2007

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M. Mura, A. B. Joyner and A. Parrillo. (2007). Decreasing elevator travel in women using sign prompts encouraging stair use. Research Quarterly For Exercise And Sport.
M. Naito, T. Nakayama, T. Okamura, K. Miura, M. Yanagita, Y. Fujieda, F. Kinoshita, Y. Naito, H. Nakagawa, T. Tanaka and H. Ueshima. (2007). Effect of a 4-year workplace-based physical activity intervention program on the blood lipid profiles of participating employees: The high-risk and population strategy for occupational health promotion (HIPOP-OHP) study. Atherosclerosis.

Individuals who are physically fit or engage in regular physical activity have a lower incidence of cardiovascular disease and risk of mortality. We conducted a large-scale controlled trial of interventions to decrease cardiovascular risk factors, during which we assessed the effect of a workplace-based intervention program, which was part of a population strategy for promoting long-term increases in physical activity, on the blood lipid profiles of participating employees. Data were collected from 2929 participants and this report presents the results of a survey conducted in five factories for the intervention group and five factories for the control group at baseline and year 5. The absolute/proportional changes in HDL-cholesterol were 2.7mg/dL (4.8%) in the intervention group and -0.6mg/dL (-1.0%) in the control group. The differences between the two groups in the change in serum levels of HDL-cholesterol were highly significant (p<0.001) in each analysis of covariance, in which the number of cigarettes smoked was included or excluded. In the intervention group, the daily walking time increased significantly (p<0.001) when compared between baseline and year 5, whereas no significant difference was observed in daily walking time in the control group over the identical period. Our results show that an intervention program promoting physical activity raises serum HDL-cholesterol levels of middle-aged employees. Increased awareness of the benefits of physical activity, using environmental rearrangement and health promotion campaigns, which especially target walking, may have contributed to a beneficial change in serum HDL-cholesterol levels in the participants.

P. Nowicka, P. Hoglund and C. E. Flodmark. (2007). Family Weight School based on family therapy in group meetings reduces BMI SD scores in severely obese adolescents. International Journal Of Obesity.
D. Ogilvie, C. E. Foster, H. Rothnie, N. Cavill, V. Hamilton, C. F. Fitzsimons and N. Mutrie. (2007). Interventions to promote walking: systematic review. British Medical Journal.

OBJECTIVE: To assess the effects of interventions to promote walking in individuals and populations. DESIGN: Systematic review. DATA SOURCES: Published and unpublished reports in any language identified by searching 25 electronic databases, by searching websites, reference lists, and existing systematic reviews, and by contacting experts. REVIEW METHODS: Systematic search for and appraisal of controlled before and after studies of the effects of any type of intervention on how much people walk, the distribution of effects on walking between social groups, and any associated effects on overall physical activity, fitness, risk factors for disease, health, and wellbeing. RESULTS: We included 19 randomised controlled trials and 29 non-randomised controlled studies. Interventions tailored to people's needs, targeted at the most sedentary or at those most motivated to change, and delivered either at the level of the individual (brief advice, supported use of pedometers, telecommunications) or household (individualised marketing) or through groups, can encourage people to walk more, although the sustainability, generalisability, and clinical benefits of many of these approaches are uncertain. Evidence for the effectiveness of interventions applied to workplaces, schools, communities, or areas typically depends on isolated studies or subgroup analysis. CONCLUSIONS: The most successful interventions could increase walking among targeted participants by up to 30-60 minutes a week on average, at least in the short term. From a perspective of improving population health, much of the research currently provides evidence of efficacy rather than effectiveness. Nevertheless, interventions to promote walking could contribute substantially towards increasing the activity levels of the most sedentary.

A. V. Ortiz, J. D. M. Murguia, A. J. de la Mota, S. R. Orozco and O. A. N. Sanchez. (2007). Effect of an intervention program for overweight and obesity in school-age children in the city of Colima, Mexico. Salud Publica De Mexico.
R. R. Pate, R. Saunders, R. K. Dishman, C. Addy, M. Dowda and D. S. Ward. (2007). Long-term effects of a physical activity intervention in high school girls. American Journal Of Preventive Medicine.

Background: Physical activity (PA) decreases during childhood and adolescence, and PA levels are significantly lower in females than males, particularly during adolescence. Schools are attractive settings in which to implement interventions designed to promote PA in girls and young women, but few studies have tested the sustained effects of such interventions. Design: Cross-sectional. Data were collected in 2002-2003 and analyzed in 2006-2007. Setting/participants: 1594 adolescent girls in 22 high schools. Intervention: The intervention, Lifestyle Education for Activity Program (LEAP), was designed to increase physical activity in 9th-grade girls through two channels: changes in instructional practices and changes in the school environment. This study (LEAP 2) examined the extent to which effects of the intervention were maintained when the girls were in the 12th grade. Main outcome measures: Number of 30-minute blocks per day of vigorous physical activity. Results: Girls in the intervention schools that most fully implemented and maintained the intervention were more likely than girls in the other schools to participate in an average of one or more blocks of vigorous physical activity per day (p=0.04, odds ratio=1.49, 95% confidence interval=1.01-2.20). Conclusions: A comprehensive physical activity intervention that is fully implemented and maintained can increase participation in vigorous physical activity by high school girls.

R. Pazoki, I. Nabipour, N. Seyednezami and S. R. Imami. (2007). Effects of a community-based healthy heart program on increasing healthy women's physical activity: a randomized controlled trial guided by Community-based Participatory Research (CBPR). Bmc Public Health.

Background: Cardiovascular disease remains the leading killer of women in most developed areas of the world. Rates of physical inactivity and poor nutrition, which are two of the most important modifiable risk factors for cardiovascular disease in women, are substantial. This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women's physical activity in a randomized trial guided by community-based participatory research (CBPR) methods. Methods: A total of 335 healthy, 25-64 years old women who had been selected by a multiple-stage stratified cluster random sampling method in Bushehr Port/I.R. Iran, were randomized into control and intervention groups. The intervention group completed an 8-week lifestyle modification program for increasing their physical activity, based on a revised form of Choose to Move program; an American Heart Association Physical Activity Program for Women. Audio-taped activity instructions with music and practical usage of the educational package were given to the intervention group in weekly home-visits by 53 volunteers from local non-governmental and community-based organizations. Results: Among the participants, the percentage who reported being active (at lease 30 minutes of moderate intensity physical activity for at least 5 days a week, or at least 20 minutes of vigorous physical activity for at least three days a week) increased from 3% and 2.7% at baseline to 13.4% and 3% (p < 0.0001) at the ending of the program in the intervention and control groups, respectively. The participants in the intervention group reported more minutes of physical activity per week (mean = 139.81, SE = 23.35) than women in the control group (mean = 40.14, SE = 12.65) at week 8 (p < 0.0001). The intervention group subjects exhibited a significantly greater decrease in systolic blood pressure (-10.0 mmHg) than the control group women (+ 2.0. mmHg). The mean ranks for posttest healthy heart knowledge in the intervention and control groups were 198.91 and 135.77, respectively (P < 0.0001). Conclusion: An intervention based on CBPR methods can be effective for the short-term adoption of physical activity behavior among women. The development of participatory process to support the adequate delivery of lifestyle-modification programs is feasible and an effective healthcare delivery strategy for cardiovascular community health promotion. Trial Registration: ACTRNO12606000521527.

L. E. Peck, P. A. Sharpe, E. L. Burroughs and M. L. Granner. (2007). Recruitment Strategies and Costs for a Community-Based Physical Activity Program. Health Promotion Practice.

A community-based participatory research project using social marketing strategies was implemented to promote physical activity among women aged 35 to 54 who were insufficiently active or completely inactive. A variety of media were used to disseminate messages about how to enroll in Step Up. Step Out! This article describes the effectiveness and cost of the recruitment strategies and lessons learned in recruiting the women. Of the total inquiries (n = 691), 430 women were eligible and enrolled in the program. Based on data from questionnaires, the most effective method of recruiting women into Step Up. Step Out! was word of mouth (36%). Newspaper ads accounted for 29% of the women's responses. The least effective method was billboards. Mass media was not as effective in recruiting women for the program as interpersonal efforts such as word of mouth. Interpersonal efforts are a valuable and possibly underrated recruitment and promotion tool.

C. K. Perry, A. G. Rosenfeld, J. A. Bennett and K. Potempa. (2007). Heart-to-Heart - Promoting walking in rural women through motivational interviewing and group support. Journal Of Cardiovascular Nursing.

Background: Walking can significantly increase cardiorespiratory fitness and thereby reduce the incidence of heart disease in women. However, there is a paucity of research aimed at increasing walking in rural women, a high-risk group for heart disease and one for which exercise strategies may pose particular challenges. Purpose: This study tested Heart-to-Heart (HTH), a 12-week walking program, designed to increase fitness through walking in rural women. Heart-to-Heart integrated individual-oriented strategies, including motivational interviewing, and group-based strategies, including team building. Methods: Forty-six rural women were randomized to either HTH or a comparison group. The primary outcome of cardiorespiratory fitness and secondary outcomes of self-efficacy and social support were measured preintervention and postintervention. Group differences were analyzed with repeated-measures analysis of variance. Results: Women in HTH had a greater improvement in cardiorespiratory fitness (P=.057) and in social support (P=.004) compared with women in the comparison group. Neither group of women experienced a change in exercise self-efficacy (P=.814). Conclusions: HTH was effective in improving cardiorespiratory fitness in a sample of rural women. Further research is needed to refine HTH and determine the optimal approach in rural women to increase their walking.

C. K. Perry, A. G. Rosenfeld and J. Kendall. (2007). Rural Women Walking for Health. Western Journal of Nursing Research.

The purpose of this qualitative study is to describe rural women's barriers and motivators for participation in a walking program. Twenty rural women, ages 22 to 65, participated in a 12-week walking program. Data from field notes and focus groups were analyzed using qualitative content analysis. Data were inductively coded, codes were categorized into themes, and themes were classified as barriers or motivators to adopting a walking program. Three main barriers are identified: balancing family and self, chronic illness gets in the way of routine, and illness or injury breaks routine. Seven motivators are identified: being part of a group, group camaraderie, learning, pacesetter, seeing progress, energizing, and I am a walker. Women report that family responsibilities are a powerful and pervasive barrier. Motivators center on the importance of group interaction. This qualitative study increases our understanding of rural women's barriers and motivators to embarking on and sustaining a regular walking routine.

K. E. Peterson and M. K. Fox. (2007). Addressing the epidemic of childhood obesity through school-based interventions: what has been done and where do we go from here? Journal of Law, Medicine & Ethics.

Schools are ideal settings for implementing multi-component programs to prevent and control childhood obesity. Thoughtful improvements to proven strategies, coupled with careful evaluation, can contribute to accumulation of evidence needed to design and implement the next generation of optimal interventions.

R. A. Prosser, A. C. Thomas and C. S. Darling-Fisher. (2007). Physical activity intervention in an academic setting: focus group results. Aaohn J.

The purpose of this study was to elicit beliefs and attitudes about increasing physical activity in the workplace among staff and faculty in an academic setting as the first phase of a three-phase pilot study. Focus groups were conducted using the Theory of Planned Behavior as the basis for exploratory questions regarding workplace physical activity. The responses were tallied and themes emerged from the qualitative analysis. The primary themes indicated that physical activity at work would be beneficial because it could allow for more free time at home. However, it would not be advantageous if it took time away from work or conflicted with supervisors' needs. Differences in the likelihood of participation in a physical activity program were noted between staff and faculty. It was clear that successful design and implementation of the program needed the support of all employees in the school.

J. M. Rasmussen. (2007). Fight the fat: An after-school program to prevent obesity. Research Quarterly For Exercise And Sport.
J. Rice, D. Thombs, R. Leach and R. Rehm. (2008). Successes and barriers for a youth weight-management program. Clinical Pediatrics (Phila).

A patient recruiting process was developed for a youth weight-management program in a metropolitan area, and the clinical effects of the program on overweight and obese children aged 7 to 17 years old were assessed. During the 12-month effort, 68 overweight children were enrolled. The program included exercise, nutrition coaching, and behavior change counseling. Clinical outcomes were measured. Patient recruiting methods were monitored and included working with physicians and schools and marketing to consumers. Program adherence was 71% attendance, 5% noncompliance, and 5% drop out rates. Clinical outcomes were excellent: 68% of participants lowered their body mass index by an average of 2.5% (mean, 24 weeks). The program was clinically successful, but patient recruitment initiatives were unsuccessful and the program was discontinued. Parents were the largest obstacle to patient recruiting efforts. For children's weight-management programs to be commercially viable, new models of patient recruiting and promotion of parental acceptance are needed.

M. L. Richert, A. J. Webb, N. A. Morse, M. L. O'Toole and C. A. Brownson. (2007). Move More Diabetes: using Lay Health Educators to support physical activity in a community-based chronic disease self-management program. Diabetes Education.

PURPOSE: The purpose of this article is to describe Move More Diabetes (MMD), which is used by Lay Health Educators (LHEs) to promote physical activity and improve diabetes self-management among individuals with type 2 diabetes. METHODS: Move More Diabetes used social marketing strategies to choose and segment the target audience, develop messages, and determine message delivery. Based on market research results, MMD chose natural peer support from LHEs as the main intervention strategy. RESULTS: Move More Diabetes built a sustainable volunteer network of 35 LHEs who recorded 1500 contacts with enrollees from 2004 to 2006. Participation improved when the program was not specific for diabetes. CONCLUSION: The MMD program demonstrated benefits of partnership and natural peer support and the utility of social marketing in planning and implementing a community-based chronic disease self-management and physical activity promotion program. This low-cost program can serve as a model for other rural communities interested in increasing physical activity to address chronic disease.

N. D. Ridgers, G. Stratton, S. J. Fairclough and J. W. R. Twisk. (2007). Long-term effects of a playground markings and physical structures on children's recess physical activity levels. Preventive Medicine.

Objective. The aim of the study was to investigate the impact of a playground redesign intervention across time on children's recess physical activity levels using combined physical activity measures and to evaluate the potential influence of covariates on the intervention effect. Method. Fifteen schools located in areas of high deprivation in one large city in England each received 20,000 pound through a national 10 pound million Sporting Playgrounds Initiative to redesign the playground environment based on a multicolored zonal design. Eleven schools served as matched socioeconomic controls. Physical activity levels during recess were quantified using heart rate telemetry and accelerometry at baseline, 6 weeks and 6 months following the playground redesign intervention. Data were collected between July 2003 and January 2005 and analyzed using multilevel modeling. Results. Statistically significant intervention effects were found across time for moderate-to-vigorous and vigorous physical activity assessed using both heart rate and accelerometry. Conclusions. The results suggest that a playground redesign, which utilizes multicolor playground markings and physical structures, is a suitable stimulus for increasing children's school recess physical activity levels. (C) 2007 Elsevier Inc. All rights reserved.

S. J. Robroek, F. J. Bredt and A. Burdorf. (2007). The (cost-)effectiveness of an individually tailored long-term worksite health promotion programme on physical activity and nutrition: design of a pragmatic cluster randomised controlled trial. BMC Public Health.

BACKGROUND: Cardiovascular disease is the leading cause of disability and mortality in most Western countries. The prevalence of several risk factors, most notably low physical activity and poor nutrition, is very high. Therefore, lifestyle behaviour changes are of great importance. The worksite offers an efficient structure to reach large groups and to make use of a natural social network. This study investigates a worksite health promotion programme with individually tailored advice in physical activity and nutrition and individual counselling to increase compliance with lifestyle recommendations and sustainability of a healthy lifestyle. METHODS/DESIGN: The study is a pragmatic cluster randomised controlled trial with the worksite as the unit of randomisation. All workers will receive a standard worksite health promotion program. Additionally, the intervention group will receive access to an individual Health Portal consisting of four critical features: a computer-tailored advice, a monitoring function, a personal coach, and opportunities to contact professionals at request. Participants are employees working for companies in the Netherlands, being literate enough to read and understand simple Internet-based messages in the Dutch language.A questionnaire to assess primary outcomes (compliance with national recommendations on physical activity and on fruit and vegetable intake) will take place at baseline and after 12 and 24 months. This questionnaire also assesses secondary outcomes including fat intake, self-efficacy and self-perceived barriers on physical activity and fruit and vegetable intake. Other secondary outcomes, including a cardiovascular risk profile and physical fitness, will be measured at baseline and after 24 months.Apart from the effect evaluation, a process evaluation will be carried out to gain insight into participation and adherence to the worksite health promotion programme. A cost-effectiveness analysis and sensitivity analysis will be carried out as well. DISCUSSION: The unique combination of features makes the individually tailored worksite health promotion programme a promising tool for health promotion. It is hypothesized that the Health Portal's features will counteract loss to follow-up, and will increase compliance with the lifestyle recommendations and sustainability of a healthy lifestyle. TRIAL REGISTRATION: Current Controlled Trials ISRCTN52854353.

C. Rowley, L. Dixon and R. Palk. (2007). Promoting physical activity: walking programmes for mothers and children. Community Practice.

This article considers the development of two walking programmes by a health visiting team to encourage parents and children to undertake regular exercise. Government reports have stressed the importance of regular physical activity to promote physical and mental health. A survey of physical activity within a semi-rural caseload highlighted that the majority of families did not take regular exercise to maintain health. A programme of walks for post-natal mothers and a programme of activity walks for parents and young children were developed. Evaluation indicated that the walking programmes provided an acceptable and supported opportunity for parents and children to participate in physical activity. Participants increased their levels of regular physical activity and reported psychological benefits.This initiative demonstrates that health visitors have a key role in influencing, enabling and supporting people to participate in health activities.

J. Salmon, M. L. Booth, P. Phongsavan, N. Murphy and A. Timperio. (2007). Promoting physical activity participation among children and adolescents. Epidemiologic Reviews.

With global increases in the prevalence of overweight and obesity among children and adolescents, there has never been a more urgent need for effective physical activity programs. The aim of this narrative review is to summarize the evidence of the effectiveness of interventions that report physical activity outcomes in children aged 4-12 years and adolescents aged 13-19 years. A systematic search of electronic databases identified 76 interventions. Most interventions were delivered via the school setting (57 interventions), nine through the family setting, six via primary care, and four in community- or Internet-based settings. Children's physical activity interventions that were most effective in the school setting included some focus on physical education, activity breaks, and family strategies. Interventions delivered in the family setting were not highly effective, but many were pilot studies. The use of motivationally tailored strategies and program delivery in the primary care setting showed promise among adolescents. Many studies had methodological and reporting flaws (e.g., no baseline data, poor study design, physical activity measures of unknown reliability and validity, and poor reporting of sample size, response rates, attrition/retention, compliance, year of intervention, and duration of intervention). Publications reporting the results of evaluations of intervention studies should follow the Consolidated Standards of Reporting Trials guidelines or, for nonrandomized studies, should follow the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines. Further evidence of the effectiveness of interventions promoting young people's physical activity in family and community settings is needed.

A. Sanigorski, C. Bell, P. Kremer and B. Swinburn. (2007). Can community-based childhood obesity prevention programs reduce the socioeconomic status (SES) gradient with body mass index (BMI)? International Journal Of Obesity.
M. Schneider, G. F. Dunton, S. Bassin, D. J. Graham, A. F. Eliakim and D. M. Cooper. (2007). Impact of a school-based physical activity intervention on fitness and bone in adolescent females. Journal of Physical Activity and Health.

BACKGROUND: Many female adolescents participate in insufficient physical activity to maintain cardiovascular fitness and promote optimal bone growth. This study evaluates the impact of a school-based intervention on fitness, activity, and bone among adolescent females. METHODS: Subjects were assigned to an intervention (n = 63) or comparison (n = 59) group, and underwent assessments of cardiovascular fitness (VO2peak), physical activity, body composition, bone mineral density (BMD), bone mineral content (BMC), and serum markers of bone turnover at baseline and at the end of each of two school semesters. RESULTS: The intervention increased physical activity, VO2peak, and BMC for the thoracic spine (P values < 0.05). Bone turnover markers were not affected. In longitudinal analyses of the combined groups, improvements in cardiovascular fitness predicted increased bone formation (P < 0.01) and bone resorption (P < 0.05). CONCLUSION: A school-based intervention for adolescent females effectively increased physical activity, cardiovascular fitness, and thoracic spine BMC.

U. Scholz, F. F. Sniehotta, S. Burkert and R. Schwarzer. (2007). Increasing physical exercise levels - Age-specific benefits of planning. Journal Of Aging And Health.

Purpose: This study examines the differential age effects on physical exercise of two planning interventions, action planning (when, where, how) and coping planning (anticipating barriers, mental simulation of success scenarios), and examines the mediating mechanisms of the interventions. Methods: The study assigned the participants, 205 cardiac rehabilitation patients, to one of the intervention groups (action-planning only or combined-planning group) or to a control group. Baseline measurement and follow-up took place 2 months apart. Results: The interventions enhanced physical exercise independently of age. Pretreatment coping planning was higher in older (65-82 years) than in younger (38-54 years) or middle-aged (55-64 years) participants. At Time 2, older participants were the only ones without further increase in coping planning. Advancement in coping planning partially mediated the effect of the intervention. Conclusion: Coping planning facilitates improvement of physical exercise. Implications of age differences in planning are discussed.

M. A. Sevick, M. A. Napolitano, G. D. Papandonatos, A. J. Gordon, L. M. Reiser and B. H. Marcus. (2007). Cost-effectiveness of alternative approaches for motivating activity in sedentary adults: results of Project STRIDE. Preventive Medicine.

OBJECTIVE: To evaluate the cost-effectiveness of non-face-to-face interventions for increasing physical activity in sedentary adults. The study took place in Providence, Rhode Island between the years 2000 and 2004. METHODS: Two hundred and thirty-nine participants were randomized to Phone, Print or a contact control. Phone and Print groups were mailed regular surveys regarding their level of physical activity, motivational readiness and self-efficacy. Surveys were scanned by a computer expert system to generate feedback reports. Phone group participants received feedback by telephone. Print group participants received feedback by mail. The contact control group received mailings unrelated to physical activity. Intervention costs were assessed prospectively, from a payer perspective. Physical activity was measured using the 7-day Physical Activity Recall. Ambulatory health service use was assessed via monthly surveys. RESULTS: The Print intervention was more economically efficient than the Phone intervention in engaging participants in a more active lifestyle. CONCLUSION: The Print intervention provides an efficient approach to increasing physical activity. Research is needed to determine the cost-effectiveness of the intervention in a more diverse population, within the context of the health service delivery system and over a longer period of time.

M. Sharma. (2007). International school-based interventions for preventing obesity in children. Obesity Reviews.

The purpose of this article was to review international (excluding the United States) school-based interventions for preventing obesity in children published between 1999 and 2005. A total of 21 such interventions were found from Australia (1), Austria (1), Canada (1), Chile (1), France (1), Germany (3), Greece (1), New Zealand (1), Norway (1), Singapore (1) and the United Kingdom (9). The grade range of these interventions was from pre-school to high school with the majority (17) from elementary schools. Nine of these interventions targeted nutrition behaviours followed by seven aiming to modify both physical activity and nutrition behaviours. Only five interventions in international settings were based on any explicit behavioural theory which is different than the interventions developed in the United States. Majority of the interventions (9) were one academic year long. It can be speculated that if the interventions are behavioural theory-based, then the intervention length can be shortened. All interventions that documented parental involvement successfully influenced obesity indices. Most interventions (16) focused on individual-level behaviour change approaches. Most published interventions (16) used experimental designs with at least 1-year follow-up. Recommendations from international settings for enhancing the effectiveness of school-based childhood obesity interventions are presented.

D. Shelton, K. Le Gros, L. Norton, S. Stanton-Cook, J. Morgan and P. Masterman. (2007). Randomised controlled trial: A parent-based group education programme for overweight children. Journal of Paediatrics and Child Health.

AIM: Childhood overweight and obesity is a significant community health problem with severe long-term complications. This paper aims to evaluate a four-by-two-hour weekly group parent education programme targeting children who are overweight. METHODS: A randomised time series design with wait-list controls was conducted for overweight and obese children aged 3-10 years. RESULTS: A statistically significant reduction in child body mass index and energy intake was found post treatment; no differences were reported for child sedentary electronic media time, physical activity and waist circumference. Children's baseline activity levels were found to be at or slightly above national recommended standards. No change occurred in primary parent body mass index or waist circumference after treatment. CONCLUSIONS: A brief group education programme for parents was effective in reducing childhood overweight at 3 months follow-up.

B. J. Sherman, G. Gilliland, J. L. Speckman and K. M. Freund. (2007). The effect of a primary care exercise intervention for rural women. Preventive Medicine.

OBJECTIVE: Rural women have limited exercise opportunities and significant barriers to engaging in physical activity. This study assessed the effect of a brief primary care based walking intervention in rural women. METHODS: The participants were recruited in March, 2003 by a primary care nurse at three locations in rural Missouri. The enrolled subjects were given a pedometer, exercise videotape and provided exercise counseling at intake and four time points over 6 months. The week 1 pedometer step counts were compared with step counts at 6-month follow-up. RESULTS: Of the initial 75 participants, 61 completed at least one follow up encounter. The participant's mean age was 42.5 years. At intake, the majority of women (90%) exhibited one or more risk factors for cardiovascular disease; 78% were obese or overweight. Although most (62%) women reported being physically active, the mean pedometer reading was low at 6337 steps per day at week 1. Over the follow-up period, participants increased their step counts by a mean of 2573 steps per day (p<.001). Increases in step counts were seen in normal weight, overweight and obese participants. CONCLUSIONS: A simple walking intervention through a primary care practice was effective in increasing the short term walking rates of rural women.

A. S. Singh, M. Paw, J. Brug and W. van Mechelen. (2007). Short-term effects of school-based weight gain prevention among adolescents. Archives Of Pediatrics & Adolescent Medicine.

Objective: To determine whether a multicomponent health promotion intervention for Dutch adolescents would be successful in influencing body composition and aerobic fitness. Design: Randomized controlled trial. Setting: Ten intervention and 8 control prevocational secondary schools. Participants: A total of 978 adolescents (mean age, 12.7 years). intervention: An interdisciplinary multicomponent intervention program with an adapted curriculum for 11 biology and physical education lessons and environmental change options, including additional lessons on physical education and advice on the school canteen selection. Main Outcome Measures: Body height and weight, hip and waist circumference, 4 skinfold thickness measurements, and aerobic fitness. Results: Multilevel analyses showed significant differences in changes after the 8-month intervention period in favor of the intervention group with regard to hip circumference (mean difference, 0.53 cm; 95% confidence interval, 0.07 to 0.98) and sum of skinfolds among girls (mean difference, -2.31 mm; 95% confidence interval, -4.34 to -0.28). In boys, the intervention resulted in a significant difference in waist circumference (mean difference, -0.57 cm; 95% confidence interval, -1.10 to -0.05). No significant intervention effects were found related to aerobic fitness. Conclusions: The multicomponent Dutch Obesity Intervention in Teenagers program positively influenced several measures of body composition among both girls and boys. Our results indicate that second-try prevocational school curriculum changes may contribute to excessive weight gain prevention among adolescents.

S. A. Smith, C. L. O'Malley, L. Avery, R. Lang, D. Simpson, F. Hillier, V. J. Whittaker and C. D. Summerbell. (2007). The feasibility of a school-based intervention (Tees Consumption and Activity in Kids Experience; TeesCAKE) for the prevention of childhood obesity in a socially-deprived area of the UK. Proceedings Of The Nutrition Society.
B. J. Speck, V. Hines-Martin, B. A. Stetson and S. W. Looney. (2007). An environmental intervention aimed at increasing physical activity levels in low-income women. The Journal of Cardiovascular Nursing.

BACKGROUND: Regular physical activity is a health promotion and disease prevention behavior. Of all demographic groups, low-income women report the lowest levels of physical activity. RESEARCH OBJECTIVE: The purpose of this study was to test an intervention aimed at reducing community environmental barriers to physical activity in low-income women. METHODS: The research design was mixed methodology: (1) quantitative (quasi-experimental, pretest-posttest, cohort design in which no treatment partitioning was possible) and (2) qualitative (focus groups). The setting was a church-sponsored community center centrally located in a low-income urban neighborhood. The comparison group was recruited first followed by the intervention group to control for setting. The sample consisted of 104 women (comparison group, n = 53; intervention group, n = 51) between the ages of 18 and 63 years who were residents of neighborhoods served by the community center. RESULTS: No between-group differences were found for physical activity behavior. Significant between-group differences in cholesterol (P =.007) and perception of physical activity (P =.033) were observed. Significant intervention group increases from pretest to posttest were found related to advanced registered nurse practitioner support, friend support, and more positive physical activity environment at the community center. Qualitative data supported and enriched the quantitative data. CONCLUSIONS: Physical activity levels were not significantly different between the groups. In a sample of low-income women who have multiple barriers, improving attitudes, expanding their knowledge of community resources, and providing physical activity opportunities in their neighborhoods are important intermediate steps toward initiation and maintenance of regular physical activity.

K. G. Speroni, C. Earley and M. Atherton. (2007). Evaluating the effectiveness of the Kids Living Fit program: a comparative study. The Journal of School Nursing.

After-school programs can be implemented by school nurses to facilitate healthy lifestyle choices in children with the goal of decreasing obesity. Kids Living Fit (KLF), an after-school program designed by community hospital nurses, was implemented in elementary schools and focused on best lifestyle choices regarding foods consumed and activities chosen for children in grades 2 through 5. Study measures included comparison of body mass index (BMI) percentiles for age and gender and waist circumference between two self-selected groups composing a total sample size of 185 participants: the KLF intervention group (n = 80) and the no-intervention/ contrast group (n = 105). The 12-week intervention included a weekly fitness program and monthly dietitian presentations. Participants completed food and activity diaries and wore pedometers. In pairwise comparisons, the KLF group had a significant decrease in BMI percentile between baseline and follow-up (-2.3%) compared with the contrast group. The KLF group also demonstrated a smaller increase in waist circumference than the contrast group.

H. Spittaels, I. De Bourdeaudhuij and C. Vandelanotte. (2007). Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population. Preventive Medicine.

OBJECTIVE: To examine if a website-delivered physical activity intervention, that provides participants with computer-tailored feedback, can improve physical activity in the general population. METHODS: Healthy adults (n=434), recruited from parents and staff of 14 primary and secondary schools in Belgium in the spring of 2005, were allocated into one of two intervention groups (receiving intervention with or without repeated feedback) or a no-intervention control group. Physical activity-levels were self-reported at baseline and at 6 months (n=285), using a computerized long version of the International Physical Activity Questionnaire online. Repeated measures analysis of co-variances were used to examine differences between the three groups. RESULTS: Intent-to-treat analysis showed significant time by group interaction effects in favor of both intervention groups compared with the control group. Significant increases were found for active transportation (+20, +24, +11 min/week respectively) and leisure-time physical activity (+26, +19, -4 min/week respectively); a significant decrease for minutes sitting on weekdays (-22, -34, +4 min/day respectively). No significant differences were found between both intervention groups. CONCLUSION: A website-delivered intervention, including computer-tailoring, was able to increase physical activity when compared to a no-intervention control group. High drop-out rate and the low number of participants who received repeated feedback indicated that engagement and retention are important challenges in e-health studies.

R. Tanas, R. Marcolongo, S. Pedretti and G. Gilli. (2007). A family-based education program for obesity: a three-year study. BMC Pediatrics.

BACKGROUND: The epidemic of obesity is increasing in all countries. However, the number of controlled studies focusing on childhood obesity, with a long follow-up is still limited. Even though Behavioral Therapy shows some efficacy, it requires a prolonged teamwork that is not always available in public health settings. In addition, Behavioral Therapy is not always accepted. We describe a new intensive and sustainable family-based, Therapeutic Education program for childhood obesity. METHODS: Controlled clinical study: a family-based Therapeutic Education program without dietetic prescription involving overweight and obese children/adolescents, without evident psychological troubles, and their families. The program consisted of three clinical and therapeutic education sessions, carried out by a single physician. Further sessions were carried out every six months in the first year and then every year.Study population: 190 overweight children, 85 treated with a therapeutic education program (45 males and 40 females, mean age of 10.43 +/- 3) with an average BMI% of 154.72 +/- 19.6% and 105 matched children, treated with traditional dietary approach.Children's Body Mass Index (BMI) % and BMI Standard Deviation Score measured at baseline and after a three year-follow-up, were compared. Statistical tests: ANOVA-RM (repeated measures) controlled for distribution by Kolmogorov-Smirnov, Bartlett's test or correspondent non-parametric procedures, X2 tests or Fisher's exact test and simple linear regression. RESULTS: After a follow-up of 2.7 +/- 1.1 years, 72.9% of the children who followed the Therapeutic Education Program obtained a BMI% reduction, compared to 42.8% of children who followed the traditional dietary treatment. Weight reduction was good in moderately obese children and in the severely obese. In addition, a smaller proportion of children treated with therapeutic education had negative results (BMI increase of >10%) compared to those treated with dietary approach (11.8% vs. 25.7%); finally, periodic phone calls reduced the drop-out rate in the therapeutic education group. CONCLUSION: These results indicate the efficacy and sustainability of the Therapeutic Education program, that was completely carried out by a single pediatrician; in addition, it met with an elevated participant acceptance, suggesting a convenient therapeutic solution for skilled pediatricians and selected obese children, when Behavioral Therapy is not available or teamwork is poor.

C. Tannenbaum and B. Shatenstein. (2007). Exercise and nutrition in older Canadian women: opportunities for community intervention. Canadian Journal of Public Health.

BACKGROUND: The objectives of this study were to examine age differences in the extent to which older Canadian women exercise and eat nutritiously, and to identify the interventions they desire to help them adopt and maintain physical and nutritional fitness. METHODS: A cross-sectional postal survey of 5,000 community-dwelling women aged 55-95 was conducted across Canada in October 2003. The survey queried exercise frequency, nutritional risk, functional status, and factors deemed facilitative to adopting and maintaining a physically fit and nutritiously healthy lifestyle. RESULTS: Data from 2,484 women were available for analysis; 31% were 75 years and older. Among women aged 55-74 versus those over age 75, 62% compared to 56% reported exercising 3 times/week for 20 minutes or longer (p = 0.003), 33% in both age groups were eating nutritiously, and 24% compared to 21% were both exercising and eating nutritiously. Thirty-five percent of women aged 55-74 who were not exercising or eating nutritiously desired increased availability of low-cost, suitable health promotion programs and additional written materials to improve these health habits, compared to 25% of women in the 75 year and older group (p < 0.001). Improved transportation to programs was the only intervention preferred by women aged 75 years and older (OR 1.66 (1.30-2.11)). Sedentary women and those at higher nutritional risk were two to three times more likely to identify encouragement from health professionals (OR 1.93 (1.48-2.52)), as well as from family and friends (OR 3.03 (1.89-4.85)) as important facilitators. INTERPRETATION: Women aged 55-74 who do not exercise and eat nutritiously are most receptive to a variety of health-promoting community interventions.

R. W. Taylor, K. A. McAuley, W. Barbezat, A. Strong, S. M. Williams and J. I. Mann. (2007). APPLE Project: 2-y findings of a community-based obesity prevention program in primary school age children. American journal of clincial nutrition.

BACKGROUND: Developing effective strategies for obesity prevention in children is urgently required. OBJECTIVE: We determined the effectiveness of a 2-y controlled community-based intervention to prevent excessive weight gain in 5-12-y-old children by enhancing opportunities for healthy eating and noncurricular physical activity. DESIGN: Children (n = 730) from 4 intervention and 3 control schools underwent measurements of height, weight, waist circumference, blood pressure, diet, and physical activity at baseline and at 1 and 2 y. Intervention components included nutrition education that targeted reductions in sweetened drinks and increased fruit and vegetable intake and activity coordinators who managed an activity program that focused on noncurricular lifestyle-based activities (eg, community walks). RESULTS: Body mass index (BMI; in kg/m2) z score was significantly lower in intervention children than in control children by a mean of 0.09 (95% CI: 0.01, 0.18) after 1 y and 0.26 (95% CI: 0.21, 0.32) at 2 y, but the prevalence of overweight did not differ. Waist circumference was significantly lower at 2 y (-1 cm), and systolic blood pressure was reduced at 1 y (-2.9 mm Hg). An interaction existed between intervention group and overweight status (P = 0.029), such that mean BMI z score was reduced in normal-weight (-0.29; 95% CI: -0.38, -0.21) but not overweight (-0.02; 95% CI: -0.16, 0.12) intervention children relative to controls. Intervention children consumed fewer carbonated beverages (67% of control intake; P = 0.04) and fruit juice or drinks (70%; P = 0.03) and more fruit (0.8 servings/3 d; P < 0.01). CONCLUSION: A relatively simple approach, providing activity coordinators and basic nutrition education in schools, significantly reduces the rate of excessive weight gain in children, although this may be limited to those not initially overweight. This trial was registered at Australian Clinical Trials Registry as #12605000578606.

W. G. Thompson, R. Foster, D. Eide and J. A. Levine. (2007). Feasibility of a walking workstation to increaSEaily walking. British Journal Of Sports Medicine.

OBJECTIVE: The number of calories expended in the workplace has declined significantly in past 75 years. A walking workstation allowing workers to walk while they work has the potential to increase caloric expenditure. We evaluated whether employees can and will use walking workstations while performing their jobs. Methods and Procedures: We studied nurses, clinical assistants, secretaries, and appointment secretaries using the StepWatch Activity Monitor System (which accurately measures steps taken at slow speeds) while performing their job functions in their usual fashion and while using the walking workstation. RESULTS: Subjects increased the number of steps taken during the workday by 2000 steps per day (p < 0.05). This was equivalent to an increase in caloric expenditure of 100 kcal/day. Subjects reported that they enjoyed using the workstation, that it could be used in the actual work arena and that, if available, they would use it. DISCUSSION: Walking workstations have the potential for promoting physical activity and facilitating weight loss. Several subjects in this study expended more than 200 extra calories daily using such a system. Further trials are indicated.

J. Tranquist, C. Bergholm, C. Ulvmyr and C. Eriksson. (2007). Promotion of daily physical activity among school children - national initiatives in Sweden. European Journal Of Public Health.

G. C. Vachon, N. Ezike, M. Brown-Walker, V. Chhay, I. Pikelny and T. B. Pendergraft. (2007). Improving access to diabetes care in an inner-city, community-based outpatient health center with a monthly open-access, multistation group visit program. Journal of the National Medical Association.

OBJECTIVE: To describe the development and implementation of a multifaceted program in an inner-city healthcare center designed to improve access to care and empower patients to take a more active role in managing diabetes. PROCEDURES: AHC is one of 30 outpatient health centers in the Ambulatory and Community Health Network of the Cook County Bureau of Health Services. AHC serves a predominantly African-American population with four full-time-equivalent primary care providers treating approximately 700 diabetes patients with >450 waitlisted patients, many with diabetes. Budget constraints limit capacity to add providers. In January 2005, open-access, multi-station group visits were implemented to improve access to care and empower patients to take a more active role in managing diabetes. The program is called Diabetic Rewards Issued Via Everyone (DRIVE) Day. Elements include: 1. group visits held monthly; 2. patient-selected activities, including diabetes education, nutrition, exercise, group discussions and Q&A sessions; 3. provider support, including implementation of evidence-based guidelines for glycemic, lipid and hypertension management, retinal screening, foot exams and medication adjustment; and 4. web-based patient registry FINDINGS: Of the clinic's 737 diabetes patients, 294 (40%) have attended > or =1 DRIVE Days, for a total of 775 patient encounters between January 2005 and October 2006. CONCLUSIONS: In an environment with limited resources, DRIVE Day has improved access to care, provided an opportunity for diabetes patients to take a more active role in their care and enabled providers to see a higher volume of patients and offer efficient, comprehensive care.

M. A. Van Duyn, T. McCrae, B. K. Wingrove, K. M. Henderson, J. K. Boyd, M. Kagawa-Singer, A. G. Ramirez, I. Scarinci-Searles, L. S. Wolff, T. L. Penalosa and E. W. Maibach. (2007). Adapting evidence-based strategies to increase physical activity among African Americans, Hispanics, Hmong, and Native Hawaiians: a social marketing approach. Preventing Chronic Disease.

INTRODUCTION: Using a social marketing approach, we studied how best to adapt proven, evidence-based strategies to increase physical activity for use with underserved racial or ethnic groups. METHODS: We conducted focus groups with low-income Hispanic women in Texas, Hmong parents and their children in California, low-income African American women and men in the Mississippi Delta, and Native Hawaiian college students in Hawaii. We also interviewed key leaders of these communities. Topics of discussion were participants' perceptions about 1) the benefits of engaging in physical activity, 2) the proposed evidence-based strategies for increasing each community's level of physical activity, and 3) the benefits and barriers to following the proposed interventions for increasing physical activity. A total of 292 individuals participated in the study. RESULTS: All groups considered that being physically active was part of their culture, and participants found culturally relevant suggestions for physical activities appealing. Overwhelmingly, strategies that aimed to create or improve social support and increase access to physical activity venues received the most positive feedback from all groups. Barriers to physical activity were not culturally specific; they are common to all underserved people (lack of time, transportation, access, neighborhood safety, or economic resources). CONCLUSION: Results indicate that evidence-based strategies to increase physical activity need to be adapted for cultural relevance for each racial or ethnic group. Our research shows that members of four underserved populations are likely to respond to strategies that increase social support for physical activity and improve access to venues where they can be physically active. Further research is needed to test how to implement such strategies in ways that are embraced by community members.

R. Van Houten, J. Van Houten and J. E. Malenfant. (2007). Impact of a comprehensive safety program on bicycle helmet use among middle-school children. Journal of Applied Behavior Analysis.

A bicycle helmet program was evaluated in three middle schools using a multiple baseline across schools design. Two of the three schools had histories of enforcement of helmet use. During baseline many students riding their bikes to and from school did not wear their helmets or wore them incorrectly. A program that consisted of peer data collection of correct helmet use, education on how to wear a bicycle helmet correctly, peer goal setting, public posting of the percentage of correct helmet use, and shared reinforcers, all of which were implemented by the school resource officer, increased afternoon helmet use and afternoon correct helmet use in all three schools. Probe data collected a distance from all three schools indicated that students did not remove their helmets once they were no longer in close proximity to the school, and probe data collected in the morning at two of the schools showed that the behavior change transferred to the morning.

E. M. van Sluijs, A. M. McMinn and S. J. Griffin. (2007). Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. British Medical Journal.

OBJECTIVE: To review the published literature on the effectiveness of interventions to promote physical activity in children and adolescents. DESIGN: Systematic review. DATA SOURCES: Literature search using PubMed, SCOPUS, Psychlit, Ovid Medline, Sportdiscus, and Embase up to December 2006. Review methods Two independent reviewers assessed studies against the following inclusion criteria: controlled trial, comparison of intervention to promote physical activity with no intervention control condition, participants younger than 18 years, and reported statistical analyses of a physical activity outcome measure. Levels of evidence, accounting for methodological quality, were assessed for three types of intervention, five settings, and three target populations. RESULTS: The literature search identified 57 studies: 33 aimed at children and 24 at adolescents. Twenty four studies were of high methodological quality, including 13 studies in children. Interventions that were found to be effective achieved increases ranging from an additional 2.6 minutes of physical education related physical activity to 283 minutes per week of overall physical activity. Among children, limited evidence for an effect was found for interventions targeting children from low socioeconomic populations, and environmental interventions. Strong evidence was found that school based interventions with involvement of the family or community and multicomponent interventions can increase physical activity in adolescents. CONCLUSION: Some evidence was found for potentially effective strategies to increase children's levels of physical activity. For adolescents, multicomponent interventions and interventions that included both school and family or community involvement have the potential to make important differences to levels of physical activity and should be promoted. A lack of high quality evaluations hampers conclusions concerning effectiveness, especially among children.

S. J. Verstraete, G. M. Cardon, D. L. De Clercq and I. M. De Bourdeaudhuij. (2007). A comprehensive physical activity promotion programme at elementary school: the effects on physical activity, physical fitness and psychosocial correlates of physical activity. Public Health Nutrition.

OBJECTIVE: To evaluate the effects of a comprehensive physical activity (PA) promotion programme in elementary schools on children's total PA levels, leisure-time PA, physical fitness and psychosocial correlates of PA. DESIGN: A pre-test-post-test design over two school years. SETTING AND SUBJECTS: Sixteen elementary schools (764 children, mean age: 11.2 +/- 0.7 years) were randomly assigned to the intervention condition (n = 8) and the control condition (n = 8). The intervention included a health-related physical education programme, an extracurricular PA promotion programme and classroom-based PA education lessons. In the total sample, leisure-time PA, psychosocial correlates of PA and physical fitness were measured using a PA questionnaire and the Eurofit test battery. In a sub-sample, total PA levels were measured using an accelerometer. RESULTS: According to accelerometer data, children's moderate PA and moderate-to-vigorous PA (MVPA) levels decreased less in the intervention schools than in the control schools (P < 0.01). The average time spent on MVPA decreased by 9 min per day in the intervention schools compared with 33 min per day in the control schools. Children in the intervention schools reported significantly more moderate PA in leisure time than the controls (P < 0.05). No overall improvement of physical fitness and no effects on the psychosocial correlates of PA were found. CONCLUSIONS: The comprehensive PA promotion programme was successful in preventing a decline in children's total activity levels. Furthermore, the intervention increased children's PA engagement in leisure time. Therefore, implementation needs to be encouraged.

M. Vieira, G. V. B. dos Santos, M. Mauad, E. M. M. Marchi and S. M. X. de Souza. (2007). Passport for health: Healthful feeding and physical activity in the schools district of a southeastern city in Brazil. Annals Of Nutrition And Metabolism.
D. Vissers, C. Vanroy, A. Demeulenaere, K. Vanherle, B. Matthyssen, A. Van de Sompel, S. Truijen and L. Van Gaal. (2007). Validation of a multidisciplinary school-based health programme for overweight and obese youngsters. International Journal Of Obesity.
A. T. Ward, M. Lipton, H. Pankratz, S. Braun, K. Klier, M. Halvorson, D. Dreimane, R. Monzavi and F. Kaufman. (2007). Taking it to the community: Translation of a hospital-based pediatric weight-management program. Diabetes.

L. S. Webber, C. C. Johnson, D. Rose and J. C. Rice. (2007). Development of ACTION! Wellness Program for Elementary School Personnel. Obesity (Silver Spring).

OBJECTIVE: The prevalence of overweight and obesity has increased dramatically in the adult population over the past 2 decades. Almost two-thirds of the adult population works outside the home; thus, interventions implemented at the worksite are viable for obesity reduction. Elementary schools are worksites that have a number of resources that can encourage a healthy lifestyle. The purpose of this paper is to describe the formative research activities and how these were used to design the ACTION! Wellness Program for Elementary School Personnel. RESEARCH METHODS AND PROCEDURES: Formative data were collected using focus groups, a school survey, and an environmental audit. Focus groups were conducted in three elementary schools, whereas the school survey and environmental audit were collected in 24 elementary schools. The intervention was then tested as a pilot study in one school to determine feasibility and receptivity and refine its components. RESULTS: Participants in the focus groups indicated that most had experience with trying to lose weight, some had positive social support, and most had little free time at school; however, most were very receptive to having a weight control intervention program at their school. Eighteen (75%) of the schools had snack vending machines on the school site, and all had cold drink machines. All 24 schools had at least one indoor site that could be used for physical activity programs. All schools were in neighborhoods conducive for walking. DISCUSSION: ACTION! will take advantage of the school resources in implementing an environmental intervention to reduce overweight and obesity. This paper describes the progression of events that led to the final trial.

L. S. Webber, D. J. Catellier, L. A. Lytle, D. M. Murray, C. A. Pratt, D. R. Young, J. P. Elder, T. G. Lohman, J. Stevens and R. R. Pate. (2007). Outcomes of a randomized controlled field trial to promote physical activity in middle-school girls: Trial of activity for adolescent girls. Circulation.

N. S. Wellman, B. Kamp, N. J. Kirk-Sanchez and P. M. Johnson. (2007). Eat better & move more: a community-based program designed to improve diets and increase physical activity among older Americans. American Journal of Public Health.

OBJECTIVES: We assessed outcomes of an integrated nutrition and exercise program designed for Older Americans Act Nutrition Program participants as part of the Administration on Aging's You Can! campaign. METHODS: A 10-site intervention study was conducted. Preintervention and postintervention assessments focused on nutrition and physical activity stages of change, self-reported health status, dietary intakes, physical activity, and program satisfaction. RESULTS: Of 999 enrollees, the 620 who completed the program were aged 74.6 years on average; 82% were women, and 41% were members of racial/ethnic minority groups. Factors associated with program completion were site, health conditions, and nutrition risk. Seventy-three percent and 75% of participants, respectively, made a significant advance of 1 or more nutrition and physical activity stages of change; 24% reported improved health status. Daily intake of fruit increased 1 or more servings among 31% of participants; vegetables, 37%; and fiber, 33%. Daily steps increased 35%; blocks walked, 45%; and stairs climbed, 24%. Program satisfaction was 99%. CONCLUSIONS: This easy-to-implement program improves diets and activity levels. Local providers should offer more such programs with the goal of enabling older Americans to take simple steps toward successful aging.

K. White and P. H. Jacques. (2007). Combined diet and exercise intervention in the workplace: effect on cardiovascular disease risk factors. Aaohn J.

This study assessed the effectiveness of a 12-week pilot employee wellness program in reducing risk factors for coronary heart disease. Fifty university employees with at least one cardiovascular disease risk factor participated in the program. Interventions focused on diet, exercise, and monthly workshops. Pre- and post-intervention measurements included weight, body composition, blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and blood sugar. Twenty-five employees had post-intervention measurements. A survey was administered to assess adherence. The correlation between adherence and improvement in cardiovascular disease risk factors was also tested. Significant differences were observed between pre- and post-intervention measurements of total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and weight. A significant correlation existed between self-reported level of participation in the diet aspect of the program and improvement in LDL levels. This multi-component, 12-week pilot employee wellness program was effective in reducing cardiovascular disease risk.

S. Wilcox, M. Laken, M. Bopp, O. Gethers, P. Huang, L. McClorin, A. W. Parrott, R. Swinton and A. Yancey. (2007). Increasing physical activity among church members - Community-based participatory research. American Journal Of Preventive Medicine.

Background: Faith-based interventions using a community-based participatory approach hold promise for eliminating ethnic health disparities. This study evaluated the effects of a volunteer-led statewide program to increase physical activity among members of African-American churches. Methods: African Methodist Episcopal churches within six regions (Conferences) were randomly assigned to receive training in the program immediately or 1 year later. A cohort of 20 randomly selected churches and 571 members within them took part in telephone surveys at baseline (May-September 2003) and 1 year (May August 2004) and 2 years later (June-September 2005). Primary outcomes were physical activity participation, meeting physical activity recommendations, and stage of readiness for physical activity change. Statistical analyses were completed in April 2006. Results: Volunteers (N = 889) from 303 churches were trained. Among survey respondents, physical activity did not increase significantly over time, although 67% were aware of the program. Program awareness was significantly related to all three physical activity outcomes and to fruit and vegetable consumption. Pastoral support was significantly associated with physical activity. Conclusions: Although this intervention reached a large number of churches and created awareness of intervention components, no effects on physical activity behaviors were found. Potential reasons for the lack of significant effects are discussed.

A. E. Williams, T. M. Vogt, V. J. Stevens, C. A. Albright, C. R. Nigg, R. T. Meenan and M. L. Finucane. (2007). Work, Weight, and Wellness: the 3W Program: a worksite obesity prevention and intervention trial. Obesity (Silver Spring).

OBJECTIVE: In this paper, we describe the aims, intervention, and design of the Work, Weight, and Wellness program, a group-randomized worksite obesity prevention and intervention trial being conducted at 31 hotels with 11,559 employees on the island of Oahu in Hawaii. We report baseline prevalence of overweight and obesity, and the distribution of BMI (kilograms per meter squared) across sex, race, and job categories. We also describe factors that have influenced intervention adoption and employee participation. RESEARCH METHODS AND PROCEDURES: The study's primary outcome is change in BMI among hotel employees over a 2-year intervention period. The intervention includes environmental and group components that target diet, physical activity, and weight management. RESULTS: Men, Pacific Islanders, and individuals employed in managerial or facility maintenance roles had higher prevalence of obesity and higher mean BMI than women and individuals from other races or in other occupational categories. DISCUSSION: These results may be helpful in guiding choices about the adoption or design of future worksite and community interventions addressing at-risk ethnically diverse populations and are especially relevant to the hotel industry and similar industries.

D. A. Williamson, A. L. Copeland, S. D. Anton, C. Champagne, H. Han, L. Lewis, C. Martin, R. L. Newton, Jr., M. Sothern, T. Stewart and D. Ryan. (2007). Wise Mind project: a school-based environmental approach for preventing weight gain in children. Obesity (Silver Spring).

OBJECTIVE: The Wise Mind pilot study compared the efficacy of an environmental approach for prevention of inappropriate weight gain in children with an active control condition that used an environmental approach for modifying expectancies related to the use of alcohol, tobacco, and drugs. RESEARCH METHODS AND PROCEDURES: A total of 670 second to sixth grade students from four schools were enrolled in the study. The study spanned 2 academic years, and 586 students were available for evaluation at the end of the study. Two schools were randomly assigned to each treatment arm. The environmental approach for weight gain prevention focused on modification of eating habits and physical activity, and the active control group focused on modification of expectancies related to substance use. RESULTS: Using an intention to treat design, the study found no differences in weight gain prevention between the two interventions. The weight gain prevention program was associated with reduction of total caloric intake, reduction of dietary fat intake, reduction of protein intake, and increased physical activity in comparison with the active control group and relative to baseline. These changes in food intake were attributed to changes in food selections that resulted from modification of school cafeteria menus and food preparation. DISCUSSION: The Wise Mind school-based weight gain prevention program induced behavioral changes in healthy eating and physical activity but did not induce significant changes in body weight in comparison with the control arm. Recommendations for future research are provided.

R. A. Winett, E. S. Anderson, J. R. Wojcik, S. G. Winett and T. Bowden. (2007). Guide to health: nutrition and physical activity outcomes of a group-randomized trial of an Internet-based intervention in churches. Annals of behavioral medicine.

BACKGROUND: Theory-based interventions accessible to large groups of people are needed to induce favorable shifts in health behaviors and body weight. PURPOSE: The aim was to assess nutrition; physical activity; and, secondarily, body weight in the tailored, social cognitive Guide to Health (GTH) Internet intervention delivered in churches. METHODS: Participants (N = 1,071; 33% male, 23% African American, 57% with body mass index > or = 25, 60% sedentary, Mdn age = 53 years) within 14 Baptist or United Methodist churches were randomized to the GTH intervention only (GTH-Only; 5 churches), with church-based supports (GTH-Plus; 5 churches), or to a waitlist (control; 4 churches). Verified pedometer step counts, measured body weight, fat, fiber, and fruit and vegetable (F&V) servings from food frequency and supermarket receipts were collected at pretest, posttest (7 months after pretest), and follow-up (16 months after pretest). RESULTS: Participants in GTH-Only increased F&V at post (approximately 1.50 servings) compared to control (approximately 0.50 servings; p =.005) and at follow-up (approximately 1.20 vs. approximately 0.50 servings; p m =.038) and increased fiber at post (approximately 3.00 g) compared to control (approximately 1.5 g; p =.006) and follow-up (approximately 3.00 g vs. approximately 2.00 g; p =.040). GTH-Plus participants compared to control increased steps at post (approximately 1,500 steps/day vs. approximately 400 steps/day; p =.050) and follow-up (approximately 1,000 steps/day vs. approximately - 50 steps/day; p =.010), increased F&V at post (approximately 1.5 servings; p =.007) and follow-up (approximately 1.3 servings; p =.014), increased fiber at post (approximately 3.00A g; p =.013), and follow-up (approximately 3.00; p =.050) and decreased weight at post (approximately - 0.30 kg vs. approximately + 0.60 kg; p =.030). CONCLUSIONS: Compared to control, both GTH treatments improved nutrition at posttest, but church supports improved physical activity and nutrition at posttest and follow-up, suggesting environmental supports may improve Internet-based interventions.

J. F. Wyman, C. F. Croghan, N. M. Nachreiner, C. R. Gross, H. H. Stock, K. Talley and M. Monigold. (2007). Effectiveness of education and individualized counseling in reducing environmental hazards in the homes of community-dwelling older women. Journal of the American Geriatrics Society.

OBJECTIVES: To test the effectiveness of an education and counseling intervention on reducing environmental hazards in the homes of older women. DESIGN: Secondary analysis from a randomized, controlled trial with two arms: fall prevention program and health education program (control). Environmental hazards were assessed at baseline and immediately posttreatment (12-weeks). SETTING: Participants' homes. PARTICIPANTS: Two hundred seventy-two community-dwelling women aged 70 and older at risk for falling. INTERVENTION: The fall prevention program involved a comprehensive fall risk evaluation, exercise, education, individualized counseling, and referrals. The health education program included topics unrelated to fall prevention. With the exception of the fall risk evaluation conducted by a nurse practitioner, baccalaureate-prepared nurses carried out the interventions. MEASUREMENTS: Summed and individual scores for hazards related to the bathroom, floor surfaces, lighting, furniture, stairways, and storage areas. RESULTS: Environmental hazards were found in all homes, with a baseline mean+/-standard deviation of 10.7+/-2.6 total hazards and range of four to 17 hazards. Analysis of within-group changes indicated that the fall prevention group had significantly fewer bathroom, lighting, and total hazards after the intervention, whereas the health education group had significantly fewer bathroom hazards but more floor hazards. At follow-up, the fall prevention group had significantly fewer lighting hazards and total hazards than the health education group. CONCLUSION: Education and counseling have only modest effects in helping older women make recommended home modifications. To be most effective in reducing environmental hazards, fall prevention programs may need to provide and install safety devices.

J. Zapka, S. C. Lemon, B. B. Estabrook and D. G. Jolicoeur. (2007). Keeping a Step Ahead: formative phase of a workplace intervention trial to prevent obesity. Obesity (Silver Spring).

OBJECTIVE: Ecological interventions hold promise for promoting overweight and obesity prevention in worksites. Given the paucity of evaluative research in the hospital worksite setting, considerable formative work is required for successful implementation and evaluation. This paper describes the formative phases of Step Ahead, a site-randomized controlled trial of a multilevel intervention that promotes physical activity and healthy eating in six hospitals in central Massachusetts. The purpose of the formative research phase was to increase the feasibility, effectiveness, and likelihood of sustainability of the intervention. RESEARCH METHODS AND PROCEDURES: The Step Ahead ecological intervention approach targets change at the organization, interpersonal work environment, and individual levels. The intervention was developed using fundamental steps of intervention mapping and important tenets of participatory research. Formative research methods were used to engage leadership support and assistance and to develop an intervention plan that is both theoretically and practically grounded. This report uses observational data, program minutes and reports, and process tracking data. RESULTS: Leadership involvement (key informant interviews and advisory boards), employee focus groups and advisory boards, and quantitative environmental assessments cultivated participation and support. Determining multiple foci of change and designing measurable objectives and generic assessment tools to document progress are complex challenges encountered in planning phases. DISCUSSION: Multilevel trials in diverse organizations require flexibility and balance of theory application and practice-based perspectives to affect impact and outcome objectives. Formative research is an essential component.

P. Zeitler. (2007). Editorial: School-based intervention to reduce obesity and diabetes risks: small steps for a big problem. The Journal of clinical endocrinology and metabolism.
C. Probart, E. McDonnell, J. E. Weirich, P. Birkenshaw and V. Fekete. (2007). Addressing childhood overweight through schools. Collegium antropologicum.

Rates of childhood obesity in have reached alarming proportions in many countries. Sixteen percent of school-aged children and adolescents in the U.S. are overweight. Legislation implemented in 2004 in the U.S. requires local education agencies (LEAs) that sponsor school meal programs to establish local wellness policies to address childhood obesity. Project PA, a collaboration between a state agency and a university providing school-based interventions focuses on the school environment and policy changes. Interventions have targeted foodservice personnel, administrators, teachers, parents and students. In two recent projects schools assessed their school nutrition environments, developed nutrition policies, and implemented strategies to encourage healthier food selections. Schools identified weaknesses in the areas of marketing and communication of policies. Media attention on the childhood obesity facilitated policy changes. Time and cost were identified as barriers to policy development and there were concerns about weak enforcement of policies. These themes are discussed.

R. C. Brownson, P. Ballew, K. L. Brown, M. B. Elliott, D. Haire-Joshu, G. W. Heath and M. W. Kreuter. (2007). The effect of disseminating evidence-based interventions that promote physical activity to health departments. American Journal of Public Health.

OBJECTIVES: We explored the effect of disseminating evidence-based guidelines that promote physical activity on US health department organizational practices in the United States. METHODS: We implemented a quasi-experimental design to examine changes in the dissemination of suggested guidelines to promote physical activity (The Guide to Community Preventive Services) in 8 study states; the remaining states and the Virgin Islands served as the comparison group. Guidelines were disseminated through workshops, ongoing technical assistance, and the distribution of an instructional CD-ROM. The main evaluation tool was a pre- and postdissemination survey administered to state and local health department staffs (baseline n=154; follow-up n=124). RESULTS: After guidelines were disseminated through workshops, knowledge of and skill in 11 intervention-related characteristics increased from baseline to follow-up. Awareness-related characteristics tended to increase more among local respondents than among state participants. Intervention adoption and implementation showed a pattern of increase among state practitioners but findings were mixed among local respondents. CONCLUSIONS: Our exploratory study provides several dissemination approaches that should be considered by practitioners as they seek to promote physical activity in the populations they serve.

S. Kingham and S. Ussher. (2007). An assessment of the benefits of the walking school bus in Christchurch, New Zealand. Transportation Research Part A-Policy And Practice.

A Walking School Bus involves parents or other adults escorting a group of children on a set route to school. The first one was established in 1996 in. Canada. They can now be found in a variety of countries, including New Zealand. Many of the benefits associated with them are based on the general benefits of affecting a modal shift away from cars in favour of walking. However, there is still relatively little known about the less quantifiable benefits of them, and there has been some suggestion that they can adversely affect children's independent mobility. This research examined the perceived benefits of Walking School Buses by interviewing people involved in the day to running of the scheme in Christchurch, New Zealand. The results suggest that walking school buses have many social benefits and that if anything; they encourage children's independent mobility. (c) 2006 Elsevier Ltd. All rights reserved.

I. Lissau. (2007). Prevention of overweight in the school arena. Acta Paediatrica Supplementum.

This paper gives an overview of studies with the main purpose to intervene against obesity in children at the school arena. Through databases and Cochrane reviews, 14 studies fulfilled the criteria for inclusion. Most of the studies are American and none were performed in Scandinavia. The European studies were performed in Germany and in the United Kingdom. The studies, which had a significant effect on overweight were 'Dance for Health', 'Planet Health', 'San Jose Study', 'Kiel Obesity Prevention Study', 'Healthy Schools' programme, 'El Paso Catch', and 'Medical College of Georgia FitKid Project'. The studies differ greatly in regards to age group, type of and length of intervention and type and amount of actions. Furthermore, the measures used to evaluate the effect differed. It seems to be important to use several measures of obesity in order to accurately detect a possible effect. In conclusion, half of the studies were successful and had an effect on either overweight or obesity. Much more research is needed in order to effectively prevent paediatric obesity.

J. Haines, D. Neumark-Sztainer and L. Thiel. (2007). Addressing weight-related issues in an elementary school: what do students, parents, and school staff recommend? Eating Disorders.

This study examined weight-related issues affecting elementary school children to gain insight into how best to address these issues within a school-based intervention. The study population included 21 students, 12 school staff members, and 21 parents from a school that serves an ethnically-diverse population. Data were collected using focus groups and individual interviews and were analyzed using qualitative research methodology. Weight-related teasing and poor body image emerged as prominent issues affecting students. Results suggest that programs aimed at the prevention of weight-related disorders should go beyond issues of nutrition and physical activity and include strategies to reduce weight-related mistreatment and to improve students' body image.

K. S. Martin and A. M. Ferris. (2007). Food insecurity and gender are risk factors for obesity. Journal of Nutrtion Education and Behavior.

OBJECTIVE: Examine relationships between adult obesity, childhood overweight, and food insecurity. DESIGN: Cross-sectional retrospective study. SETTING: Community settings in Hartford, Connecticut. PARTICIPANTS: Convenience sample of 200 parents and their 212 children, aged 2-12. MAIN OUTCOME MEASURES: Adult obesity (Body Mass Index [BMI] > 30), childhood overweight (BMI-for-age > 95(th) percentile), and household food security (U.S. Department of Agriculture module). ANALYSIS: Chi-square tests between weight status and socioeconomic characteristics. Multinomial regression analyses to determine risk factors for adult obesity and childhood overweight. RESULTS: Over half of parents (51%) were obese, and almost one-third of children (31.6%) were overweight. Over half of households were food insecure. Food insecure adults were significantly more likely to be obese as those who were food secure (Odds Ratio [OR]=2.45, p =.02). Being a girl and having an obese parent doubled the likelihood of children being overweight (OR=2.56, P =.01; OR=2.32, P =.03). Children with family incomes below 100% of poverty were half as likely to be overweight as those with higher incomes (OR=.47, P =.05). Food insecurity did not increase odds of childhood overweight. CONCLUSIONS AND IMPLICATIONS: Obesity prevention programs and policies need to address food insecurity and gender as key risk factors.

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