A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents Standing Up for Student Health: An Application of the Health Action Process Approach for Reducing Student Sedentary Behavior-Randomised Control Pilot Trial. Definition, measurement, and health risks associated with sedentary behavior. Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Comparison of Actical and activPAL measures of sedentary behaviour in preschool children. Correlates of preschool children’s objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study Comparing the effects of two different break strategies on occupational sedentary behavior in a real world setting: A randomized trial Higher levels of objectively measured sedentary behavior is associated with worse cognitive ability: Two-year follow-up study in community-dwelling older adults Sedentary behavior & health-related quality of life among congestive heart failure patients. Examination of mid-intervention mediating effects on objectively assessed sedentary time among children in the Transform-Us! cluster-randomized controlled trial Motivational counselling and SMS-reminders for reduction of daily sitting time in patients with rheumatoid arthritis: a descriptive randomised controlled feasibility study Adherence to physical activity guidelines in mid-pregnancy does not reduce sedentary time: an observational study Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial Effects of swaddled and traditional tub bathing methods on crying and physiological responses of newborns Prostate cancer diagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy--prospective multicenter study. What helps children to move more at school recess and lunchtime? Mid-intervention results from Transform-Us! cluster-randomised controlled trial Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: a two-year follow-up preliminary randomized study One-year changes in physical activity and sedentary behavior among adolescents: the Croatian Physical Activity in Adolescence Longitudinal Study (CRO-PALS). Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults Magnetic resonance enterography versus capsule endoscopy activity indices for quantification of small bowel inflammation in Crohn’s disease Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews
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 BACKGROUND Sedentary behavior ( SB ) has been associated with chronic diseases . University students are a high-risk population for excessive SB . The purpose of this pilot study was to determine if a Health Action Process Approach ( HAPA ) based intervention , specifically action and coping planning , would increase student break frequency and decrease duration . METHODS Fifty-two university students ( 14 men , mean age 23.5 ) were r and omised into an 8-week HAPA-treatment ( sedentary behavior ) or HAPA-control ( nutrition ) group . Participants completed an SB question naire that assessed break frequency and duration of student SB ( Baseline , Weeks 1 - 6 Treatment , and Weeks 7 - 8 Follow-up ) , and received behavioral counselling on either dietary information or SB ( Baseline and Week 3 ) . RESULTS An intent-to-treat analysis revealed a significant group by time interaction effect for student break frequency ( p = .05 , ηρ2 = 0.27 ) , and a non-significant effect for student break duration ( p = .10 , ηρ2 = 0.23 ) . For occupational ( student ) break frequency and duration , the large accompanying effect sizes favored the treatment group . CONCLUSIONS The current pilot study provides preliminary evidence for the potential of a HAPA-based intervention for increasing student break frequency in full-time university students PURPOSE AND METHODS Although evidence is accumulating that sedentary behavior ( SB ) , independent of moderate-to-vigorous intensity physical activity ( MVPA ) , is associated with cardiometabolic and aging outcomes in adults , several gaps present opportunities for future research . This article reports on the " Research Evidence on Sedentary Behavior " session of the Sedentary Behavior : Identifying Research Priorities workshop , sponsored by the National Heart , Lung , and Blood Institute and the National Institute on Aging , which aim ed to identify priorities in SB research . RESULTS AND CONCLUSIONS A consensus definition of SB has not yet been established , although agreement exists that SB is not simply all behaviors other than MVPA . The two most common definitions are as follows : one based solely on intensity ( < 1.5 metabolic equivalents [ METs ] ) and another which combines low intensity ( ≤1.5 METs ) with a seated or reclining posture . Thus , for the definition of SB , evaluation of whether or not to include a postural component is a research priority . SB assessment method ologies include self-report and objective measurement , each offering distinct information . Therefore , evaluation , st and ardization , and comparison across self-report and objective assessment methods are needed . Specific priorities include the development and validation of novel devices capable of assessing posture and st and ardization of research practice s for SB assessment by accelerometry . The prospect i ve evidence that SB relates to health outcomes is limited in that SB is almost exclusively measured by self-report . The lack of longitudinal studies with objective ly measured SB was recognized as a major research gap , making examination of the association between objective ly measured SB and adverse health outcomes in longitudinal studies a research priority . Specifically , studies with repeated measures of SB , evaluating dose-response relationships , with inclusion of more diverse population s are needed 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 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 OBJECTIVES The purpose of this study was to examine the convergent validity of the Actical and activPAL to measure  sedentary behaviour ( SB ) and non-SB in preschoolers in a free-living environment . DESIGN A convenience sample of 49 preschoolers ( 22 boys ; 4.0 ± 0.5 years ) from six early childhood centres in Auckl and , New Zeal and were included in data analysis . METHODS Participants wore a hip-mounted Actical and a thigh-mounted activPAL accelerometer simultaneously during centre attendance for one day and data were collected in 15s epochs . Bl and -Altman tests were used to assess differences in group mean minutes and percentage of time in (non-)SB between both monitors . Agreement between binary coded ( SB vs. non-SB ) 15s-by-15s Actical and activPAL data was evaluated by calculating percentage agreement and κ statistic . RESULTS The monitors were worn on average for 294.8 ± 46.3 min result ing in a total of 57,780 15s epochs . Bl and -Altman tests suggested a small group mean difference in (non-)SB ( 1.3 min ; 0.1 % ) and a wide prediction interval ( 121.3 min ; 39.2 % ) . No obvious systematic bias was observed in the Bl and -Altman plot . Percentage agreement between the 15s-by-15s Actical and activPAL data of all participants was 73.0 % ( inter-child range : 36.8 - 93.8 % ) . The κ statistic showed moderate agreement with a value of 0.46 ( 95 % CI : 0.45 - 0.47 ) . CONCLUSIONS Although the group mean estimate of (non-)SB was similar between the Actical and activPAL , the output of both monitors can not be considered convergent as meaningful r and om disagreement was found between both monitors 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 ) 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 Background : A number of cross‐sectional studies have suggested that higher levels of  sedentary behavior ( SB ) are associated with worse cognitive abilities  in older age . There is a paucity of longitudinal studies investigating this relationship utilizing objective ly assessed SB . This study investigated the relationship between objective ly assessed SB and future cognitive abilities in a cohort of older adults . Methods : A longitudinal study over 22.12 ± 1.46 months including 285 community‐dwelling older adults across 14 regions in Taiwan was undertaken . Cognitive ability was ascertained using a Chinese version of the Ascertain Dementia 8‐item Question naire ( AD8 ) and SB captured by 7 days accelerometer data . Multivariable negative binomial regression models adjusted for confounders were undertaken . Results : 274 community‐dwelling older adults finished the study ( age = 74.6 ± 6.2 , % female = 54.4 % ) . At baseline , 20.1 % ( n = 55 ) , 48.5 % ( n = 133 ) and 31.4 % ( n = 86 ) of the sample engaged in high ( 11 + h ) , medium ( 7–10.99 h ) and low ( < 7 h ) of SB respectively . In the fully adjusted model , higher levels of SB were associated with an increased risk of worse cognitive ability at follow up ( adjusted rate ratio (ARR)1.09 ( 95%CI:1.00–1.19 ) ) , with the strongest relationship evident in those engaging in over 11 h of SB ( ARR 2.27 ( 95%CI:1.24–4.16 ) ) . The relationship remained evident after adjusting for depressive symptoms and physical activity . Conclusion : Our data suggests that objective ly assessed SB , particularly when over 11 h a day , is independently associated with worse cognitive ability over a two year period . Our data adds to the pressing reasons to reduced SB in older age . HighlightsFirst prospect i ve study to investigate objective  ly sedentary behavior ( SB ) and cognition in older adults . Higher levels of objective SB were independently associated with worse cognitive ability over two years . This relationship was most pronounced in older people spending over 11 h a day being sedentary BACKGROUND Previous research demonstrates that participation in light-intensity physical activity ( LIPA ) and moderate-to-vigorous physical activity ( MVPA ) are favorably associated with health-related quality of life ( HRQOL ) . Emerging work demonstrates that  sedentary behavior  ( SB ) is detrimentally associated with various cardiometabolic biomarkers , with few studies exploring the association of SB on HRQOL , and no studies examining this among congestive heart failure patients . Therefore , the purpose of this study was to examine the potential independent associations of SB on HRQOL among congestive heart failure patients . METHODS Data from the 2003 - 2006 National Health and Nutrition Examination Survey were used .  Physical activity was assessed over 7days during all waking hours using the ActiGraph 7164 accelerometer .  HRQOL was assessed using the Centers for Disease Control HRQOL index survey . RESULTS 190 participants self-reported a physician-diagnosis of congestive heart failure . After adjustments , SB behavior ( 1-min/day increase ) was associated with worse HRQOL ( β=0.004 ; 95 % CI : 0.0004 - 0.007 ; P=0.03 ) . When MVPA was added as a covariate to this model , SB remained significantly associated with worse HRQOL ( β=0.003 ; 95 % CI : 0.0001 - 0.007 ; P=0.04 ) . However , when adding LIPA to this model that also included MVPA as a covariate , SB was no longer associated with HRQOL ( β=0.0001 ; 95 % CI : -0.003 - 0.004 ; P=0.92 ) . CONCLUSIONS If confirmed by prospect ive/experimental work , this suggests that SB may not have detrimental HRQOL effects among congestive heart failure patients 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 Background Patients with rheumatoid arthritis ( RA ) spend a high proportion of their waking time in sedentary behaviour ( SB ) and have an increased risk of cardiovascular disease . Reduction of SB and increase in light intensity physical activity has been suggested as a means of improvement of health in patients with mobility problems . Short-term intervention studies have demonstrated that SB can be reduced by behavioural interventions in sedentary population s. To evaluate descriptively the feasibility of recruitment , r and omisation , outcome assessment s , retention and the acceptability of an individually tailored , theory-based behavioural intervention targeting reduction in daily sitting time in patients with RA . Methods A r and omised , controlled trial with two parallel groups . RA patients > 18 years of age and Health Assessment Question naire ( HAQ ) score < 2.5 were consecutively invited and screened for daily leisure time sitting > 4 h. The 16-week intervention included 1 ) three individual motivational counselling sessions and 2 ) individual text message reminders aim ed at reducing daily sitting time . The control group was encouraged to maintain their usual lifestyles . Outcomes were assessed at baseline and after the 16 week intervention . Daily sitting time was measured using  an ActivPAL3TM activity monitor .  The study was not powered to show superiority ; rather the objective was to focus on acceptability among patients and clinical health professionals . Results In total , 107 patients were invited and screened before 20 met eligibility criteria and consented ; reasons for declining study participation were mostly flares , lack of time and co-morbidities . One patient from the control group dropped out before end of intervention ( due to a RA flare ) . Intervention participants completed all counselling sessions . All procedures regarding implementation of the trial protocol were feasible . The daily sitting time was reduced on average by 0.30 h in the intervention group unlike the control group that tended to increase it by 0.15 h after 16 weeks . Conclusions This study shows that an individually tailored behavioural intervention targeting reduction of SB was feasible and acceptable to patients with RA.Trial registration The Danish Data Protection Agency ( ref.nb . 711 - 1 - 08 - 20 March 2011 ) , the Ethics Committee of the Capital Region of Denmark ( ref.nb . H-2 - 2012 - 112- 17 October 2012 ) , clinical trials.gov ( NCT01969604 - October 17 2013 , retrospectively registered ) Background Physical activity ( PA ) interventions design ed to prevent prenatal complications have focused on increasing moderate PA yielding conflicting results . Minimal attention has focused on the evaluation of sleep , sedentary behavior ( SB ) , light activity or total daily PA during pregnancy . The purpose of this prospect i ve , longitudinal study was to 1 ) objective ly quantify and compare habitual PA and SB during the 2nd and 3rd trimester ; and 2 ) evaluate differences in activity patterns for women meeting prenatal PA guidelines versus those that did not . Methods Forty-six participants wore 2 PA monitors ( SenseWear ® Mini and activPAL ™ ) during week 18 and week 35 of pregnancy . We compared differences in sleep duration , postural allocation , daily steps , and PA between the 2nd and 3rd trimester and for women who met and did not meet PA guidelines . Results During the 2nd trimester , 30 % of the women ’s day ( 24-hours ) was total sleep ; 52 % SB ; 13 % light ; 3 % moderate ; and 0 % vigorous PA . Light ( P = 0.05 ) , vigorous ( P = 0.02 ) , and moderate-vigorous PA ( MET-minutes ; P = 0.02 ) , decreased with a trend in increased SB ( P = 0.07 ) . Activity of other intensities and sleep duration did not significantly change . Only 39 % and 37 % of participants slept between 7–9 hours/night at week 18 and 35 , respectively . Forty-six percent ( n = 21 ) and 28 % ( n = 13 ) of participants met prenatal PA guidelines during the 2nd and 3rd trimester , respectively . At week 18 , no differences in total sleep , SB , or light PA existed for women who met PA guidelines versus those who did not ; total PA was significantly greater for women who met guidelines . At week 35 , women that met PA guidelines had significantly less SB ( P < 0.005 ) than women who did not . Conclusions This study demonstrates that pregnant women spend the majority of their day in SB . Significant reductions in total activity across pregnancy may be attributed , in part to shifts in light PA and increased SB . Based on the lifestyle of our sample , regardless of meeting PA guidelines in mid-pregnancy , no significant difference exists in time spent in SB , however meeting PA recommendations in late pregnancy may reduce SB . Future interventions should target reducing SB by increasing light and moderate PA beyond volitional exercise 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 Regular physical activity ( PA ) and the avoidance of prolonged sitting are essential for children ’s healthy growth , and for the physical and mental wellbeing of both children and adults . In the context of exercise , music may promote behavioral change through increased exercise adherence and participation . The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior ( SB ) and increase PA in mother-child pairs in the home environment . A r and omized controlled trial was conducted in the Pirkanmaa region , Finl and , in 2014–2016 . The participants consisted of 228 mother-child pairs ( child age 5–7 years ) . The primary outcomes of interest were tri-axial accelerometer-derived SB and PA , which were measured in weeks one ( baseline ) , two , and eight in both the intervention and control groups . Further , the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight . Secondary outcomes included self-reported screen time . The statistical methods employed comprised an intention-to-treat and linear mixed effects model design . No statistically significant differences between groups were found in primary or secondary outcomes . Among the children in the control group  , light PA  decreased significantly over time and screen time increased from 89 ( st and ard deviation , SD 37 ) to 99 ( SD 41 ) min/d . Among mothers and children in the intervention group , no statistical differences were found . In supplementary analysis , the children who stayed at home instead of attending daycare/preschool had on average 25 ( 95 % confidence interval , CI 19–30 ) min/d more sedentary time and 11 ( 95 % CI 8–14 ) min/d less moderate-to-vigorous PA than those who were at daycare/preschool . The higher body mass index of mothers was related with 5 ( 95 % CI 2–7 ) min/d more sedentary time and 1 ( 95 % CI 0–2 ) min/d less moderate-to-vigorous PA . The movement-to-music video program did not change the objective ly measured SB or PA of the mother-child pairs . However , mothers and children seemed to be more sedentary at home , and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment PURPOSE The purpose of this study was to examine the effects of two bathing methods on crying duration and physiological measurements of newborns .  DESIGN AND METHODS A r and omized trial design was used in this study . The sample consisted of newborns ( n = 80 ) who were admitted to neonatal intensive care unit of a university hospital located in a large city . The groups were determined as swaddled bathing ( SB ) ( n = 40 ) and traditional tub bathing ( TTB ) ( n = 40 ) by using r and om number table . All newborns were bathed 24 hours after the birth . Environmental variables were organised identically in both experimental and control groups . Duration of bathing was determined as maximum 5 min in both groups . Body temperature , heart rate ( HR ) , and O2 saturation values were evaluated before bath , just after the bath and at 10 min after the bath . The groups were compared in terms of all vital symptoms and duration of crying during bath . Pre-bath and post-bath stress levels between newborns in both groups were compared by using the Newborn Infant Pain Scale ( NIPS ) . RESULTS When the newborns were compared based on groups , it was observed that there was no statistically significant difference between SB and TTB groups in terms of the gestational week , APGAR score , postnatal age , and body weight . Body temperatures of the newborns in SB group just after the bath and 10 minutes after the bath were significantly higher than those in TTB group . HR was higher in TTB group in the post-bath period . NIPS scores of the newborns in SB group after bath decreased at a statistically significant level , but the scores of the newborns in TTB group increased . The results of the study indicated that SB was effective in maintaining body temperature , SpO2 level , and HR of newborns within normal limits and may decrease stress experienced during the bath . PRACTICE IMPLICATION S Swaddled bathing decreases behavioural stress symptoms such as crying , agitation , and pulling arms and legs back unintentionally and thus the infants feel relaxed . Swaddled bathing can be recommended because swaddled bathing method decreases behavioural stress symptoms in infants PURPOSE To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targeted biopsy ( TB ) with that of extended systematic biopsy ( SB ) in prostate cancer ( PCa ) detection . MATERIAL S AND METHODS This institutional review board-approved multicenter prospect i ve study ( May 2009 to January 2011 ) included 95 patients with informed consent who were suspected of having PCa , with a suspicious abnormality ( target ) at prebiopsy MR . Patients underwent  12-core SB and four-core TB with transrectal ultrasonographic ( US ) guidance , with two cores aim ed visually ( cognitive TB [ TB-COG ] ) and two cores aim ed using transrectal US-MR fusion software ( fusion-guided TB [ TB-FUS ] ) . SB and TB positivity for cancer and sampling quality ( mean longest core cancer length , Gleason score ) were compared . Clinical ly significant PCa was any 3 mm or greater core cancer length or any greater than 3 Gleason pattern for SB or any cancer length for TB . Statistical analysis included t test , paired χ(2 ) test , and κ statistic . Primary end point ( core cancer length ) was calculated ( paired t test ) . RESULTS Among 95 patients ( median age , 65 years ;  mean prostate-specific antigen level  , 10.05 ng/mL [ 10.05 μg/L ] ) , positivity rate for PCa was 59 % ( n = 56 ) for SB and 69 % ( n = 66 ) for TB ( P = .033 ) ; rate for clinical ly significant PCa was 52 % ( n = 49 ) for SB and 67 % ( n = 64 ) for TB ( P = .0011 ) . Cancer was diagnosed through TB in 16 patients ( 17 % ) with negative SB results . Mean longest core cancer lengths were 4.6 mm for SB and 7.3 mm for TB ( P < .0001 ) . In 12 of 51 ( 24 % ) MR imaging targets with positive SB and TB results , TB led to Gleason score upgrading . In 79 MR imaging targets , positivity for cancer was 47 % ( n = 37 ) with TB-COG and 53 % ( n = 42 ) with TB-FUS ( P = .16 ) . Neither technique was superior for Gleason score assessment .  CONCLUSION Prebiopsy MR imaging combined with transrectal US-guided TB increases biopsy performance in detecting PCa , especially clinical ly significant PCa . No significant difference was observed between TB-FUS and TB-COG for TB guidance Background To investigate the interpersonal and physical environment mediators of the Transform-Us ! mid-intervention effects on  physical activity ( PA )  during recess and lunchtime . Methods Transform-Us ! is a clustered r and omised school-based intervention with four groups : sedentary behaviour intervention ( SB-I ) , PA intervention ( PA-I ) , combined PA+SB-I and control group .  All children in grade 3 from 20 participating primary schools in Melbourne , Australia were eligible to complete annual evaluation assessment s. The outcomes were the proportion of time spent in moderate-to-vigorous PA ( MVPA ) and light PA ( LPA )  during recess and lunchtime assessed by accelerometers . Potential mediators included : perceived social support from teachers ; perceived availability of line markings ; perceived accessibility of sports equipment ; and perceived school play environment . Generalised linear models were used and mediation effects were estimated by product-of-coefficients ( a·b ) approach . Results 268 children ( 8.2 years , 57 % girls at baseline ) provided complete data at both time points . A significant intervention effect on MVPA during recess in the SB-I and PA-I groups compared with the control group ( proportional difference in MVPA time ; 38 % ( 95 % CI 21 % to 57 % ) and 40 % ( 95 % CI 20 % to 62 % ) , respectively ) was found . The perceived school play environment was significantly positively associated with MVPA at recess among girls . An increase in perceived social support from teachers suppressed  the PA+SB-I effect on light PA  during recess ( a·b= −0.03 , 95 % CI −0.06 to −0.00 ) . No significant mediating effects  on PA during recess and lunchtime were observed . Conclusions A positive perception of the school play environment was associated with higher MVPA during recess among girls . Future studies should conduct mediation analyses to explore underlying mechanisms of PA interventions Background Individuals affected by severe Borderline Personality Disorder ( BPD ) are often heavy users of Mental Health Services ( MHS ) . Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use . Therefore , alternative short-term treatments , less complex than long-term psychodynamic psychotherapies but specifically oriented to BPD core problems , need to be developed to reduce MHS overuse . This study aim ed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy ( SB-APP ) to Supervised Team Management ( STM ) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD . Effectiveness was evaluated 6 times along a two-year follow-up . Methods Thirty-five out patients who met inclusion criteria were r and omly assigned to two treatment groups ( STM = 17 ; SB-APP = 18 ) and then compared . Clinical Global Impression ( CGI ) and CGI-modified ( CGI-M ) for BPD , Global Assessment of Functioning ( GAF ) , State-Trait Anger Expression Inventory ( STAXI ) , and Symptom Checklist-90 Revised ( SCL-90-R ) were administered at T1 , T3 , T6 , T12 , T18 and T24 . At T12 the Working Alliance Inventory-Short Form ( WAI-S ) was also completed . At the one-year follow-up , SB-APP group did not receive any additional individual psychological support . MHS team was specifically trained in BPD treatment and had regular supervisions . Results All patients improved on CGI , GAF , and STAXI scores after 6 and 12 months , independently of treatment received . SB-APP group showed better outcome on impulsivity , suicide attempts , chronic feelings of emptiness , and disturbed relationships . We found a good stabilization at the one year follow-up , even after the interruption of brief psychotherapy in the SB-APP group . Conclusions Although STM for BPD applied to heavy MHS users was effective in reducing symptoms and improving their global functioning , adding a time-limited and focused psychotherapy was found to achieve a better outcome . In particular , focusing treatment on patients ' personality with a specific psychotherapeutic approach ( i.e. SB-APP ) seemed to be more effective than STM alone . Trial Registration Clinical Trials.gov : Background Little is known about the concurrent change in  physical activity ( PA )  ,  sedentary behavior ( SB ) and  sport participation  ( SP ) during adolescence . The main purpose of this prospect i ve and partly objective study was to simultaneously investigate PA , SBs and SP changes between the 1st and 2nd grade s of high school in urban adolescents . Methods In this 1-year follow-up study , the participants were 81 secondary -school students ( 28 boys and 53 girls ) aged 15.5 years at the baseline .  PA was assessed with the SenseWear Armb and multi-sensor activity monitor , while SBs were assessed by using School Health Action , Planning and Evaluation System ( SHAPES ) PA question naire . The SHAPES question naire was supplemented with two questions inquiring about SP in organized sports in school and outside of school . Results PA decreased markedly in both genders between the 1st and 2nd grade s of high school . Total energy expenditure ( TEE ) was reduced by 13 kcal/kg/day on average in boys and by 10 kcal/kg/day in girls ( p for both < 0.001 ) , while mean daily active energy expenditure ( AEE ) decreased by 7 kcal/kg/day ( p < 0.001 ) and 3 kcal/kg/day ( p = 0.04 ) in boys and girls , respectively . Similarly , the amount of moderate PA declined by 49 min/day in boys and 21 min/day in girls ( p for both < 0.001 ) . At the same time vigorous PA was cut by 14 min/day ( p < 0.001 ) and 3 min/day ( p = 0.003 ) in boys and girls , respectively . Conversely , time spent in SBs did not show any change . Conclusion In conclusion , a decline in PA between the 1st and 2nd grade s of high school was marked but was not accompanied with an increase in SBs . Policies aim ed at increasing PA should be targeting the period of entering secondary school to offset the observed drop in PA 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 Background : Video capsule endoscopy ( VCE ) and magnetic resonance enterography ( MRE ) are the prime modalities for the evaluation of small bowel ( SB ) Crohn ’s disease ( CD ) . Mucosal inflammation on VCE is quantified using the Lewis score ( LS ) . Diffusion-weighted ( DW ) magnetic resonance imaging ( MRI ) allows for accurate assessment of SB inflammation without administration of intravenous contrast material . The Magnetic Resonance Index of Activity ( MaRiA ) and the Clermont index are quantitative activity indices vali date d for contrast-enhanced MRE and DW-MRE , respectively . The aim of this study was to compare the quantification of distal SB inflammation by VCE and MR-related activity indices . Methods : Patients with known quiescent SB CD were prospect ively recruited and underwent MRE and VCE . LS , MaRIA and Clermont scores were calculated for the distal SB . Results : Both MRI-based indices significantly correlated with the LS and the Clermont index ( r = 0.50 , p = 0.001 and r = 0.53 , p = 0.001 , respectively ) . Both MaRIA and Clermont scores were significantly lower in patients with mucosal healing ( LS < 135 ) . The area under the curve ( AUC ) with both MR scores was moderate for prediction of any mucosal inflammation ( LS ⩾ 135 ) and excellent for prediction of moderate-to-severe inflammation ( LS ⩾ 790 ) ( 0.71 and 0.74 versus 0.93 and 0.91 for MaRIA and Clermont score , respectively ) . Conclusions : Modest correlation between VCE- and MRE-based quantitative indices of inflammation in patients with quiescent SB CD was observed . Between-modality correlation was higher in patients with endoscopically severe disease . DW-MRE gauged by Clermont score was at least as accurate as contrast-enhanced MRE for quantification of SB inflammation PURPOSE Health interventions based on theory may be more effective than those that are not . This review of review s synthesizes all published r and omized controlled trial ( RCT ) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective  adult health behaviour change interventions . METHODS Systematic review s including meta-analyses were identified by search ing Medline , CINAHL , PsycINFO , and CDSR . A narrative synthesis was used to summarize and analyse the evidence . Only review s including RCTs of health behaviour change interventions with adults aged 18 + published from 2007 to 2017 were included . RESULTS Of 8,659 articles , nine systematic review s met inclusion criteria . The majority of review s ( n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour . Less than half of the RCTs included in the review s reported the use of theory ( 85/183 ) . Two review s suggested interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Method ological and reporting issues limit the conclusions . CONCLUSIONS Theory-based interventions as currently operationalized in systematic review s were not found to be more effective than non-theory-based interventions . Method ological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions . The promotion of theory use may benefit from using a multifaceted argument , rather than a narrow focus of increased effectiveness . Statement of contribution What is already known on this subject ? Theory use is regularly promoted by cl aim ing that it will lead to more effective behaviour change interventions . Theory use has been frequently linked to effectiveness within systematic review s of behaviour change interventions . The theory-effectiveness hypothesis has not been systematic ally examined at the systematic review level . What does this study add ? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic review s examining r and omized controlled trials of behaviour change interventions in adults . Interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Theory use should be promoted using a multifaceted argument , and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this cl aim
Associations between objective ly measured total sedentary time and indicators of adiposity and motor development were predominantly null .
Associations between screen time and indicators of adiposity , motor or cognitive development , and psychosocial health were primarily unfavourable or null .
Associations between time spent seated ( e.g. , in car seats or strollers ) or in the supine position , and indicators of adiposity and motor development , were primarily unfavourable or null .
Conclusions These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years , but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling .
Background The purpose of this systematic review was to examine the relationships between  sedentary behaviour ( SB ) and health indicators in children aged 0 to 4 years , and to determine what doses of SB ( i.e. , duration , patterns [ frequency , interruptions ] , and type ) were associated with health indicators .