Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified , providing a set of specific evidence -based strategies that deserve close attention and prioritization for wider implementation .
Effective interventions included specific approaches in all 6 domains evaluated for improving diet , increasing activity , and reducing tobacco use .
The writing group also identified several specific interventions in each of these domains for which current evidence was less robust , as well as other inconsistencies and evidence gaps , informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies .
This systematic review identified and grade d the evidence for a range of population -based strategies to promote lifestyle change .
BACKGROUND Poor lifestyle behaviors , including suboptimal diet , physical inactivity , and tobacco use , are leading causes of preventable diseases globally .
Although even modest population shifts in risk substantially alter health outcomes , the optimal population -level approaches to improve lifestyle are not well established .
Prevention through Activity in Kindergarten Trial (PAKT): A cluster randomised controlled trial to assess the effects of an activity intervention in preschool children
Background Physical activity and motor skills acquisition are of high importance for health-related prevention and a normal development in childhood . However , few intervention studies exist in preschool children focussing on an increase in physical activity and motor skills  . Proof of positive effects is available but not consistent . Methods / Design The design , curriculum , and evaluation strategy of a cluster r and omised intervention study in preschool children are described in this manuscript . In the Prevention through Activity in Kindergarten Trial ( PAKT ) , 41 of 131 kindergartens of Wuerzburg and Kitzingen , Germany , were r and omised into an intervention and a control group by a r and om number table stratified for the location of the kindergarten in an urban ( more than 20.000 inhabitants ) or rural area . The aims of the intervention were to increase physical activity and motor skills in the participating children , and to reduce health risk factors as well as media use . The intervention was design ed to involve children , parents and teachers , and lasted one academic year . It contained daily 30-min sessions of physical education in kindergarten based on a holistic pedagogic approach termed the " early psychomotor education " . The sessions were instructed by kindergarten teachers under regular supervision by the research team . Parents were actively involved by physical activity homework cards . The kindergarten teachers were trained in workshops and during the supervision . Assessment s were performed at baseline , 3 - 5 months into the intervention , at the end of the intervention and 2 - 4 months after the intervention . The primary outcomes of the study are increases in physical activity ( accelerometry ) and in motor skills performance ( composite score of obstacle course , st and ing long jump , balancing on one foot , jumping sidewise to and fro ) between baseline and the two assessment s during the intervention . Secondary outcomes include decreases in body adiposity ( BMI , skin folds ) , media use ( question naire ) , blood pressure , number of accidents and infections ( question naire ) , increases in specific motor skills ( throwing , balancing , complex motor performance , jumping ) and in flexibility . Discussion If this trial proofs the effectiveness of the multilevel kindergarten based physical activity intervention on preschooler 's activity levels and motor skills , the programme will be distributed nationwide in Germany . Trial Registration Clinical Trials.gov Identifier :
Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified , providing a set of specific evidence -based strategies that deserve close attention and prioritization for wider implementation .
Effective interventions included specific approaches in all 6 domains evaluated for improving diet , increasing activity , and reducing tobacco use .
The writing group also identified several specific interventions in each of these domains for which current evidence was less robust , as well as other inconsistencies and evidence gaps , informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies .
This systematic review identified and grade d the evidence for a range of population -based strategies to promote lifestyle change .
BACKGROUND Poor lifestyle behaviors , including suboptimal diet , physical inactivity , and tobacco use , are leading causes of preventable diseases globally .
Although even modest population shifts in risk substantially alter health outcomes , the optimal population -level approaches to improve lifestyle are not well established .