Physical inactivity and short-term all-cause mortality in adults with chronic disease. School physical education: effect of the Child and Adolescent Trial for Cardiovascular Health. Prevalence of physical inactivity in nine rural INDEPTH Health and Demographic Surveillance Systems in five Asian countries Physical inactivity is a risk factor for physical activity-related injuries in children Design of the Quality of Life in Motion (QLIM) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of a combined physical exercise and psychosocial training program to improve physical fitness in children with cancer Physical activity and cause-specific mortality in men: Further evidence from the Whitehall study The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study Physical activity and obesity mediate the association between childhood motor function and adolescents’ academic achievement A school-based physical activity program to improve health and fitness in children aged 6–13 years ("Kinder-Sportstudie KISS"): study design of a randomized controlled trial [ISRCTN15360785] The economic burden of physical inactivity in Canada. Effect of a school-based intervention to promote healthy lifestyles in 7–11 year old children Impact of a nurse-directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: a parallel-group, randomized control trial. Associations between Physical Activity and Health Parameters in Adolescent Pupils in Egypt A school-based intervention to teach third grade children about the prevention of heart disease. Long term health implications of fitness and physical activity patterns. Physical activity trajectories and mortality: population based cohort study Dance for health: improving fitness in African American and Hispanic adolescents.
OBJECTIVE To ascertain the relationship of physical inactivity and short-term all-cause mortality in a prospect i ve cohort of r and omly selected managed care organization members aged 40 years and older who have multiple chronic diseases . METHODS Clinical data bases were used to identify all health plan members aged 40 years and older with 2 or more chronic health conditions ( hypertension , coronary heart disease , diabetes mellitus , or dyslipemia ) in 1994 . A r and om sample of 2336 members was surveyed by mail and telephone interview regarding their health-related behaviors .  Survey data were linked to mortality data from the 1995 to 1997 Minnesota Death Index . Cox proportional hazards regression was used to ascertain the association between physical inactivity and subsequent all-cause mortality , adjusting for potential confounders . RESULTS Members who reported less than 30 minutes a week of physical activity at baseline had a subsequent mortality risk ratio of 2.82 ( P<.001 ) vs those with 30 or more minutes of physical activity a week . Increased mortality risk persisted ( mortality risk ratio , 2.15 ; P<.001 ) after adjustments for age , sex , current smoking , functional impairment , and comorbidity score . CONCLUSIONS In adults with chronic diseases , the physically inactive had higher observed mortality within a 42-month period . If physical inactivity reflects an independent mortality risk , efforts to maintain physical activity in such patients may yield significant clinical benefits within a short period . By contrast , if inactivity is primarily a proxy for other factors that elevate mortality risks , a simple physician inquiry regarding inactivity may help to identify patients at risk of death BACKGROUND Physical inactivity is a risk behavior for cardiovascular and other diseases . Schools can promote public health objectives by increasing physical activity among youth . METHODS The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) was a multicenter , r and omized trial to test the effectiveness of a cardiovascular health promotion program in 96 public schools in four states . A major component of CATCH was an innovative , health-related physical education ( P+ ) program . For 2.5 years , r and omly assigned schools received a st and ardized PE intervention , including curriculum , staff development , and follow-up . RESULTS Systematic analysis of 2,096 PE lessons indicated students engaged in more moderate-to-vigorous physical activity ( MVPA ) in intervention than in control schools ( P = 0.002 ) . MVPA during lessons in intervention schools increased from 37.4 % at baseline to 51.9 % , thereby meeting the established Year 2000 objective of 50 % . Intervention children reported 12 more min of daily vigorous physical activity ( P = 0.003 ) and ran 18.6 yards more than control children on a 9-min run test of fitness ( P = 0.21 ) . CONCLUSIONS The implementation of a st and ardized curriculum and staff development program increased children 's  MVPA in existing school PE classes in four geographic and ethnically diverse communities . CATCH PE provides a tested model for improving physical education in American schools Background : Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases ( NCDs ) such as stroke and heart disease . In high income countries , studies have measured the population level of physical activity , but comparable data are lacking from most low and middle-income countries . Objective : To assess the level of physical inactivity  and its associated factors in selected rural sites in five Asian countries . Methods : The multi-site cross-sectional study was conducted in nine rural Health and Demographic Surveillance System ( HDSS ) sites within the INDEPTH Network in Bangladesh , India , Indonesia , Thail and , and Vietnam . Using the methodology from the WHO STEPwise approach to Surveillance ( STEPS ) , about 2,000 men and women aged 25–64 years were selected r and omly from each HDSS sampling frame .  Physical activity at work and during leisure time , and on travel to and from places , was measured using the Global Physical Activity Question naire version 2 ( GPAQ2 ) . The total activity was calculated as the sum of the time spent in each domain of activities in metabolic equivalent-minutes per week , and was used to determine the level of physical activity . Multivariable logistic regression was used to assess demographic factors associated with a low level of physical activity . Results : The prevalence of physical inactivity ranged from 13 % in Chililab HDSS in Vietnam to 58 % in Filabavi HDSS in Vietnam . The majority of men  were physically active , except in the two sites in Vietnam . Most of the respondents walked or cycled for at least 10 minutes to get from place to place , with some exceptions in the HDSSs in Indonesia and Thail and . The majority of respondents , both men and women , were inactive during their leisure time . Women , older age , and high level of education were significantly associated with physical inactivity . Conclusion : This study showed that over 1/4 men and 1/3 women in Asian HDSSs within the INDEPTH Network are physically inactive . The wide fluctuations between the two HDSS in Vietnam offer an opportunity to explore further urbanisation and environmental impacts on physical activity . Considering the importance of physical activity in improving health and preventing chronic NCDs , efforts need to be made to promote physical activity particularly among women , older people , and high education groups in these setting Objectives To describe the risk factors associated with injuries result ing from physical education ( PE ) , leisure time physical activity ( leisure time PA ) and sports in 9–12-year-old children . Design Prospect i ve cohort study . Setting Primary schools . Participants Nine hundred and ninety-five children aged 9–12 years . Main outcome measures Injuries occurring during either PE class  , leisure time PA or sports , and caused the child to at least stop the current activity were recorded prospect ively . Individual weekly exposure was estimated from baseline and follow-up question naires . Potential risk factors were gender , age , socioeconomic status , ethnicity , habitual level of PA , body mass index and a motor fitness . A multivariate Cox proportional hazard regression model was developed , accounting for clustering within schools . Results Gender , age and level of PA were independent significant risk factors for injury . Different modalities of PA had different injury risk factors . Most importantly , the low levels of habitual PA  significantly increased injury risk . Conclusions The children at highest injury risk are the target audience of the contemporary PA promotion efforts . PA promotion should also focus on injury prevention Background Childhood cancer and its treatment have considerable impact on a child 's physical and mental wellbeing . Especially long-term administration of chemotherapy and /or radiotherapy impairs physical fitness both during and after therapy , when children often present with muscle weakness and /or low cardiorespiratory fitness . Physical exercise can improve these two elements of physical fitness , but the positive effects of physical exercise might be further increased when a child 's wellbeing is simultaneously enhanced by psychosocial training . Feeling better may increase the willingness and motivation to engage in sports activities . Therefore , this multi-centre study evaluates the short and long-term changes in physical fitness of a child with a childhood malignancy , using a combined physical exercise and psychosocial intervention program , implemented during or shortly after treatment . Also examined is whether positive effects on physical fitness reduce inactivity-related adverse health problems , improve quality of life , and are cost-effective . Methods This multi-centre r and omized controlled trial compares a combined physical and psychosocial intervention program for children with cancer , with care as usual ( controls ) . Children with cancer ( aged 8 - 18 years ) treated with chemotherapy and /or radiotherapy , and who are no longer than 1 year post-treatment , are eligible for participation . A total of 100 children are being recruited from the paediatric oncology/haematology departments of three Dutch university medical centres . Patients are stratified according to pubertal stage ( girls : age ≤10 or > 10 years ; boys : ≤11 or > 11 years ) , type of malignancy ( haematological or solid tumour ) , and moment of inclusion into the study ( during or after treatment ) , and are r and omly assigned to the intervention or control group . Discussion Childhood cancer patients undergoing long-term cancer therapy may benefit from a combined physical exercise and psychosocial intervention program since it may maintain or enhance their physical fitness and increase their quality of life . However , the feasibility , patient need , and effectiveness of such a program should be established before the program can be implemented as part of st and ard care . Trial registration numberNTR1531 ( The Netherl and s National Trial Register Reports of studies relating physical activity to stroke and cancer sub-types indicate inconsistent findings . Some are hampered by low statistical power , owing to a low number of events , and a failure to adjust for potential confounding variables . The purpose of this study was to relate physical activity to 12 mortality endpoints in a prospect i ve cohort study of 11,663 men aged 40–64 years who responded to an enquiry about travel activity during a baseline medical examination conducted between 1967 and 1969 . During 25 years of follow-up there were 4672  deaths .  Travel activity  was inversely related to mortality attributable to all-causes , coronary heart disease , respiratory disease and lung cancer , whereas the association with stroke was positive . There was evidence for attenuation of some of these associations on adjustment for potentially confounding variables . Our simplistic measure of physical activity may , in part , explain the weak associations seen BACKGROUND Physical activity has a protective effect against  cardiovascular disease ( CVD )  in high-income countries , where physical activity is mainly recreational , but it is not known if this is also observed in lower-income countries , where physical activity is mainly non-recreational . We examined whether different amounts and types of physical activity are associated with lower mortality and CVD  in countries at different economic levels . METHODS In this prospect i ve cohort study , we recruited participants from 17 countries ( Canada , Sweden , United Arab Emirates , Argentina , Brazil , Chile , Pol and , Turkey , Malaysia , South Africa , China , Colombia , Iran , Bangladesh , India , Pakistan , and Zimbabwe ) . Within each country , urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity . Within these communities , we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years .  Total physical activity  was assessed using the  International Physical Activity Question naire ( IPQA ) . Participants with pre-existing CVD were excluded from the analyses . Mortality and CVD were recorded during a mean of 6·9 years of follow-up . Primary clinical outcomes during follow-up were mortality plus major CVD ( CVD mortality , incident myocardial infa rct ion , stroke , or heart failure ) , either as a composite or separately . The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household , community , and country clustering . FINDINGS Between Jan 1 , 2003 , and Dec 31 , 2010 , 168 916 participants were enrolled , of whom 141 945 completed the IPAQ . Analyses were limited to the 130 843 participants without pre-existing CVD . Compared with low physical activity ( < 600 metabolic equivalents [ MET ] × minutes per week or < 150 minutes per week of moderate intensity physical activity ) , moderate ( 600 - 3000 MET × minutes or 150 - 750 minutes per week ) and high physical activity ( > 3000 MET × minutes or > 750 minutes per week ) were associated with grade d reduction in mortality ( hazard ratio 0·80 , 95 % CI 0·74 - 0·87 and 0·65 , 0·60 - 0·71 ; p<0·0001 for trend ) , and major CVD ( 0·86 , 0·78 - 0·93 ; p<0·001 for trend  ) . Higher physical activity was associated with lower risk of CVD and mortality  in high-income , middle-income , and low-income countries . The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0 % for mortality and 4·6 % for major CVD , and for not meeting high physical activity was 13·0 % for mortality and 9·5 % for major CVD . Both recreational and non-recreational physical activity were associated with benefits . INTERPRETATION Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income , middle-income , and high-income countries . Increasing physical activity is a simple , widely applicable , low cost global strategy that could reduce deaths and CVD in middle age . FUNDING Population Health Research Institute , the Canadian Institutes of Health Research , Heart and Stroke Foundation of Ontario , Ontario SPOR Support Unit , Ontario Ministry of Health and Long-Term Care , AstraZeneca , Sanofi-Aventis , Boehringer Ingelheim , Servier , GSK , Novartis , King Pharma , and national and local organisations in participating countries that are listed at the end of the Article The global epidemic of obesity and physical inactivity may have detrimental implication s for young people ’s  cognitive function and academic achievement . This prospect i ve study investigated whether childhood motor function predicts later academic achievement via physical activity , fitness , and obesity . The study sample included 8,061 children from the Northern Finl and Birth Cohort 1986 , which contains data about parent-reported motor function at age 8 y and self-reported physical activity , predicted cardiorespiratory fitness ( cycle ergometer test ) , obesity ( body weight and height ) , and academic achievement ( grade s ) at age 16 y.  Structural equation models with unst and ardized ( B ) and st and ardized ( β ) coefficients were used to test whether , and to what extent , physical activity , cardiorespiratory fitness , and obesity at age 16 mediated the association between childhood motor function and adolescents ’ academic achievement . Physical activity was associated with a higher grade -point average , and obesity was associated with a lower grade -point average in adolescence . Furthermore , compromised motor function in childhood had a negative indirect effect on adolescents ’ academic achievement via physical inactivity ( B = –0.023 , 95 % confidence interval = –0.031 , –0.015 ) and obesity ( B = –0.025 , 95 % confidence interval = –0.039 , –0.011 ) , but not via cardiorespiratory fitness . These results suggest that physical activity and obesity may mediate the association between childhood motor function and adolescents ’ academic achievement . Compromised motor function in childhood may represent an important factor driving the effects of obesity and physical inactivity on academic underachievement Background Childhood obesity is the result of a long lasting imbalance between energy intake and energy expenditure . A major contributing factor is physical inactivity which is closely linked to bone health , cardiovascular disease risk , fitness and psychological factors . The school seems to provide an excellent setting to enhance levels of  physical activity ( PA ) .  However , there is insufficient data from previous school-based intervention trials on how to enhance overall PA . It is also unknown whether an intervention aim ed at increasing PA is effective in improving the children 's health . The purpose of this paper is to outline the design of a school-based r and omized , controlled trial ( RCT ) aim ing to increase overall PA and to improve fitness and health in 6- to 13-year-old children . Methods / Design 15 schools were r and omized to the intervention ( n = 9 ) or the control ( n = 6 ) group , stratified by geographic region ( urban vs. rural ) and by age ( 1st and 5th grade ) . Participation was given for all children in the intervention group since in this group the intervention was part of the normal school curriculum . The intervention during one academic year consisted of : 1 . two additional physical education classes per week given by trained physical education teachers adding up to a total of five PA classes per week , 2 . short PA breaks ( 2–5 min each ) during academic lessons , 3 . PA home work , and 4 . adaptation of recreational areas around the school . All children underwent  anthropometric measurements , blood pressure assessment , fitness testing , measurement of PA  and they filled out question naires . At least 70 % of all children agreed to blood sampling and measurements of body composition and bone mineral measurements by dual energy x-ray absorptiometry . The primary endpoints of the study after one year were an increase in total PA by accelerometry , an increase in aerobic fitness measured by the 20 m shuttle run , a decrease in percent body fat derived from skinfold measurements and an increase in quality of life as assessed by the child health question naire in the intervention group compared to the control group . Secondary outcomes were overall fitness , differences in body composition including body fat distribution , cardiovascular risk factors , psychosocial health , bone mineral content and density of femur , lumbar spine and total body and food intake . Discussion Our preliminary data suggest that the children were representative of Swiss children with respect to sex , socio-demographic status , and body mass index . Short-term results can be expected by the beginning of 2007 . We hypothesized that our intervention will lead to an increase in PA , fitness and overall health . Based on our data , we aim to provide important information regarding the influence of such an intervention on these outcome measures in school-aged children and to provide nationwide guidelines to improve PA in children BACKGROUND About two-thirds of Canadians are physically inactive . As a risk factor for several chronic diseases , physical inactivity can potentially be a substantial public health burden . We estimated the direct health care costs attributable to  physical inactivity  in Canada , the number of lives lost prematurely each year that are attributable to a sedentary lifestyle and the effect that a reduction of 10 % in inactivity levels ( a Canadian objective for 2003 ) could have on reducing direct health care costs . METHODS We calculated summary relative risk ( RR ) estimates from prospect i ve longitudinal studies of the effects of physical inactivity on coronary artery disease , stroke , colon cancer , breast cancer , type 2 diabetes mellitus and osteoporosis . We then computed the population -attributable fraction ( PAF ) for each illness from the summary RR and the prevalence of physical inactivity ( i.e. , 62 % ) and applied the PAF to the total direct health care expenditures for 1999 and to the number of deaths in 1995 associated with each disease to determine the health care costs and lives lost prematurely that were directly attributable to physical inactivity . RESULTS About $ 2.1 billion , or 2.5 % of the total direct health care costs in Canada , were attributable to physical inactivity in 1999 . A sensitivity analysis ( simultaneously varying each of the health care costs and PAF by + /- 20 % ) indicated that the costs could be as low as $ 1.4 billion and as high as $ 3.1 billion . About 21,000 lives were lost prematurely in 1995 because of inactivity . A 10 % reduction in the prevalence of physical inactivity has the potential to reduce direct health care expenditures by $ 150 million a year . INTERPRETATION Physical inactivity represents an important public health burden in Canada . Even modest reductions in inactivity levels could result in substantial cost savings Background Physical inactivity is recognised as a public health concern within children and interventions to increase physical activity are needed . The purpose of this research was to evaluate the effect of a school-based healthy lifestyles intervention on physical activity , fruit and vegetable consumption , body composition , knowledge , and psychological variables . Method A non-r and omised controlled study involving 8 primary schools ( 4 intervention , 4 control ) . Participants were 589 children aged 7–11 years . The intervention lasted 10 months and comprised a CD-rom learning and teaching re source for teachers ; an interactive website for pupils , teachers and parents ; two highlight physical activity events ( 1 mile school runs/walks ) ; a local media campaign ; and a summer activity wall planner and record . Primary outcome measures were objective ly measured physical activity ( pedometers and accelerometers ) and fruit and vegetable consumption . Secondary outcomes included body mass index , waist circumference , estimated percent body fat , knowledge , psychological variables . Multi-level modelling was employed for the data analysis . Results Relative to children in control schools , those in intervention schools significantly increased their total time in moderate-to-vigorous physical activity ( MVPA ) ( by 9 minutes/day vs a decrease of 10 minutes/day ) , their time in MVPA bouts lasting at least one minute ( 10 minutes/day increase vs no change ) and increased daily steps ( 3059 steps per day increase vs 1527 steps per day increase ) . A similar pattern of results was seen in a subset of the least active participants at baseline . Older participants in intervention schools showed a significant slowing in the rate of increase in estimated percent body fat , BMI , and waist circumference . There were no differences between groups in fruit and vegetable intake . Extrinsic motivation decreased more in the intervention group . Conclusion The intervention produced positive changes in physical activity levels and body composition . It appeared to have little or no effect on consumption of fruit and vegetables . Schools are a suitable setting for the promotion of healthy lifestyles although more work , particularly focussed on dietary change , is needed in a variety of schools and social setting BACKGROUND Underserved children , particularly girls and those in urban communities , do not meet the recommended physical activity guidelines ( > 60min of daily physical activity ) , and this behavior can lead to obesity . The school years are known to be a critical period in the life course for shaping attitudes and behaviors . Children look to schools for much of their access to physical activity . Thus , through the provision of appropriate physical activity programs , schools have the power to influence apt physical activity choices , especially for underserved children where disparities in obesity-related outcomes exist . OBJECTIVES To evaluate the impact of a nurse directed , coordinated , culturally sensitive , school-based , family-centered lifestyle program on activity behaviors and body mass index . DESIGN , SETTING S AND PARTICIPANTS This was a parallel group , r and omized controlled trial utilizing a community-based participatory research approach , through a partnership with a University and 5 community schools . Participants included 251 children ages 8 - 12 from elementary schools in urban , low-income neighborhoods in Los Angeles , USA . METHODS The intervention included Kids N Fitness ( © ) , a 6-week program which met weekly to provide 45min of structured physical activity and a 45min nutrition education class for parents and children . Intervention sites also participated in school-wide wellness activities , including health and counseling services , staff professional development in health promotion , parental education newsletters , and wellness policies for the provision of healthy foods at the school . The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Question naire measured physical activity behavior , including : daily physical activity , participation in team sports , attending physical education class , and TV viewing/computer game playing . Anthropometric measures included height , weight , body mass index , resting blood pressure , and waist circumference . Measures were collected at baseline , completion of the intervention phase ( 4 months ) , and 12 months post-intervention . RESULTS Significant results for students in the intervention , included for boys decreases in TV viewing ; and girls increases in daily physical activity , physical education class attendance , and decreases in body mass index z-scores from baseline to the 12 month follow-up . CONCLUSIONS Our study shows the value of utilizing nurses to implement a culturally sensitive , coordinated , intervention to decrease disparities in activity and TV viewing among underserved girls and boys Physical activity ( PA ) could be protective against  hypertension  , atherosclerosis , coronary heart disease and cardiovascular disease . This quantitative study assessed the association between a PA intervention and three anthropometric parameters ( weight , body mass index , body fat ) and four physiological parameters ( cholesterol level , systolic blood pressure , diastolic blood pressure , heart rate ) among secondary school pupils ( N = 160 ) in Egypt through the school term . The pupils were r and omised to an intervention group ( 80 pupils ) and controls ( 80 pupils ) . Measurements were obtained for all pupils twice : at baseline ; and then again after three months . The PA intervention programme comprised an ‘ afterschool ’ one hour of moderate exercise three times a week for three months . Both the controls and the intervention pupils attended the ‘ normal ’ exercise schedule provided by the school ; in addition , the intervention group attended afterschool PA programme from about 2–3 o’clock in the afternoon . At baseline , employing pupil ’s BMI , 27.5 % and 28.8 % of the intervention and control pupils respectively were classified as overweight . After three months , the percentage of overweight decreased to 12.5 % in the intervention pupils , while it increased to 37.3 % in the controls . At the end of the three months period , there were significant improvements across most anthropometric and physiological parameters of the intervention pupils when compared with the control children . The correlation coefficient of the improvements for the boys and the girls was 0.97 , indicating clearly that the intervention was having nearly the same beneficial effect for boys and girls . A moderate PA programme for a modest period of 3 months could be effective in maintaining or enhancing pupil ’s anthropometric and physiological parameters in comparison to the controls where there was deterioration in both parameters . Policy makers and secondary schools in Egypt might need to pay more attention to PA programmes conducted on school days , in order to motivate pupils to attend such programmes . There is also an urgent need to look at current PA systems within schools in Egypt in order to assess PA outside school times Coronary heart disease continues to be a leading cause of death in adults . Because many risk factors for heart disease make their first appearance in childhood , early intervention is an attractive strategy for this disease . A convenience sample of 58 third grade children participated in a year-long , quasi-experimental study to compare a school-based educational program , HeartPower ! , to the st and ard health education curriculum . Variables examined included knowledge , hypercholesterolemia , obesity , sedentary lifestyle , hypertension , exposure to cigarette smoke , and parental participation . The students who participated in the HeartPower ! Program showed improvement ( p < 0.05 ) in their knowledge of healthy lifestyles . Modest improvements in hypertension and exposure to tobacco smoke were observed . These results indicate that focused instruction on important health issues may be preferable to a broad approach Northern Irel and has the highest incidence of coronary heart disease ( CHD ) in the world . The physical fitness , activity patterns , health knowledge , attitudes , and dietary habits of a r and om , stratified sample of 3211 Northern Irish children , comprising 1540 boys and 1671 girls , age range 11 - 18 years were examined . At all ages boys were significantly more active than girls . The most important finding was an appreciable decline in physical activity levels after the age of 14 years reaching extremely low levels in older girls . While 75 % of exercise taken was not related to school , physical education classes constituted the only exercise taken by one third of pupils . Girls had healthier nutritional habits and were more inclined to employ weight control measures than boys . There was a preponderance of children with a higher body mass index indicating a tendency to obesity in the child population . Over 20 % of school leavers of both sexes regularly smoked cigarettes and 20 % regularly drank alcohol . The postulated relationship between childhood inactivity , adult sedentary lifestyle , and increased risk of CHD raises serious cause for concern regarding the future cardiovascular health of many children Abstract Objective To assess the prospect i ve associations of baseline and long term trajectories of physical activity on mortality from all causes , cardiovascular disease , and cancer . Design Population based cohort study . Setting Adults from the general population in the UK . Participants 14 599 men and women ( aged 40 to 79 ) from the European Prospect i ve Investigation into Cancer and Nutrition-Norfolk cohort , assessed at baseline ( 1993 to 1997 ) up to 2004 for lifestyle and other risk factors ; then followed to 2016 for mortality ( median of 12.5 years of follow-up , after the last exposure assessment ) . Main exposure  Physical activity energy expenditure ( PAEE ) derived from question naires , calibrated against combined movement and heart rate monitoring . Main outcome measures Mortality from all causes , cardiovascular disease , and cancer . Multivariable proportional hazards regression models were adjusted for age , sex , sociodemographics , and changes in medical history , overall diet quality , body mass index , blood pressure , triglycerides , and cholesterol levels . Results During 171 277 person years of follow-up , 3148 deaths occurred . Long term increases in PAEE were inversely associated with mortality , independent of baseline PAEE . For each 1 kJ/kg/day per year increase in PAEE ( equivalent to a trajectory of being inactive at baseline and gradually , over five years , meeting the World Health Organization minimum physical activity guidelines of 150 minutes/week of moderate-intensity physical activity ) , hazard ratios were : 0.76 ( 95 % confidence interval 0.71 to 0.82 ) for all cause mortality , 0.71 ( 0.62 to 0.82 ) for cardiovascular disease mortality , and 0.89 ( 0.79 to 0.99 ) for cancer mortality , adjusted for baseline PAEE , and established risk factors . Similar results were observed when analyses were stratified by medical history of cardiovascular disease and cancer . Joint analyses with baseline and trajectories of physical activity show that , compared with consistently inactive individuals , those with increasing physical activity trajectories over time experienced lower risks of mortality from all causes , with hazard ratios of 0.76 ( 0.65 to 0.88 ) , 0.62 ( 0.53 to 0.72 ) , and 0.58 ( 0.43 to 0.78 ) at low , medium , and high baseline physical activity , respectively . At the population level , meeting and maintaining at least the minimum physical activity recommendations would potentially prevent 46 % of deaths associated with physical inactivity . Conclusions Middle aged and older adults , including those with cardiovascular disease and cancer , can gain substantial longevity benefits by becoming more physically active , irrespective of past physical activity levels and established risk factors . Considerable population health impacts can be attained with consistent engagement in physical activity during mid to late life Cardiovascular disease begins early in life but might be prevented or delayed by primary prevention programs design ed for children and adolescents .  Regular physical activity is an important part of primary prevention programs , and school physical education programs have potential for the promotion of regular physical activity . Cardiovascular disease is the major cause of death among Hispanics and African Americans in the United States . Low levels of fitness and increased body mass index are common in African American and Hispanic adolescents . Increased physical activity and the adoption of healthy eating habits would increase fitness and reduce body mass index among these adolescents . The purpose of the study was to undertake a small-scale controlled trial to determine if Dance for Health , an intervention program design ed to provide an enjoyable aerobic program for African American and Hispanic adolescents , has a significant effect on improving aerobic capacity , helping students maintain or decrease weight , and on improving attitudes toward physical activity and physical fitness . In the first year of the program ( 1990 - 91 ) , approximately 110 boys and girls ages 10 - 13 years participated in an aerobic dance pilot program three times per week for 12 weeks . Dance for Health was revised and continued in the 1992 - 93 school year with seventh grade students and an added culturally sensitive health curriculum . Forty-three students were r and omized to Dance for  Health and 38 to  usual physical activity . Those in the intervention class received a health education curriculum twice a week and a dance oriented physical education class three times a week . The usual physical activity consisted mostly of playground activities . Students in the intervention had a significantly greater lowering in body mass index and resting heart rate than students in regular physical activity
There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures .
Specifically positive effects were observed for duration of physical activity , television viewing , VO2 max , and blood cholesterol .
Generally school-based interventions had no effect on leisure time physical activity rates , systolic and diastolic blood pressure , body mass index , and pulse rate .
At a minimum , a combination of printed educational material s and changes to the school curriculum that promote physical activity result in positive effects .
BACKGROUND The World Health Organization estimates that 1.9 million deaths worldwide are attributable to physical inactivity .
Chronic diseases associated with physical inactivity include cancer , diabetes and coronary heart disease .
OBJECTIVES The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents .