***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 The modern classroom is an inherently sedentary environment . Virtual Field Trips ( VFTs ) using interactive whiteboards to explore virtual scenes are a potential method of converting sedentary class-time into physically active teaching . This pilot aim ed to assess the effects of a developed VFT on physical activity and learning in primary -school children . Methods Participants ( n = 85 ) were r and omly assigned to a ) a 30-minute physically active London 2012 Olympics-themed VFT , or b ) a 30-minute sedentary version of the same VFT .  Activity was measured using GT1 M Actigraphs , content recall was assessed with a quiz and user evaluations were gained from teacher and pupil question naires . Results Pupils in the active VFT displayed significantly less sedentary time ( p < 0.001 ) , and significantly more light ( p < 0.001 ) , moderate ( p = 0.01 ) and vigorous physical activity ( p < 0.001 ) than sedentary VFT pupils . No differences in content recall were found between intervention groups : suggesting that adding physical activity into classroom teaching may not compromise attainment . High acceptability was found in teachers and active VFT students rated their session significantly higher than sedentary pupils ( p < 0.002 ) . Conclusions This one-day pilot provides early evidence of the ability of VFTs to convert sedentary academic time into active time . Longitudinal research is needed to assess prolonged effects of active VFTs in reducing sedentary time Objective : An emerging field of research indicates that physical activity can benefit cognitive functions and academic achievements in children . However , less is known about how academic achievements can benefit from specific types of motor activities ( e.g. , fine and gross ) integrated into learning activities . Thus , the aim of this study was to investigate whether fine or gross motor activity integrated into math lessons ( i.e. , motor-enrichment ) could improve  children 's mathematical performance . Methods : A 6-week within school cluster-r and omized intervention study investigated the effects of motor-enriched mathematical teaching in Danish preadolescent children ( n = 165 , age = 7.5 ± 0.02 years ) . Three groups were included : a control group ( CON ) , which received non-motor enriched conventional mathematical teaching , a fine motor math group ( FMM ) and a gross motor math group ( GMM ) , which received mathematical teaching enriched with fine and gross motor activity , respectively . The children were tested before ( T0 ) , immediately after ( T1 ) and 8 weeks after the intervention ( T2 ) . A st and ardized mathematical test ( 50 tasks ) was used to evaluate mathematical performance . Furthermore , it was investigated whether motor-enriched math was accompanied by different effects in low and normal math performers . Additionally , the study investigated the potential contribution of cognitive functions and motor skills on mathematical performance . Results : All groups improved their mathematical performance from T0 to T1 . However , from T0 to T1 , the improvement was significantly greater in GMM compared to FMM ( 1.87 ± 0.71 correct answers ) ( p = 0.02 ) . At T2 no significant differences in mathematical performance were observed . A subgroup analysis revealed that normal math-performers benefitted from GMM compared to both CON 1.78 ± 0.73 correct answers ( p = 0.04 ) and FMM 2.14 ± 0.72 correct answers ( p = 0.008 ) . These effects were not observed in low math-performers . The effects were partly accounted for by visuo-spatial short-term memory and gross motor skills . Conclusion : The study demonstrates that motor enriched learning activities can improve mathematical performance . In normal math performers GMM led to larger improvements than FMM and CON . This was not the case for the low math performers . Future studies should further eluci date the neurophysiological mechanisms underlying the observed behavioral effects Background There are a number of practical and ethical issues raised in school-based health research , particularly those related to obtaining consent from parents and assent from children . One approach to developing , strengthening , and supporting appropriate consent and assent processes is through community engagement . To date , much of the literature on community engagement in biomedical research has concentrated on community- or hospital-based research , with little documentation , if any , of community engagement in school-based health research . In this paper we discuss our experiences of consent , assent and community engagement in implementing a large school-based cluster r and omized trial in rural Kenya . Methods Data collected as part of a qualitative study investigating the acceptability of the main trial , focus group discussion s with field staff , observations of practice and authors ’ experiences are used to : 1 ) highlight the challenges faced in obtaining assent/consent ; and 2 ) strategies taken to try to both protect participant rights ( including to refuse and to withdraw ) and ensure the success of the trial . Results Early meetings with national , district and local level stakeholders were important in establishing their co-operation and support for the project . Despite this support , both practical and ethical challenges were encountered during consenting and assenting procedures . Our strategy for addressing these challenges focused on improving communication and underst and ing of the trial , and maintaining dialogue with all the relevant stakeholders throughout the study period . Conclusions A range of stakeholders within and beyond schools play a key role in school based health trials . Community entry and information dissemination strategies need careful planning from the outset , and with on-going consultation and feedback mechanisms established in order to identify and address concerns as they arise . We believe our experiences , and the ethical and practical issues and dilemmas encountered , will be of interest for others planning to conduct school-based research in Africa . Trial registration National Institute of Health We compared changes in academic achievement across 3years between children in elementary schools receiving the Academic Achievement and Physical Activity Across the Curriculum intervention ( A+PAAC )  , in which classroom teachers were trained to deliver academic lessons using moderate-to-vigorous physical activity ( MVPA ) compared to a non-intervention control .  Elementary schools in eastern Kansas ( n=17 ) were cluster r and omized to A+PAAC ( N=9 , target ≥100min/week ) or control ( N=8 ) . Academic achievement ( math , reading , spelling ) was assessed using the Wechsler Individual Achievement Test-Third Edition ( WIAT-III ) in a sample of children ( A+PAAC=316 , Control=268 ) in grade s 2 and 3 at baseline ( Fall 2011 ) and repeated each spring across 3years . On average 55min/week of A+PACC lessons were delivered each week across the intervention . Baseline WIAT-III scores ( math , reading , spelling ) were significantly higher in students in A+PAAC compared with control schools and improved in both groups across 3years . However , linear mixed modeling , accounting for baseline between group differences in WIAT-III scores , ethnicity , family income , and cardiovascular fitness , found no significant impact of A+PAAC on any of the academic achievement outcomes as determined by non-significant group by time interactions . A+PAAC neither diminished or improved academic achievement across 3-years in elementary school children compared with controls . Our target of 100min/week of active lessons was not achieved ; however , students attending A+PAAC schools received an additional 55min/week of MVPA which may be associated with both physical and mental health benefits , without a reduction in time devoted to academic instruction Background Active educational video games ( AVGs ) appear to have a positive effect on elementary school students ' motivation leading to enhanced learning outcomes . The purpose of this study was to identify the effectiveness of an AVG on elementary school students ' science knowledge learning , physical activity ( PA ) level , and interest-based motivation . Methods In this r and omized controlled study , 53 elementary school students were assigned to an experimental condition or a comparison condition . The experimental condition provided an AVG learning environment , whereas the comparison condition was based on sedentary educational video games . Results The results of repeated measures analysis of variance ( ANOVA ) on the knowledge test showed that students in both groups performed better on the post-test than they did on the pre-test ( p < 0.001 , η2 = 0.486 ) , and their post-test scores did not differ significantly . The experimental condition provided a more active environment since the students ' average heart rates ( HRs ) were in the Target-Heart-Rate-Zone ( HR = 134 bpm ) , which was significantly higher than the average HR ( 103 bpm ) from the comparison condition ( t = 7.212 , p < 0.001 ) . Students in the experimental condition perceived a higher level of situational interest than their counterparts in the comparison group ( p < 0.01 , and η2 = 0.301 ) . Conclusion These results suggest that AVGs benefit children more in terms of PA and motivation  than traditional video games by providing an enjoyable learning experience and sufficient PA Background . Physically active lessons have not often been assessed with r and omized controlled trials . Aims . Evaluate the effects of the “ Virtual Traveller ” ( VT ) intervention delivered using classroom interactive whiteboards on physical activity , on-task behavior , and student engagement . Methods . Participants were 219 children aged 8 to 9 years from 10 schools in Greater London , assessed in a cluster-r and omized controlled trial between March 2015 and May 2016 . For 6 weeks , intervention children received 10-minute VT sessions three times a week during math and English lessons ( VT group : n = 113 ) . Children in control schools received regular teaching ( COM group : n = 106 ) . Outcomes were school-day , weekend-day , and lesson-time sedentary behavior ( SB ) , light physical activity ( LPA ) and moderate-to-vigorous physical activity ( MVPA ) , and on-task behavior and student engagement , assessed at baseline ( T0 ) , 2 weeks ( T1 ) , and 4 weeks ( T2 ) during the VT intervention and 1 week ( T3 ) and 3 months ( T4 ) postintervention using multilevel modeling . Results . VT pupils engaged in significantly more school-day MVPA at T1 only , with no other significant differences between groups in overall school-day or weekend-day activity . VT pupils engaged in significantly less SB and more MVPA during lesson time than COM pupils . More on-task behavior was shown in VT pupils than COM pupils but there was no difference in student engagement . Discussion . VT  reduced sedentary behavior and increased physical activity during lesson time but not across overall school or weekend days . VT improved on-task behavior but had no effect on student engagement . Conclusion . Physical activity can be integrated into teaching using interactive whiteboards with no detriment to educational outcomes A cluster-r and omized controlled trial was conducted to examine the effects of a 4-week program that integrated movements into cognitive tasks related to numerical skills . Participants ( N = 120 , Mage = 4.70 years , SD = 0.49 ; 57 girls ) were assigned to one of the following four conditions : performing integrated physical activity ( task relevant ) , performing nonintegrated physical activity ( task nonrelevant ) , observing integrated physical activity , or conventional sedentary teaching ( without performing or observing physical activity ) . Results showed that children who performed task-relevant integrated physical activity performed better than children in all other conditions . In addition , children who performed physical activity , either integrated or nonintegrated , reported higher scores for enjoyment of the instructional method than the two sedentary learning conditions . Implication s for educational theory and practice are discussed PURPOSE To examine the impact of integrating physical activity with elementary curricula on fluid intelligence and academic achievement . METHODS A r and om sample of 3rd grade teachers  integrated physical activity into their core curricula approximately 30 minutes a day , 3 days a week from January 2008 to April 2008 . Noninvasive fluid intelligence cognitive measures were used along with State-m and ated academic achievement tests . RESULTS Experimental Group children averaged close to 1200 pedometer steps per integration day , thus averaging 3600 steps per week . Children in the Experimental Group performed significantly better on the SPM Fluid Intelligence Test . Children in the Experimental Group also performed significantly better on the Social Studies State m and ated academic achievement test . Experimental Group children also received higher scores on the English/ Language Arts , Math and Science achievements tests , but were not statistically significant compared with Control Group children . Children classified in Fitnessgram 's Healthy Fitness Zone for BMI earned lower scores on many of the SPM Fluid Intelligence components . DISCUSSION This investigation provides evidence that movement can influence fluid intelligence and should be considered to promote cognitive development of elementary-age children . Equally compelling were the differences in SPM Fluid Intelligence Test scores for children who were distinguished by Fitnessgram 's BMI cut points Background Physical activity interventions targeting children and adolescents ( ≤18 years ) often focus on complex intra- and inter-personal behavioral constructs , social-ecological frameworks , or some combination of both . Recently published meta-analytical review s and large-scale r and omized controlled trials have demonstrated that these intervention approaches have largely produced minimal or no improvements in young people ’s physical activity levels . Discussion In this paper , we propose that the main reason for previous studies ’ limited effects is that fundamental mechanisms that lead to change in youth physical activity have often been overlooked or misunderstood . Evidence from observational and experimental studies is presented to support the development of a new theory positing that the primary mechanisms of change in many youth physical activity interventions are approaches that fall into one of the following three categories : ( a ) the expansion of opportunities for  youth  to be active by the inclusion of a new occasion to be active , ( b ) the extension of an existing physical activity opportunity by increasing the amount of time allocated for that opportunity , and /or ( c ) the enhancement of existing physical activity opportunities through strategies design ed to increase physical activity above routine practice . Their application and considerations for intervention design and interpretation are presented . Summary The utility of these mechanisms , referred to as the Theory of Exp and ed , Extended , and Enhanced Opportunities ( TEO ) , is demonstrated in their parsimony , logical appeal , support with empirical evidence , and the direct and immediate application to numerous setting s and context s. The TEO offers a new way to underst and youth physical activity behaviors and provides a common taxonomy by which interventionists can identify appropriate targets for interventions across different setting s and context s. We believe the formal 
    Output:
    
Physically active classrooms may slightly improve academic achievement compared to the traditional sedentary lessons .