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] Improving health-related fitness in children: the fit-4-Fun randomized controlled trial study protocol Design of the iPlay Study [Physical fitness enhancement through education, EDUFIT study: background, design, methodology and dropout analysis]. School physical education: effect of the Child and Adolescent Trial for Cardiovascular Health. 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. Influence of a Health-Related Physical Fitness Model on Students' Physical Activity, Perceived Competence, and Enjoyment A provincial study of opportunities for school-based physical activity in secondary schools. The relationship between school physical activity policy and objectively measured physical activity of elementary school students: a multilevel model analysis Methods of the NSW Schools Fitness and Physical Activity Survey, 1997. Effects of a physical education program on physical activity, fitness, and health in children: the JuvenTUM project. Will they stay fit and healthy? A three-year follow-up evaluation of a physical activity and health intervention in Polish youth Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children. Effect of a school-based intervention on physical activity: cluster-randomized trial. The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, Play and Active Recreation for Kids. Social and physical contexts of schools and neighborhoods: associations with physical activity among young people in New Zealand.
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 Declining levels of physical fitness in children are linked to an increased risk of developing poor physical and mental health .  Physical activity programs for children that involve regular high intensity physical activity , along with muscle and bone strengthening activities , have been identified by the World Health Organisation as a key strategy to reduce the escalating burden of ill health caused by non-communicable diseases . This paper reports the rationale and methods for a school-based intervention design ed to improve physical fitness and physical activity levels of Grade s 5 and 6 primary school children . Methods / Design Fit-4-Fun is an 8-week multi-component school-based health-related fitness education intervention and will be evaluated using a group r and omized controlled trial . Primary schools from the Hunter Region in NSW , Australia , will be invited to participate in the program in 2011 with a target sample size of 128 primary schools children ( age 10 - 13 ) . The Fit-4-Fun program is theoretically grounded and will be implemented applying the Health Promoting Schools framework . Students will participate in weekly curriculum-based health and physical education lessons , daily break-time physical activities during recess and lunch , and will complete an 8-week ( 3 × per week ) home activity program with their parents and /or family members . A battery of six health-related fitness assessment s , four days of pedometery-assessed physical activity and a question naire , will be administered at baseline , immediate post-intervention ( 2-months ) and at 6-months ( from baseline ) to determine intervention effects . Details of the method ological aspects of recruitment , inclusion criteria , r and omization , intervention program , assessment s , process evaluation and statistical analyses are described . Discussion The Fit-4-Fun program is an innovative school-based intervention targeting fitness improvements in primary school children . The program will involve a range of evidence -based behaviour change strategies to promote and support physical activity of adequate intensity , duration and type , needed to improve health-related fitness . Trial Registration NoAustralia and New Zeal and Clinical Trials Register ( ANZCTR ) : Health benefits of physical activity  in children are well known . However , a drawback is the risk of physical activity-related injuries . Children are at particular risk for these injuries , because of a high level of exposure . Because of the high prevalence of physical activity injuries and the negative short- and long-term consequences , prevention of these injuries in children is important . This article describes how we systematic ally developed a school-based physical activity injury prevention programme using the intervention mapping ( IM ) protocol .IM describes a process for developing theory- and evidence -based health promotion programmes . The development can be described in six steps : ( i ) perform a needs assessment ; ( ii ) identify programme and performance objectives ; ( iii ) select methods and strategies ; ( iv ) develop programme ; ( v ) adopt and implement ; and ( vi ) evaluate . First , the results of the needs assessment showed the injury problem in children and the different risk factors for physical activity injuries . Based on the results of the needs assessment the main focus of the injury prevention programme was described . Second , the overall programme objective of the injury prevention programme was defined as reducing the incidence of lower extremity physical activity injuries . Third , theoretical methods and practical strategies were selected to accomplish a decrease in injury incidence . The theoretical methods used were active learning , providing cues and scenariobased risk information , and active processing of information . The practical strategy of the injury prevention programme was an 8-month course about injury prevention to be used in physical education classes in primary schools . Fourth , programme material s that were used in the injury prevention programme were developed , including newsletters for children and parents , posters , exercises to improve motor fitness , and an information website . Fifth , an implementation plan was design ed in order to ensure that the prevention programme would be implemented , adopted and sustained over time . Finally , an evaluation plan was design ed . The injury prevention programme is being evaluated in a cluster r and omized controlled trial with more than 2200 children from 40 primary schools throughout the Netherl and s . The IM process is a useful process for developing an injury prevention programme . Based on the steps of the IM we developed an 8-month injury prevention programme to be used in physical education classes of primary schools Physical fitness is a powerful marker of cardiovascular health already at early stages in life . To promote physical fitness enhancement from the school is therefore needed . The present study describes a school intervention program specifically design ed for these purpose s , called EDUFIT ( EDUcation for FITness ) . The study was carried out in 2007 and comprised 67 adolescents aged 13+/-1 years from a secondary school who belonged to three different classes . The classes were r and omly allocated to control group ( CG ) , experimental group 1 ( EG1 ) and experimental group 2 ( EG2 ) . The CG was involved in 2 physical education sessions/week , the EG1 was involved in 4 physical education sessions/week ( volume increased ) and the EG2 was involved in 4 physical education sessions/week of high intensity ( volume+intensity increased ) . Several health parameters were assessed before and after a 16-weeks intervention : physical fitness , body composition , lipid-metabolic profile , ventilatory parameters , blood pressure , and cognitive and academic performance . The intervention was feasible and well-tolerated . There were high participation and adherence rates , i.e. 96 % ( n=67 ) and 84 % ( n=56 ) respectively . Yet not always significant ( 0,1>P>0,05 ) , we observed that the adolescents who satisfactory complete the program showed better cognitive and academic performance , and worse levels of adiposity , diastolic tension , h and grip strength and maximal expiratory pressure . The hypothesis of the EDUFIT study is that to double the number of physical education classes will improve physical fitness in adolescents . The confirmation of the hypothesis could have important public health implication 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 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 This study was design ed to explore the effects of a health-related physical fitness physical education model on students ' physical activity , perceived competence , and enjoyment .  61 students ( 25 boys , 36 girls ; M age = 12.6 yr . , SD = 0.6 ) were assigned to two groups ( health-related physical fitness physical education group , and traditional physical education group ) , and participated in one 50-min . weekly basketball class for 6 wk . Students ' in-class physical activity was assessed using NL-1000 pedometers . The physical subscale of the Perceived Competence Scale for Children was employed to assess perceived competence , and children 's enjoyment was measured using the Sport Enjoyment Scale . The findings suggest that students in the intervention group increased their perceived competence , enjoyment , and physical activity over a 6-wk . intervention , while the comparison group simply increased physical activity over time . Children in the intervention group had significantly greater enjoyment PURPOSE Adolescents spend considerable time at school and thus it is important to underst and their opportunities for school-based physical activity . This study surveyed Ontario secondary schools to identify the range of structured opportunities and their engagement by students . METHODS A question naire was mailed to key informants in 600 r and omly selected secondary schools in Ontario , for which 474 respondents ( 79 % ) returned completed question naires . RESULTS  Curriculum-based physical education ( PE )  classes in grade nine were reported to be offered in all schools and these classes in grade s 10 , 11 and 12 were offered in almost all schools . Student enrollment in PE decreased from grade s 9 to 12 ( 97.9 % , 49.6 % , 43.3 % and 35.9 % , respectively ) . Respondents reported that funding , timetable , facilities and re sources made it somewhat difficult to implement the health and physical education curriculum in their schools . About two-thirds ( 65.5 % ) of the schools had an intramural program and 15.0 % of students participated in it , whereas 97.2 % of the schools had an inter-school sports program and 25.0 % of students participated in it . Supervision issues made it difficult to provide intramural programs and funding made it difficult to provide inter-school sports programs . CONCLUSIONS Although provision of physical activity opportunities in Ontario appears satisfactory , actual engagement by students is low . The results suggest that strategies to increase student participation in PE , intramural programs , and inter-school sports programs need further consideration Background There is evidence of school level variability in the physical activity of children and youth . Less is known about factors that may contribute to this variation . The purpose of this study was to examine if the school health environment ( Healthy Physical Environment , Instruction and Programs , Supportive Social Environment , and Community Partnerships ) is associated with objective ly measured time spent in light to vigorous physical activity among a sample of Toronto children . Methods The sample comprised 856 grade 5 and 6 students from 18 elementary schools in Toronto , Ontario .  Multilevel linear regression analyses were used to examine the impact of school physical activity policy on students ’ time spent in light-to-vigorous physical activity . Results Significant between-school r and om variation in objective ly measured time spent in light-to-vigorous physical activity was identified [ σ2μ0 = 0.067 ; p < 0.001 ] ; school-level differences accounted for 6.7 % of the variability in the time individual students spent in light-to-vigorous physical activity . Of the 22 school-level variables , students attending schools with support for active transportation to/from school and written policies/ practice s for physical activity , accumulated significantly more minutes of physical activity per school week than students who attended schools that did not . Conclusions School physical activity policy and support for active school travel is associated with objective ly measured time spent in light to vigorous physical activity . School physical activity policy might be a critical mechanism through which schools can impact the physical activity levels of their students Physical fitness , participation in physical activity , fundamental motor skills and body composition are important contributors to the health and the development of a healthy lifestyle among children and youth . The New South Wales Schools  Fitness and Physical Activity Survey , 1997 , was conducted to fill some of the gaps in our knowledge of these aspects of the lives of young people in New South Wales . The survey was conducted in February and March , 1997 and collected data on a r and omly-selected sample of students ( n = 5518 ) in Years 2 , 4 , 6 , 8 and 10 . Measures were taken on body composition ( height and weight , waist and hip girths , skinfolds ) , health-related fitness ( aerobic capacity , muscular strength , muscular endurance , flexibility ) , fundamental motor skills ( run , vertical jump , catch , overh and throw , foreh and strike and kick ) , self-reported physical activity , time spent in sedentary recreation , and physical education ( PE ) classes . The methods are described to assist in the development of surveys of other population s and to provoke debate relevant to the development and dissemination of st and ard approaches to monitoring the fitness , physical activity habits and body composition of Australian children and youth . Finally , we offer comments on some of the strengths and limitations of the methods employed The purpose of the study was to investigate the effects of a school-based prevention program on physical activity , fitness , and obesity . We performed a prospect i ve study in eight Bavarian primary schools ( n = 724 children , 8.4 ± 0.7 years ) r and omized one to one to either an  intervention school ( IS , n = 427 ) or a  control school ( CS , n = 297 ) . Children in IS attended 10 health-related lessons at school over a period of 1 year . Parents and teachers attended two and three educational health-related lessons , respectively , and also received 10 newsletters on health issues . Daily physical activity ( ≥ 60 min/day ) , physical fitness ( six-item test battery ) , and anthropometric data were obtained at baseline and after 1 year . Physical activity and physical fitness increased in IS , but it failed to reach significant intervention effects . Nevertheless , a reduction in waist circumference was observed for all children [ mean change 1.7 cm ; 95 % confidence interval ( CI ) 1.2 - 2.3 ; P < 0.001 ) . This effect was more pronounced in overweight children ( > 90th percentile , n = 99 , mean change 3.2 cm ; 95 % CI 1.5 - 4.8 ; P < 0.001 ) . This easily administered preventative program involving children , parents , and teachers revealed that a generalized approach increasing physical activity will even be favorable in a subgroup of obese children Aims : In this paper we evaluate the sustainability of changes of involvement in physical activity . The paper examines the effectiveness of a model aim ing at influencing the frequency of leisuretime physical activity , physical fitness and body constituency in youth . Methods : The baseline of this study was a r and omly selected sample of 13 year olds who participated in an intervention programme carried out in three schools in Poznan in 2005—08 . From a total of 199 adolescent boys a sub sample of 38 individuals from the experimental group and 34 from the control group were followed for 15 months after the interventional programme finished . From 170 girls , a sub sample of 33 from the experimental group and 32 girls from the control group were also r and omly selected for the follow-up study . Among the variables monitored were : physical fitness , body constituency , and frequency of leisuretime physical activity . All the variables were monitored in pre-test , post-test and follow-up examinations . Results : It was established that 15 months after the end of the interventional programme boys and girls from the intervention groups maintained a higher level of leisuretime physical activity than their control group peers , and similarly in the case of selected health-related components of physical fitness . No distinctive differences were found in the case of body constituency , though , apart from muscle mass and the sum of skinfolds in girls . Conclusions : The study exposed an increase in leisuretime physical activity in time and a positive influence on selected components of health-related variables . The findings confirm the effectiveness of a multi-level intervention programme involving self-determined out-of-school physical activity planning for school-age youths , indicating the importance of personal and social context 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 OBJECTIVE Our primary objective was to determine whether a novel ' active school ' model -- Action Schools ! BC -- improved the cardiovascular disease ( CVD ) risk profile in elementary-school children . Our secondary objective was to determine the percentage of children with elevated CVD risk factors . METHODS We undertook a cluster-r and omized controlled school-based trial with 8 elementary schools across 1 school year , in British Columbia , Canada , beginning in 2003 . Boys and girls ( n=268 , age 9 - 11 years ) were r and omly assigned ( by school ) to usual practice ( UP , 2 schools ) or intervention ( INT , 6 schools ) groups . We assessed change between groups in cardiovascular fitness ( 20-m Shuttle Run ) , blood pressure ( BP ) , and body mass index ( BMI , wt/ht(2 ) ) . We evaluated total cholesterol ( TC ) , total : high-density cholesterol ( TC : HDL-C ) , low-density lipoprotein , apolipoprotein B , C-reactive protein and fibrinogen on a subset of volunteers ( n=77 ) . RESULTS INT children had a 20 % greater increase in fitness and a 5.7 % smaller increase in BP compared with children attending UP schools ( P<0.05 ) . Forty five percent of children had at least one elevated risk factor ( fitness , BP or BMI ) at baseline . There were no significant differences between groups for change in BMI or in any of the blood variables . CONCLUSION Action Schools ! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children . Our multi-component intervention exposed children to fitness enhancing physical activity . It may be important for education stakeholders to adequately re source the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis PURPOSE Physical activity in childhood has many health benefits ; however , the majority of children in many countries , including Mexico , are insufficiently active . The objective of this investigation was to test the effect of a school-based environmental intervention on the physical activity and physical fitness of students attending public primary schools in Mexico City . METHODS Twenty-seven schools were r and omly assigned to basic or plus intervention or control . The basic and plus groups were exposed to school environment and policy changes to enhance physical activity .  Physical activity was evaluated in 699 r and omly selected fourth- and fifth- grade students by measuring school-day and all-day ( 24 h ) steps using pedometers worn for 5 d before and after the 6-month intervention . Physical fitness was assessed by measuring the 9-min run , flexibility , and sit-ups . We calculated the average change in school-day and all-day steps and fitness measures from baseline to follow-up . Using linear regression , we tested the effect of intervention on change controlling for baseline measures and covariates and accounting for the design effect of school . Using logistic regression , we tested the effect of intervention on reaching step cutoffs at baseline and follow-up . RESULTS The plus group significantly ( P < 0.05 ) increased school-day steps relative to control ( change = 687 vs -639 ) . Significantly ( P < 0.05 ) more participants in the basic ( 25.8 % ) and plus ( 36.4 % ) groups reached step cutoffs during school relative to control ( 12.0 % ) . The basic group significantly ( P < 0.05 ) increased all-day steps relative to control ( change = 581 vs -419 ) . The plus group significantly ( P = 0.05 ) increased sit-ups relative to control ( change = 0.3 vs -1.7 ) . CONCLUSIONS A school-based environmental intervention improved student  physical activity during school in public schools in Mexico City OBJECTIVES This study evaluated a health-related physical education program for fourth- and fifth- grade students design ed to increase physical activity during physical education classes and outside of school . METHODS Seven schools were assigned to three conditions in a quasi-experimental design . Health-related physical education was taught by physical education specialists or trained classroom teachers . Students from these classes were compared with those in control classes . Analyses were conducted on 955 students with complete data . RESULTS Students spent more minutes per week being physically active in specialist-led ( 40 min ) and teacher-led ( 33 min ) physical education classes than in control classes ( 18 min ; P < .001 ) . After 2 years , girls in the specialist-led condition were superior to girls in the control condition on abdominal strength and endurance ( P < .001 ) and cardiorespiratory endurance ( P < .001 ) . There were no effects on physical activity outside of school . CONCLUSIONS A health-related physical education curriculum can provide students with substantially more physical activity during physical education classes . Improved physical education classes can potentially benefit 97 % of elementary school students OBJECTIVES We sought to determine the association between school- and neighborhood-level characteristics and physical activity among young people . METHODS We collected the data as part of Youth'07 , a nationally representative survey of the health and well-being of high school students in New Zeal and . In total , 9107 students from 96 schools participated ( 63 % response rate ) . Students answered questions about their schools ( e.g. , support for physical activity ) and neighborhoods ( e.g. , community cohesion , disintegration , safety , and recreational facilities ) . We created school-level measures by aggregating the students ' reports within their schools and we created neighborhood-level measures by aggregating the students ' reports of their neighborhoods to the census area unit of their residential address . We conducted analyses by using cross-classified r and om-effects models controlling for individual variables , with school and neighborhoods treated as r and om effects . RESULTS Schools characterized by high sports team participation and neighborhoods characterized by high social connections were positively associated with student physical activity . We observed few other significant characteristics of school and neighborhood environments . CONCLUSIONS Our findings highlight that opportunity for sports participation and strong social connections in neighborhoods are particularly important for youths ' physical activity
Results Physical activity was associated with numerous health benefits .
The dose-response relations observed in observational studies indicate that the more physical activity , the greater the health benefit .
Results from experimental studies indicate that even modest amounts of physical activity can have health benefits in high-risk youngsters ( e.g. , obese ) .
Vigorous intensity activities may provide even greater benefit .
Aerobic-based activities had the greatest health benefit , other than for bone health , in which case high-impact weight bearing activities were required .
Some of the health benefits can be achieved through an average of 30 minutes per day . [
Level 2 , Grade A ] .
Background The purpose was to : 1 ) perform a systematic review of studies examining the relation between physical activity , fitness , and health in school-aged children and youth , and 2 ) make recommendations based on the findings .