Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Healthy caregivers-healthy children (HC2) phase 2: Integrating culturally sensitive childhood obesity prevention strategies into childcare center policies. Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. High prevalence of obesity in low income and multiethnic schoolchildren: a diet and physical activity assessment. Nutritional Intervention as a Preventive Approach for Cognitive-Related Outcomes in Cognitively Healthy Older Adults: A Systematic Review. Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review A parent focused child obesity prevention intervention improves some mother obesity risk behaviors: the Melbourne inFANT Program The Colorado LEAP study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program Long term health implications of fitness and physical activity patterns. The effect of family-based multidisciplinary cognitive behavioral treatment in children with obesity: study protocol for a randomized controlled trial Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals: a systematic review of randomised controlled trials The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Psychosocial correlates of physical activity in healthy children. Physical activity and body mass index of school children and adolescents in Abeokuta, Southwest Nigeria Health promotion intervention in low socioeconomic kindergarten children. Predictive ability of social cognitive theory in exercise research: an integrated literature review. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Enhancing early child care quality and learning for toddlers at risk: the responsive early childhood program. Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting Impact of aerobic exercise on neurobehavioral outcomes. VIP in construction: systematic development and evaluation of a multifaceted health programme aiming to improve physical activity levels and dietary patterns among construction workers The Infant Feeding Activity and Nutrition Trial (INFANT) an early intervention to prevent childhood obesity: Cluster-randomised controlled trial
Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : OBJECTIVE Despite the high prevalence of obesity among preschool-aged children , most states lack childcare center ( CCC ) nutrition and physical activity policies . The Healthy Caregivers , Healthy Children ( HC ) Phase 2 project is examining the relationship between the CCC nutrition and physical activity environment and child dietary intake/physical activity patterns and body mass index ( BMI ) . PARTICIPANTS A total of 24 " Quality Counts " ( Miami Dade County , Florida 's Quality Rating Improvement System [ QRIS ) ] ) CCCs serving low re source families with ≥50 2-to-5year olds attending have been r and omized to either intervention ( n=12 ) or control ( n=12 ) . INTERVENTION The HC2 intervention arm CCCs receive implementation of a daily curricula for ( 1 ) teachers/parents ; ( 2 ) children ; ( 3 ) snack , beverage , physical activity , and screen time policies ; and ( 4 ) technical assistance with menu modifications . Control arm schools receive an attention control safety curriculum . HC2 is delivered once a month in year 1 , quarterly in year 2 and will be disseminated throughout the Quality Counts network in year 3 . MAIN OUTCOME MEASURES Primary outcome measures include the Environment and Policy Assessment and Observation tool ( EPAO ) , st and ardized dietary intake and physical activity patterns surveys , and child BMI . The ' Reach , Effectiveness , Adoption , Implementation , and Maintenance ( RE- AIM ) ' framework will guide the interpretation of outcome measures . CONCLUSIONS CCCs are in need of evidence -based st and ardized nutrition and physical activity policies . The intersection of RE- AIM and early childhood obesity prevention in the childcare setting could generate robust and new information to the field about potential barriers , facilitators , adoption , and sustainability in this setting The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight The objective of the study was to assess the prevalence of obesity and /or undernutrition and evaluate diet and activity patterns among schoolchildren from an ethnically diverse low income urban population . A cross-sectional survey of 498 children aged 9 - 12 y from 24 schools in low income multiethnic neighborhoods in Montreal , Canada was undertaken . Height , weight , dietary intake , physical activity record , and lifestyle and demographic characteristics were measured . There was no evidence of undernutrition because linear growth was appropriate for age , but 39.4 % of children were overweight ( > 85th percentile NHANES II ) .  Dietary fat intake  was higher in children from single-parent families ( P < 0.001 ) and those with mothers born in Canada .  Intake of vitamins A , C , iron and folate was directly related to income sufficiency . Children who did more physical activity had significantly higher intakes of energy , calcium , iron , zinc and fiber but were not heavier . Dietary intake  was systematic ally underreported among overweight children , i.e. , their reported intakes did not meet calculated energy needs . This underreporting makes it difficult to attribute the accumulated energy imbalance to either energy intake or expenditure The link diet-cognitive function/dementia has been largely investigated in observational studies ; however , there was a lack of evidence from r and omized clinical trials ( RCTs ) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults . In the present article , we systematic ally review ed RCTs published in the last four years ( 2014 - 2017 ) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation ( i.e. , dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches ) as well as possible underlying mechanisms of nutritional prevention . From the 35 included RCTs , there was moderate evidence that intervention through dietary pattern changes , medical food/nutraceutical supplementation , and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers . There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect on cognitive function . For fatty acid supplementation , mainly long-chain polyunsaturated fatty acids , there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains , magnetic resonance imaging ( MRI ) findings , and /or cognitive-related biomarkers also in selected subgroups of older subjects , although some results were conflicting . There was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and /or MRI findings . Finally , there was only low evidence suggesting efficacy of intervention with homocysteine-related and antioxidant vitamins in improving cognitive functions , dementia incidence , or cognitive-related biomarkers in cognitively healthy older subjects Background Worldwide in 2000 , 10 % of children aged five to 17 years were reported as being overweight with an additional 2‐3 % being obese . Overweight and obesity in childhood can adversely impact on both physical and psychological health . The rise in the prevalence of childhood obesity is a complex issue but widely recognised contributors include increased energy intake , decreased levels of physical activity and greater time spent in sedentary pursuits . A large number of environmental and cultural factors have also been identified as contributing to the problem . Evidence to support an optimal approach to treating childhood obesity is limited with many studies showing only modest results at best in the long‐term . However , the importance of family‐based treatment that combines diet , physical activity and behavioral components has been acknowledged in a recent Cochrane Systematic Review . It has also been suggested that interventions offered in the community setting may help overcome barriers to participation , by making programs more accessible and allowing the targeting of specific sub‐groups of the population . Objectives The objective of this review was to identify the effectiveness of parent‐centred interventions implemented in the community setting in modifying eating and physical activity behaviors or weight‐related outcomes of children . Inclusion criteria Types of participants This review considered studies that included free‐living children of pre‐school , primary and secondary school age and /or their parents/guardians aged > 18 years . Types of intervention(s)/phenomena of interest Intervention programs were required to have a parental component , to target eating and /or exercise behaviors for the prevention or treatment of obesity , and child weight status reported . Types of studies All intervention studies were included in the review including : r and omized controlled trials ( RCTs ) ; non‐r and omized controlled trials , longitudinal studies , cohort ( both retrospective and prospect i ve ) , case control and time series studies which had been conducted in a community setting . Types of outcomes This review considered studies that included overweight/obesity related outcomes , eating behavior outcomes , physical activity behaviour outcomes , and sedentary behavior outcomes and constructs . Search strategy A literature search of community‐based parent‐centred intervention studies to promote nutrition and physical activity for the prevention and treatment and of childhood overweight and obesity was performed in eight electronic data bases dating from 1975 to April 2009 . Method ological quality Studies were critically appraised for method ological quality using st and ardized tools . Data collection Data was extracted by one review er using a st and ardized data extraction form developed by the research ers and checked for accuracy and consistency by a second review er . Data synthesis Data in relation to setting , methodology , intervention components and effect on weight , dietary intake and physical activity was extracted , and described in a narrative synthesis . Where possible a meta‐ analysis was undertaken . Results Of the home‐based interventions , five of nine studies reported statistically significant changes in anthropometric outcomes post intervention . Of the 10 studies in the before and after school care setting , seven reported a significant decrease in a weight‐related outcome post intervention , with only one reporting an increase . Conclusions Results from the review support the after‐school setting as the most promising for community intervention setting for targeting parents as agents of change within child obesity prevention and treatment programs . Implication s for practice At this stage , interventions to support parents should target the after‐school environment as opposed to being conducted in the home , summer camps , leisure centers or churches . Targeting a decrease in energy intake and sweetened beverages in parallel with increasing number of daily steps and decreasing screen time use . Implication s for research Future studies of high quality are needed across the full range of community setting s. Given that currently most of the higher quality RCTs and the studies showing positive impacts of weight change are in the after‐school setting , further studies in this area using similar method ologies to those already published will facilitate future meta‐analyses in this area Background The diets , physical activity and sedentary behavior levels of both children and adults in Australia are suboptimal . The family environment , as the first ecological niche of children , exerts an important influence on the onset of children ’s habits . Parent modeling is one part of this environment and a logical focus for child obesity prevention initiatives . The focus on parent ’s own behaviors provides a potential opportunity to decrease obesity risk behaviors in parents as well . Objective To assess the effect of a parent-focused  early childhood obesity prevention  intervention on  first-time mothers ’ diets , physical activity and TV viewing time .  Methods The Melbourne InFANT Program is a cluster-r and omized controlled trial which involved 542 mothers over their newborn ’s first 18 months of life . The intervention focused on parenting skills and strategies , including parental modeling , and aim ed to promote development of healthy child and parent behaviors from birth , including healthy diet , increased physical activity and reduced TV viewing time . Data regarding mothers ’ diet ( food frequency question naire ) , physical activity and TV viewing times ( self-reported question naire ) were collected using vali date d tools at both baseline and post-intervention . Four dietary patterns were derived at baseline using principal components analyses including frequencies of 55 food groups . Analysis of covariance was used to measure the impact of the intervention . Results The scores of both the " High-energy snack and processed foods " and the " High-fat foods " dietary patterns decreased more in the intervention group : -0.22 ( −0.42;-0.02 ) and −0.25 ( −0.50;-0.01 ) , respectively . No other significant intervention vs. control effects were observed regarding total physical activity , TV viewing time , and the two other dietary patterns , i.e. “ Fruits and vegetables ” and “ Cereals and sweet foods ” . Conclusions These findings suggest that supporting first-time mothers to promote healthy lifestyle behaviors in their infants impacts maternal dietary intakes positively . Further research needs to assess ways in which we might further enhance those lifestyle behaviors not impacted by the InFANT intervention Background The preschool years are a critical window for obesity prevention efforts ; representing a time when children establish healthy eating habits and physical activity patterns . Underst and ing the context in which these behaviors develop is critical to formulating a model to address childhood obesity . The Colorado LEAP Study , an intervention study design ed to prevent early childhood obesity , utilizes a social ecological approach to explore individual , family and environmental factors and their relationship to child weight status over a 3 year timeframe . Methods The study is located in 5 rural Colorado preschool centers and elementary schools ( 2 treatment and 3 control ) . Treatment sites receive The Food Friends ® nutrition ( 12 weeks ) and physical activity ( 18 weeks ) interventions during preschool . Observational measures assess 3 layers of the social ecological model including individual , family and organizational inputs . Children ’s food preferences , food intake , gross motor skills , physical activity ( pedometers/accelerometers ) , cognitive , physical and social self-competence and height/weight are collected . Parents provide information on feeding and activity practice s , child ’s diet , oral sensory characteristics , food neophobia , home food and activity environment , height/weight and physical activity ( pedometers ) . School personnel complete a school environment and policy assessment . Measurements are conducted with 3 cohorts at 4 time points – baseline , post-intervention , 1- and 2-year follow-up . Discussion The design of this study allows for longitudinal exploration of relationships among eating habits , physical activity patterns , and weight status within and across spheres of the social ecological model . These methods advance traditional study design s by allowing not only for interaction among spheres but predictively across time . Further , the recruitment strategy includes both boys and girls from ethnic minority population s in rural areas and will provide insights into obesity prevention effects on these at risk population s . Trial registration Clinical Trials.gov : NCT01937481 Northern Irel and has the highest incidence of coronary heart disease ( CHD ) in the world . The physical fitness , activity patterns , health knowledge , attitudes , and dietary habits of a r and om , stratified sample of 3211 Northern Irish children , comprising 1540 boys and 1671 girls , age range 11 - 18 years were examined . At all ages boys were significantly more active than girls . The most important finding was an appreciable decline in physical activity levels after the age of 14 years reaching extremely low levels in older girls . While 75 % of exercise taken was not related to school , physical education classes constituted the only exercise taken by one third of pupils . Girls had healthier nutritional habits and were more inclined to employ weight control measures than boys . There was a preponderance of children with a higher body mass index indicating a tendency to obesity in the child population . Over 20 % of school leavers of both sexes regularly smoked cigarettes and 20 % regularly drank alcohol . The postulated relationship between childhood inactivity , adult sedentary lifestyle , and increased risk of CHD raises serious cause for concern regarding the future cardiovascular health of many children Background The prevalence of childhood obesity has increased rapidly during the last three decades in the Netherl and s. It is assumed that mainly environmental factors have contributed to this trend . Parental overweight and low social economic status are risk factors for childhood obesity . Childhood obesity affects self-esteem and has negative consequences on cognitive and social development . Obese children tend to become obese adults , which increases the risk for developing cardiovascular complications , type 2 diabetes mellitus , and psychosocial problems . Additionally , the secretion of several gastrointestinal hormones , responsible for appetite and food intake , is impaired in obese subjects . Weight reduction through lifestyle changes in order to change health risks is , until now , suggested as the preferred treatment for childhood obesity . The objective of this study is the effect evaluation of a family-based cognitive behavioral multidisciplinary lifestyle treatment . The intervention aims to establish long-term weight reduction and stabilization , reduction of obesity-related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques . Study design / Methods In this r and omized clinical trial newly presented children with obesity ( 8 - 17 years old ) are divided , by r and omization , in an intervention and  control  group , both consisting of 40 obese children . The intervention is carried out in groups of 8 - 11 children , and consists of respectively 7 and 5 separate group meetings for the children and their parents and 1 joint group meeting of 2 ½ hours . Main topics are education on nutrition , self-control techniques , social skills , physical activity and improvement of self-esteem . The control group is given advice on physical activity and nutrition . For normal data comparison , data were collected of 40 normal-weight children , 8 - 17 years old . Discussion Because of the increasing prevalence of childhood obesity and the impact on the individual as well as on society , prevention and treatment of obesity in children is of great importance . For evaluation of short- and long-term effects of the treatment , measurements are taken before and after 3 months of treatment , and after 12 and 24 months follow-up . During these visits clinical and biochemical data are determined , cardiovascular fitness tests are performed and quality of life question naires are completed . Trial registration International St and ard R and omised Controlled Trial Number Register IS RCT Background The prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace . We conducted a systematic review to ( i ) examine the effectiveness of workplace-based diet and /or physical activity interventions aim ed at healthcare professionals and to ( ii ) identify and describe key components of effective interventions . Seven electronic data bases were systematic ally search ed . Results Thirteen r and omised controlled trials met the inclusion criteria , of which seven had data available for meta- analysis . Where meta- analysis was possible , studies were grouped according to length of follow-up ( < 12 months and ≥12 months ) and behavioural target ( diet only , physical activity only or diet and physical activity ) , with outcome data pooled using a weighted r and om effects model . Nine studies reported statistically significant ( between-group ) differences . Four studies reported being informed by a behaviour change theory . Meta- analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight ( −3.95 Kg , [ 95 % CI −4.96 to- 2.95 Kg ] ) than controls up to 12 months follow up . Conclusions Workplace diet and /or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous . To improve the evidence base , we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers BACKGROUND Underst and ing the determinants of physical activity in children is critical for the treatment and prevention of childhood obesity . Social-cognitive theory has been used to underst and behavioral patterns in children . OBJECTIVES To explore the relationship between health beliefs , self-efficacy , social support , and sedentary activities and physical  activity levels in children and to examine the relationship between physical activity and  children 's  self-esteem . METHODS Ninety-two children aged 10 to 16 years completed the study .  Physical activity was monitored for 1 week with a motion detector ( Actitrac ; IM Systems , Baltimore , Md ) . Moderate-level activity and high-level activity were defined based on the results of treadmill testing . Health beliefs , self-efficacy , social influences , and time spent in sedentary behaviors were determined through question naires . Self-esteem was measured using the Piers-Harris Children 's Self-Concept Scale . Chronic anxiety was measured with the Revised Children 's Manifest Anxiety Scale . RESULTS There was a significant decline in physical activity levels between ages 10 and 16 years , particularly in girls . Preteen girls spent approximately 35 % more time in low- and high-level activity than did teenage girls ( P<.001 ) . Overall , children spent 75.5 % of the day inactive , with a mean + /- SD of 5.2 + /- 1.8 hours watching television , sitting at the computer , and doing homework . In contrast , only 1.4 % of the day ( 12.6 + /- 12.2 minutes ) was spent in vigorous activity . Time spent in sedentary behaviors was inversely correlated with the amount of moderate-level activity ( P<.001 ) but not high-level activity . In contrast , time spent in high-level activity correlated with self-efficacy scores ( P<.001 ) and social influences scores ( P<.005 ) . High-level physical activity was also associated with improved self-esteem ( P<.05 ) . Higher health beliefs scores were not correlated with physical activity levels . CONCLUSIONS Children and adolescents are largely sedentary . Correlates of high- and low-level physical activity are different . Time spent on sedentary activities is inversely correlated with moderate-level activity , while self-efficacy and social influences are positively correlated with more intense physical activity . In addition , increased high-level physical activity is an important component in the development of self-esteem in children Background Physical inactivity and sedentary lifestyles are known to predispose to overweight and obesity . These lifestyles are also known to track from childhood into adulthood with consequent cardiovascular and metabolic problems . This study aim ed to describe the frequency of physical activity  and the relationship between physical activity and body mass index of urban Nigerian school children and adolescents . Methods Children from seven schools in Abeokuta , southwest Nigeria were selected using a multi-staged r and om sampling technique . Results Of 570 children , 411 ( 72.1 % ) were involved in moderate to vigorous physical activities . Involvement in physical activity was higher in older children ( P<0.001 ) , males ( P<0.001 ) , and children of mothers with a higher educational level ( P=0.03 ) . Eleven ( 1.9 % ) children were overweight or obese whereas 163 ( 28.6 % ) were underweight . There were more children with underweight than overweight among the subject population with a high level of physical activity ( 35.6 % vs. 4.4 % , P=0.499 ) . Conclusions A large proportion of the children in urban Nigeria participate in physical activity . The prevalence of overweight and obesity is low but undernutrition is a major nutritional problem among these children OBJECTIVE To prospect ively examine the effects of a r and omized school-based intervention on nutrition and physical activity knowledge and preferences , anthropometric measures , and fitness in low socioeconomic kindergarten children . STUDY DESIGN A total of 376 children completed a school-year combined dietary-behavioral-physical activity intervention  and were compared with 349 control subjects ( age 3.8 to 6.8 years ) . RESULTS The prevalence of overweight and obesity among the kindergarten children was 27.7 % . Even though the intervention was not associated with between group differences in body mass index changes , it was associated with significantly ( P < .05 ) greater increase in nutrition knowledge and preferences , physical activity knowledge and preferences , and improvement in fitness . There was a greater ( P < .05 ) decrease in the number of overweight children in the intervention group ( -31.9 % ) compared with the controls ( -17.5 % ) . CONCLUSIONS A kindergarten dietary-physical activity intervention applied by the kindergarten teachers , had no effect on body mass index changes between the groups , but improved nutrition and physical activity knowledge and preferences , improved fitness , and decreased the percent of overweight children . This intervention may play an important role in health promotion , prevention and treatment of childhood obesity The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood . Few theoretical models have used consistent explanatory variables that are theory-driven and many findings that use extant models are equivocal . Social Cognitive Theory ( SCT ) as presented by B and ura ( 1986 , 1997 ) appears to have strong promise as a guide to underst and ing physical activity behaviors and developing clinical ly relevant interventions to promote the initiation and maintenance of physical activity . This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance . Following review for quality and adequacy , published research during the years 1990 - 1998 contained 27 studies that examined the relationship between the construct of SCT , self-efficacy  , and physical activity .  All of the descriptive studies found a statistically significant relationship between self-efficacy and exercise behavior . Intervention studies demonstrated that participation in an exercise program promoted self-efficacy , and that programs design ed to increase outcome expectations and self-efficacy significantly increased exercise behavior . Due to the central ity of self-efficacy in many of the social psychological theories that help explain the attitude-intention-behavior triad , a strong need remains to design interventions to maximize its usefulness . Clear , generalizable , systematic and theoretically comprehensive , r and omized , controlled studies are needed to underst and the usefulness of the construct BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge Despite reports of positive effects of high- quality child care , few experimental studies have examined the process of improving low- quality center-based care for toddler-age children . In this article , we report intervention effects on child care teachers ' behaviors and children 's  social , emotional , behavioral , early literacy , language , and math outcomes as well as the  teacher-child relationship . The intervention targeted the use of a set of responsive teacher practice s , derived from attachment and sociocultural theories , and a comprehensive curriculum . Sixty-five childcare classrooms serving low-income 2- and 3-year-old children were r and omized into 3 conditions : business-as-usual control , Responsive Early Childhood Curriculum ( RECC ) , and RECC plus explicit social-emotional classroom activities ( RECC+ ) . Classroom observations showed greater gains for  RECC and RECC+ teachers ' responsive practice s including helping children manage their behavior , establishing a predictable schedule , and use of cognitively stimulating activities ( e.g. , shared book reading ) compared with controls ; however , teacher behaviors did not differ for focal areas such as sensitivity and positive discipline supports . Child assessment s demonstrated that children in the interventions outperformed controls in areas of social and emotional development , although children 's performance in control and intervention groups was similar for cognitive skills ( language , literacy , and math ) . Results support the positive impact of responsive teachers and environments providing appropriate support for toddlers ' social and emotional development . Possible explanations for the absence of systematic differences in children 's cognitive skills are considered , including implication s for practice and future research targeting low-income toddlers Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes Background Many unhealthy dietary and physical activity habits that foster the development of obesity are established by the age of five . Presently , approximately 70 percent of children in the United States are currently enrolled in early childcare facilities , making this an ideal setting to implement and evaluate childhood obesity prevention efforts . We describe here the methods for conducting an obesity prevention r and omized trial in the child care setting . Methods / design A r and omized , controlled obesity prevention trial is currently being conducted over a three year period ( 2010-present ) . The sample consists of 28 low-income , ethnically diverse child care centers with 1105 children ( sample is 60 % Hispanic , 15 % Haitian , 12 % Black , 2 % non-Hispanic White and 71 % of caregivers were born outside of the US ) . The purpose is to test the efficacy of a parent and teacher role-modeling intervention on children ’s nutrition and physical activity behaviors . . The Healthy Caregivers-Healthy Children ( HC2 ) intervention arm schools received a combination of ( 1 ) implementing a daily curricula for teachers/parents ( the nutritional gatekeepers ) ; ( 2 ) implementing a daily curricula for children ; ( 3 ) technical assistance with meal and snack menu modifications such as including more fresh and less canned produce ; and ( 4 ) creation of a center policy for dietary requirements for meals and snacks , physical activity and screen time . Control arm schools received an attention control safety curriculum . Major outcome measures include pre-post changes in child body mass index percentile and z score , fruit and vegetable and other nutritious food intake , amount of physical activity , and parental nutrition and physical activity knowledge , attitudes , and beliefs , defined by intentions and behaviors . All measures were administered at the beginning and end of the school year for year one and year two of the study for a total of 4 longitudinal time points for assessment . Discussion Although few attempts have been made to prevent obesity during the first years of life , this period may represent the best opportunity for obesity prevention . Findings from this investigation will inform both the fields of childhood obesity prevention and early childhood research about the effects of an obesity prevention program housed in the childcare setting .Trial registration Trial registration number : Numerous studies have examined the relationship between physical activity and cognitive function , demonstrating that greater physical activity is associated with lower incidence of cognitive impairment in later life . Due to an increasingly large number of older adults at risk for cognitive impairment , the relationship between physical activity and cognition has garnered increasing public health relevance and multiple r and omized trials have demonstrated that exercise interventions among sedentary adults improve cognitive performance in multiple domains of function . This article will examine the relationship between physical activity and cognitive function by review ing several different areas of literature , including the prevalence of cognitive impairment , assessment methods , observational studies examining physical activity and cognition , and intervention studies . The present review is intended to provide a historical tutorial of existing literature linking  physical activity , exercise , and cognitive function among both healthy and clinical population Background The prevalence of both overweight and musculoskeletal disorders ( MSD ) in the construction industry is high . Many interventions in the occupational setting aim at the prevention and reduction of these health problems , but it is still unclear how these programmes should be design ed . To determine the effectiveness of interventions on these health outcomes r and omised controlled trials ( RCTs ) are needed . The aim of this study is to systematic ally develop a tailored intervention for prevention and reduction of overweight and MSD among construction workers and to describe the evaluation study regarding its (cost-)effectiveness . Methods / Design The Intervention Mapping ( IM ) protocol was applied to develop and implement a tailored programme aim ed at the prevention and reduction of overweight and MSD . The ( cost- ) effectiveness of the intervention programme will be evaluated using an RCT . Furthermore , a process evaluation will be conducted . The research population will consist of blue collar workers of a large construction company in the Netherl and s . InterventionThe intervention programme will be aim ed at improving ( vigorous ) physical activity levels and healthy dietary behaviour and will consist of tailored information , face-to-face and telephone counselling , training instruction ( a fitness " card " to be used for exercises ) , and material s design ed for the intervention ( overview of the company health promoting facilities , waist circumference measuring tape , pedometer , BMI card , calorie guide , recipes , and knowledge test).Main study parameters/endpointsThe intervention effect on body weight and waist circumference ( primary outcome measures ) , as well as on lifestyle behaviour , MSD , fitness , CVD risk indicators , and work-related outcomes ( i.e. productivity , sick leave ) ( secondary outcome measures ) will be assessed . Discussion The development of the VIP in construction intervention led to a health programme tailored to the needs of construction workers . This programme , if proven effective , can be directly implemented . Trial registration Netherl and s Trial Register ( NTR ) : Background Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours ( poor diet , low physical activity and high sedentary behaviour ) from their inception . These factors include the rapidly increasing prevalence of fatness throughout childhood , the instigation of obesity-promoting behaviours in infancy , and the tracking of these behaviours from childhood through to adolescence and adulthood . The Infant Feeding Activity and Nutrition Trial ( INFANT ) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents . The intervention , conducted with parents over the infant 's first 18 months of life , will use existing social networks ( first-time parent 's groups ) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours , and reduced sedentary behaviours in infancy . Methods / Design This cluster-r and omised controlled trial , with first-time parent groups as the unit of r and omisation , will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents ' group at Maternal and Child Health Centres . Using a two-stage sampling process , local government areas in Victoria , Australia will be r and omly selected at the first stage . At the second stage , a proportional sample of first-time parent groups within selected local government areas will be r and omly selected and invited to participate . Informed consent will be obtained and groups will then be r and omly allocated to the intervention or control group . Discussion The early years hold promise as a time in which obesity prevention may be most effective . To our knowledge this will be the first r and omised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating , physical activity and reduced sedentary behaviours . If proven to be effective , INFANT may protect children from the development of obesity and its associated social and economic costs . Trial registration Current Controlled Trials IS RCT
A healthier dietary pattern was associated with better cognitive outcomes in all studies , although some of the reported associations were weak and the measures used varied across the studies .
Conclusions Physical activity and healthy diets in early childhood are associated with better cognitive outcomes  in young children .
Objective Given the high prevalence of suboptimal nutrition and low activity levels in children , we systematic ally review ed the literature on the relationship between physical activity and dietary patterns and cognitive development in early childhood ( six months to five years ) .