Introduction to the Active Living Research Reference List January – July 2008


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D. A. Abood, D. R. Black and D. C. Coster. (2008). Evaluation of a school-based teen obesity prevention minimal intervention. J Nutr Educ Behav. 40, 168-74.

OBJECTIVE: A school-based nutrition education minimal intervention (MI) was evaluated. DESIGN: The design was experimental, with random assignment at the school level. SETTING: Seven schools were randomly assigned as experimental, and 7 as delayed-treatment. PARTICIPANTS: The experimental group included 551 teens, and the delayed treatment group included 329 teens. INTERVENTION: The minimal intervention was Present and Prevent, a commercially available PowerPoint program presented in two 30-minute time slots over 1 week. MAIN OUTCOME MEASURES: The dependent variables were nutrition knowledge, attitudes, peer and family influences, behavioral intentions, and program satisfaction. The independent variable was group assignment. ANALYSES: A matched-pairs and 2-sample t test were used respectively to assess within-group and between-group changes. RESULTS: Significant experimental posttest improvements occurred in the following: knowledge (P <.001); intention to maintain a healthy body weight because of importance to friends (P <.001); and intention to eat fewer fried foods, eat fewer sweets, look more at food labels, and limit TV watching (all P <.001). Program satisfaction measures were significantly associated with each of the healthy weight maintenance behavioral intentions. CONCLUSIONS AND IMPLICATIONS: The MI teen obesity prevention program made an impact on nutrition knowledge and positive behavioral intentions in only 2 classroom sessions and was well received by participants.

R. E. Andersen, A. E. Bauman, S. C. Franckowiak, S. M. Reilley and A. L. Marshall. (2008). Promting health professionals to be activity role models- Motivating stairs use at the 2001 ACSM Scientific Meeting. Journal of Physical Activity and Health. 5, 607-618.

O. Batik, E. A. Phelan, J. A. Walwick, G. Wang and J. P. LoGerfo. (2008). Translating a community-based motivational support program to increase physical activity among older adults with diabetes at community clinics: a pilot study of Physical Activity for a Lifetime of Success (PALS). Prev Chronic Dis. 5, A18.

BACKGROUND: Regular physical activity is an important goal for elders with chronic health conditions. CONTEXT: This report describes Physical Activity for a Lifetime of Success (PALS), an attempt to translate a motivational support program for physical activity, Active Choices, for use by a group of diverse, low-income, community-dwelling elders with diabetes. METHODS: PALS linked physical activity assessment and brief counseling by primary care providers with a structured referral to a community-based motivational telephone support program delivered by older adult volunteers. People with diabetes aged 65 years or older who were receiving care at two community clinics were randomized to receive either immediate or delayed intervention. The main intended outcome measure was physical activity level; the secondary outcome measure was mean hemoglobin A1c. CONSEQUENCES: One-third of those offered referral to the PALS program in the clinic setting declined. Another 44% subsequently declined enrollment or were unreachable by the support center. Only 14 (21%) of those offered referral enrolled in the program. Among these 14, the percentage who were sufficiently active was higher at follow-up than at enrollment, though not significantly so. Using an intent-to-treat analysis, which included all randomized clinic patients, we found no significant change in mean hemoglobin A1c for the intervention group compared with controls. INTERPRETATION: A community-based referral and support program to increase physical activity among elderly, ethnically diverse, low-income people with diabetes, many of whom are not English-speaking, may be thwarted by unforeseen barriers. Those who enroll and participate in the PALS program appear to increase their level of physical activity.

M. Blackstone and J. Callahan. (2008). An unsteady walk in the park. Pediatr Emerg Care. 24, 193-5.

R. A. Carels, K. Konrad, K. M. Young, L. A. Darby, C. Coit, A. M. Clayton and C. K. Oemig. (2008). Taking control of your personal eating and exercise environment: a weight maintenance program. Eat Behav. 9, 228-37.

The current investigation examined the impact of a weight maintenance intervention (MI) designed to empower people to create a personal healthy food and physical activity environment on weight loss treatment outcomes. It was hypothesized that behavioral weight loss program (BWLP) participants who received an additional MI would evidence superior weight loss maintenance compared to participants who received a BWLP alone (no contact [NC]). Fifty-one obese adults were randomly assigned to participate in a 16-week weight loss intervention followed by NC or a 6-week MI. Thirty-eight participants completed the six-month follow-up. Body weight, percent body fat, cardiorespiratory fitness, self-reported physical activity, and self-reported diet (i.e., calories, percent daily intake of fat, protein, and carbohydrates) were assessed. Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). MI participants had significantly greater weight loss maintenance than NC participants (ps<.05). Helping obese individuals to modify their personal eating and physical activity environment in order to reduce exposure to "obesogenic" cues may contribute to long-term weight loss maintenance.

K. D. DuBose, M. S. Mayo, C. A. Gibson, J. L. Green, J. O. Hill, D. J. Jacobsen, B. K. Smith, D. K. Sullivan, R. A. Washburn and J. E. Donnelly. (2008). Physical activity across the curriculum (PAAC): rationale and design. Contemp Clin Trials. 29, 83-93.

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

J. C. Eisenmann, D. A. Gentile, G. J. Welk, R. Callahan, S. Strickland, M. Walsh and D. A. Walsh. (2008). SWITCH: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to childhood obesity. Bmc Public Health. 8,

Background: Although several previous projects have attempted to address the issue of child obesity through school-based interventions, the overall effectiveness of school-based programs on health-related outcomes in youth has been poor. Thus, it has been suggested that multi-level interventions that aim to influence healthy lifestyle behaviors at the community, school and family levels may prove more successful in the prevention of childhood obesity. Methods/Design: This paper describes the rationale, design, and implementation of a community, school-, and family-based intervention aimed at modifying key behaviors (physical activity, screen time (Internet, television, video games), and nutrition) related to childhood obesity among third through fifth graders in two mid-western cities. The intervention involves a randomized study of 10 schools (5 intervention and 5 control schools). The intervention is being conducted during the duration of the academic year - approximately 9 months - and includes baseline and post-intervention measurements of physical activity, dietary intake, screen time and body composition. Discussion: We hope this report will be useful to researchers, public health professionals, and school administrators and health professionals (nurses and physical/health educators) seeking to develop similar prevention programs. It is obvious that more collaborative, inter-disciplinary, multi-level work is needed before a proven, effective intervention package to modify behaviors related to childhood obesity can be generally recommended. It is our hope that SWITCH is a step in that direction. Trial Registration: ClinicalTrials. gov NCT00685555.

P. A. Estabrooks, M. Bradshaw, D. A. Dzewaltowski and R. L. Smith-Ray. (2008). Determining the impact of walk kansas: Applying a team-building approach to community physical activity promotion. Annals of Behavioral Medicine. 36, 1-12.

S. J. Fairclough, G. Stratton and Z. H. Butcher. (2008). Promoting health-enhancing physical activity in the primary school: a pilot evaluation of the BASH health-related exercise initiative. Health Education Research. 23, 576-581.

The 'Be Active Stay Healthy' (BASH) health-related exercise (HRE) programme was delivered to Year 5 students (age 9-10 years) in two primary schools situated in the same area of a northwest England town. BASH aims to improve students' participation in and knowledge of HRE through structured physical activities. Fifty-five students completed pre- and post-programme HRE knowledge and understanding questionnaires. Moderate to vigorous physical activity (MVPA) levels of 13 students were assessed using accelerometers during two contrasting lessons focusing on optimal activity levels (active) and cognitive learning (cognitive). Mean percentage of correct questionnaire answers improved from 60.8 to 83.8% (P = 0.0001, effect size (ES) = 1.44), and questionnaire performance was significantly better among students in one of the schools (P = 0.017, ES = 0.72). Boys engaged in MVPA for 11% more time than girls during the active lessons (P = 0.0006, ES = 1.21) but MVPA during cognitive lessons was similar. The BASH programme has potential to use structured physical activity as a medium to enhance students' HRE knowledge, particularly in relation to the fundamental understanding of healthy and active lifestyles. HRE knowledge may differ between schools, even when they are similarly sized and located, with analogous student catchment areas. Recommendations for the future delivery and evaluation of the programme are made.

C. Graf, B. Koch, G. Falkowski, S. Jouck, H. Christ, K. Staudenmaier, W. Tokarski, A. Gerber, H.-G. Predel and S. Dordel. (2008). School-based prevention: Effects on obesity and physical performance after 4 years. Journal of Sports Sciences. 26, 987.

Juvenile obesity is increasing worldwide. Preventive strategies are warranted. The school-based Children's Health Interventional Trial (the CHILT Project) combines health education and physical activity for children. The effect on obesity and physical performance was studied after four years in 12 primary schools compared with five control schools. Anthropometric data were recorded. Physical performance was measured by a coordination test for children (balancing backwards, one-legged obstacle jumping, lateral jumping, sideways movements) and a 6-min run (endurance). No difference in the prevalence and incidence of overweight and obesity was found between the intervention and control schools before and after the intervention. Remission of overweight was higher in the intervention schools (23.2 vs. 19.2%), but not significant. An increase in coordination related to lateral jumping and balancing backwards was apparent in the intervention schools (30.6, s = 10.8 vs. 26.1, s = 10.8, P = 0.005; 21.8, s = 11.8 vs. 19.4, s = 11.7, P = 0.007), and the increase in endurance performance tended to be higher in intervention schools (100.8, s = 122.7 vs. 92.8, s = 126.0, P = 0.055), adjusted for age, sex, baseline test result, and body mass index at final examination. Therefore, preventive intervention in primary school offers the possibility to improve physical performance in children. The prevalence and incidence of obesity were not affected.

B. Gutin, Z. Yin, M. Johnson and P. Barbeau. (2008). Preliminary findings of the effect of a 3-year after-school physical activity intervention on fitness and body fat: the Medical College of Georgia Fitkid Project. Int J Pediatr Obes. 3 Suppl 1, 3-9.

OBJECTIVE: To evaluate the effect of a 3-year after-school physical activity (PA) intervention on aerobic fitness and percent body fat (%BF). METHODS: In total, 18 schools were randomized into intervention or control arms. Measurements were made at the beginning and end of the third, fourth and fifth grades. Fitness was measured with heart rate response to a bench-stepping task.%BF and bone density were measured with dual-energy x-ray absorptiometry. The intervention included 40 min of academic enrichment activities, during which healthy snacks were provided, and 80 min of moderate-to-vigorous PA (MVPA). RESULTS: Data analyses were performed on 206 youths who remained in the same schools for the 3-year period, who were measured at all six time points and, for the intervention group, who attended at least 40% of the sessions in each of the 3 years. The group by time interactions were significant for fitness (p < 0.01) and %BF (p < 0.05). Children in intervention schools improved in fitness and %BF during the school years and returned to levels similar to those in control schools during the summers. Over the six measurement points, the intervention group increased more than the control group in bone density (p < 0.01), fat-free soft tissue (p < 0.01), weight (p < 0.01), height (p < 0.01), and body mass index (p < 0.05). CONCLUSIONS: An after-school program focusing on MVPA had a beneficial effect on fitness and body composition. During the summers, the beneficial effect of the previous year's participation on fitness and %BF was lost. This highlights the importance of year-round programs to promote healthy growth in youths.

L. Haerens, E. Cerin, L. Maes, G. Cardon, B. Deforche and I. De Bourdeaudhuij. (2008). Explaining the effect of a 1-year intervention promoting physical activity in middle schools: a mediation analysis. Public Health Nutr. 11, 501-12.

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

J. Henaghan, N. McWhannell, L. Foweather, N. T. Cable, A. M. Batterham, G. Stratton and K. P. George. (2008). The Effect of Structured Exercise Classes and a Lifestyle Intervention on Cardiovascular Risk Factors in Primary Schoolchildren: An Exploratory Trial (The A-CLASS Project). Pediatric Exercise Science. 20, 169.

This exploratory trial evaluates the effect of a structured exercise (STEX) or lifestyle intervention (PASS) program upon cardiovascular (CV) disease risk factors in children. Sixty-one schoolchildren were randomly assigned by school to an intervention or control (CON) condition. The effect of the STEX (compared with CON) was a mean benefit of -0.018 mm for average maximum carotid intimamedia thickness. The PASS intervention did not result in clinically important effects, and no other substantial changes were observed. Relatively high probability of clinically beneficial effects of the STEX intervention suggests that a larger, definitive randomized trial with longer follow-up is warranted. ABSTRACT FROM AUTHOR

C. M. Hoehner, J. Soares, D. P. Perez, I. C. Ribeiro, C. E. Joshu, M. Pratt, B. D. Legetic, D. C. Malta, V. R. Matsudo, L. R. Ramos, E. J. Simoes and R. C. Brownson. (2008). Physical activity interventions in Latin America - A systematic review. American Journal Of Preventive Medicine. 34, 224-233.

Background: Recommendations for physical activity in the Guide to Community Preventive Services (the Community Guide) have not been systematically examined or applied in developing countries such as those in Latin America. The aim of this systematic review was to assess the current evidence base concerning interventions to increase physical activity in Latin America using a modified Community Guide process and to develop evidence-based recommendations for physical activity interventions. Methods: In 2006, a literature review of both peer-reviewed and non-peer-reviewed literature in Portuguese, Spanish, and English was carried out to identify physical activity interventions conducted in community settings in Latin America. Intervention studies were identified by searching ten databases using 16 search terms related to physical activity, fitness, health promotion, and community interventions. All intervention studies related to physical activity were summarized into tables. Six reviewers independently classified the intervention studies by the categories used in the Community Guide and screened the studies for inclusion in a systematic abstraction process to assess the strength of the evidence. Five trained researchers conducted the abstractions. Results: The literature search identified 903 peer-reviewed articles and 142 Brazilian theses related to physical activity, of which 19 were selected for full abstraction. Only for school-based physical education classes was the strength of the evidence from Latin America sufficient to support a practice recommendation. Conclusions: This systematic review highlights the need for rigorous evaluation of promising interventions to increase physical activity in Latin America. Implementation and maintenance of school physical education programs and policies should be strongly encouraged to promote the health of Latin American children.

J. M. Jancey, A. H. Lee, P. A. Howat, A. Clarke, K. Wang and T. Shilton. (2008). The effectiveness of a physical activity intervention for seniors. American Journal Of Health Promotion. 22, 318-321.

Purpose. To determine whether a tailored, 6-month, neighborhood-based, physical activity intervention for people aged 65 to 74 years could increase their total physical activity levels and to identify factors associated with physical activity times. Design. A longitudinal, prospective, intervention study. Setting. Perth, Western Australia. Subjects. A total of 573 older adults, recruited from 30 intervention (n = 260) and 30 control (n 313) neighborhoods. Initial response rates were 74% (260/352) in the intervention group and 82% (313/382) in the control group, which provided the 5 73 adults for participation in the study. A total of 413 participants (177 and 236 in the intervention and control groups, respectively) completed the program. Intervention. A neighborhood-based physical activity intervention. Measures. A self-reported questionnaire administered, at three time points. Physical activity levels were measured using the International Physical Activity Questionnaire. Personal and demographic information, including perceived financial. struggle and proximity to friends, were collected. Analysis. Descriptive statistics, repeated measures analysis of variance, and generalized estimating equations (GEE). Results. The intervention resulted in a significant increase in total average physical activity times of 2.25 hours per week (p <.001). The GEE analysis confirmed significant increases in physical activity from baseline to midpoint (p =.002) and to postintervention (p =.031). Perception of financial struggle (p =.020) was positively associated with physical activity time spent by participants, whereas having no friends or acquaintances living nearly (p =.037) had a significant negative correlation. The main limitation of this study was the restricted duration of the intervention. Conclusion. The program was successful in increasing weekly mean time for physical activity in seniors and in identifying factors that affect their commitment to physical activities.

R. R. Kipping, C. Payne and D. A. Lawlor. (2008). Randomised controlled trial adapting US school obesity prevention to England. Archives Of Disease In Childhood. 93, 469-473.

Objectives: To determine whether a school obesity prevention project developed in the United States can be adapted for use in England. Methods: A pilot cluster randomised controlled trial and interviews with teachers were carried out in 19 primary schools in South West England. Participants included 679 children in year 5 (age 9-10). Baseline and follow-up assessments were completed for 323 children (screen viewing) and 472 children (body mass index). Sixteen lessons on healthy eating, physical activity and reducing TV viewing were taught over 5 months by teachers. Main outcome measures were hours of screen activities, body mass index, mode of transport to school and teachers' views of the intervention. Results: Children from intervention schools spent less time on screen-viewing activities after the intervention but these differences were imprecisely estimated: mean difference in minutes spent on screen viewing at the end of the intervention (intervention schools minus control schools) adjusted for baseline levels and clustering within schools was -11.6 (95% CI -42.7 to 19.4) for a week day and was -15.4 (95% CI -57.5 to 26.8) for a Saturday. There was no difference in mean body mass index or the odds of obesity. Conclusions: It is feasible to transfer this US school-based intervention to UK schools, and it may be effective in reducing the time children spend on screen-based activities. The study has provided information for a full-scale trial, which would require 50 schools (similar to 1250 pupils) to detect effects on screen viewing and body mass index over 2 years of follow-up.

A. Lara, A. K. Yancey, R. Tapia-Conye, Y. Flores, P. Kuri-Morales, R. Mistry, E. Subirats and W. J. McCarthy. (2008). Pausa para tu Salud: reduction of weight and waistlines by integrating exercise breaks into workplace organizational routine. Prev Chronic Dis. 5, A12.

INTRODUCTION: Proactive worksite strategies that change the physical or sociocultural environment(s) to incorporate obligatory physical activity may be necessary to engage sedentary people. This study describes implementation and evaluation of an intervention, Pausa para tu Salud (Pause for Your Health), that integrated a brief period of group exercise into the workday. METHODS: An uncontrolled pretest-post-test study design tested the effects of integrating daily 10-minute exercise breaks during paid work time during January 2003 through January 2004. A total of 335 Mexican Ministry of Health office workers provided baseline data as a part of routine annual clinical screening examinations. RESULTS: Baseline mean body mass index and waist circumferences were 27.8 kg/m(2) and 87.6 cm for women and 26.6 kg/m(2) and 89.7 cm for men. Complete data were available for 271 (80.9%) employees at 1-year follow-up. Two-tailed, paired t-test comparisons were used. Body mass index decreased by 0.32 kg/m(2) (P =.05), and waist circumference by 1.6 cm (P =.0009) overall. The body mass index decrease, however, was significant only for men (-0.43 kg/m(2), P =.03). Multivariate analyses revealed a significant decrease in diastolic blood pressure among women (z = -2.04, P =.042). CONCLUSION: The intervention was associated with significant improvements in both measures of body composition. Substantive health and organizational benefits may result from integrating brief periods of physical activity into the workday if these findings are replicated in randomized controlled trials in other worksites.

A. Liu, X. Hu, G. Ma, Z. Cui, Y. Pan, S. Chang, W. Zhao and C. Chen. (2008). Evaluation of a classroom-based physical activity promoting programme. Obesity Reviews. 9, 130-134.

The purpose of the present study was to evaluate the effect of the Happy 10 programme on the promotion of physical activity, physical growth and development of primary school students, and on obesity control and prevention. Two similar primary schools from one district of Beijing, China were selected, one as an intervention school and the other as a control school. A Happy 10 programme was implemented at least once every school day in the intervention school for two semesters, whereas no intervention was adopted in the control school. The information on energy expenditure and duration of physical activity was collected by a validated 7-day physical activity questionnaire. Height and weight were measured by the trained investigators following standardized procedure. Energy expenditure and intensity of each Happy 10 session were measured by a physical activity monitor. The average energy expenditure and duration of total physical activity per day among students in the intervention school increased significantly from 15.0 to 18.2 kcal kg(-1) and 2.8 to 3.3 h, respectively, whereas the figures significantly decreased in the control school. There was a significant difference in change of weight and body mass index between girls in the intervention and control school (2.4 kg vs. 4.6 kg; 0.47 kg m(-2) vs. 0.66 kg m(-2)). The prevalence of overweight and obesity in the intervention school decreased by 0.4-5.6%, as compared with the increase by 0.6-4.5% in the control school. The average energy expenditure and intensity per 10-min session ranged from 25.0 to 35.1 kcal and from 4.8 to 6.2 kcal kg(-1) h(-1), respectively, in grades 1-5. The Happy 10 programme provides a useful strategy to promote physical activity among school children, and also plays a positive role in building up physical growth and development of girls.

P. J. Naylor, H. M. Macdonald, D. E. R. Warburton, K. E. Reed and H. A. McKay. (2008). An active school model to promote physical activity in elementary schools: Action schools! BC. British Journal Of Sports Medicine. 42,

Objective: To assess the impact of an active school model on children's physical activity (PA). Design: 16-month cluster randomised controlled trial. Setting: 10 elementary schools in Greater Vancouver, BC. Participants: 515 children aged 9-11 years. Intervention: Action Schools! BC (AS! BC) is an active school model that provided schools with training and resources to increase children's PA. Schools implemented AS! BC with support from either external liaisons (liaison schools, LS; four schools) or internal champions (champion schools, CS; three schools). Outcomes were compared with usual practice (UP) schools (three schools). Main outcome measurements: PA was measured four times during the study using pedometers (step count, steps/day). Results: Boys in the LS group took 1175 more steps per day, on average, than boys in the UP group (95% CI: 97 to 2253). Boys in the CS group also tended to have a higher step count than boys in the UP group (+ 804 steps/day; 95% CI: 2341 to 1949). There was no difference in girls' step counts across groups. Conclusions: The positive effect of the AS! BC model on boys' PA is important in light of the current global trend of decreased PA.

J. O'Connor, K. Steinbeck, A. Hill, M. Booth, M. Kohn, S. Shah and L. Baur. (2008). Evaluation of a community-based weight management program for overweight and obese adolescents: The Loozit study. Nutrition & Dietetics. 65, 121.

Aim: To evaluate a community-based weight management program for overweight and obese adolescents aged 13–16 years. Methods: The present study was a group-based intervention over five months conducted in Australian community health centres. Program evaluation questionnaires were completed by adolescents and their parents. Seven semi-structured group sessions were held for adolescents: weekly for four weeks and then at two, four and five months. The program sessions focused on healthy eating, increasing physical activity, decreasing sedentary behaviour and increasing self-esteem. Adolescents' anthropometry, blood pressure and fasting blood biochemistry were measured. Adolescents completed validated questionnaires on diet, physical activity and self-esteem. Results: Twenty-two overweight and obese adolescents were recruited with a median body mass index (BMI) z-score 2.30. Recruitment strategies were identified and a high retention rate (91%) was achieved. The program was well received by adolescents. Parents reported their adolescents were making healthier food choices and increasing physical activity. At treatment end there were clinically significant improvements in self-perception scores for physical appearance and romantic appeal (P < 0.05), waist circumference (median 100.1 cm vs 97.1 cm; P < 0.0001) and HDL cholesterol (median 1.10 mmol/L vs 1.20 mmol/L; P = 0.02), but not BMI or BMI z-score. Conclusions: The Loozit weight management intervention is one of the first to involve adolescents in the evaluation of the program and to operate at a sustainable intensity in an accessible community setting. The present study provides valuable insights into the elements of a program that is acceptable to adolescents.

R. R. Pate and J. R. O'Neill. (2008). Summary of the American Heart Association scientific statement: promoting physical activity in children and youth: a leadership role for schools. J Cardiovasc Nurs. 23, 44-9.

Schools have long played an important role in providing students with healthful physical activity. However, the decline in population-level physical activity suggests that schools should play an even greater role in providing and promoting physical activity. Recently, the American Heart Association issued a set of recommendations that, if implemented, would position schools as leaders in helping children and youth become more physically active. This article summarizes an American Heart Association scientific statement on physical activity and the schools that was recently developed by the Association's Council on Nutrition, Physical Activity, and Metabolism in collaboration with the Council on Cardiovascular Disease in the Young and the Council on Cardiovascular Nursing.

J. A. Perman, T. L. Young, E. Stines, J. Hamon, L. M. Turner and M. G. Rowe. (2008). A community-driven obesity prevention and intervention in an elementary school. J Ky Med Assoc. 106, 104-8.

In partnership with community agencies and organizations, University of Kentucky College of Medicine (UKCOM) launched an after-school program focusing on creating healthy, active lifestyles for students at a Lexington elementary school. Chosen for the underserved population of children it cares for, the school exhibits all of the national risk factors for obesity: low-income families (57% of annual household incomes less than $10,000); minority population (80% of the children African-American or Hispanic); and located in an unsafe neighborhood for outdoor physical activity. These demographics resulted in a school population that had body mass index (BMI) demographics of 48.8% overweight (BMI >85%), including 30.7% obese (BMI >95%), in contrast with the national average of 16% obese. METHODS: Targeting the school's children with a BMI >85th percentile, an after-school program was created. The students met twice a week for 90-minute sessions of fun physical activities, proper nutritional information, as well as small group sessions with pediatric psychiatry residents focusing on good choices and proper motivations in life. Universal school interventions were also instituted in an attempt to reach the entire school population. RESULTS: Initial findings after the first year of the program indicated a slowing in the average rate of weight gain by the targeted population. While the results, compared to accessible data in a school population with similar demographics, did not reach statistical significance, the trends were in the desired direction. A statistically significant difference (p=0.027) was observed in mean BMI percentile for the universal school population versus the comparison school. CONCLUSION: School-based prevention and intervention conducted by a coalition of community agencies and organizations is a promising and cost-effective approach to curtailing childhood obesity.

K. E. Reed, D. E. R. Warburton, H. M. Macdonald, P. J. Naylor and H. A. McKay. (2008). Action Schools! BC: A school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children. Preventive Medicine. 46, 525-531.

Objective. Our primary objective was to determine whether a novel 'active school' model - Action Schools! BC - improved the cardiovascular disease (CVD) risk profile in elementary-school children. Our secondary objective was to determine the percentage of children with elevated CVD risk factors. Methods. We undertook a cluster-randomized controlled school-based trial with 8 elementary schools across I school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268, age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools) or intervention (INT, 6 schools) groups. We assessed change between groups in cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index (BMI, wt/ht(2)). We evaluated total cholesterol (TC), total: high-density cholesterol (TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and fibrinogen on a subset of volunteers (n=77). Results. INT children had a 20% greater increase in fitness and a 5.7% smaller increase in BP compared with children attending UP schools (P<0.05). Forty five percent of children had at least one elevated risk factor (fitness, BP or BMI) at baseline. There were no significant differences between groups for change in BMI or in any of the blood variables. Conclusion. Action Schools! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children. Our multi-component intervention exposed children to fitness enhancing physical activity. It may be important for education stakeholders to adequately resource the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis.

J. Rice, D. Thombs, R. Leach and R. Rehm. (2008). Successes and barriers for a youth weight-management program. Clin Pediatr (Phila). 47, 143-7.

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.

F. T. Shaya, D. Flores, C. M. Gbarayor and J. Wang. (2008). School-Based Obesity Interventions: A Literature Review. Journal of School Health. 78, 189.

Background: Childhood obesity is an impending epidemic. This article is an overview of different interventions conducted in school settings so as to guide efforts for an effective management of obesity in children, thus minimizing the risk of adult obesity and related cardiovascular risk. Methods: PubMed and OVID Medline databases were searched for school-based obesity interventions with anthropometric measures in children and adolescents between the ages of 7 and 19 years from June 1986 to June 2006. Studies were reviewed by duration, type of intervention, and defined qualitative and quantitative measures, resulting in a yield of 51 intervention studies. Results: The interventions ranged from 4 weeks in length to as long as 8 continuing years. In total, 15 of the intervention studies exclusively utilized physical activity programs, 16 studies exclusively utilized educational models and behavior modification strategies, and 20 studies utilized both. In addition, 31 studies utilized exclusively quantitative variables like body mass indices and waist-to-hip ratios to measure the efficacy of the intervention programs, and another 20 studies utilized a combination of quantitative and qualitative measures that included self-reported physical activity and attitude toward physical activity and the tested knowledge of nutrition, cardiovascular health, and physical fitness. A total of 40 studies achieved positive statistically significant results between the baseline and the follow-up quantitative measurements. Conclusions: No persistence of positive results in reducing obesity in school-age children has been observed. Studies employing long-term follow-up of quantitative and qualitative measurements of short-term interventions in particular are warranted.

W. G. Thompson, R. C. Foster, D. S. Eide and J. A. Levine. (2008). Feasibility of a walking workstation to increase daily walking. Br J Sports Med. 42, 225-8; discussion 228.

OBJECTIVE: The number of calories expended in the workplace has declined significantly in the past 75 years. A walking workstation that allows 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.

D. S. Ward, S. E. Benjamin, A. S. Ammerman, S. C. Ball, B. H. Neelon and S. I. Bangdiwala. (2008). Nutrition and physical activity in child care: results from an environmental intervention. American Journal of Preventive Medicine. 35, 352-356.

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, J. B. Jobe and R. R. Pate. (2008). Promoting physical activity in middle school girls - Trial of activity for adolescent girls. American Journal Of Preventive Medicine. 34, 173-184.

Background: Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls. Design: Group randomized controlled trial. Setting/participants: Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502). Intervention: A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities. Main outcome measures: The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry. Results: After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean=-0.4, 95% CI=-8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint. Conclusion: A school-based, community-linked intervention modestly improved physical activity in girls. Trial Registration: NCT00006409.

J. Wolman, E. Skelly, M. Kolotourou, M. Lawson and P. Sacher. (2008). Tackling toddler obesity through a pilot community-based family intervention. Community Pract. 81, 28-31.

The lack of effective child obesity intervention and intervention prevention programmes is an increasing concern for public health professionals. Since eating and physical activity habits become established in the early years, these efforts should start as early as possible. A pilot programme, Fighting Fit Tots, was developed within a local Sure Start area. It consiste, of 11 weekly parent and toddler physical activity sessions, followed by a parent/carer healthy lifestyle workshop. Fighting Fit Tots was modelled on The MEND Programme, a successful community-based obesity intervention for school-aged children. Toddle recruitment criteria were based on the children's age, body mass index and parental obesity status. It was noticed that uptake and attendance were unsatisfac tory due to poor parental perception of child weight status, commitment issues, and limited staff capacity for outreach work. Therefore, the group was extended to all families with a toddler and this proved more successful.The pilot was a promising experience, an more community practitioners should be encourager to adopt and improve a public health approach to obesity prevention in the early years.

H. R. Wyatt, B. T. Jortberg, C. Babbel, S. Garner, F. Dong, G. K. Grunwald and J. O. Hill. (2008). Weight loss in a community initiative that promotes decreased energy intake and increased physical activity and dairy consumption: Calcium Weighs-In. J Phys Act Health. 5, 28-44.

BACKGROUND: This project addresses the need to identify feasible, effective weight-management programs that can be implemented within communities. The controversial role of dairy products in weight-management programs is also explored. METHODS: The "Calcium Weighs-In" weight-loss program placed equal emphasis on diet and physical activity and was delivered within a community intervention to promote dairy consumption in Calcium, New York. One hundred ninety-nine adults in Calcium, NY, participated in the weight-loss program. Weight loss, increase in dairy intake, increase in steps, decrease in blood pressure, decrease in waist circumference, and decrease in body mass index (BMI) were examined. RESULTS: The mean weight loss for 116 subjects who completed the program was 6.0 +/- 4.2 kg (mean +/- SD, P <.0001) with a percent weight change of 6.4% +/- 4.2% (P <.0001). An increase of 3582 +/- 4070 steps (P <.0001), as well as an increase of 0.8 +/- 1.2 dairy servings (P <.0001) was seen. Higher average dairy consumption was associated with greater weight loss and a greater decrease in waist circumference. CONCLUSION: The results show that effective weight-management programs can be implemented within communities. The results are also consistent with recommendations to include low-fat dairy products and a physical activity component in weight-management programs.

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