***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Although school-based behavioral interventions for increasing physical activity ( PA ) in children and adolescents have been conducted , little evidence suggests that these curriculum-based approaches lead to increases in overall activity outside of program days . The overall goal of the " Active by Choice Today " ( ACT ) trial is to exp and the body of knowledge concerning the factors that influence long-term increases in PA in underserved adolescents ( low socioeconomic status , minorities ) during their middle school years . DESIGN AND SETTING An overview of the ACT study design , theoretical framework , process evaluation , and primary hypotheses is presented . The trial involves twenty-four middle schools ( 1560 6th grade rs ) in South Carolina that are r and omly assigned to one of two after-school programs ( motivational and life skills intervention , or general health education ) .  INTERVENTION The intervention integrates constructs from Self-Determination and Social Cognitive Theories to enhance intrinsic motivation and behavioral skills for PA . The intervention targets skill development for PA outside of program days and the after-school program social environment ( autonomy , choice , participation , belongingness , fun , enjoyment , support ) is design ed to positively impact cognitive mediators ( self-efficacy , perceived competence ) , and motivational orientation ( intrinsic motivation , commitment , positive self-concept ) . MAIN HYPOTHESES/ OUTCOMES : It is hypothesized that the 17-week motivational and life skills intervention will lead to greater increases in moderate-to-vigorous PA ( based on 7-day accelerometry estimates ) at post-intervention as compared to the general health education program . CONCLUSIONS Implication s of this innovative school-based trial are discussed OBJECTIVE To test the feasibility , acceptability , and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , among African-American girls . DESIGN Twelve-week , 2-arm parallel group , r and omized controlled trial . SETTING Low-income neighborhoods . PARTICIPANTS Sixty-one 8 - 10-year-old African-American girls and their parents/guardians . INTERVENTIONS The treatment intervention consisted of after-school dance classes at 3 community centers , and a 5-lesson intervention , delivered in participants ' homes , and design ed to reduce television , videotape , and video game use . The active control intervention consisted of disseminating newsletters and delivering health education lectures . MAIN OUTCOME MEASURES Implementation and process measures , body mass index , waist circumference , physical activity measured by accelerometry , self-reported media use , and meals eaten with TV . RESULTS Recruitment and retention goals were exceeded . High rates of participation were achieved for assessment s and intervention activities , except where transportation was lacking . All interventions received high satisfaction ratings . At follow up , girls in the treatment group , as compared to the control group , exhibited trends toward lower body mass index ( adjusted difference = -.32 kg/m2 , 95 % confidence interval [ CI ] -.77 , .12 ; Cohen 's d = .38 st and ard deviation units ) and waist circumference ( adjusted difference = -.63 cm , 95 % CI -1.92 , .67 ; d = .25 ) ; increased after-school physical activity ( adjusted difference = 55.1 counts/minute , 95 % CI -115.6 , 225.8 ; d = .21 ) ; and reduced television , videotape , and video game use ( adjusted difference = -4.96 hours/week , 95 % CI -11.41 , 1.49 ; d = .40 ) . The treatment group reported significantly reduced household television viewing ( d = .73 , P = .007 ) and fewer dinners eaten while watching TV ( adjusted difference = -1.60 meals/week , 95 % CI -2.99 , -.21 ; d = .59 ; P = .03 ) . Treatment group girls also reported less concern about weight ( d = .60 ; P = .03 ) , and a trend toward improved school grade s ( d = .51 ; P = .07 ) . CONCLUSIONS This study confirmed the feasibility , acceptability , and potential efficacy of using dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , in African-American girls OBJECTIVE To evaluate the feasibility , acceptability , and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children . DESIGN Six-month , 2-arm , parallel-group , pilot r and omized controlled trial . SETTING Low-income , racial/ethnic minority community . PARTICIPANTS Twenty-one children in grade s 4 and 5 with a body mass index at or above the 85th percentile . INTERVENTIONS The treatment intervention consisted of an after-school soccer program . The " active placebo " control intervention consisted of an after-school health education program . MAIN OUTCOME MEASURES Implementation , acceptability , body mass index , physical activity measured using accelerometers , reported television and other screen time , self-esteem , depressive symptoms , and weight concerns . RESULTS All 21 children completed the study . Compared with children receiving health education , children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily , moderate , and vigorous physical activity at 3 months . CONCLUSION An after-school team soccer program for overweight children can be a feasible , acceptable , and efficacious intervention for weight control OBJECTIVE To evaluate the effect of a 3-year after-school physical activity ( PA ) intervention on aerobic fitness and percent body fat ( % BF ) . METHODS In total , 18 schools were r and omized into intervention or control arms . Measurements were made at the beginning and end of the third , fourth and fifth grade s. Fitness was measured with heart rate response to a bench-stepping task.%BF and bone density were measured with dual-energy x-ray absorptiometry . The intervention included 40 min of academic enrichment activities , during which healthy snacks were provided , and 80 min of moderate-to-vigorous PA ( MVPA ) . RESULTS Data analyses were performed on 206 youths who remained in the same schools for the 3-year period , who were measured at all six time points and , for the intervention group , who attended at least 40 % of the sessions in each of the 3 years . The group by time interactions were significant for fitness ( p < 0.01 ) and % BF ( p < 0.05 ) . Children in intervention schools improved in fitness and % BF during the school years and returned to levels similar to those in control schools during the summers . Over the six measurement points , the intervention group increased more than the control group in bone density ( p < 0.01 ) , fat-free soft tissue ( p < 0.01 ) , weight ( p < 0.01 ) , height ( p < 0.01 ) , and body mass index ( p < 0.05 ) . CONCLUSIONS An after-school program focusing on MVPA had a beneficial effect on fitness and body composition . During the summers , the beneficial effect of the previous year 's participation on fitness and % BF was lost . This highlights the importance of year-round programs to promote healthy growth in youths PURPOSE The study evaluated whether targeted changes in factors influencing enjoyment of physical education ( PE ) , physical activity enjoyment , and self-efficacy beliefs about participating in physical activity mediated the effect of the Lifestyle Education for Activity Program ( LEAP ) intervention on participation in physical activity . METHODS High schools ( N=24 ) paired on enrollment size , racial composition , urban or rural location , and class structure were r and omized into control ( N=12 ) or experimental ( N=12 ) groups . Of the 4044 girls enrolled and eligible , 2087 ( 51.6 % ) participated in the measurement component of the study . There were 1038 girls in the control group and 1049 girls in the experimental group . INTERVENTION LEAP was a comprehensive school-based intervention emphasizing changes in instruction and school environment design ed to increase physical activity among black and white adolescent girls . It was organized according to the Coordinated School Health Program and included a PE component with core objectives of promoting enjoyment of PE , physical activity enjoyment , and self-efficacy . RESULTS Latent variable structural equation modeling indicated that : 1 ) the intervention had direct , positive effects on physical activity and factors influencing enjoyment of PE , which subsequently explained the effects of increased physical activity enjoyment and self-efficacy on increased physical activity ; and 2 ) an additional , indirect effect of physical activity enjoyment on physical activity operated by an influence on self-efficacy . CONCLUSIONS Increases in enjoyment partially mediated the positive effect of the LEAP intervention . To our knowledge , we have provided the first experimental evidence from a r and omized controlled trial linking increased enjoyment with increased physical activity among black and white adolescent girls OBJECTIVE African-American girls and women are at high risk of obesity and its associated morbidities . Few studies have tested obesity prevention strategies specifically design ed for African-American girls . This report describes the design and baseline findings of the Stanford GEMS ( Girls health Enrichment Multi-site Studies ) trial to test the effect of a two-year community- and family-based intervention to reduce weight gain in low-income , pre-adolescent African-American girls . DESIGN R and omized controlled trial with measurements scheduled in girls ' homes at baseline , 6 , 12 , 18 and 24 month post-r and omization . SETTING Low-income areas of Oakl and , CA . PARTICIPANTS Eight , nine and ten year old African-American girls and their parents/caregivers . INTERVENTIONS Girls are r and omized to a culturally-tailored after-school dance program and a home/family-based intervention to reduce screen media use versus an information-based community health education Active-Placebo Comparison intervention . Interventions last for 2 years for each participant . MAIN OUTCOME MEASURE Change in body mass index over the two-year study . RESULTS Recruitment and enrollment successfully produced a predominately low-socioeconomic status sample . Two-hundred sixty one ( 261 ) families were r and omized . One girl per family is r and omly chosen for the analysis sample . R and omization produced comparable experimental groups with only a few statistically significant differences . The sample had a mean body mass index ( BMI ) at the 74 th percentile on the 2000 CDC BMI reference , and one-third of the analysis sample had a BMI at the 95th percentile or above . Average fasting total cholesterol and LDL cholesterol were above NCEP thresholds for borderline high classifications . Girls averaged low levels of moderate to vigorous physical activity , more than 3 h per day of screen media use , and diets high in energy from fat . CONCLUSIONS The Stanford GEMS trial is testing the benefits of culturally-tailored after-school dance and screen-time reduction interventions for obesity prevention in low-income , pre-adolescent African-American girls OBJECTIVE This paper describes the development of an after-school obesity-prevention program for African-American girls , and presents findings from a 12-week pilot trial conducted by the University of Minnesota . This study was part of the GEMS project , created to test interventions design ed to reduce excess weight gain in African-American girls . DESIGN Two-arm parallel group , r and omized controlled trial . Measures were taken at baseline and at 12 weeks follow up . SETTING An after-school community program . PARTICIPANTS Fifty-four African-American girls , 8- to 10-years of age , and their parents/caregivers . INTERVENTION The after-school intervention was conducted twice a week for 12 weeks , and focused on increasing physical activity and healthy eating .  A family component was also included . Girls in the control group received a program over 12 weeks unrelated to nutrition and physical activity . OUTCOMES Measures included height and weight ( body mass index ) , percent body fat ( DEXA ) , physical activity , assessed using a CSA accelerometer and self-report , two 24-hour dietary recalls , and psycho-social and demographic variables . Parental data included demographic and psycho-social characteristics , and dietary measures . Additionally , process evaluation data on the intervention were collected . RESULTS Recruitment goals were met . After adjustment for baseline level , follow-up BMI did not differ between the treatment groups , an expected finding , given that this was a pilot study . At 12 weeks follow up , differences between the intervention and control groups were in the hypothesized direction of change for most variables , among both the girls and their parents . Process evaluation results demonstrated that the program was well attended , and well received , by girls and parents . CONCLUSIONS An after-school obesity prevention program for low-income African-American girls is a promising model for future efforts Abstract Opportunities for children to be physically active during school time are sparse and becoming increasingly so . The purpose of this investigation was to determine if children would compensate for school days ( 9 a.m.–3 p.m. ) of restricted physical activity opportunities by increasing activity levels after school ( 3 p.m.–7:30 p.m. ) . Third and fourth grade children ( N = 76 ) each wore a CSA accelerometer for 4 nonconsecutive days . Two days were categorized as active — during school , all children participated in outdoor recess and physical education class . Two days were categorized as restricted — all children spent their recess time indoors at a computer terminal , and no physical education class was scheduled . Dependent t tests revealed that children did not compensate for a sedentary school day by increasing their levels of physical activity after school . In fact , average movement counts per minute were higher in the 3 p.m.–7:30 p.m. period following the active day ( 525 counts·min−1 ) versus the restricted day ( 186 counts·min−1 ) . These findings suggest cause for concern if children 's opportunities to be active within school time are limited . Several reasons are given as to why children did not 
    Output:
    
The limited evidence suggests that  after-school programs  can improve physical activity levels and other health-related aspects .