Guidelines for school and community programs to promote lifelong physical activity among young people. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and prevention

The Effects of an Inclusive Badminton Program on Static Postural Control for Individuals with Intellectual and Developmental Disabilities

The purpose of the study was to examine static postural control/balance in young adults with intellectual and developmental disabilities (IDD) and typically developing (TD) young adults before, during, and after an inclusive badminton intervention. Eight participants (four IDD-BADM and four TD-BADM) participated in a 12-week inclusive badminton intervention, with the other eight participants as matched controls (four IDD-CONTR and four TD-CONTR) (74.19 kg ± 9.8 kg, 171.96 cm ± 5.4 cm; 21.7 ± 1.8 years of age; nine females and seven males; eight with IDD and eight TD). The study followed a repeated measures design (pre, mid, post) before the intervention, at 6 weeks, and after 12 weeks. Static postural sway conditions included: bilateral stance eyes open (20 s), eyes closed (10 s), foam eyes open (20 s), foam eyes closed (10 s), and unilateral stance eyes open (10 s) and foam eyes open (10 s). Sway measurements included: average anterior/posterior (A/P) displacement (in), average medial/lateral (M/L) displacement (in), average 95% ellipsoid area (in2), and average velocity (ft/s). Significant time × group interactions were reported for average velocity (EO) (p = 0.030), average length (EO) (p = 0.030), 95% ellipsoid area (EO) (p = 0.049), and average A/P displacement (1LEO) (p = 0.036) for IDD-BADM. Significant time main effects were reported for average A/P displacement (FEO) (p = 0.040) for IDD groups. Significant time main effects were reported for average M/L displacement (EO) (p = 0.001), (EC) (p = 0.004), (FEO) (p = 0.005), (FEC) (p = 0.004), and average A/P displacement (EO) (p = 0.006) and (FEO) (p = 0.005) for TD groups. An inclusive badminton program indicated evidence of improved static postural control for those with IDD. However, no significant differences were reported for TD peers.

A Participatory Design Approach to Develop Visualization of Wearable Actigraphy Data for Health Care Professionals: Case Study in Qatar

Background

Several tools have been developed for health care professionals to monitor the physical activity of their patients, but most of these tools have been considering only the needs of users in North American and European countries and applicable for only specific analytic tasks. To our knowledge, no research study has utilized the participatory design (PD) approach in the Middle East region to develop such tools, involving all the stakeholders in the product development phases, and no clear use cases have been derived from such studies that could serve future development in the field.

Objective

This study aims to develop an interactive visualization tool (ActiVis) to support local health care professionals in monitoring the physical activity of their patients measured through wearable sensors, with the overall objective of improving the health of the Qatari population.

Methods

We used PD and user-centered design methodologies to develop ActiVis, including persona development, brainwriting, and heuristic walkthrough as part of user evaluation workshops; and use cases, heuristic walkthrough, interface walkthrough, and survey as part of expert evaluation sessions.

Results

We derived and validated 6 data analysis use cases targeted at specific health care professionals from a collaborative design workshop and an expert user study. These use cases led to improving the design of the ActiVis tool to support the monitoring of patients’ physical activity by nurses and family doctors. The ActiVis research prototype (RP) compared favorably with the Fitbit Dashboard, showing the importance of design tools specific to end users’ needs rather than relying on repurposing existing tools designed for other types of users. The use cases we derived happen to be culturally agnostic, despite our assumption that the local Muslim and Arabic culture could impact the design of such visualization tools. At last, taking a step back, we reflect on running collaborative design sessions in a multicultural environment and oil-based economy.

Conclusions

Beyond the development of the ActiVis tool, this study can serve other visualization and human–computer interaction designers in the region to prepare their design projects and encourage health care professionals to engage with designers and engineers to improve the tools they use for supporting their daily routine. The development of the ActiVis tool for nurses, and other visualization tools specific to family doctors and clinician researchers, is still ongoing and we plan to integrate them into an operational platform for health care professionals in Qatar in the near future.

Improving Balance in Adults With Intellectual Developmental Disorder via Virtual Environments

Balance problems have been found among 57% of adults with Intellectual Developmental Disorder (IDD). Moreover, these adults have only partially participated in conventional activity programs. There is a clear need for new interventions that will enhance these individuals' interest and motivation toward improving their balance skills. Virtual gaming training experiences are a promising prospect in that regard. The purpose of this study was to examine the effect of virtual reality games on improving balance for adults with IDD. We recruited 31 individuals with mild-moderate IDD who had fallen at least twice in the year prior to initiating this intervention, and we evaluated these participants using the Timed Up and Go (TUG) test. The participants were randomly assigned to control and experimental groups, and only the latter group took part in a series of twelve 30-minute bi-weekly virtual game sessions, designed to improve balance using the SeeMe virtual game system. We found significant (p < .001) pre-post improvements in balance abilities in the experimental group and no significant pre-post change in the control group (p < .77). These data suggest that virtual game technology is a viable tool for improving balance among adults with IDD.

University-based physical literacy programming for children: Canadian community stakeholders' recommendations

'Physical literacy' (PL) education-that is, teaching foundational skills, attitudes, behaviors and knowledge about lifelong involvements in physical activities, is an important aspect for health promotion among children. Universities have been playing a critical role by teaching future PL professionals. Additionally, various universities have offered university-based PL programming for neighborhood children as a way of public health promotion service and community engagement. However, this additional role of universities and the ways of promoting the quality of this type of health promotion service programming have not been investigated in the current research literature. Therefore, the purpose of this study was to identify the practicable strategies to enhance the quality of university-based PL programming for children from the perspectives of community stakeholders. Overall, 24 community stakeholders who held professional positions that are related to PL education participated in a 90-min focus group interview. This grounded theory study identified that university-based PL programming for children should be (i) inclusive, (ii) collaborative, (iii) welcoming and (iv) responsive. Practical suggestions and recommendations were also provided. This study has provided empirical knowledge to prioritize aspects for the future actions in planning and implementing university-based PL programming for children and informed for further cross-cultural comparisons amongst the perspectives of participants, university service providers and community stakeholders. The knowledge acquired from this research will also be translated to university service providers who operate similar type of health promotion service programming to the public.

Individual, social and neighbourhood correlates of cycling among children living in disadvantaged neighbourhoods

OBJECTIVES

To describe cycling behaviours and examine individual, social and neighbourhood correlates of cycling among children living in socio-economically disadvantaged neighbourhoods.

DESIGN

Cross-sectional.

METHODS

Mothers of 289 children (46% boys) aged 8-15 (mean 12±2.2) years living in disadvantaged neighbourhoods in Victoria, Australia were surveyed about their child's cycling frequency and duration in a typical week. Perceptions of cycling, cycling ability, cycling behaviours and road safety were proxy- and self-reported by mothers. Shortest road distance from home to school was determined using a Geographic Information System. Multivariable logistic regression analyses examined associations between individual, social and neighbourhood variables and cycling frequency (>once/week) and duration (>60min/week).

RESULTS

Overall, 70% of boys and 49% of girls cycled>once/week; rates of cycling for >60min/week were 60% and 32%, respectively. Children had greater odds of cycling>once/week if they enjoyed cycling for fun (OR=13.3, 95%CI=2.0, 86.9). Children had greater odds of cycling for >60min/week if they enjoyed cycling for fun (OR=17.1, 95%CI=1.7, 167.7) or if they were allowed to cycle on main roads (OR=3.2, 95%CI=1.1, 9.1). Children who had to cross several roads to access play areas had lower odds of cycling for >60min/week (OR=0.3, 95%CI=0.1, 0.7).

CONCLUSIONS

Future research should investigate strategies to increase children's enjoyment of cycling, independent mobility and safe access by cycling to key destinations such as play areas.

Participation in school sports among children and adolescents with juvenile idiopathic arthritis in the German National Paediatric Rheumatologic Database, 2000-2015: results from a prospective observational cohort study

BACKGROUND

Regular school sports can help adolescents achieve the recommended amount of daily physical activity and provide knowledge, attitudes and behavioral skills that are needed in order to adopt and maintain a physically active lifestyle. Furthermore, it reaches all children including those that are at risk for engaging in more sedentary types of behavior. Since adolescents with juvenile idiopathic arthritis (JIA) are less involved in physical and social activities than their healthy peers, the objectives were to (1) estimate the prevalence of participation in school sports among patients with JIA; (2) determine the correlates associated with school sports absenteeism; and (3) investigate whether attendance in school sports has changed in the era of biologics.

METHODS

Data from schoolchildren with JIA recorded in the German National Paediatric Rheumatologic Database (NPRD) in the years 2000 to 2015 were considered for the analyses. Data from the year 2015 were inspected to analyze correlates of school sports absenteeism. Whether school sports participation had changed between 2000 and 2015 was determined using linear mixed models.

RESULTS

During the 15-year period, the participation rates in school sports were determined in 23,016 patients. The proportion of patients who participated in school sports almost always steadily increased from 31% in 2000 to 64% in 2015 (β = 0.017, 95% confidence interval (CI) 0.015, 0.020), whereas the exemption rate simultaneously decreased from 44% in 2000 to 16% in 2015 [β = - 0.009, 95% CI -0.011, - 0.007]. In 2015, the data from 5879 patients (mean age 13.1 ± 3.3 years, female 65%, disease duration 5.9 ± 4.0 years, persistent oligoarthritis 37%) were available for evaluation. Full exemption from school sports (in 16.1% of cases) was associated with functional limitations, disease activity and any use of DMARDs, intra-articular glucocorticoid injections or physiotherapy.

CONCLUSIONS

School sports attendance among children and adolescents with JIA has increased significantly over the past 15 years. Possible explanations include improved functional ability probably due to better treatment options. The integration of patients with child acceptable symptom states who have previously been fully exempted from school sports needs to be addressed in the future.

48-Hour Effects of Monitored Cooperative High-Intensity Interval Training on Adolescent Cognitive Functioning

Physical activity has been positively related to better cognitive performance though the effects of varied exercise type and intensity and the duration of cognitive benefits are unclear. This study analyzed the effect of 16 minutes of monitored cooperative high-intensity interval training (monitored C-HIIT) at the start of the school day, on various cognitive variables over the next 24-48 hours. We randomly assigned 158 participants either to a control group ( n = 81) that engaged only in static stretching or to an experimental group ( n = 77) that performed monitored C-HIIT. We assessed cognitive functioning before the exercise, immediately afterward, and for five follow-up time points over the next two days (i.e., at 2, 3, 4, 24, and 48 hours). We analyzed age, sex, body mass index, and moderate-to-vigorous physical activity as potential confounder variables. Adolescents in the monitored C-HIIT group increased selective attention by 17.39% during the next hour ( p = .015) and increased concentration by 20.31% and 15.26% during the first ( p = .022) and second ( p = .059) subsequent hours, respectively. This positive short-term benefit of monitored C-HIIT during immediate subsequent hours is an important finding with implications for the school curricula and schedule.

Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking?

Sitting has frequently been equated with smoking, with some sources even suggesting that smoking is safer than sitting. This commentary highlights how sitting and smoking are not comparable. The most recent meta-analysis of sedentary behavior and health outcomes reported a hazard ratio of 1.22 (95% confidence interval [CI] = 1.09, 1.41) for all-cause mortality. The relative risk (RR) of death from all causes among current smokers, compared with those who have never smoked, is 2.80 (95% CI = 2.72, 2.88) for men and 2.76 for women (95% CI = 2.69, 2.84). The risk is substantially higher for heavy smokers (> 40 cigarettes per day: RR = 4.08 [95% CI = 3.68, 4.52] for men, and 4.41 [95% CI = 3.70, 5.25] for women). These estimates correspond to absolute risk differences of more than 2000 excess deaths from any cause per 100 000 persons per year among the heaviest smokers compared with never smokers, versus 190 excess deaths per 100 000 persons per year when comparing people with the highest volume of sitting with the lowest. Conflicting or distorted information about health risks related to behavioral choices and environmental exposures can lead to confusion and public doubt with respect to health recommendations.

Relationships among cardiorespiratory fitness, muscular fitness, and cardiometabolic risk factors in Japanese adolescents: Niigata screening for and preventing the development of non-communicable disease study-Agano (NICE EVIDENCE Study-Agano) 2

OBJECTIVE

To examine the independent and combined associations of cardiorespiratory fitness (CRF) and muscular fitness (MF) with cardiometabolic risk factors in Japanese adolescents.

METHODS

A cross-sectional study including 993 Japanese adolescents (aged 13-14 years) was undertaken. Height, body mass, blood pressure, lipid profile (non-fasting), and HbA1c were measured. The physical fitness (PF) test included measurements of CRF (20 m multistage shuttle run test), upper limb strength (hand grip strength), lower limb strength (standing long jump), and muscular endurance (sit-ups). The clustered cardiometabolic risk (CCMR) was estimated by summing standardized Z-scores of body mass index (BMI), mean arterial pressure (MAP), non-high-density lipoprotein cholesterol (non-HDL-C), and HbA1c.

RESULTS

Linear regression analysis showed that all PF factors except for muscular endurance were inversely correlated with CCMR (P < .001). Among metabolic risk components, HbA1c was unrelated to PF, while non-HDL-C was inversely associated with CRF (B = -2.40; P < .001), upper limb strength (B = -1.77; P < .05), and lower limb strength (B = -1.53; P < .05) after adjustment for lifestyle factors. Logistic regression showed that the probability of having high CCMR (≥1SD) was synergistically higher in those with the lowest tertiles of both CRF and upper limb strength (P for interaction = .001); however, a substantially lower likelihood of having high CCMR was observed among individuals with the lowest tertile of upper limb strength but moderate CRF.

CONCLUSIONS

Lower CRF and MF were significantly and synergistically associated with an unhealthier metabolic risk profile.

Do school physical activity policies and programs have a role in decreasing multiple screen time behaviours among youth?

Screen time in youth has been associated with a wide range of poor health outcomes. Evidence indicates the need to develop physical activity (PA) school policies and programs that are aimed at decreasing youth screen time behaviours. This study aims to understand the association between PA policies and programs embedded into the functioning of 89 schools across two provinces in Canada and multiple screen time behaviours. As part of the COMPASS Study, a total of 44,861 youth aged between 13 and 18years and belonging to 89 schools in two Canadian provinces completed a validated questionnaire for health behaviours and outcomes data. PA policies and programs were measured using the School Policies and Practices Questionnaire, completed by the relevant school administrator. Participation in before-school, noon hour, or after-school intramural programs, participation in varsity sports, and access to indoor areas of PA during non-instructional time, was associated with significantly lower multiple screen time behaviours across both provinces. With exposure to multiple electronic and digital devices only predicted to increase among youth in the future, there is a need to conceptualize and integrate school-based screen time reducing PA policies and programs into the regular functioning of the schools.

Neurodevelopmental readiness of children for participation in sports

Many children participate in organized sports each year as a means of socialization, and physical skill building. Sports participation is dependent on physical growth, and neurodevelopmental readiness of the child. It is important to be aware of a child's level across the various streams of development and engage in specific strategies to optimize their ability at each age group. This article first outlines developmental skills across various age groups in childhood, and makes suggestions for such strategies.

The Association of Physical Activity and Academic Behavior: A Systematic Review

BACKGROUND

In this systematic review, we assessed the existing research describing the effects of physical activity (PA) on academic behavior, with a special focus on the effectiveness of the treatments applied, study designs, outcome measures, and results.

METHODS

We obtained data from various journal search engines and 218 journal articles were downloaded that were relevant to PA and academic performance topics. The abstracts of all the articles were independently peer reviewed to assess whether they met the inclusion criteria for further analysis. The literature search was ongoing. Of the reviewed articles, 9 were chosen on the topic of PA effects on academic behavior. Each article was analyzed and summarized using a standard summary template.

RESULTS

Overall, PA interventions commonly found positive effects on academic behavior, with few exceptions. There were additional unique findings regarding differences in outcome measures and PA treatments.

CONCLUSIONS

The findings from these studies are significant and support the implementation or continuation of PA in schools to improve academic behavior and associated performance. More research needs to be conducted using the effective aspects of the treatments from this review with consistent outcome measures.

Associations between Body Mass Index and Visual Impairment of School Students in Central China

Body Mass Index (BMI) is a risk indicator for some eye diseases. However, the association between BMI and Visual Impairment (VI) was not quite certain in Chinese students. Our aim was to assess the relationship between BMI and VI with a cross-sectional study. A total of 3771 students aged 6–21 years, including 729 with VI, were sampled from 24 schools in Huangpi District of central China to participate in the study. A multistage stratified cluster random sampling was adopted. Each of the students answered a questionnaire and had physical and eye examinations. The association between BMI and VI was examined with logistic regression and threshold effect analysis. The prevalence of VI was 19.33% (729/3771). Compared to normal and underweight, overweight/obese students showed a stronger relation with VI in age- and sex-adjusted (Odds Ratio (OR) = 16.16, 95% Confidence Interval (CI): 12.37–21.09, p < 0.001) and multivariable models (OR = 8.32, 95% CI: 6.13–11.30, p < 0.001). There was a nonlinear dose–response relation between levels of BMI and the prevalence of VI (p < 0.001). A high level of BMI (≥19.81 kg/m²) was associated with a higher VI prevalence (adjusted OR = 1.20, 95% CI: 1.15–1.25, p < 0.001). In conclusion, the study demonstrated BMI levels were significantly associated with the prevalence of VI.

Opportunities for Student Physical Activity in Elementary Schools: A Cross-Sectional Survey of Frequency and Correlates

The objectives of this study were to describe opportunities for student physical activity (PA) in elementary schools and to identify factors in the school environment associated with higher PA opportunity. Self-report questionnaires were completed by school principals and physical education teachers in 277 schools (88% response) in metropolitan Montreal. Correlates of opportunity were identified using ordinal logistic regression. There was substantial variation in PA opportunities between schools. Higher opportunity was associated with role modeling of PA by school principals, their interest in increasing PA through links to the municipality, adequate financial and human resources, access to school sports facilities, adequate space for storing student sports equipment, and suburban location. There is both the need and the potential for intervention to increase PAopportunities in elementary schools. Addressing barriers related to resources and access to sports facilities may help reduce disparities between schools in opportunities for students to engage in PA.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

Shared medical appointments in pulmonary hypertension

We aimed to adapt the shared medical appointment (SMA) model to the care of pulmonary hypertension (PH) patients and evaluate patient satisfaction. Our SMA team included a PH specialist, a PH nurse, and one research fellow. Eight to twelve PH patients with a family member were invited during office visits and by phone calls. Attendance was verified and encouraged by phone calls and informational letters. The meetings started with a 30-minute presentation on various PH topics, which was followed by each patient's individual visit and a focused examination in front of the group, allowing group questions and interaction. Of the total number of patients (n = 53), 84% stated that they would attend a future SMA. The care provided was rated excellent to very good by 98% of the patients. Ninety-two percent stated that they improved their understanding of the disease and treatment options, and 59% acknowledged a preference for the group visit over the private visit. Twenty-five percent of patients stated that they were very likely to likely to some extent to agree to change or seek a change in treatment modality on the basis of conversation with other patients in the SMA. The majority of our patients expressed no privacy concerns before the meeting (76%), and even more expressed no such concerns afterward (88%). In conclusion, the SMA model allows PH patients to increase understanding of their disease process while integrating peer support, promoting social interaction, and addressing patients' emotional needs. Other (rare) pulmonary diseases may benefit from this model.

Withholding recess from elementary school students: policies matter

BACKGROUND

Recess is a key aspect of a healthy elementary school environment and helps to keep students physically active during the school day. Although national organizations recommend that students not be withheld from recess, this practice occurs in schools. This study examined whether district policies were associated with school practices regarding the withholding of recess for behavior management or academic reasons, as well as the use of physical activity (eg, running laps) for behavior management.

METHODS

Data were gathered from administrators at US public elementary schools by mail-back surveys conducted during the spring of the 2008-2009, 2009-2010, and 2010-2011 school years. Corresponding school district policies were gathered and coded. Each year's sample was nationally representative and data were analyzed as a stacked cross-sectional sample. A total of 1,919 surveys were received (61.2% response rate).

RESULTS

Averaged over the 3 years, students were not withheld from recess for poor behavior or academic reasons at 28.3% and 26.7% of elementary schools, respectively. Strong district policy was associated with an increased odds of not withholding students from recess for poor behavior (adjusted odds ratio [OR] = 2.27, p < .001) or completing schoolwork (adjusted OR = 1.99, p < .001). Withholding recess was less common in the South versus the West, Midwest, and Northeast. Use of physical activity for behavior management was rare and not associated with district policy.

CONCLUSIONS

Strengthening district policies may be an effective strategy for changing school practices pertaining to withholding of recess, and to ensure that all students have opportunities to be physically active during the school day.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

BACKGROUND

The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades.

OBJECTIVES

The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents.

SEARCH METHODS

The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.

SELECTION CRITERIA

To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate.

DATA COLLECTION AND ANALYSIS

Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured.

MAIN RESULTS

In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review.

AUTHORS' CONCLUSIONS

The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.

Lessons learned from the HEALTHY primary prevention trial of risk factors for type 2 diabetes in middle school youth

The HEALTHY trial was designed to take a primary prevention approach to risk factors for type 2 diabetes in youth, primarily obesity. The study involved over 6,000 students at 42 middle schools across the U.S. Half received an integrated intervention program of components addressing the school food environment, physical education, lifestyle behaviors, and promotional messaging. The intervention was designed to be more comprehensive than previous efforts, and the research was amply funded. Although the primary objective of reducing the percentage of overweight and obesity in schools that received the intervention program, as compared with control schools, was not obtained, key secondary outcomes indicated an intervention effect. In retrospect, senior investigators involved in the study's design, conduct, and analysis discuss weaknesses and strengths and offer recommendations for future research efforts that address prevention of childhood obesity from a public health perspective.

Pedometer-assessed physical activity in children and young adults with CKD

BACKGROUND AND OBJECTIVES

Data on physical activity are limited in children with CKD. The objectives of this study were to measure the level and correlates of physical activity in children and young adults with CKD and to determine the association of physical activity with physical performance and physical functioning.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Physical activity was measured for 7 days using pedometers; physical performance was measured by the 6-minute walk distance (6MWD) and physical functioning with the PedsQL 4.0.

RESULTS

Study participants were 44 patients 7-20 years of age who had CKD stage 1-4 (n=12), had ESRD and were undergoing dialysis (n=7), or had undergone kidney transplantation (n=25). Participants were very sedentary; they walked 6218 (interquartile range, 3637, 9829) steps per day, considerably less than recommended. Physical activity did not differ among participants in the CKD stage 1-4, ESRD, and transplant groups. Females were less active than males (P<0.01), and physical activity was 44% lower among young adults (18-20 years) than younger participants (P<0.05). Physical activity was associated positively with maternal education and hemoglobin concentration and inversely with body mass index. Respective 6MWD in males and females was 2 and approximately 4 SDs below expected. Low levels of physical activity were associated with poor physical performance and physical functioning, after adjustment for age, sex, and body mass index.

CONCLUSIONS

In most participants with CKD, physical activity was considerably below recommended levels. Future studies are needed to determine whether increasing physical activity can improve physical performance and physical functioning.

Associations between screen time and physical activity among Spanish adolescents

BACKGROUND

Excessive time in front of a single or several screens could explain a displacement of physical activity. The present study aimed at determining whether screen-time is associated with a reduced level of moderate to vigorous physical activity (MVPA) in Spanish adolescents living in favorable environmental conditions.

METHODOLOGY/PRINCIPAL FINDINGS

A multi-stage stratified random sampling method was used to select 3503 adolescents (12-18 years old) from the school population of Gran Canaria, Spain. MVPA, screen-time in front of television, computer, video game console and portable console was assessed in the classroom by fulfilling a standardized questionnaire. Bivariate and multivariate logistic regression analyses adjusted by a set of social-environmental variables were carried out. Forty-six percent of girls (95% CI±2.3%) and 26% of boys (95% CI±2.1%) did not meet the MVPA recommendations for adolescents. Major gender differences were observed in the time devoted to vigorous PA, video games and the total time spent on screen-based activities. Boys who reported 4 hours•week(-1) or more to total screen-time showed a 64% (OR = 0.61, 95% CI, 0.44-0.86) increased risk of failing to achieve the recommended adolescent MVPA level. Participation in organized physical activities and sports competitions were more strongly associated with MVPA than screen-related behaviors.

CONCLUSIONS/SIGNIFICANCE

No single screen-related behavior explained the reduction of MVPA in adolescents. However, the total time accumulated through several screen-related behaviors was negatively associated with MVPA level in boys. This association could be due to lower availability of time for exercise as the time devoted to sedentary screen-time activities increases. Participation in organized physical activities seems to counteract the negative impact of excessive time in front of screens on physical activity.

Changes in K-12 physical education programs from 2001 to 2006

In this study, we investigated the changes in physical education programs from 2001 to 2006 based on an analysis of data reported in The Shape of the Nation Report: Status of Physical Education in the USA (National Association for Sport and Physical Education, 2006). Means and standard deviations for numeric variables in the reports were computed, and percentages were calculated for the categorical variables. The data indicated a significant increase from 2001 to 2006 in establishing state physical education standards. Mandated class size at all educational levels and required physical education units for high school graduation remained the same. The requirement for physical education assessment and mandated fitness testing did not increase significantly. Furthermore, there was no significant improvement in state regulations.

School opportunities and physical activity frequency in nine year old children

OBJECTIVE

To examine the association between physical activity (PA) opportunities at school and participation in PA outside of school physical education (PE) classes among 9 year old children.

METHODS

Data were obtained in a representative sample of 1 267 students nested within 69 schools who completed questionnaires; principals provided data on schools. Students' PA frequency was defined as all reported episodes of past week PA, excluding PE class. Schools were categorized as "high-opportunity" if they provided > or = 4 of the following opportunities: PE class > or = 2 times/week, extracurricular sports animator, gymnasium, swimming pool, schoolyard equipped for games, and > or = 1 outdoor sports playing fields. Multilevel modelling techniques were used to investigate the association between school-level PA opportunity and student-level PA frequency.

RESULTS

No main effect of school-level PA opportunities on PA frequency was observed. However, overweight boys attending high-opportunity schools were significantly more active than those attending low-opportunity schools.

CONCLUSIONS

The association between PA frequency and school-level PA opportunity differs by sex and weight status. Overweight boys in particular may benefit from health promotion strategies providing greater opportunities for school PA.

HEALTHY study rationale, design and methods: moderating risk of type 2 diabetes in multi-ethnic middle school students

The HEALTHY primary prevention trial was designed and implemented in response to the growing numbers of children and adolescents being diagnosed with type 2 diabetes. The objective was to moderate risk factors for type 2 diabetes. Modifiable risk factors measured were indicators of adiposity and glycemic dysregulation: body mass index > or =85th percentile, fasting glucose > or =5.55 mmol l(-1) (100 mg per 100 ml) and fasting insulin > or =180 pmol l(-1) (30 microU ml(-1)). A series of pilot studies established the feasibility of performing data collection procedures and tested the development of an intervention consisting of four integrated components: (1) changes in the quantity and nutritional quality of food and beverage offerings throughout the total school food environment; (2) physical education class lesson plans and accompanying equipment to increase both participation and number of minutes spent in moderate-to-vigorous physical activity; (3) brief classroom activities and family outreach vehicles to increase knowledge, enhance decision-making skills and support and reinforce youth in accomplishing goals; and (4) communications and social marketing strategies to enhance and promote changes through messages, images, events and activities. Expert study staff provided training, assistance, materials and guidance for school faculty and staff to implement the intervention components. A cohort of students were enrolled in sixth grade and followed to end of eighth grade. They attended a health screening data collection at baseline and end of study that involved measurement of height, weight, blood pressure, waist circumference and a fasting blood draw. Height and weight were also collected at the end of the seventh grade. The study was conducted in 42 middle schools, six at each of seven locations across the country, with 21 schools randomized to receive the intervention and 21 to act as controls (data collection activities only). Middle school was the unit of sample size and power computation, randomization, intervention and primary analysis.

Improving physical fitness of individuals with intellectual and developmental disability through a Virtual Reality Intervention Program

Individuals with intellectual and developmental disabilities (IDD) are in need of effective physical fitness training programs. The aim was to test the effectiveness of a Virtual Reality (VR)-based exercise program in improving the physical fitness of adults with IDD. A research group (N=30; mean age=52.3+/-5.8 years; moderate IDD level) was matched for age, IDD level and functional abilities with a control group (N=30, mean age=54.3+/-5.4 years). A 5-6 week fitness program consisting of two 30 min sessions per week included game-like exercises provided by the Sony PlayStation II EyeToy VR system. Changes in physical fitness were monitored by the Energy Expenditure Index (EEI), the modified 12 min walk/run and the Total Heart Beat Index (THBI). Significant (p<0.05) improvements in physical fitness were demonstrated for the research group in comparison to the control group for the Modified Cooper test and the THBI but not for the EEI test. The EEI, Modified Cooper and THBI tests were found feasible to evaluate physical fitness levels and change of individuals with IDD under clinical conditions. VR technology intervention was suitable for adults with IDD and resulted in significant improvements in the physical fitness levels of the participants.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18

BACKGROUND

The World Health Organization estimates that 1.9 million deaths worldwide are attributable to physical inactivity. Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease.

OBJECTIVES

The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents.

SEARCH STRATEGY

The search strategy included searching several databases. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.

SELECTION CRITERIA

To be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group.

DATA COLLECTION AND ANALYSIS

Standardized tools were used by two independent reviewers to rate each study's methodological quality and for data extraction. Where discrepancies existed discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated and outcomes measured.

MAIN RESULTS

13,841 titles were identified and screened and 482 articles were retrieved. Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies). Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak. In total 26 studies were included in the review. There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally school-based interventions had no effect on leisure time physical activity rates, systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects.

AUTHORS' CONCLUSIONS

Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time.

Factors related to leader implementation of a nationally disseminated community-based exercise program: a cross-sectional study

Background

The benefits of community-based health programs are widely recognized. However, research examining factors related to community leaders' characteristics and roles in implementation is limited.

Methods

The purpose of this cross-sectional study was to use a social ecological framework of variables to explore and describe the relationships between socioeconomic, personal/behavioral, programmatic, leadership, and community-level social and demographic characteristics as they relate to the implementation of an evidence-based strength training program by community leaders. Eight-hundred fifty-four trained program leaders in 43 states were invited to participate in either an online or mail survey. Corresponding community-level characteristics were also collected. Programmatic details were obtained from those who implemented. Four-hundred eighty-seven program leaders responded to the survey (response rate = 57%), 78% online and 22% by mail.

Results

Of the 487 respondents, 270 implemented the program (55%). One or more factors from each category – professional, socioeconomic, personal/behavioral, and leadership characteristics – were significantly different between implementers and non-implementers, determined by chi square or student's t-tests as appropriate. Implementers reported higher levels of strength training participation, current and lifetime physical activity, perceived support, and leadership competence (all p < 0.05). Logistic regression analysis revealed a positive association between implementation and fitness credentials/certification (p = 0.003), program-specific self-efficacy (p = 0.002), and support-focused leadership (p = 0.006), and a negative association between implementation and educational attainment (p = 0.002).

Conclusion

Among this sample of trained leaders, several factors within the professional, socioeconomic, personal/behavioral, and leadership categories were related to whether they implemented a community-based exercise program. It may benefit future community-based physical activity program disseminations to consider these factors when selecting and training leaders.

Physical environmental characteristics and individual interests as correlates of physical activity in Norwegian secondary schools: the health behaviour in school-aged children study

BACKGROUND

The school has been identified as a key arena for physical activity promotion for young people. Effective change of physical activity behaviour requires identification of consistent and modifiable correlates. The study explores students' interests in school physical activity and facilities in the school environment and examines their associations with students' participation in physical activity during recess and their cross-level interaction effect.

METHODS

This cross-sectional study was based on a national representative sample of Norwegian secondary schools and grade 8 students who participated in the Health Behaviour in School-aged Children (HBSC) 2005/06 study. The final sample comprised 68 schools and 1347 students. Physical environment characteristics were assessed through questionnaires completed by the principals, and students' physical activity and interests in physical activity were assessed through student self-completion questionnaires.

RESULTS

Most students were interested in more opportunities for physical activity in school. Multilevel logistic regression models demonstrated that students attending schools with many facilities had 4.49 times (95% Confidence Interval (CI) = 1.93-10.44) higher odds of being physically active compared to students in schools with fewer facilities when adjusting for socio-economic status, sex and interests in school physical activity. Also open fields (Odds Ratio (OR) = 4.31, 95% CI = 1.65-11.28), outdoor obstacle course (OR = 1.78, 95% CI = 1.32-2.40), playground equipment (OR = 1.73, 95% CI = 1.24-2.42) and room with cardio and weightlifting equipment (OR = 1.58, 95%CI = 1.18-2.10) were associated with increased participation in physical activity. Both students' overall interests and the physical facilitation of the school environment significantly contributed to the prediction of recess physical activity. The interaction term demonstrated that students' interests might moderate the effect of facilities on recess physical activity.

CONCLUSION

The findings support the use of an ecological approach and multilevel analyses in the investigation of correlates of physical activity that allows for a broader understanding of the influence of and interaction between factors at multiple levels on physical activity behaviour. In the promotion of physical activity in lower secondary schools, the study suggests that programmes should include a focus on environmental facilitation and incorporate strategies to increase students' interests for school physical activity.

Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls

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.

Serious psychological distress in U.S. adults with arthritis

BACKGROUND

Arthritis and mental health disorders are leading causes of disability commonly seen by health care providers. Several studies demonstrate a higher prevalence of anxiety and depression in persons with arthritis versus those without arthritis.

OBJECTIVES

Determine the national prevalence of serious psychological distress (SPD) and frequent anxiety or depression (FAD) in adults with arthritis, and in adults with arthritis, identify risk factors associated with SPD.

METHODS

Cross-sectional data from the 2002 National Health Interview Survey, an in-person household interview survey, were used to estimate the prevalence of SPD and FAD in adults with (n=6,829) and without (n=20,676) arthritis. In adults with arthritis, the association between SPD and sociodemographic, clinical, and functional factors was evaluated using multivariable logistic regression.

RESULTS

The prevalence of SPD and FAD in adults with arthritis is significantly higher than in adults without arthritis (5.6% vs 1.8% and 26.2% vs 10.7%, P<.001, respectively). In adults with arthritis, SPD was significantly associated with younger age, lower socioeconomic status, divorce/separation, recurrent pain, physical inactivity, having functional or social limitations, and having comorbid medical conditions. Adults aged 18 to 44 years were 6.5 times more likely to report SPD than those 65 years or older, and adults with recurrent pain were 3 times more likely to report SPD than those without recurrent pain.

CONCLUSIONS

Serious psychological distress and FAD affect persons with arthritis and should be addressed in their treatment. Younger adults with arthritis, and those with recurrent pain or either functional or social limitations, may be at higher risk for SPD.

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE

The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood.

METHOD

After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts.

RESULTS

As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity.

CONCLUSIONS

Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.

Impact of preschool environment upon children's physical activity and sun exposure

BACKGROUND

The physical qualities of outdoor environments are important to trigger healthy behavior in children. We studied the impact of outdoor environments upon spontaneous physical activity and exposure to ultraviolet (UV) radiation in 4- to 6-year-old children at 11 preschools in Stockholm county.

METHODS

In May-June 2004, pedometry and measurement of UV radiation were carried out on 197 children from 11 preschools in Stockholm county. Outdoor environments differed regarding vegetation, topography, space, and education. Ambient global UV radiation data were collected, free sky, and ground surface assessed. Arrival, in- and outdoor stay, and departure were recorded. For analysis, linear mixed model analysis was applied.

RESULTS

In environments with trees, shrubbery, and broken ground, the mean step count/min was 21.5, and mean exposure to UV radiation as fraction of available UV during play outdoors 14.6%. In delimited environments with little vegetation, the mean step count/min was 17.7 and mean exposure fraction to UV radiation 24.3% (P < 0.001, crude). Step/min range was 8.9-30.0 (girls) and 8.8-37.2 (boys), UV radiation exposure range 4-60% (no difference between genders).

CONCLUSION

Spacious preschool environments with trees, shrubbery, and broken ground trigger physical activity and yield sun protection in outdoor play. As many children attend preschool, access to such environments is recommended in community architecture.

Factors that influence physical activity participation among high- and low-SES youth

Researchers have rarely addressed the relationship between socioeconomic status (SES) and physical activity from the perspective of youth. To illuminate the factors that youth from low and high-SES areas consider important to increase physical activity participation among their peers, 160 youth (12-18 years) participated in small focus group interviews. Guiding questions centered on the general theme, "If you were the one in charge of increasing the physical activity levels of kids your age, what would you do?" Findings show that environmental factors (i.e., proximity, cost, facilities, and safety) are very important for youth living in low-SES areas to ensure participation in physical activity. Results also show that intrapersonal (i.e., perceived skill, competence, time) and social factors (i.e., friends, adult support) must be considered to help improve participation rates among both high- and low-SES youth.

Childhood obesity: a growing public health concern

Childhood obesity has been deemed epidemic, a term usually reserved for infectious diseases that sweep populations. This review begins with guidance regarding obesity definitions and a review of the data on global prevalence. The next section details the myriad health consequences for immediate and long-term physical and psychosocial health outcomes. The authors then discuss what is known regarding distal and proximal causes and correlates at the individual and contextual levels of family, health care, schools and community. The final sections provide a summary of interventions in diverse settings and some current thinking on how the field is likely to evolve over the next several years.

Prevention and control of coronary heart disease and stroke--nomenclature for prevention approaches in public health: a statement for public health practice from the Centers for Disease Control and Prevention

Successful prevention and control of coronary heart disease and stroke requires extensive collaboration and strategic partnerships with many health and non-health-related organizations and agencies in the voluntary, public, and private sectors. To assure a common language and purpose and to facilitate communication in these multiple settings, a simplified classification of prevention levels for public health practice is essential. This statement proposes three levels of prevention (health promotion, primary prevention, and secondary prevention) as a guide for public health practice. This statement is also intended to inform the design, implementation, and evaluation of programs and research initiatives that address the prevention and control of coronary heart disease and stroke, and to enhance communication and dialogue among health professionals, policymakers, and the public.

Childhood obesity in Taiwan: review of the Taiwanese literature

In a number of countries, including Taiwan, the prevalence of childhood obesity has been steadily increasing. A study to assess school nurses' perspective on their role in supporting children and preventing childhood obesity in Taiwan is currently being undertaken. A search of the literature reveals that most research publications come from the West and these studies have been useful. However, it is important to isolate the research and policy materials that take into account the contextually and culturally relevant factors in Taiwan and neighboring countries. Findings from a review of the Taiwanese literature are presented in this paper. The literature reveals the factors associated with the prevalence of childhood obesity and prevention strategies. A significant proportion of the research is medical and focuses on cardiovascular disease rather than health promotion and education. However, there are findings in this review that generally support health promotion activities and programs that are school based. There appears to be an urgent need for investment in research that assesses the long-term effectiveness of interventions designed to promote the maintenance of healthy weight during childhood in the Taiwanese society. Western literature is referred to occasionally in this paper in order to introduce an issue or to compare with a Taiwanese paper.

Design of the Trial of Activity in Adolescent Girls (TAAG)

The primary aim of the Trial of Activity in Adolescent Girls (TAAG) is to test an intervention to reduce by half the age-related decline in moderate to vigorous physical activity (MVPA) in middle school girls. The intervention will be evaluated using a group-randomized trial involving 36 middle schools. The primary endpoint is the mean difference in intensity-weighted minutes (i.e., MET-minutes) of MVPA between intervention and comparison schools assessed using accelerometry. The TAAG study design calls for two cross-sectional samples, one drawn from 6th graders at the beginning of the study and the second drawn from 8th graders at the end of the study following the 2-year implementation of the intervention. An important strength of this design over a cohort design is the consistency with the goals of TAAG, which focus on environmental-level rather than individual-level interventions to produce change. The study design specifies a recruitment rate of 80% and a smaller sample of girls at baseline (n=48 per school) than at follow-up (n=96 per school). A two-stage model will be used to test the primary hypothesis. In the first stage, MET-weighted minutes of MVPA will be regressed on school, time (baseline or follow-up), their interaction, ethnicity and week of data collection. The second stage analysis will be conducted on the 72 adjusted means from the first stage. In the main-effects model, we will regress the follow-up school mean MET-weighted minutes of MVPA on study condition, adjusting for the baseline school mean. The TAAG study addresses an important health behavior, and also advances the field of group-randomized trials through the use of a study design and analysis plan tailored to serve the main study hypothesis.

Factors associated with overweight and obesity among Kuwaiti kindergarten female teachers

Levels of overweight and obesity among Kuwaiti women are high, and the objective of this study was to explore factors that may be responsible. A sample of 461 Kuwaiti kindergarten female teachers was studied; weight and height were measured, and the classification of overweight or obese taken as having a Body Mass Index of 25-30 or >30, respectively. This revealed that 41.2 and 19.7% of the teachers were overweight or obese, respectively. Factors found to be significantly associated with overweight and obesity among the teachers included age, marital status, parents living at home, subjects' parental obesity, number of obese relatives, exercise, last dental check-up and dental status.

Physical activity among children attending preschools

OBJECTIVES

Obesity rates are increasing among children of all ages, and reduced physical activity is a likely contributor to this trend. Little is known about the physical activity behavior of preschool-aged children or about the influence of preschool attendance on physical activity. The purpose of this study was to describe the physical activity levels of children while they attend preschools, to identify the demographic factors that might be associated with physical activity among those children, and to determine the extent to which children's physical activity varies among preschools.

METHODS

A total of 281 children from 9 preschools wore an Actigraph (Fort Walton Beach, FL) accelerometer for an average of 4.4 hours per day for an average of 6.6 days. Each child's height and weight were measured, and parents of participating children provided demographic and education data.

RESULTS

The preschool that a child attended was a significant predictor of vigorous physical activity (VPA) and moderate-to-vigorous physical activity (MVPA). Boys participated in significantly more MVPA and VPA than did girls, and black children participated in more VPA than did white children. Age was not a significant predictor of MVPA or VPA.

CONCLUSIONS

Children's physical activity levels were highly variable among preschools, which suggests that preschool policies and practices have an important influence on the overall activity levels of the children the preschools serve.

Pediatric neurodevelopment and sports participation. When are children ready to play sports?

A fundamental knowledge of normal child and adolescent development is essential to providing a developmentally appropriate sports experience for the child, and to providing guidance to parents regarding their child's sport participation. This article reviews neurodevelopment, normal child and adolescent development relevant to sport participation, and developmental readiness to participate in sports. Neurodevelopmental maturation is a complex, continuous process. The sense of social comparison is not achieved until after 6 years of age, and the ability to understand the competitive nature of sports is generally not achieved until 9 years of age. By about 12 years of age, most children are mature enough to comprehend the complex tasks of sports and are physically and cognitively ready to participate in competitive sports with appropriate supervision.