Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial The effect of a cluster randomised control trial on objectively measured sedentary time and parental reports of time spent in sedentary activities in Belgian preschoolers: the ToyBox-study Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Longitudinal sedentary behavior changes in adolescents in Ho Chi Minh City. The effect of the UP4FUN pilot intervention on objectively measured sedentary time and physical activity in 10–12 year old children in Belgium: the ENERGY-project Examination of mid-intervention mediating effects on objectively assessed sedentary time among children in the Transform-Us! cluster-randomized controlled trial A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes) One-year changes in physical activity and sedentary behavior among adolescents: the Croatian Physical Activity in Adolescence Longitudinal Study (CRO-PALS). Impact of a classroom standing desk intervention on daily objectively measured sedentary behavior and physical activity in youth. Effect of a family focused active play intervention on sedentary time and physical activity in preschool children Determinants of sufficient daily activity in Australian primary school children. Investigating children's physical activity and sedentary behavior using ecological momentary assessment with mobile phones. The effects of a lifestyle intervention on leisure-time sedentary behaviors in adults at risk: the Hoorn Prevention Study, a randomized controlled trial. Kids Out; evaluation of a brief multimodal cluster randomized intervention integrated in health education lessons to increase physical activity and reduce sedentary behavior among eighth graders Multicomponent intervention to reduce daily sedentary time: a randomised controlled trial Effect of a school-based intervention to promote healthy lifestyles in 7–11 year old children
Objective To investigate the effectiveness of a school based intervention to increase physical activity , reduce sedentary behaviour , and increase fruit and vegetable consumption in children . Design Cluster r and omised controlled trial . Setting 60 primary schools in the south west of Engl and . Participants Primary school children who were in school year 4 ( age 8 - 9 years ) at recruitment and baseline assessment , in year 5 during the intervention , and at the end of year 5 ( age 9 - 10 ) at follow-up assessment . Intervention The Active for Life Year 5 ( AFLY5 ) intervention consisted of teacher training , provision of lesson and child-parent interactive homework plans , all material s required for lessons and homework , and written material s for school newsletters and parents . The intervention was delivered when children were in school year 5 ( age 9 - 10 years ) . Schools allocated to control received st and ard teaching . Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day , accelerometer assessed minutes of sedentary behaviour per day , and reported daily consumption of servings of fruit and vegetables . Results 60 schools with more than 2221 children were recruited ; valid data were available for fruit and vegetable consumption for 2121 children , for accelerometer assessed physical activity and sedentary behaviour for 1252 children , and for secondary outcomes for between 1825 and 2212 children for the main analyses . None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group . The difference in means comparing the intervention group with the control group was –1.35 ( 95 % confidence interval –5.29 to 2.59 ) minutes per day for moderate to vigorous physical activity , –0.11 ( –9.71 to 9.49 ) minutes per day for sedentary behaviour , and 0.08 ( –0.12 to 0.28 ) servings per day for fruit and vegetable consumption . The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account : self reported time spent in screen viewing at the weekend ( –21 ( –37 to –4 ) minutes per day ) , self reported servings of snacks per day ( –0.22 ( –0.38 to –0.05 ) ) , and servings of high energy drinks per day ( –0.26 ( –0.43 to –0.10 ) ) were all reduced . Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results . Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity , decreasing sedentary behaviour , and increasing fruit and vegetable consumption in primary school children . Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level , as well as at the school environment level . These findings have relevance for research ers , policy makers , public health practitioners , and doctors who are involved in health promotion , policy making , and commissioning services . Trial registration Current Controlled Trials IS RCT N50133740 Background In preschoolers , high levels of sedentary behaviour are associated with several adverse health outcomes . The purpose of this study is to report the effects of the ToyBox-intervention ( a European 24-week cluster r and omised controlled trial ) on sedentary behaviour  in preschoolers . Methods In Belgium , 859 preschoolers from 27 kindergartens ( 15 intervention and 12 control ) wore an accelerometer  to objective ly measure  their  sedentary time  and 1715 parents/caregivers completed a question naire to assess sedentary activities in which preschoolers participate at home . Main outcomes were objective ly measured sedentary time , time spent watching TV , using the computer and time spent in quiet play . Multilevel repeated measures analyses were conducted to take clustering into account . Intention to treat analysis was used to h and le missing data . Results A sample of 859 ( 29.5 % of all contacted children ) preschoolers ( 4.4 ± 0.6 years , 54.4 % boys ) provided valid accelerometer data at either baseline or follow-up and parents of 1715 ( 58.9 % of all contacted children ) preschoolers ( 4.4 ± 0.5 years , 52.5 % boys ) completed a question naire at either baseline or follow-up . No intervention effects were found on objective ly and subjectively measured total sedentary time in the total sample . However , some effects on objective ly and subjectively measured sedentary time were found in specific subgroups . Preschoolers from the intervention group from high SES kindergartens and preschoolers with high levels of sedentary time at baseline decreased their sedentary time , while preschoolers from the control group increased their sedentary time . Girls in the intervention group decreased their TV viewing time during weekend days ( -5.83 min/day ) , while girls ’ & TV viewing in the control group increased ( + 4.15 min/day ) . In low SES kindergartens , a smaller increase for computer time during weekend days was found in preschoolers in intervention kindergartens ( + 6.06 min/day ) than in control kindergartens ( + 12.49 min/day ) . Conclusion While some small positive effects were found in some sub-groups , the ToyBox-intervention had no effect on objective ly and subjectively measured sedentary time in the total sample . A longer period to implement the intervention and a more active involvement of parents/caregivers might enhance intervention effects . The ToyBox- study is registered with the clinical trials registry clinical trials.gov , ID : NCT02116296 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 Physical activity ( PA ) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior ( SB ) may be detrimental to children 's health independent of PA . The primary aim of the Transform-Us ! study is to determine whether an 18-month , behavioral and environmental intervention in the school and family setting s results in higher levels of PA and lower rates of SB among 8 - 9 year old children compared with usual practice ( post-intervention and 12-months follow-up ) . The secondary aims are to determine the independent and combined effects of PA and SB on  children 's cardio-metabolic health risk factors ; identify the factors that mediate the success of the intervention ; and determine whether the intervention is cost-effective . Methods / design A four-arm cluster-r and omized controlled trial ( RCT ) with a 2 × 2 factorial design , with schools as the unit of r and omization . Twenty schools will be allocated to one of four intervention groups , sedentary behavior ( SB-I ) , physical activity ( PA-I ) , combined SB and PA ( SB+PA-I ) or current practice control ( C ) , which will be evaluated among approximately 600 children aged 8 - 9 years in school year 3 living in Melbourne , Australia . All children in year 3 at intervention schools in 2010 ( 8 - 9 years ) will receive the intervention over an 18-month period with a maintenance ' booster ' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessment s. To maximize the sample and to capture new students arriving at intervention and control schools , recruitment will be on-going up to the post-intervention time point . Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey . Discussion To our knowledge , Transform-Us ! is the first RCT to examine the effectiveness of intervention strategies for reducing children 's overall sedentary time , promoting PA and optimizing health outcomes . The integration of consistent strategies and messages to children from teachers and parents in both school and family setting s is a critical component of this study , and if shown to be effective , may have a significant impact on educational policies as well as on pedagogical and parenting practice s . Trial registration ACTRN12609000715279 ; Current Controlled Trials IS RCT BACKGROUND Sedentary behavior is associated with increased risk of chronic disease and sedentary behavior is increasing among adolescents . Data on changes in sedentary behavior in developing countries are limited . PURPOSE To describe 5-year longitudinal changes in nonschool sedentary hours among urban adolescents in Ho Chi Minh City , and to identify correlates with this change . METHODS This is a 5-year longitudinal cohort with systematic r and om sampling of 759 students from 18 junior high schools . All measures were taken annually between 2004 and 2009 .  Sedentary behavior  was assessed by self-report and accelerometry . Generalized linear latent and mixed models were used to analyze the data in 2011 . RESULTS Between 2004 and 2009 , self-reported time spent in nonschool sedentary behavior  increased from 498 to 603 minutes/day . In the 5th survey year , boys and girls ( aged 16 years ) were , respectively , 3.6 times ( 95 % CI=2.3 , 6.0 ) and 3.1 times ( 95 % CI= 1.8 , 5.0 ) more likely to spend ≥2 hours/day on screen time compared with baseline ( aged 12 years ) . Accelerometer data adjusted for wearing time revealed that boys and girls aged 16 years had , respectively , 78 minutes/day ( 95 % CI=48 , 104 ) and 69 minutes/day ( 95 % CI=34 , 95 ) more nonschool sedentary time than those at the first accelerometer assessment ( at age 13 years ) . Girls in the highest socioeconomic quartile spent an additional 90 minutes/day in sedentary behavior compared with girls in the lowest quartile ( 95 % CI=52 , 128 ) .  CONCLUSIONS Nonschool sedentary behavior  increased among Vietnamese adolescents with age . The largest increase was in recreational screen time ( 28 % ) , which would be the most obvious target for preventive health strategies BakckgroundThe first aim was to examine the effect of the UP4FUN pilot intervention on children ’s total sedentary time . The second aim was to investigate if the intervention had an effect on  children ’s physical activity ( PA ) level . Finally , we aim ed to investigate demographic differences ( i.e. age , gender , ethnicity , living status and having siblings ) between children in the intervention group who improved in sedentary time and PA at post-test and children in the intervention group who worsened in sedentary time and PA at post-test . Methods The six weeks UP4FUN intervention was tested in a r and omized controlled trial with pre-test post-test design with five intervention and five control schools in Belgium and included children of the 5th and 6th grade . The children wore accelerometers for seven days at pre- and post-test . Analyses included children with valid accelerometer data for at least two weekdays with minimum 10h-wearing time and one weekend day with 8h-wearing time . Result Final analyses included 372 children ( 60 % girls , mean age = 10.9 ± 0.7 years ) . There were no significant differences in the change in sedentary time or light PA between intervention and control schools for the total sample or for the subgroup analyses by gender . However , children ( specifically girls ) in the intervention group had a higher decrease in moderate-to-vigorous PA than children in the control group . In the intervention group , children who lived with both parents and children with one or more siblings were less likely to reduce sedentary time after exposure to the intervention . Older children , girls and children who lived with both parents were less likely to increase light PA after the intervention . Conclusion The UP4FUN intervention did not result in an effect on children ’s sedentary time . Based on the high amounts of accelerometer-derived sedentary time in this age group , more efforts are needed to develop strategies to reduce children ’s sedentary time 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 Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT Background 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 OBJECTIVES We investigated the impact of a st and ing desk intervention on daily objective ly monitored sedentary behavior and physical activity in 6th grade school students . DESIGN Cluster non-r and omised controlled trial . METHOD Two classes ( intervention students : n=22 [ aged 11.8±0.4years ] ; control students : n=27 [ 11.6±0.5years ] ) from a public school in Lisbon were selected . The intervention involved replacing traditional seated classroom desks for st and ing desks , for a total duration of 16 weeks , in addition to performing teacher training and holding education/motivation sessions with students and parents . Sedentary behavior ( ActivPAL inclinometer ) and physical activity ( Actigraph GT3X+ accelerometer )  were measured for seven days immediately before and after the intervention . RESULTS There were no differences in baseline behaviors between intervention and control groups ( p>0.05 ) . At follow-up ( 16 weeks ) , it was observed that the intervention group had decreased time spent sitting ( total week : -6.8 % and at school : -13.0 % relative to baseline ) and increased st and ing ( total week : 16.5 % and at school : 31.0 % ) based on inclinometer values ( p-value for interaction group*time < 0.05 ) . No significant differences in activity outcomes were observed outside school time ( week or weekend ) between groups . CONCLUSION We conclude that a 16 week classroom st and ing desk intervention  successfully reduced sitting time and increase st and ing time at school , with no observed compensatory effects outside of school time Background Early childhood provides a window of opportunity for the promotion of physical activity . Given the limited effectiveness of interventions to date , new approaches are needed . Socio-ecological models suggest that involving parents as intervention targets may be effective in fostering healthier lifestyles in children . This study describes the effectiveness of a family-focused ‘ Active Play ’ intervention in decreasing sedentary time and increasing total physical activity in preschool children . MethodS eventy-seven families were recruited from 8 r and omly selected SureStart children ’s centres in the North West of Engl and . Centres were r and omly assigned to either an intervention ( n = 4 ) or a comparison group ( n = 4 ) . Parents and children in the intervention group received a 10-week active play programme delivered by trained active play professionals ; this included an activity and educational component . Families in the comparison group were asked to maintain their usual routine . Each participating parent and child wore a  uni-axial accelerometer  for 7 days at baseline and post-test . Week and weekend day sedentary time and total physical activity adjusted for child- and home- level covariates were analysed using multilevel analyses . Results Significant intervention effects were observed for sedentary time and physical activity for both week and weekend days . Children in the intervention group engaged in 1.5 % and 4.3 % less sedentary time during week and weekend days , respectively and 4.5 % and 13.1 % more physical activity during week and weekend days , respectively than children in the comparison group . Parent ’s participation in sport and their physical activity levels , child ’s sex , availability of media in the home and attendance at organised activities were significant predictors of sedentary time and physical activity in this age group . Conclusion A 10-week family focused active play intervention produced positive changes in sedentary time and total physical activity levels in preschool children . Specific covariates were identified as having a significant effect on the outcome measures . Moreover , children whose parents were active engaged in less sedentary time and more physical activity suggesting that parent ’s activity habits are mediators of physical activity engagement in this age group AIMS Australian guidelines recommend that children participate in at least one hour of physical activity every day . We aim ed to measure physical activity  participation in a r and om sample of Australian primary school children and to determine the biological , behavioural , environmental and social influences associated with insufficient daily activity . METHOD We analysed the following cross-section data from a r and omly selected sample of children ( N=518 ) aged 5 to 12 years : age , gender , socioeconmic status ( SES ) indicators , family size , home play equipment availability , transport method to school , and estimated time per week in physical and sedentary activity . Logistic regression analysis was performed to determine variables that were associated with insufficient ( < 60 minutes ) daily activity . RESULTS Seventy-six children ( 15 % of the cohort ) failed to meet the minimum activity recommendations of 60 minutes of daily activity . These children were significantly less likely to walk or cycle to school ( adjusted odds ratio ( OR ) 0.43 ; 95 % CI=0.24 - 0.77 ) or participate in organised sports or activity ( OR 0.42 ; 95 % CI=0.28 - 0.64 ) and were more likely to spend in excess of 2 hours a day watching television of using a computer for entertainment ( OR 2.10 ( 1.16 - 3.78 ) . Age , gender , SES and family size were not significantly associated with insufficient activity . CONCLUSION There exists a significant proportion of the paediatric population who are insufficiently active . Interventions to encourage increased activity  in this sub-group may be successful if they seek to alter sedentary behaviour ( namely television use ) and method of transportation to and from school The risk of obesity during childhood can be significantly reduced through increased physical activity and decreased sedentary behavior . Recent technological advances have created opportunities for the real-time measurement of these behaviors . Mobile phones are ubiquitous and easy to use , and thus have the capacity to collect data from large numbers of people . The present study tested the feasibility , acceptability , and validity of an electronic ecological momentary assessment ( EMA ) protocol using electronic surveys administered on the display screen of mobile phones to assess children 's physical activity and sedentary behaviors .  A total of 121 children ( ages 9 - 13 , 51 % male , 38 % at risk for overweight/overweight ) participated in EMA monitoring from Friday afternoon to Monday evening during children 's nonschool time , with 3 - 7 surveys/day . Items assessed current activity ( e.g. , watching TV/movies , playing video games , active play/sports/exercising ) . Children simultaneously wore an Actigraph GT2 M accelerometer . EMA survey responses were time-matched to total step counts and minutes of moderate-to-vigorous physical activity ( MVPA ) occurring in the 30 min before each EMA survey prompt . No significant differences between answered and unanswered EMA surveys were found for total steps or MVPA . Step counts and the likelihood of 5 + min of MVPA were significantly higher during EMA-reported physical activity ( active play/sports/exercising ) vs. sedentary behaviors ( reading/computer/homework , watching TV/movies , playing video games , riding in a car ) ( P < 0.001 ) . Findings generally support the acceptability and validity of a 4-day EMA protocol using mobile phones to measure physical activity and sedentary behavior in children during leisure time OBJECTIVE This study set out to assess the short- and long-term effects of a primary care-based lifestyle intervention on different domains of leisure-time sedentary behaviors in Dutch adults at risk of type 2 diabetes and cardiovascular diseases . METHODS Between 2007 and 2009 , adults ( n=622 ) at risk were r and omly assigned to a counseling intervention aim ed at adopting healthy lifestyle behaviors , or a control group that only received health brochures . Follow-up measures were done after 6 , 12 and 24months . Linear regression analysis was used to examine between-group differences in self-report minutes per day sedentary behaviors , adjusted for baseline values . Stratified analyses were performed for sex and educational attainment . RESULTS Seventy-nine percent ( n=490 ) of participants completed the last follow-up . Mean baseline sedentary behaviors were 254.6min per day ( SD=136.2 ) . Intention-to-treat analyses showed no significant differences in overall or domain-specific sedentary behaviors between the two groups at follow-up . Stratified analyses for educational attainment revealed a small and temporary between-group difference in favor of the intervention group , in those who finished secondary school . CONCLUSIONS A primary care-based general lifestyle intervention was not more effective in reducing leisure-time sedentary behaviors than providing brochures in adults at risk for chronic diseases Background Most Finnish adolescents are not sufficiently physically active . Health education ( HE ) provides beneficial starting point for physical activity ( PA ) promotion in schools . This study evaluates an intervention integrated into three HE lessons to increase  PA and reduce sedentary behavior ( SB )  among eighth grade rs . Methods All public secondary schools in Tampere , Finl and participated and were r and omized to intervention ( INT , n = 7 ) and comparison group ( COM , n = 7 ) . In INT ( 690 students , 36 classes ) the teachers ( n = 14 ) implemented behavioral theory-driven content during three HE lessons . In COM ( 860 students , 41 classes ) the teachers ( n = 14 ) carried out st and ard lessons . The evaluation was based on RE- AIM : Effectiveness was assessed from baseline to 4 weeks ( Follow-up 1 ) and Maintenance from 4 weeks to 7 months ( Follow-up 2 ) with change in students ’ PA and SB and related psychosocial and parental factors . Methods included question naire , accelerometer  and  activity diary . Linear mixed models with baseline adjustments and r and om effect correction were used to compare the difference in change between INT and COM . Data on Reach , Adoption and Implementation were collected during the process . Results Intervention effects were only seen in the self-reported data favoring INT in the weekly number of days with at least 1 h of brisk leisure PA ( 0.3 [ 95%CI 0.1 to 0.6 ] ) , proportion of students meeting PA recommendations ( 4.1 [ 95%CI 2.5 to 5.7 ] ) , proportion of students reporting that their family sets limitations for screen time ( 5.4 [ 95%CI 3.3 to 7.4 ] ) and in the number of days on which the students intended to do leisure PA in the following week ( 0.3 [ 95%CI 0.1 to 0.6 ] ) . The effects on PA were still beneficial for INT at Follow-up 2 . The intervention reached 96 % of the students , was adopted in all 7 schools and was implemented by 13/14 teachers in 35/36 classes . Conclusions The intervention was feasible and had small favorable effects on students ’ self-reported PA , intention to do PA and family norm in screen time . The effects on PA persisted until Follow-up 2 . It is likely that for greater impacts the HE lessons should have been supported with other actions without compromising feasibility . Trial registration NCT01633918 ( June 27th , 2012 ) Objectives To test the efficacy of a multicomponent technology intervention for reducing daily sedentary time and improving cardiometabolic disease risk among sedentary , overweight university employees . Design Blinded , r and omised controlled trial . Setting A large south-eastern university in the USA . Participants 49 middle-aged , primarily female , sedentary and overweight adults working in sedentary jobs enrolled in the study . A total of 40 participants completed the study . Interventions Participants were r and omised to either : ( 1 ) an intervention group ( N=23 ; 47.6 + 9.9 years ; 94.1 % female ; 33.2 + 4.5 kg/m2 ) ; ( 2 ) or wait-list control group ( N=17 ; 42.6 + 8.9 years ; 86.9 % female ; 31.7 + 4.9 kg/m2 ) . The intervention group received a theory-based , internet-delivered programme , a portable pedal machine at work and a pedometer for 12 weeks . The wait-list control group maintained their behaviours for 12 weeks . Outcome measures Primary ( sedentary and physical activity behaviour measured objective ly through StepWatch ) and secondary ( heart rate , blood pressure , height , weight , waist circumference , per cent body fat , cardiorespiratory fitness , fasting lipids ) outcomes were measured at baseline and postintervention ( 12 weeks ) . Exploratory outcomes including intervention compliance and process evaluation measures were also assessed postintervention . Results Compared to controls , the intervention group reduced daily sedentary time ( mean change ( 95%CI ) : −58.7 min/day ( −118.4 to 0.99 ; p<0.01 ) ) after adjusting for baseline values and monitor wear time . Intervention participants logged on to the website 71.3 % of all intervention days , used the pedal machine 37.7 % of all working intervention days and pedalled an average of 31.1 min/day . Conclusions These findings suggest that the intervention was engaging and result ed in reductions in daily sedentary time among full-time sedentary employees . These findings hold public health significance due to the growing number of sedentary jobs and the potential of these technologies in large-scale worksite programmes . Trial Registration Clinical Trials.gov # NCT01371084 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
Conclusions Multicomponent interventions which also include the use of st and ing desks may be an effective method for reducing  children 's sedentary time  in a school-based intervention .
Introduction Prolonged , uninterrupted periods of sedentary time may be associated with increased risk of Type II diabetes , cardiovascular disease and all-cause mortality even if the minimum recommended levels of daily physical activity are achieved .
It is reported that children spend approximately 80 % of their day engaged in sedentary behaviours .
Since children spend a large portion of their waking time at school , school-based interventions targeting excessive or interrupted periods of sedentary time have been investigated in a number of studies .
However , results of the effectiveness of studies to- date have been inconsistent .
Aim To conduct a systematic review to evaluate the effectiveness of school-based interventions design ed to reduce sedentary behaviour on objective ly measured sedentary time in children .