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 A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Correlates of preschool children’s objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study Feasibility and Efficacy of a Parent-Focused, Text Message–Delivered Intervention to Reduce Sedentary Behavior in 2- to 4-Year-Old Children (Mini Movers): Pilot Randomized Controlled Trial Screen-time Weight-loss Intervention Targeting Children at Home (SWITCH): A randomized controlled trial study protocol Effectiveness of parent‐centred interventions for the prevention and treatment of childhood overweight and obesity in community settings: a systematic review Physical activity, sedentary behavior, and adiposity in English children. Randomized, Controlled Trial of a Best-Practice Individualized Behavioral Program for Treatment of Childhood Overweight: Scottish Childhood Overweight Treatment Trial (SCOTT) Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials Executive function mediates prospective relationships between sleep duration and sedentary behavior in children. A cluster-randomized controlled trial of strategies to increase adolescents’ physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial Decreasing sedentary behaviors in treating pediatric obesity. Prevention of overweight in preschool children: results of kindergarten-based interventions Psychosocial correlates of physical activity in healthy children. The prediction of preschool children's weight from family environment factors: gender-linked differences. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Changes in physical activity and sedentary behavior in a randomized trial of an internet-based versus workbook-based family intervention study. Examination of mid-intervention mediating effects on objectively assessed sedentary time among children in the Transform-Us! cluster-randomized controlled trial Comparing the effects of two different break strategies on occupational sedentary behavior in a real world setting: A randomized trial Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Efficacy of a behavioral intervention for reducing sedentary behavior in persons with multiple sclerosis: a pilot examination. A randomised controlled trial for overweight and obese parents to prevent childhood obesity - Early STOPP (STockholm Obesity Prevention Program) Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region
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 : Background Physical activity ( PA ) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior ( SB ) may be detrimental to children 's health independent of PA . The primary aim of the Transform-Us ! study is to determine whether an 18-month , behavioral and environmental intervention in the school and family setting s results in higher levels of PA and lower rates of SB among 8 - 9 year old children compared with usual practice ( post-intervention and 12-months follow-up ) . The secondary aims are to determine the independent and combined effects of PA and SB on  children 's cardio-metabolic health risk factors ; identify the factors that mediate the success of the intervention ; and determine whether the intervention is cost-effective . Methods / design A four-arm cluster-r and omized controlled trial ( RCT ) with a 2 × 2 factorial design , with schools as the unit of r and omization . Twenty schools will be allocated to one of four intervention groups , sedentary behavior ( SB-I ) , physical activity ( PA-I ) , combined SB and PA ( SB+PA-I ) or current practice control ( C ) , which will be evaluated among approximately 600 children aged 8 - 9 years in school year 3 living in Melbourne , Australia . All children in year 3 at intervention schools in 2010 ( 8 - 9 years ) will receive the intervention over an 18-month period with a maintenance ' booster ' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessment s. To maximize the sample and to capture new students arriving at intervention and control schools , recruitment will be on-going up to the post-intervention time point . Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey . Discussion To our knowledge , Transform-Us ! is the first RCT to examine the effectiveness of intervention strategies for reducing children 's overall sedentary time , promoting PA and optimizing health outcomes . The integration of consistent strategies and messages to children from teachers and parents in both school and family setting s is a critical component of this study , and if shown to be effective , may have a significant impact on educational policies as well as on pedagogical and parenting practice s . Trial registration ACTRN12609000715279 ; Current Controlled Trials IS RCT Background Identifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue . Research on the putative influences on preschool children ’s  physical activity ( PA ) and  sedentary behavior  ( SB ) is limited and has yielded inconsistent results . Our aim was to identify correlates of PA and SB in preschool children . Methods Cross-sectional data were drawn from the Swiss Preschoolers ’ Health Study ( SPLASHY ) , a Swiss population -based cohort study . Of 476 two to six year old children , 394 ( 54 % boys ) had valid PA data assessed by accelerometry .  Information on exposure data was directly measured or extracted from parental question naires . Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and  total PA ( TPA ) , moderate-to-vigorous PA ( MVPA ) and SB . Results In total , 12 correlates from different domains were identified . TPA and MVPA were greater in boys than girls , increased with age and were positively associated with gross motor skills . Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents . Time spent outdoors was positively associated with TPA and negatively with SB . The child ’s activity temperament was related all three outcomes , whereas parental sports club membership , living area per person and neighborhood safety were associated with SB only . Fixed and r and om factors in the final models accounted for 28 % , 32 % and 22 % of the total variance in TPA , MVPA and SB , respectively . Variance decomposition revealed that age , sex and activity temperament were the most influential correlates of both , TPA and MVPA , whereas the child ’s activity temperament , time outdoors and neighborhood safety were identified as the most important correlates of SB . Conclusions A multidimensional set of correlates of young children ’s  activity behavior has been identified . Personal factors had the greatest influence on PA , whereas environmental-level factors had the greatest influence on SB . Moreover , we identified a number of previously unreported , potentially modifiable correlates of young children ’s PA and SB . These factors could serve to define target groups or become valuable targets for change in future interventions .Trial registration Current Controlled Trials IS RCT N41045021 ( date of registration : 21.03.14 ) Background Despite public health guidelines to limit sedentary behavior , many young children spend large amounts of time sedentary ( eg , screen and sitting time ) during waking hours . Objective The objective of this study was to test the feasibility and efficacy of a parent-focused , predominantly text message – delivered intervention to support parents to reduce the amount of time their children spend in sedentary behavior . Methods Mini Movers was a pilot r and omized controlled trial delivered to parents of 2- to 4-year-old children in Melbourne , Australia . Participants were recruited through playgroups ,  social media , and snowball sampling . Eligibility criteria were having an ambulatory child ( 2 - 4 years ) , English literacy , and smartphone ownership . Participants were r and omized to intervention or wait-list control on a 1:1 ratio after baseline data collection . The 6-week intervention was predominantly delivered via text messages , using a Web-based bulk text message platform managed by the interventionist . Intervention strategies focused on increasing parental knowledge , building self-efficacy , setting goals , and providing reinforcement , and were underpinned by the Coventry , Aberdeen & London-Refined taxonomy of behavior change techniques and social cognitive theory . The primary outcome was intervention feasibility , measured by recruitment , retention , intervention delivery , and fidelity ; process evaluation question naires ; and qualitative interviews with a sub sample of participants . Secondary outcomes were children ’s screen and restraint time ( parent report ) , sitting time ( parent report , activPAL ) , and potential mediators ( parent report ) . Linear regression models were used to determine intervention effects on secondary outcomes , controlling for the child ’s sex and age and clustering by playgroup ; effect sizes ( Cohen 's d ) were calculated . Results A total of 57 participants ( 30 intervention ; 27 wait-list control ) were recruited  , and retention was high ( 93 % ) . Process evaluation results showed that the intervention was highly acceptable to parents . The majority of intervention components were reported to be useful and relevant . Compared with children in the control group , children in the intervention group had significantly less screen time postintervention ( adjusted difference [ 95 % CI]=−35.0 [ −64.1 to −5.9 ] min/day ; Cohen 's d=0.82 ) . All other measures of sedentary behavior were in the expected direction , with small to moderate effect sizes . Conclusions Mini Movers was shown to be a feasible , acceptable , and efficacious pilot intervention for parents of young children , warranting a larger-scale r and omized control trial . Trial Registration Australian New Zeal and Clinical Trials registry : ACTRN12616000628448 ; https://www.anzctr.org.au/ Trial/ Registration /Trial Review .aspx?ACTRN=12616000628448p ( Archived by WebCite at http://www.webcitation.org/ 6wZcA3cYM Background Approximately one third of New Zeal and children and young people are overweight or obese . A similar proportion ( 33 % ) do not meet recommendations for physical activity , and 70 % do not meet recommendations for screen time . Increased time being sedentary is positively associated with being overweight . There are few family-based interventions aim ed at reducing sedentary behavior in children . The aim of this trial is to determine the effects of a 24 week home-based , family oriented intervention to reduce sedentary screen time  on children 's body composition , sedentary behavior , physical activity , and diet . Methods / Design The study design is a pragmatic two-arm parallel r and omized controlled trial . Two hundred and seventy overweight children aged 9 - 12 years and primary caregivers are being recruited . Participants are r and omized to intervention ( family-based screen time intervention ) or control ( no change ) . At the end of the study , the control group is offered the intervention content . Data collection is undertaken at baseline and 24 weeks . The primary trial outcome is child body mass index ( BMI ) and st and ardized body mass index ( z BMI ) . Secondary outcomes are change from baseline to 24 weeks in child percentage body fat ; waist circumference ; self-reported average daily time spent in physical and sedentary activities ; dietary intake ; and enjoyment of physical activity and sedentary behavior . Secondary outcomes for the primary caregiver include change in BMI and self-reported physical activity . Discussion This study provides an excellent example of a theory-based , pragmatic , community-based trial targeting sedentary behavior in overweight children . The study has been specifically design ed to allow for estimation of the consistency of effects on body composition for Māori ( indigenous ) , Pacific and non-Māori/non-Pacific ethnic groups . If effective , this intervention is imminently scalable and could be integrated within existing weight management programs . Trial Registration 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 importance of variation in total volume of physical activity or moderate- to vigorous-intensity physical activity ( MVPA ) to development of body fatness in childhood is unclear , and it is unclear if physical activity has a greater influence on adiposity in boys than girls . PURPOSE To assess relationships between 2-year changes in objective ly measured physical activity , sedentary behavior , and adiposity in English children . METHODS Prospect i ve cohort study , set in Northeast Engl and , of a socioeconomically representative sample of 403 children . Measures were change in accelerometer-determined physical activity and sedentary behavior  from age 7 to 9 years ( data collected 2006/2007 and 2008/2009 ; analyzed in 2010 ) and concurrent change in adiposity ( fat mass index derived from bioelectric impedance ) and change in BMI Z-score . RESULTS Decline in MVPA was associated with a greater increase in fat mass index in boys but not girls . Declining MVPA was associated with increased BMI Z-score in boys but not girls . Increased sedentary behavior was not associated with increased BMI Z-score in either gender . CONCLUSIONS Avoiding mid-late childhood reductions in MVPA may reduce excessive fat gain , although such strategies may have greater impact on boys than girls OBJECTIVE . The objective of this study was to determine whether a generalizable best- practice individualized behavioral intervention  reduced BMI z score relative to st and ard dietetic care among overweight children . METHODS . The design consisted of an assessor-blinded , r and omized , controlled trial involving 134 overweight children ( 59 boys , 75 girls ; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years ) who were r and omly assigned to a best- practice behavioral program ( intervention ) or st and ard care ( control ) .  The intervention used family-centered counseling and behavioral strategies to modify diet , physical activity , and sedentary behavior . BMI z score , weight , objective ly measured physical activity and sedentary behavior , fat distribution , quality of life , and height z score were recorded at baseline and at 6 and 12 months . RESULTS . The intervention had no significant effect relative to st and ard care on BMI z score from baseline to 6 months and 12 months . BMI z score decreased significantly in both groups from baseline to 6 and 12 months . For those who complied with treatment , there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months . There were significant between-group differences in favor of the intervention for changes in total physical activity , percentage of time spent in sedentary behavior , and light-intensity physical activity . CONCLUSIONS . A generalizable , best- practice individualized behavioral intervention had modest benefits on objective ly measured physical activity and sedentary behavior but no significant effect on BMI z score compared with st and ard care among overweight children . The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention , although such treatments may not be realistic for many health care systems Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting Childhood sedentary behavior has been linked to increased obesity risk . Prior work has identified associations between sedentary behavior , executive function ( EF ) , and sleep . This study tested the hypothesis that reduced sleep duration may adversely impact EF and lead to increased childhood sedentary behavior . Southern California schoolchildren participating in the school-based health promotion program Pathways to Health ( N=709 ) were assessed annually from 4th through 6th grade s ( 2010 - 2013 ) on self-report measures of sedentary behavior , sleep duration , and executive function .  A series of path models were specified treating average nightly sleep duration and weekend wake/bed-time shift at 4th grade as predictors of 6th grade sedentary behavior . Four EF subdomains were tested as potential mediators of longitudinal associations at 5th grade . Significant associations between average nightly sleep duration , EF and sedentary behavior were identified ( p<0.05 ) , adjusting for participant gender , physical activity , SES , ethnicity , program group assignment , and the presence/absence of parental screen time rules . Fifth grade overall EF (p<0.05)- and in particular the subdomains of inhibitory control ( p<0.05 ) and organization of material s (p<0.01)-significantly mediated the relationship between 4th grade sleep duration and 6th grade sedentary behavior ( p<0.05 ) . Furthermore , delay of weekend bed- or wake-times relative to weekdays was prospect ively associated with decreased overall EF ( p<0.05 ) , but not increased sedentary behavior ( p=0.35 for bed-time delay ; p=0.64 for wake-time delay ) , irrespective of average nightly sleep duration . Findings suggest that sleep promotion efforts may reduce children 's sedentary behavior  both directly and indirectly through changes in EF Background The physical activity ( PA ) levels of many children and adolescents in Australia are currently insufficient to promote health benefits . Physical education ( PE ) programs aim to promote PA and reach nearly all school-aged children , but PA levels within PE lessons are often low . PE teachers may influence children ’s motivation to be physically active in PE lessons , but little is known about teacher strategies that effectively motivate children to participate in PA , and few intervention studies have examined motivational strategies in PE . The purpose of this study was to compare the effect of three motivational strategies , each based on Self-Determination Theory ( SDT ) , on PA levels , and their hypothesized antecedents , during year 8 PE lessons . Methods / design This study employed a cluster-r and omized controlled trial design . Following a familiarization session , PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson .  Teachers ( n = 16 ) and their classes from five secondary schools in Sydney , Australia were r and omly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions : ( 1 ) explaining the relevance of activities ; ( 2 ) providing choice from PA options selected by the teacher ; ( 3 ) providing equipment and free choice of activities ; or ( 4 ) usual practice . The primary outcomes were lesson time spent in moderate-to-vigorous PA , and motivation towards the lesson . Secondary outcomes were perceptions of teacher behavior , psychological needs satisfaction , and lesson time spent in sedentary behavior . PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers . Teacher behavior , psychological needs satisfaction , and motivation were assessed via question naires at the end of each lesson . Linear mixed-model analyses will be run on all outcomes , with students nested within teachers as a r and om effect . Discussion Study findings will inform the development of effective SDT-based teaching strategy interventions to enhance students ’ psychological needs satisfaction , motivation , and PA levels . More effective teaching strategies may be identified that are capable of improving  adolescents ’ PA levels , and thereby provide beneficial population health outcomes .Trial registration This trial is registered with Current Controlled Trials and is traceable as IS RCT N07038258 BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity Objective : Given the increasing prevalence of pediatric obesity , we evaluated two kindergarten-based strategies for reducing overweight in preschool children in the Haute-Garonne Department in France . Methods : Kindergartens ( n=79 ) were r and omly assigned to one of the two strategies and followed for 2 years . In the first group ( Epidémiologie et prévention de l’obésité infantile , EPIPOI-1 ) , parents and teachers received basic information on overweight and health , and children underwent screening to identify those with overweight ( body mass index ( BMI ) ⩾90th percentile ) or at risk for overweight ( BMI between 75 and 90th percentile ) , who were then followed up by their physicians . EPIPOI-2 children , in addition , received kindergarten-based education to promote healthy practice s related to nutrition , physical activity and sedentary behaviors . Data on control children from non-intervention kindergartens ( n=40 ) were retrieved from medical records at the Division of School Health . Results : At baseline , groups differed significantly on age and school area ( underprivileged/ not ) . Owing to a significant interaction between school area and group , analyses were stratified by school area . At baseline , groups did not differ on overweight prevalence and BMI z-scores for any school area . After intervention , prevalence of overweight , BMI z-score and change in BMI z-score were significantly lower in intervention groups compared with controls in underprivileged areas . Using multilevel analysis adjusted for potential confounders , a significant effect on overweight prevalence at the end of the study was noted for EPIPOI-1 in underprivileged areas only ( odds ratio and 95 % confidence interval : 0.18 ( 0.07–0.51 ) . In non-underprivileged areas , the gain in BMI z-score was lower in EPIPOI-2 group compared with control and EPIPOI-1 . Conclusion : Our results suggest that simple measures involving increasing awareness on overweight and health , and periodic monitoring of weight and height with follow-up care when indicated , could be useful to reduce  overweight in young children from underprivileged areas . A reinforced strategy with an education component , in addition , may be indicated in children in non-underprivileged areas 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 The main objective of this study was to test an explanatory model predicting preschool girls ' and boys ' body weight from certain child variables ( food intake , sedentary behaviors , and eating habits ) , as well as family variables ( interaction during mealtime and level of family financial re sources allocated to meeting children 's eating needs ) . A r and omized stratified sub sample of parents was selected from a larger study ( Quebec Longitudinal Study of Child Development , QLSCD-1998 - 2002 ) , with a breakdown of 581 girls and 611 boys of 4 years of age . Children 's skin fold ratio , weight , height , and Body Mass Index ( BMI ) were recorded . Question naires were administered to parents ( usually the mother ) . Using structural equation modeling ( SEM ) separately for girls and boys , the family environment model of healthy weight development was tested . Results yielded a good fit of the model for both genders . For boys , significant predictors of body weight in the model were family food insecurity and conflicts during mealtime . Healthy eating was predicted by food insecurity , mealtime conflicts , and sedentary behaviors . Mealtime conflicts predicted sedentary behaviors . For girls , none of the variables predicted body weight , however food insecurity predicted less healthy eating . These results outline the importance of prevention and intervention within families with young children OBJECTIVE To assess the effects of reducing television viewing and computer use on children 's  body mass index ( BMI ) as a risk factor for the development of overweight in young children . DESIGN R and omized controlled clinical trial . SETTING University children 's hospital . PARTICIPANTS Seventy children aged 4 to 7 years whose BMI was at or above the 75th BMI percentile for age and sex . INTERVENTIONS Children were r and omized to an intervention to reduce their television viewing and computer use by 50 % vs a monitoring control group that did not reduce television viewing or computer use . MAIN OUTCOME MEASURES Age- and sex-st and ardized BMI ( z BMI ) , television viewing , energy intake , and physical activity were monitored every 6 months during 2 years . RESULTS Children r and omized to the intervention group showed greater reductions in targeted sedentary behavior ( P < .001 ) , z BMI ( P < .05 ) , and energy intake ( P < .05 ) compared with the monitoring control group . Socioeconomic status moderated z BMI change ( P = .01 ) , with the experimental intervention working better among families of low socioeconomic status . Changes in targeted sedentary behavior mediated changes in z BMI ( P < .05 ) . The change in television viewing was related to the change in energy intake ( P < .001 ) but not to the change in physical activity ( P = .37 ) . CONCLUSIONS Reducing television viewing and computer use may have an important role in preventing obesity and in lowering  BMI in young children , and these changes may be related more to changes in energy intake than to changes in physical activity BACKGROUND The America on the Move ( AOM ) Family Intervention Program has been shown to prevent excess weight gain in overweight children . Providing intervention material s via the internet would have the potential to reach more families but may increase sedentary behavior . The purpose was to evaluate whether delivering the AOM Family Intervention via the internet versus printed workbook would have a similar impact on sedentary behaviors in children . METHODS 131 children ( age 8 - 12 ) were r and omized to receive the AOM Family Intervention via the internet or workbook for 12 weeks . Changes in objective ly measured sedentary time and moderate-to vigorous physical activity ( MVPA ) as well as self-reported screen time were compared between groups . RESULTS There were no significant differences between groups in screen time , sedentary time , or MVPA at the end of the 12 week intervention . Families receiving the intervention via the internet were more likely to remain in the study ( 98 % vs. 82 % , P = .016 ) . CONCLUSIONS Using the internet to deliver the lifestyle intervention did not increase  sedentary behavior in children . Attrition rates were lower when the program was delivered by internet versus via printed material s. These results provide support for using the internet to deliver healthy lifestyle programs for children Background The optimal targets and strategies for effectively reducing sedentary behavior among young people are unknown . Intervention research that explores changes in mediated effects as well as in outcome behaviors is needed to help inform more effective interventions . Therefore , the purpose of this study was to examine the mid-intervention mediating effects on children ’s objective ly assessed classroom and total weekday sedentary time in the Transform-Us ! intervention . Methods The results are based on 293 children , aged 7- to 9-years-old at baseline , from 20 schools in Melbourne , Australia . Each school was r and omly allocated to one of four groups , which targeted reducing sedentary time in the school and family setting s ( SB ; n = 74 ) , increasing or maintaining moderate- to vigorous-intensity physical activity in the school and family setting s ( PA ; n = 75 ) , combined SB and PA ( SB + PA ; n = 80 ) , or the current practice control ( C ; n = 64 ) . Baseline and mid-intervention data ( 5–9 months ) were collected in 2010 and analyzed in 2012 . Classroom and total weekday sedentary time was objective ly assessed using ActiGraph accelerometers . The hypothesized mediators including , child enjoyment , parent and teacher outcome expectancies , and child perceived access to st and ing opportunities in the classroom environment , were assessed by question naire . Results The SB + PA group spent 13.3 min/day less in weekday sedentary time at mid-intervention compared to the control group . At mid-intervention , children in the SB group had higher enjoyment of st and ing in class ( 0.9 units ; 5-unit scale ) and all intervention groups had more positive perceptions of access to st and ing opportunities in the classroom environment ( 0.3 - 0.4 units ; 3-unit scale ) , compared to the control group . However , none of the hypothesized mediator variables had an effect on sedentary time ; thus , no mediating effects were observed . Conclusions While beneficial intervention effects were observed on some hypothesized mediating variables and total weekday sedentary time at mid-intervention , no significant mediating effects were found . Given the dearth of existing information , future intervention research is needed that explores mediated effects . More work is also needed on the development of reliable mediator measures that are sensitive to change overtime . Trial registration ACTRN12609000715279IS RCT Developing interventions to reduce sedentary behavior in the workplace is an important public health priority . Furthermore , research is needed to determine whether different approaches to breaking up prolonged sitting during the workday are equally feasible and effective . Thus , the purpose of this study was to determine whether varying the frequency and duration of activity breaks during the workday would differentially impact sedentary behavior and health outcomes . Inactive females ( N = 49 ) working full-time sedentary jobs were recruited for this parallel-group r and omized trial . Participants were r and omly assigned to take short , frequent breaks from sitting ( 1–2 min every half hour ; SB ) or longer , planned breaks from sitting ( two 15-minute breaks per workday ; LB ) during each workday across an 8-week  intervention . Sedentary time and health outcomes were assessed at baseline and post-intervention . The study ran from March 2014–June 2015 . Results showed sedentary time during the workday decreased significantly in the SB group ( − 35.6 min ; d = − 0.75 ; p = 0.03 ) , but did not change in the LB group ( + 4.5 min ; d = 0.12 ) . Participants in the SB group also demonstrated small-to-moderate declines in total cholesterol ( d = − 0.33 ; p = 0.10 ) , triglycerides ( d = − 0.38 ; p = 0.06 ) and fasting blood glucose ( d = − 0.29 ; p = 0.01 ) from pre to post-intervention . Health outcomes did not change in the LB group . This study demonstrated that taking short , frequent breaks from sitting during the workday is a feasible and effective approach for reducing sedentary time at work . These results have implication s for the development of public health messages addressing sedentary behavior , and inform future interventions to reduce sedentary time in the workplace . Trial registration This study is registered at www . clinical trials.gov : NCT02609438 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 BACKGROUND Sitting time ( ST ) , a form of sedentary behavior , has been identified as a highly prevalent risk factor for multiple sclerosis (MS)-related morbidity . There is limited information on the efficacy of behavioral interventions for reducing ST in persons with MS . PURPOSE To examine the efficacy of a behavioral intervention for reducing ST in persons with MS in a pilot RCT . METHODS Seventy MS patients were r and omly assigned to intervention and waitlist control conditions . The behavioral intervention was delivered April-September 2012 via the Internet and consisted of a dedicated website and one-on-one Skype video chats that taught participants the skills , techniques , and strategies for reducing sedentary behavior based on social cognitive theory . ST was measured by questions on the abbreviated International Physical Activity Question naire ( IPAQ ) before and after the 6-month RCT . Data were analyzed in SPSS , version 21.0 in March 2014 . RESULTS ANCOVA was performed on post-intervention scores controlling for pre-intervention values using an intent-to-treat analysis . The group main effect was statistically significant ( F[1 , 67]=4.03 , p<0.05 , η²=0.06 ) and yielded a parameter estimate of 98.9 ( SE=49.3 , t=2.01 , p<0.05 ) . The adjusted mean scores for intervention and control groups were 429.2 ( 201.2 ) and 528.2 ( 200.7 ) minutes of ST , respectively ( d=0.49 ) . CONCLUSION We provide the first data on the efficacy of a behavioral intervention for reducing ST in MS patients . This highlights the importance of design ing and testing the effect of behavioral interventions that reduce ST on secondary outcomes such as function , symptoms , quality of life , and health status in persons with MS Background Overweight and obesity have a dramatic negative impact on children 's health not only during the childhood but also throughout the adult life . Preventing the development of obesity in children is therefore a world-wide health priority . There is an obvious urge for sustainable and evidence d-based interventions that are suitable for families with young children , especially for families with overweight or obese parents . We have developed a prevention program , Early STOPP , combating multiple obesity-promoting behaviors such unbalanced diet , physical inactivity and disturbed sleeping patterns . We also aim to evaluate the effectiveness of the early childhood obesity prevention in a well-characterized population of overweight or obese parents . This protocol outlines methods for the recruitment phase of the study . Design and methods This r and omized controlled trial ( RCT ) targets overweight and /or obese parents with infants , recruited from the Child Health Care Centers ( CHCC ) within the Stockholm area . The intervention starts when infants are one year of age and continues until they are six and is regularly delivered by a trained coach ( dietitian , physiotherapist or a nurse ) . The key aspects of Early STOPP family intervention are based on Swedish recommendations for CHCC , which include advices on healthy food choices and eating patterns , increasing physical activity/reducing sedentary behavior  and regulating  sleeping patterns . Discussion The Early STOPP trial design addresses weaknesses of previous research by recruiting from a well-characterized population , defining a feasible , theory-based intervention and assessing multiple measurements to vali date and interpret the program effectiveness . The early years hold promise as a time in which obesity prevention may be most effective . To our knowledge , this longitudinal RCT is the first attempt to demonstrate whether an early , long-term , targeted health promotion program focusing on  healthy eating , physical activity/reduced sedentary behaviors and normalizing sleeping patterns could be effective . If proven so , Early STOPP may protect children from the development of overweight and obesity . Trial registration The protocol for this study is registered with the clinical trials registry clinical trials.gov , ID : ES-2010 Background Few lifestyle factors have been simultaneously studied and reported for Saudi adolescents . Therefore , the purpose of the present study was to report on the prevalence of physical activity , sedentary behaviors and dietary habits among Saudi adolescents and to examine the interrelationships among these factors using representative sample s drawn from three major cities in Saudi Arabia . Methods This school-based cross-sectional study was conducted during the years 2009 - 2010 in three cities : Al-Khobar , Jeddah and Riyadh . The participants were 2908 secondary -school males ( 1401 ) and females ( 1507 ) aged 14 - 19 years , r and omly selected using a multistage stratified sampling technique . Measurements included weight , height , sedentary behaviors (  TV viewing  , playing video games and computer use ) , physical activity using a vali date d question naire and dietary habits . Results A very high proportion ( 84 % for males and 91.2 % for females ) of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines . The majority of adolescents did not have a daily intake of breakfast , fruit , vegetables and milk . Females were significantly ( p < 0.05 ) more sedentary , much less physically active , especially with vigorous physical activity , and there were fewer days per week when they consumed breakfast , fruit , milk and diary products , sugar-sweetened drinks , fast foods and energy drinks than did males . However , the females ' intake of  French fries and potato chips , cakes and donuts , and c and y and chocolate was significantly ( p < 0.05 ) higher than the males ' . Screen time was significantly ( p < 0.05 ) correlated inversely with the intake of breakfast , vegetables and fruit .  Physical activity had a significant ( p < 0.05 ) positive relationship with fruit and vegetable intake but not with sedentary behaviors . Conclusions The high prevalence of sedentary behaviors , physical inactivity and unhealthy dietary habits among Saudi adolescents is a major public health concern . There is an urgent need for national policy promoting active living and healthy eating and reducing sedentary behaviors among children and adolescents in Saudi Arabia
In conclusion , very little is known about sedentary behaviors other than screen time in this age group .
Although highly variable , findings suggest that children are already engaging in high levels of screen time by age 2 and the majority exceed current recommendations
Sedentary behavior has negative health outcomes , evident even in young children .
Identifying the prevalence of sedentary behavior in children < 2years is important for determining the necessity for intervention strategies .
The aim of this systematic review was to determine the prevalence of sedentary behavior in children < 2years .