Determinants of sufficient daily activity in Australian primary school children. Impact of prolonged sitting on vascular function in young girls. Compliance with the Australian national physical activity guidelines for children: relationship to overweight status. To remove or to replace traditional electronic games? A crossover randomised controlled trial on the impact of removing or replacing home access to electronic games on physical activity and sedentary behaviour in children aged 10–12 years Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol The effect of a healthy lifestyle programme on 8–9 year olds from social disadvantage ICAPS: a multilevel program to improve physical activity in adolescents. The Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial: study protocol for a randomized controlled trial Effect of a school-based active play intervention on sedentary time and physical activity in preschool children. The effect of the UP4FUN pilot intervention on objectively measured sedentary time and physical activity in 10–12 year old children in Belgium: the ENERGY-project The Malaysian Childhood Obesity Treatment Trial (MASCOT). Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol Screen-Time Weight-loss Intervention Targeting Children at Home (SWITCH): a randomized controlled trial A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes) An active video game intervention does not improve physical activity and sedentary time of children at-risk for developmental coordination disorder: a crossover randomized trial. Effects of a multi-pronged intervention on children's activity levels at recess: the Aventuras para Niños study. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents Organizing “Play Streets” during school vacations can increase physical activity and decrease sedentary time in children Promoting physical activity at the pre-school playground: the effects of providing markings and play equipment. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity
AIMS Australian guidelines recommend that children participate in at least one hour of physical activity every day . We aim ed to measure physical activity  participation in a r and om sample of Australian primary school children and to determine the biological , behavioural , environmental and social influences associated with insufficient daily activity . METHOD We analysed the following cross-section data from a r and omly selected sample of children ( N=518 ) aged 5 to 12 years : age , gender , socioeconmic status ( SES ) indicators , family size , home play equipment availability , transport method to school , and estimated time per week in physical and sedentary activity . Logistic regression analysis was performed to determine variables that were associated with insufficient ( < 60 minutes ) daily activity . RESULTS Seventy-six children ( 15 % of the cohort ) failed to meet the minimum activity recommendations of 60 minutes of daily activity . These children were significantly less likely to walk or cycle to school ( adjusted odds ratio ( OR ) 0.43 ; 95 % CI=0.24 - 0.77 ) or participate in organised sports or activity ( OR 0.42 ; 95 % CI=0.28 - 0.64 ) and were more likely to spend in excess of 2 hours a day watching television of using a computer for entertainment ( OR 2.10 ( 1.16 - 3.78 ) . Age , gender , SES and family size were not significantly associated with insufficient activity . CONCLUSION There exists a significant proportion of the paediatric population who are insufficiently active . Interventions to encourage increased activity  in this sub-group may be successful if they seek to alter sedentary behaviour ( namely television use ) and method of transportation to and from school NEW FINDINGS What is the central question of this study ? Children are spending more than 60 % of their waking day sedentary . The consequences of excessive sedentary behaviour are not well understood in the child , but there is growing evidence that with increasing sedentary time , cardiovascular risk in childhood also increases . What is the main finding and its importance ? Our findings show that a 3 h period of uninterrupted sitting causes a profound ( 33 % ) reduction in vascular function in young girls . Importantly , we also demonstrate that breaking up sitting with regular exercise breaks can prevent this . Excessive sedentary behaviour has serious clinical and public health implication s ; however , the physiological changes that accompany prolonged sitting in the child are not completely understood . Herein , we examined the acute effect a prolonged period of sitting has upon superficial femoral artery function in 7- to 10-year-old girls and the impact of interrupting prolonged sitting with exercise breaks . Superficial femoral artery endothelium-dependent flow-mediated dilatation , total shear rate , antero grade and retro grade shear rates and oscillatory shear index were assessed before and after two experimental conditions : a 3 h uninterrupted period of sitting ( SIT ) and a 3 h period of sitting interrupted each hour with 10 min of moderate-intensity exercise ( EX ) . A mixed-model analysis of variance was used to compare between-condition and within-condition main effects , controlling for the within-subject nature of the experiment by including r and om effects for participant . Superficial femoral artery endothelium-dependent flow-mediated dilatation decreased significantly from pre- to post-SIT ( mean difference 2.2 % flow-mediated dilatation ; 95 % confidence interval = 0.60 - 2.94 % , P < 0.001 ) . This relative decline of 33 % was abolished in the EX intervention . Shear rates were not significantly different within conditions . Our data demonstrate the effectiveness of short but regular exercise breaks in off setting the detrimental effects of uninterrupted sitting in young girls Childhood obesity incidence has increased substantially and it has been argued that decreasing physical activity levels , coinciding with an increase in sedentary behaviours , are responsible . Australian guidelines were published in 2004 , recommending that children participate in a minimum of 60 min of physical activity daily and spend no more than 2h a day using electronic media for entertainment . We aim ed to compare compliance with these guidelines amongst children of differing weight status . The Childhood Injury Prevention Study ( CHIPS ) collected data from a r and omly selected sample of Brisbane primary and preschool children aged 5 - 12 years . The following data were available for 518 participants : age , gender , measured height and weight and estimated time per week from a parent-completed 7 days diary in physical activity out of school and sedentary leisure activities including television viewing and computer use . Using age st and ardised body mass index estimates , approximately 20 % of the cohort were overweight . Non-compliance with guidelines was 14.7 % for out of school physical activity participation , and 30.9 % for excess electronic media entertainment use . There was a 63 % increase in the odds of overweight status amongst children who were non-compliant with the electronic entertainment recommendations than those who were compliant ( adjusted odds ratio=1.63 ; 95 % CI=1.05 - 2.54 ) . Female gender and school level socioeconomic category were also independently associated with overweight status . Non-compliance with the minimal physical activity guideline increased the odds of being overweight by 28 % , however this difference was not statistically significant . One in seven children from the Greater Brisbane area are at risk for being insufficiently active whilst a third overuse electronic media . Given that overuse of electronic entertainment was positively associated with childhood obesity , these children should be the target of public health campaigns to promote alternative leisure time activities Objective To evaluate the impact of ( 1 ) the removal of home access to traditional electronic games or ( 2 ) their replacement with active input electronic games , on daily physical activity and sedentary behaviour in children aged 10–12 years . Design Crossover r and omised controlled trial , over 6 months . Setting Family homes in metropolitan Perth , Australia from 2007 to 2010 . Participants 10-year-old to 12-year-old children were recruited through school and community media . From 210 children who were eligible , 74 met inclusion criteria , 8 withdrew and 10 had insufficient primary outcome measures , leaving 56 children ( 29 female ) for analysis . Intervention A counterbalanced r and omised order of three conditions sustained for 8 weeks each : no home access to electronic games , home access to traditional electronic games and home access to active input electronic games . Main outcome measures Primary outcome was accelerometer assessed moderate/vigorous physical activity ( MVPA ) . Secondary outcomes included sedentary time and diary assessed physical activity and sedentary behaviours . Results Daily MVPA across the whole week was not significantly different between conditions . However , compared with home access to traditional electronic games , removal of all electronic games result ed in a significant increase in MVPA ( mean 3.8 min/day , 95 % CI 1.5 to 6.1 ) and a decrease in sedentary time ( 4.7 min/day , 0.0 to 9.5 ) in the after-school period . Similarly , replacing traditional games with active input games result ed in a significant increase in MVPA ( 3.2 min/day , 0.9 to 5.5 ) and a decrease in sedentary time ( 6.2 min/day , 1.4 to 11.4 ) in the after-school period . Diary reports supported an increase in physical activity and a decrease in screen-based sedentary behaviours with both interventions . Conclusions Removal of sedentary electronic games from the child 's home and replacing these with active electronic games both result ed in small , objective ly measured improvements in after-school activity and sedentary time . Parents can be advised that replacing sedentary electronic games with active electronic games is likely to have the same effect as removing all electronic games . Trial Registration Australia and New Zeal and Clinical Trials Registry ( ACTRN 12609000279224 Adults are sedentary for an alarming 9 to 10 hours per day ( 1 ) . Accordingly , the popular press has coined the phrase sitting is the new smoking to describe a current epidemic of developed nations ( 24 ) . Evidence indicates that sedentary time is associated with incident cardiovascular disease , incidence of cardiovascular diseaserelated risk factors , and mortality ( 5 , 6 ) . Of note , the risk conferred by prolonged sedentariness is eliminated only by high levels of moderate- to vigorous-intensity physical activity ( MVPA ) ( about 60 to 75 min/d ) , which exceed physical activity recommendations ( 7 , 8) . As such , sedentary behavior is now believed to represent a clinical ly important aspect of a person 's physical activity profile and is no longer considered simply the extreme low end of the physical activity continuum ( 5 ) . Studies linking sedentary behavior to health outcomes have relied almost exclusively on self-reported  sedentary time  , which is subject to reporting bias and measurement error ( 9 ) . A 2015 systematic review ( 5 ) identified only 1 study ( NHANES [ National Health and Nutrition Examination Survey ] ) that examined the association between objective ly measured sedentary time and health outcomes , a study limited by a small event rate ( 10 ) . New studies using NHANES data have since been published , with longer follow-up and higher event rates ( 1115 ) . However , some of these studies have reported an association between objective ly measured sedentary time and mortality ( 11 , 14 , 15 ) , but others have not ( 12 , 13 ) . Additional cohort studies are thus needed to rectify evidence gaps . Furthermore , studies using accelerometers to objective ly measure sedentary behavior conventionally operationalize sedentary time as the total number of sedentary minutes per day . This approach ignores patterns of accumulated sedentary behavior over time . For example , accumulation of sedentary time in a few long bouts or many short bouts represents 2 distinct patterns of sedentary time accrual . Experimental studies have shown that acute periods of prolonged , uninterrupted sedentary behavior cause greater detrimental cardiometabolic effects than sedentary behavior that is periodically interrupted ( 1618 ) , suggestive that it is not just total sedentary time that is relevant to health outcomes , but also the manner in which it is accumulated . Few longitudinal studies , however , have explored the association between prolonged , uninterrupted sedentary behavior and mortality to corroborate these findings . To inform guidelines on reducing sedentary behavior ( target reductions in overall sedentary time or target interruption of prolonged sedentary bouts ) , evidence from prospect i ve studies is needed to 1 ) confirm the association between total sedentary time and mortality using objective measures , 2 ) determine whether prolonged sedentary bouts confer risk for death , and 3 ) eluci date whether the total volume of sedentary time and its pattern of accumulation individually or jointly contribute to risk for death . The purpose of this study , therefore , was to examine the association between objective ly measured sedentary time ( both total volume and accrual in prolonged bouts ) and all-cause mortality in a national cohort of U.S. middle-aged and older adults enrolled in the REGARDS ( Reasons for Geographic and Racial Differences in Stroke ) study . Methods Study Population REGARDS is a population -based study design ed to examine racial and regional disparities in stroke . It comprises 30239 white and black adults aged 45 years or older enrolled between 2003 and 2007 from across the contiguous United States ( 19 , 20 ) . Detailed design and methods for REGARDS are described elsewhere ( 21 ) . Briefly , demographic and cardiovascular risk factor data were collected by telephone interview and an in-home physical assessment on enrollment . A detailed summary of baseline measures is provided in the Supplement . Participants ( or their proxies ) were then followed for 6-month intervals to ascertain vital status . Objective measurements of sedentary behavior were collected from active REGARDS participants from 2009 to 2013 ( mean time from study enrollment , 5.7 years [ SD , 1.5 ] ; range , 1.9 to 9.5 years ) ( 22 ) . A total of 7985 participants adhered to accelerometer wear requirements ( 4 days with accelerometer wear 10 hours ) , provided follow-up data , and were available for the current analyses ( Supplement Figure 1 ) . Supplement Table 1 shows the characteristics of included versus excluded REGARDS participants . The REGARDS study protocol was approved by the institutional review boards of participating institutions . All participants provided informed consent . Supplement . Supplementary Material Accelerometer Data Collection Methods for accelerometer data collection are described elsewhere ( 22 ) . Briefly , participants were fitted with an Actical ( Philips Respironics ) accelerometer secured to their right hip using a nylon belt and were instructed to wear the device during waking hours for 7 consecutive days . The Actical had been vali date d formeasurement of physical activity and sedentary behavior and was shown to have acceptable reliability ( 2325 ) . Activity counts were summed over 1-minute epochs . Nonwear periods were defined as at least 150 consecutive minutes of 0 activity counts . This nonwear algorithm was previously vali date d against daily log sheets in REGARDS participants ( 26 ) . Measurements of 0 to 49 , 50 to 1064 , and at least 1065 counts per minute were defined as sedentary behavior , light-intensity physical activity , and MVPA , respectively , as determined in a laboratory-based calibration study ( 27 ) . A sedentary bout was defined as consecutive minutes in which the accelerometer registered fewer than 50 counts per minute . A sedentary break was defined as at least 1 minute in which 50 or more counts per minute were registered after a sedentary bout . Both sedentary bouts and breaks were exclusively continuous periods , with no interruptions or nonwear intervals allowed in the definition . Outcome Ascertainment All-cause mortality was the primary outcome , defined as any death after completion of the accelerometer protocol regardless of cause . Date s of death were confirmed through review of death certificates , medical records , and administrative data bases . Deaths through 4 September 2015 were included in the current analysis . Statistical Analysis Sedentary and physical activity variables were averaged across compliant days ( 10 hours of wear ) . Because of a high correlation between total sedentary time and wear time ( Supplement Figure 2 ) , we corrected for the influence of wear time by st and ardizing total sedentary time to 16 hours of wear time per day using the residuals obtained when regressing total sedentary time on wear time ( see Methods section of the Supplement ) ( 2830 ) . Participants were stratified into quartiles according to total sedentary time and , separately , mean sedentary bout duration ( a measure of overall prolonged , uninterrupted sedentary behavior ) . Cox proportional hazards regression modeling was used to calculate the hazard ratio ( HR ) for all-cause mortality associated with quartiles of total sedentary time ( and separately , mean sedentary bout length ) . Crude HRs were initially calculated . Subsequent HRs were calculated after adjustment for age , race , sex , region of residence , education , and season the accelerometer was worn ( model 1 ) , with further adjustment for current smoking , alcohol use , body mass index ( BMI ) , diabetes , hypertension , dyslipidemia , estimated glomerular filtration rate less than 60 mL/min/1.73 m2 , atrial fibrillation , history of coronary heart disease , and history of stroke ( model 2 ) . Models were additionally adjusted for MVPA expressed continuously ( model 3 ) . Tests for linear trend across quartiles were conducted by including the quartile for each participant as an ordinal variable in regression models . Proportional hazards assumptions were confirmed with a Kolmogorov-type supremum test ( 31 ) . The above analyses were then repeated in a fully adjusted model , testing interactions for age ( < 65 and 65 years ) , sex ( male and female ) , race ( black and white ) , BMI category ( normal weight and overweight or obese ) , and MVPA category ( < 150 min/wk and 150 min/wk ) . As a secondary analysis , we examined the continuous doseresponse relationship between each sedentary characteristic and all-cause mortality in a fully adjusted model ( model 3 ) using restricted cubic splines ( 32 ) . Cubic polynomials were fitted with the mean of each sedentary characteristic set as the reference and knots placed at the 5th , 35th , 65th , and 95th percentiles ( 33 ) . Nonlinear associations were evaluated using the likelihood ratio test . For nonlinear associations , spline models were used to describe the associations and when the association was determined to be linear , a linear model was used . Because of multicollinearity between total sedentary time and mean sedentary bout duration ( r= 0.61 ) , both variables were not included in the same model . Alternatively , to examine the individual and joint associations of total sedentary time and prolonged , uninterrupted sedentary behavior with mortality , participants were classified into 4 categories : low total sedentary time ( < 750 min/d ) and low prolonged sedentary bout time ( < 10 min/bout ) , low total sedentary time  and high prolonged sedentary bout time  ( 10 min/bout ) , high total sedentary time  ( 750 min/d ) and low prolonged sedentary bout time , and high total sedentary time and high prolonged sedentary bout time . Hazard ratios for all-cause mortality were calculated for each joint category in comparison with the lowlow group in a fully adjusted model ( model 3 ) . Thresholds for total sedentary time ( 750 min/d ) and mean sedentary bout duration ( 10 min/bout ) were selected on the basis of the restricted cubic splines and were confirmed using a method described by Contal and O'Quigley ( see Methods section of the Supplement ) ( 34 ) . To allow for the possibility that sedentary bouts Objective To investigate the effectiveness of a school based intervention to increase physical activity , reduce sedentary behaviour , and increase fruit and vegetable consumption in children . Design Cluster r and omised controlled trial . Setting 60 primary schools in the south west of Engl and . Participants Primary school children who were in school year 4 ( age 8 - 9 years ) at recruitment and baseline assessment , in year 5 during the intervention , and at the end of year 5 ( age 9 - 10 ) at follow-up assessment . Intervention The Active for Life Year 5 ( AFLY5 ) intervention consisted of teacher training , provision of lesson and child-parent interactive homework plans , all material s required for lessons and homework , and written material s for school newsletters and parents . The intervention was delivered when children were in school year 5 ( age 9 - 10 years ) . Schools allocated to control received st and ard teaching . Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day , accelerometer assessed minutes of sedentary behaviour per day , and reported daily consumption of servings of fruit and vegetables . Results 60 schools with more than 2221 children were recruited ; valid data were available for fruit and vegetable consumption for 2121 children , for accelerometer assessed physical activity and sedentary behaviour for 1252 children , and for secondary outcomes for between 1825 and 2212 children for the main analyses . None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group . The difference in means comparing the intervention group with the control group was –1.35 ( 95 % confidence interval –5.29 to 2.59 ) minutes per day for moderate to vigorous physical activity , –0.11 ( –9.71 to 9.49 ) minutes per day for sedentary behaviour , and 0.08 ( –0.12 to 0.28 ) servings per day for fruit and vegetable consumption . The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account : self reported time spent in screen viewing at the weekend ( –21 ( –37 to –4 ) minutes per day ) , self reported servings of snacks per day ( –0.22 ( –0.38 to –0.05 ) ) , and servings of high energy drinks per day ( –0.26 ( –0.43 to –0.10 ) ) were all reduced . Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results . Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity , decreasing sedentary behaviour , and increasing fruit and vegetable consumption in primary school children . Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level , as well as at the school environment level . These findings have relevance for research ers , policy makers , public health practitioners , and doctors who are involved in health promotion , policy making , and commissioning services . Trial registration Current Controlled Trials IS RCT N50133740 INTRODUCTION Replacing sedentary behaviour with light intensity physical activity ( ie , activities classified as less than three metabolic equivalents , such as slow-paced walking ) may be a more realistic strategy for reducing cardiometabolic risk in people with chronic obstructive pulmonary disease than only aim ing to increase levels of moderate-vigorous intensity physical activity . Behaviour change interventions to reduce sedentary behaviour in people with chronic obstructive pulmonary disease have not yet been developed or tested . RESEARCH QUESTIONS Is a 6-week behaviour change intervention effective and feasible in reducing sedentary time in people with chronic obstructive pulmonary disease ? DESIGN This study will be a multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis , comparing a 6-week behaviour change intervention aim ed at reducing sedentary time with a sham intervention in people with chronic obstructive pulmonary disease . PARTICIPANTS AND SETTING Seventy participants will be recruited from the waiting lists for pulmonary rehabilitation programs at Royal Prince Alfred Hospital and Prince of Wales Hospital , Sydney , Australia . INTERVENTION The behaviour change intervention aims to reduce sedentary time through a process of guided goal setting with participants to achieve two target behaviours : ( 1 ) replace sitting and lying down with light-intensity physical activity where possible , and ( 2 ) st and up and move for 2minutes after 30minutes of continuous sedentary time . Three face-to-face sessions and three phone sessions will be held with a physiotherapist over the 6-week intervention period . The ' capability ' , ' opportunity ' , ' motivation ' and ' behaviour ' ( COM-B ) model will be applied to each participant to determine which components of behaviour ( capability , opportunity or motivation ) need to change in order to reduce sedentary time . Based on this ' behavioural diagnosis ' , the Behaviour Change Wheel will be used to systematic ally select appropriate behaviour change techniques to assist participants in achieving their weekly goals . Behaviour change techniques will include providing information about the health consequences of sedentary behaviour , self-monitoring and review of weekly goals , problem-solving of barriers to achieving weekly goals , and providing feedback on sedentary time using the Jawbone UP3 activity monitor . CONTROL The sham intervention will consist of weekly phone calls for 6 weeks , to enquire whether the participants ' health status has changed over the intervention period ( eg , hospitalised for an acute exacerbation ) . No instructions regarding physical activity or exercise will be given . MEASUREMENTS Outcomes will be assessed at baseline , at the end of the 6-week intervention period , and at the 3-month follow-up . Primary outcome measures will be : ( 1 ) total sedentary time , including the pattern of accumulation of sedentary time , assessed by the activPAL3 activity monitor , and ( 2 ) feasibility of the intervention assessed by uptake and retention of participants , participant compliance , self-reported achievement of weekly goals , and adverse events . Secondary outcome measures will include functional exercise capacity , health-related quality of life , domain-specific and behaviour-specific sedentary time , patient activation , and anxiety and depression .  Semi-structured interviews will be conducted with participants who receive the behaviour change intervention to explore acceptability and satisfaction with the different components of the intervention . ANALYSIS Analysis of covariance ( ANCOVA ) will be used to calculate between-group comparisons of total sedentary time and the number of bouts of sedentary time>30minutes after adjusting baseline values . Uncertainty about the size of the mean between-group differences will be quantified with 95 % CI . Within-group comparisons will be examined using paired t-tests and described as mean differences with 95 % CIs . Secondary outcome measures will be analysed similarly . The feasibility measures will be analysed descriptively . Semi-structured interviews will be conducted until data saturation is achieved and there are no new emerging themes . De-identified interview transcripts will be coded independently by two research ers and analysed alongside data collection using the COM-B model as a thematic framework . DISCUSSION / SIGNIFICANCE If behaviour change interventions are found to be an effective and feasible method for reducing sedentary time , such interventions may be used to reduce cardiometabolic risk in people with chronic obstructive pulmonary disease . An approach that emphasises participation in light-intensity physical activity may increase the confidence and willingness of people with chronic obstructive pulmonary disease to engage in more intense physical activity , and may serve as an intermediate goal to increase uptake of pulmonary rehabilitation Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Aims This study assessed the efficacy of a school-based healthy lifestyle intervention ( Sport for LIFE ) for increasing physical activity , decreasing sedentary behaviour , reducing screen time behaviour , encouraging healthy attitudes and behaviour to nutrition , and reducing body mass index ( BMI ) in 8–9-year-old primary school children from lower socioeconomic background s in Northern Irel and . Methods A non-r and omised controlled trial of 416 children from 24 schools took part . Schools were r and omly assigned to one of two groups , an intervention or control group with 12 schools in each group . The intervention group received a 12-week school-based programme based on social cognitive theory . At baseline and follow-up , groups completed question naires assessing physical activity , screen time behaviour and dietary patterns . On each occasion anthropometric assessment  s of height and weight were taken . Physical activity and sedentary behaviour were measured by accelerometry . Results Significant effects were observed for vigorous , moderate and light activity for the intervention group at follow-up . Sedentary behaviour was significantly reduced for the intervention group but not for the control group . No significant effects of the intervention on BMI , screen time behaviour or attitudes to nutrition , with the exception of non-core foods , were shown . Conclusions The programme was effective in increasing physical activity and reducing sedentary behaviour , however no significant changes in screen time behaviour and attitude to nutrition , with the exception of non-core foods , were observed . Future research ideas are offered for tackling low levels of physical activity in children OBJECTIVES ICAPS ( Intervention Centred on Adolescents ' Physical activity and Sedentary behaviour ) is aim ed at preventing excessive weight gain and cardiovascular risk in adolescents by promoting physical activity ( PA ) with an emphasis on recreational and daily-life PA , with a lifelong perspective . DESIGN R and omized study design ed to last for four years . Study cohort constituted of 954 first-level students ( 91 % of eligible pupils ) , aged 11.7 + /- 0.6 y ( mean + /- SD ) from four pairs of schools r and omly selected in eastern France , after sociogeographical stratification . In each pair , intervention status was r and omised at school-level . The program , not limited to school setting s , involves multiple partners with three objectives : 1 ) changing attitudes through debates and access to attractive activities during breaks and after-school hours , 2 ) encouraging social support , 3 ) providing environmental conditions that enable PA . Adapted times and places , open participation , emphasis on fun , meeting with others and absence of competitive aspects are used to reduce usual barriers to PA .  Accessibility and safety are permanent concerns . RESULTS Prevalence of overweight was 23.7 % . High participation rates were attained ( 50 % participated in at least one weekly activity ) . At six-month , the proportion of intervention adolescents  not performing supervised PA out of academic PA  was reduced by half ( 36 % to 17 % vs 42 % to 42 % in controls P < 10 - 4 ) ; the proportion of those spending > 3 h/day in sedentary occupations decreased ( 34 % to 28 % vs 27 % to 36 % ; P < 10 - 4 ) . CONCLUSION These data demonstrate the feasibility of implementing a multilevel PA intervention program in adolescents . Six-month results document increased PA  and decreased sedentary behaviour Background Low levels of physical activity , high levels of sedentary behaviour and low levels of fruit and vegetable consumption are common in children and are associated with adverse health outcomes . The aim of this paper is to describe the protocol for a cluster r and omised controlled trial ( RCT ) design ed to evaluate a school-based intervention that aims to increase levels of physical activity  , decrease  sedentary behaviour  and increase consumption of fruit and vegetables in school children . Methods / design The Active for Life Year 5 ( AFLY5 ) study is a school-based , cluster RCT that targets school children in Year 5 ( age 9 - 10 years ) . All state junior/ primary schools in the area covered by Bristol City and North Somerset Council are invited to participate ; special schools are excluded . Eligible schools are r and omised to one of two arms : intervention arm ( receive the intervention 2011 - 2012 ) and control arm ( receive the intervention after the final follow-up assessment , 2013 - 2014 ) . The primary outcomes of the trial are levels of accelerometer assessed physical activity and sedentary behaviour and question naire assessed fruit and vegetable consumption . A number of secondary outcomes will also be measured , including body mass index , waist circumference and overweight/obesity . Outcomes will be assessed at baseline ( prior to intervention when the children are in Year 4 ) , at the end of intervention ' immediate follow-up ' and ' 12 months long-term ' follow-up . We will use r and om effects linear and logistic regression models to compare outcomes by r and omised arm . The economic evaluation from a societal perspective will take the form of a cost consequence analysis . Data from focus groups and interviews with pupils , parents and teachers will be used to increase underst and ing of how the intervention has any effect and is integrated into normal school activity . Discussion The results of the trial will provide information about the public health effectiveness of a school-based intervention aim ed at improving levels of physical activity , sedentary behaviour and diet in children . Trial registration IS RCT Early childhood is a critical time for promoting physical activity . Few studies have investigated the effect of interventions in this population . The aim of this study was to investigate the effect of a school-based active play intervention on preschool children 's sedentary time and physical activity .  Preschool children were recruited from r and omly selected preschools . Schools were r and omly assigned to an intervention or comparison group . One teacher per intervention school received training from active play professionals in the delivery of a 6-week active play programme . Comparison schools continued their usual practice . Children wore a  uni-axial accelerometer  for 7 days at baseline , immediately after and at 6-month post-intervention . No significant intervention effects were observed for sedentary time or physical activity . However , sex and hours spent at school were significant predictors of physical activity . Children who spent fewer hours ( half-day children ) at school were significantly more active than their full-day counterparts . Physical activity during the intervention classes was high even though neither daily physical activity nor sedentary time changed . Notably children who spent more time at preschool were less active suggesting that preschool was not as conducive to physical activity engagement as other environments BakckgroundThe first aim was to examine the effect of the UP4FUN pilot intervention on children ’s total sedentary time . The second aim was to investigate if the intervention had an effect on  children ’s physical activity ( PA ) level . Finally , we aim ed to investigate demographic differences ( i.e. age , gender , ethnicity , living status and having siblings ) between children in the intervention group who improved in sedentary time and PA at post-test and children in the intervention group who worsened in sedentary time and PA at post-test . Methods The six weeks UP4FUN intervention was tested in a r and omized controlled trial with pre-test post-test design with five intervention and five control schools in Belgium and included children of the 5th and 6th grade . The children wore accelerometers for seven days at pre- and post-test . Analyses included children with valid accelerometer data for at least two weekdays with minimum 10h-wearing time and one weekend day with 8h-wearing time . Result Final analyses included 372 children ( 60 % girls , mean age = 10.9 ± 0.7 years ) . There were no significant differences in the change in sedentary time or light PA between intervention and control schools for the total sample or for the subgroup analyses by gender . However , children ( specifically girls ) in the intervention group had a higher decrease in moderate-to-vigorous PA than children in the control group . In the intervention group , children who lived with both parents and children with one or more siblings were less likely to reduce sedentary time after exposure to the intervention . Older children , girls and children who lived with both parents were less likely to increase light PA after the intervention . Conclusion The UP4FUN intervention did not result in an effect on children ’s sedentary time . Based on the high amounts of accelerometer-derived sedentary time in this age group , more efforts are needed to develop strategies to reduce children ’s sedentary time INTRODUCTION The present study describes a r and omised controlled trial ( RCT ) based on a novel , generalisable intervention for childhood obesity , comparing the intervention with a no-treatment control group . METHOD The Malaysian Childhood Obesity Treatment Trial ( MASCOT ) was a single-blind RCT of a dietetic treatment for childhood obesity in children of primary school age ( 7 to 11 years old ) in Kuala Lumpur , Malaysia . The MASCOT comprising eight sessions , of an 8-hour family-centred group treatment programme is described , based on behavioural change techniques . The study sample was characterised by BMI z-score , health related quality of life reported by participants and their parents ( PedsQL question naire ) , objective ly measured habitual physical activity and sedentary behaviour ( Actigraph accelerometry ) RESULTS The MASCOT sample of 107 children was characterised by a low quality of life , mean total score on PedsQL 67.7 ( 4.5 ) as reported by the children , and 66.0 ( 16.4 ) as reported by their parents . The children spent , on average , 89 % of their waking day on sedentary activity , and 1 % of the day in moderate-vigorous intensity physical activity , equivalent to only around 8 minutes/day . CONCLUSION Obese children in the MASCOT study had an impaired quality of life , high levels of sedentary behaviour and very low levels of physical activity Background Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide . Most chronic diseases are associated with underlying preventable risk factors , such as elevated blood pressure , high blood glucose or glucose intolerance , high lipid levels , physical inactivity , excessive sedentary behaviours , and overweight/obesity . The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood . Sugar-sweetened beverages are known to be significant sources of additional caloric intake , and given recent attention to their contribution in the development of chronic diseases , a systematic review is warranted . We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are . Methods / Design Of interest are studies addressing sugar-sweetened beverage consumption , taking a broad perspective . Both direct consumption studies as well as those evaluating interventions that influence consumption ( e.g. school policy , educational ) will be relevant . Non-specific or multi-faceted behavioural , educational , or policy interventions may also be included subject to the level of evidence that exists for the other interventions /exposures . Comparisons of interest and endpoints of interest are pre-specified . We will include r and omized controlled trials , controlled clinical trials , interrupted time series studies , controlled before-after studies , prospect i ve and retrospective comparative cohort studies , case – control studies , and nested case – control design s. The MEDLINE ® , Embase , The Cochrane Library , CINAHL , ERIC , and PsycINFO ® data bases and grey literature sources will be search ed . The processes for selecting studies , abstract ing data , and resolving conflicts are described . We will assess risk of bias using design -specific tools . To determine sets of confounding variables that should be adjusted for , we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessment s. Meta- analysis will be conducted where appropriate ; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach will be used to determine the quality of evidence for outcomes . Systematic review registration PROSPERO CRD42014009641 Background Screen-based activities , such as watching television ( TV ) , playing video games , and using computers , are common sedentary behaviors among young people and have been linked with increased energy intake and overweight . Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child , small sample sizes , and short follow-up periods . The SWITCH ( Screen-Time Weight-loss Intervention Targeting Children at Home ) study aim ed to determine the effect of a home-based , family-delivered intervention to reduce screen-based sedentary behaviour on body composition , sedentary behaviour , physical activity , and diet over 24 weeks in overweight and obese children . Methods A two-arm , parallel , r and omized controlled trial was conducted . Children and their primary caregiver living in Auckl and , New Zeal and were recruited via schools , community centres , and word of mouth . The intervention , delivered over 20 weeks , consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content , which focused on training and educating them to use a wide range of strategies design ed to reduce their child ’s screen time . Families were given Time Machine TV monitoring devices to assist with allocating screen time , activity packages to promote alternative activities , online support via a website , and monthly newsletters . Control participants were given the intervention material on completion of follow-up . The primary outcome was change in children ’s BMI z-score from baseline to 24 weeks . Results Children ( n = 251 ) aged 9 - 12 years and their primary caregiver were r and omized to receive the SWITCH intervention ( n = 127 ) or no intervention ( controls ; n = 124 ) . There was no significant difference in change of z BMI between the intervention and control groups , although a favorable trend was observed ( -0.016 ; 95 % CI : -0.084 , 0.051 ; p = 0.64 ) . There were also no significant differences on secondary outcomes , except for a trend towards increased children ’s moderate intensity physical activity in the intervention group ( 24.3 min/d ; 95 % CI : -0.94 , 49.51 ; p = 0.06 ) . Conclusions A home-based , family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9 - 12 years . Trial registration Australian New Zeal and Clinical Trials RegistryWebsite : http://www.anzctr.org.auTrial registration number : Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT BACKGROUND Children with developmental coordination disorder ( DCD ) are highly inactive and sedentary . The purpose of this study was to assess the impact of a home-based active video game intervention on objective ly measured physical activity and sedentary behaviour in children at risk for DCD . METHODS In a crossover r and omized clinical trial , 21 children ( mean age 11.0 , SD 1.0 ; n = 11 girls ) in Perth , Western Australia participated in two 16-week periods : no active video games ( AVGs ) control period and AVGs intervention period . Two active input consoles were provided to participants along with a selection of non-violent AVGs for participants to play at home . Participants wore accelerometers at baseline and following each period to determine minutes of sedentary , light , moderate and vigorous times in addition to self-reported types of activities in a diary . Linear mixed models , adjusted for the order of periods , compared physical activity and sedentary time during the last week of each period . RESULTS There were no significant differences between the intervention and control periods in time spent in sedentary ( decrease of -1.0 min/day during the intervention period , 95%CI -12.1 , 10.1 ) , light ( increase of 2.2 min/day , 95%CI -8.8 , 13.2 ) , moderate ( decrease of 0.7 min/day , 95%CI -4.6 , 3.3 ) or vigorous ( decrease of -0.6 min/day , 95%CI -1.6 , 0.4 ) . CONCLUSIONS Among children at risk for DCD , participating in this AVG intervention did not improve objective ly measured physical activity and sedentary time Latino children spend more time in sedentary activities than other American children , and only ~1 in 5 Latino children in public elementary and middle schools meet all 6 fitness st and ards in statewide fitness testing . Schools that facilitate physical activity ( PA ) by maintaining playgrounds and providing physical education classes have children who are more active and less overweight . The aims of the present study were to examine the extent to which several social and physical environmental changes in school setting s result ed in observed changes in area characteristics and children 's activity levels during recess . Thirteen elementary schools serving predominantly Mexican American children were r and omized into  control or activity and nutrition environmental intervention conditions . Playgrounds and activities were restructured in 6 intervention schools to promote more PA . After 1 y , there were no overall statistical differences between treatment groups in PA or sedentary behavior in these setting s and results did not differ by gender . Changing the social and physical environments to promote children 's moderate-to-vigorous PA is important to the design of active and healthy recess environments . The present results are not conclusive as to the link between these interventions and actual behavior , but show sufficient promise for further population and setting specific research ABSTRACT Lack of  physical activity  (  PA  ) and high levels of sedentary behaviour ( SB ) have been associated with health problems . This systematic review evaluates the effectiveness of school-based interventions to increase PA  and decrease SB  among 15–19-year-old adolescents , and examines whether intervention characteristics ( intervention length , delivery mode and intervention provider ) and intervention content ( i.e. behaviour change techniques , BCTs ) are related to intervention effectiveness . A systematic search of r and omised or cluster r and omised controlled trials with outcome measures of PA and /or SB rendered 10 results . Risk of bias was assessed using the Cochrane risk of bias tool . Intervention content was coded using Behaviour Change Technique Taxonomy v1 . Seven out of 10 studies reported significant increases in PA . Effects were generally small and short-term ( Cohen 's d ranged from 0.132 to 0.659 ) . Two out of four studies that measured SB reported significant reductions in SB . Interventions that increased PA  included a higher number of BCTs , specific BCTs ( e.g. , goal setting , action planning and self-monitoring ) , and were delivered by research staff . Intervention length and mode of delivery were unrelated to effectiveness . More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents A Play Street is a street that is reserved for children ’s safe play for a specific period during school vacations . It was hypothesized that a Play Street near children ’s home can increase their moderate- to vigorous-intensity physical activity ( MVPA ) and decrease their sedentary time . Therefore , the aim of this study was to investigate the effect of Play Streets on children ’s MVPA and sedentary time .  A nonequivalent control group pretest-posttest design was used to determine the effects of Play Streets on children ’s MVPA and sedentary time . Data were collected in Ghent during July and August 2013 . The study sample consisted of 126 children ( 54 from Play streets , 72 from control streets ) . Children wore an accelerometer for 8 consecutive days and their parents fill out a question naire before and after the measurement period . During the intervention , streets were enclosed and reserved for children ’s play . Four-level ( neighborhood – household – child – time of measurement ( no intervention or during intervention ) ) linear regression models were conducted in MLwiN to determine intervention effects . Positive intervention effects were found for sedentary time ( β = -0.76 ± 0.39 ; χ2 = 3.9 ; p = 0.05 ) and MVPA ( β = 0.82 ± 0.43 ; χ2 = 3.6 ; p = 0.06 ) . Between 14h00 and 19h00 , MVPA from children living in Play Streets increased from 27 minutes during normal conditions to 36 minutes during the Play Street intervention , whereas control children ’s MVPA decreased from 27 to 24 minutes . Sedentary time from children living in the Play Street decreased from 146 minutes during normal conditions to 138 minutes during the Play Street intervention , whereas control children ’s sedentary time increased from 156 minutes to 165 minutes . The intervention effects on MVPA ( β = -0.62 ± 0.25 ; χ2 = 6.3 ; p = 0.01 ) and sedentary time ( β = 0.85 ± 0.0.33 ; χ2 = 6.6 ; p = 0.01 ) remained significant when the effects were investigated during the entire day , indicating that children did not compensate for their increased MVPA and decreased sedentary time , during the rest of the day . Creating a safe play space near urban children ’s home by the Play Street intervention is effective in increasing children ’s MVPA and decreasing their sedentary time OBJECTIVES We aim ed to investigate the effects of providing play equipment and markings at the pre-school playground on physical activity engagement levels . METHODS We performed a cluster r and omised control trial . In November and December 2007 , a convenience sample of 40 public pre-schools in Fl and ers , Belgium , was r and omly assigned to one of the following conditions : 1 ) in 10 pre-schools play equipment was provided , 2 ) in 10 pre-schools markings were painted on the playground , 3 ) in 10 schools play equipment was provided and markings were painted , 4 ) 10 schools served as a control condition . Accelerometer-based physical activity levels during recess were evaluated at baseline and 4 to 6 weeks after the implementation of the intervention in 583 children ( 52 % boys ; mean age 5.3 years , SD 0.4 ) . RESULTS At baseline pre-schoolers spent only 11.2 % ( average : 4.7 min ) of recess time in moderate to vigorous activity , while 61.3 % ( average : 25.7 min ) was spent in sedentary activity . The interventions were not effective in increasing the average activity levels or the percentages of engagement in moderate or vigorous activity , or in decreasing sedentary time . CONCLUSION Providing playground markings or play equipment is not sufficient to increase activity levels and decrease levels of sedentary activity during pre-school recess . More activating supervision and the inclusion of more structured physical activity seem needed Abstract Objective : To assess if a school based intervention was effective in reducing risk factors for obesity . Design : Group r and omised controlled trial . Setting : 10 primary schools in Leeds . Participants : 634 children aged 7 - 11 years . Intervention : Teacher training , modification of school meals , and the development of school action plans targeting the curriculum , physical education , tuck shops , and playground activities . Main outcome measures : Body mass index , diet , physical activity , and psychological state . Results : Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group ( weighted mean difference 0.3 portions/day , 95 % confidence interval 0.2 to 0.4 ) , representing a difference equivalent to 50 % of baseline consumption . Fruit consumption was lower in obese children in the intervention group ( −1.0 , −1.8 to −0.2 ) than those in the control group . The three day diary showed higher consumption of high sugar foods ( 0.8 , 0.1 to 1.6 ) ) among overweight children in the intervention group than the control group . Sedentary behaviour was higher in overweight children in the intervention group ( 0.3 , 0.0 to 0.7 ) . Global self worth was higher in obese children in the intervention group ( 0.3 , 0.3 to 0.6 ) . There was no difference in body mass index , other psychological measures , or dieting behaviour between the groups . Focus groups indicated higher levels of self reported behaviour change , underst and ing , and knowledge among children who had received the intervention . Conclusion : Although it was successful in producing changes at school level , the programme had little effect on children 's behaviour other than a modest increase in consumption of vegetables . What is already known on this topic Obesity is increasing among school children and dem and s preventive strategies R and omised controlled trials of school based primary prevention programmes have all used a prescriptive approach What this study adds Behavioural changes were disappointing with this programme based on the health promoting schools philosophy , despite changes at school level The only positive outcome was a modest increase in vegetable consumption The discrepancy between changes achieved at the individual and school level raises issues regarding the problems inherent in such
Conclusions Multicomponent interventions which also include the use of st and ing desks may be an effective method for reducing  children 's sedentary time  in a school-based intervention .
Introduction Prolonged , uninterrupted periods of sedentary time may be associated with increased risk of Type II diabetes , cardiovascular disease and all-cause mortality even if the minimum recommended levels of daily physical activity are achieved .
It is reported that children spend approximately 80 % of their day engaged in sedentary behaviours .
Since children spend a large portion of their waking time at school , school-based interventions targeting excessive or interrupted periods of sedentary time have been investigated in a number of studies .
However , results of the effectiveness of studies to- date have been inconsistent .
Aim To conduct a systematic review to evaluate the effectiveness of school-based interventions design ed to reduce sedentary behaviour on objective ly measured sedentary time in children .