***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 Increasing prevalences of overweight and obesity in children are known problems in industrialized countries . Early prevention is important as overweight and obesity persist over time and are related with health problems later in adulthood . " Komm mit in das gesunde Boot - Grundschule " is a school-based program to promote a healthier lifestyle . Main goals of the intervention are to increase physical activity  , decrease the consumption of sugar-sweetened beverages , and to decrease time spent sedentary by promoting active choices for healthy lifestyle . The program to date is distributed by 34 project delivery consultants in the state of Baden-Württemberg and is currently implemented in 427 primary schools . The efficacy of this large scale intervention is examined via the Baden-Württemberg Study . Methods / Design The Baden-Württemberg Study is a prospect i ve , stratified , cluster-r and omized , and longitudinal study with two groups ( intervention group and control group ) . Measurements were taken at the beginning of the academic years 2010/2011 and 2011/2012 . Efficacy of the intervention is being assessed using three main outcomes : changes in waist circumference , skinfold thickness and 6 minutes run . Stratified cluster-r and omization ( according to class grade level ) was performed for primary schools ; pupils , teachers/principals , and parents were investigated . An approximately balanced number of classes in intervention group and control group could be reached by stratified r and omization and was maintained at follow-up . Discussion At present , " Komm mit in das Gesunde Boot - Grundschule " is the largest school-based health promotion program in Germany . Comparative objective main outcomes are used for the evaluation of efficacy . Simulations showed sufficient power with the existing sample size . Therefore , the results will show whether the promotion of a healthier lifestyle in primary school children is possible using a relatively low effort within a school-based program involving children , teachers and parents . The research team anticipates that not only efficacy will be proven in this study but also expects many other positive effects of the program . Trial registration German Clinical Trials Register ( DRKS ) , DRKS-ID : BACKGROUND School performance of overweight children has been found to be inferior to normal weight children ; however , the reason(s ) for this link between overweight and academic performance remain unclear . Psychosocial factors , such as weight-based teasing , have been proposed as having a possible mediating role , although they remain largely unexplored . METHODS R and om  parental telephone survey data ( N=1 071 ) of public school students collected as part of the statewide evaluation of Arkansas Act 1220 , a law to reduce childhood obesity , were used .  Overweight status ( body mass index > 85th percentile for gender and age ) and weight-based teasing  were examined as predictors of poorer school performance . RESULTS Overweight status was a significant predictor of poorer school performance ( OR=1.51 ; 95 % CI=1.01 , 2.25 ) , after adjustment for gender , school level , free and reduced lunch participation , and race . However , the addition of weight-based teasing to the model ( with weight category and covariates ) reduced the weight category parameter estimate by 24 % , becoming non-significant ( OR=1.40 ; 95 % CI=0.93 , 2.10 ) and indicating a possible mediating effect of weight-based teasing on the relationship between weight category and school performance . Weight-based teasing was significantly associated with school performance , with lower odds of strong school performance among weight-based teased children ( OR=0.44 ; 95 % CI=0.27 , 0.74 ) . CONCLUSION Psychosocial variables , such as weight-based teasing , should be considered in future research examining the impact of childhood obesity on school performance and in future intervention studies OBJECTIVE To test a 2-year community- and family-based obesity prevention program for low-income African American girls : Stanford GEMS ( Girls ' health Enrichment Multi-site Studies ) . DESIGN R and omized controlled trial with follow-up measures scheduled at 6 , 12 , 18 , and 24 months . SETTING Low-income areas of Oakl and , California . PARTICIPANTS African American girls aged 8 to 10 years ( N=261 ) and their parents or guardians . INTERVENTIONS Families were r and omized to one of two 2-year , culturally tailored interventions : ( 1 ) after-school hip-hop , African , and step dance classes and a home/family-based intervention to reduce screen media use or ( 2 ) information-based health education . MAIN OUTCOME MEASURE Changes in body mass index ( BMI ) . RESULTS Changes in BMI did not differ between groups ( adjusted mean difference [ 95 % confidence interval ] = 0.04 [ -0.18 to 0.27 ] per year ) . Among secondary outcomes , fasting total cholesterol level ( adjusted mean difference , -3.49 [ 95 % confidence interval , -5.28 to -1.70 ] mg/dL per year ) , low-density lipoprotein cholesterol level ( -3.02 [ -4.74 to -1.31 ] mg/dL per year ) , incidence of hyperinsulinemia ( relative risk , 0.35 [ 0.13 to 0.93 ] ) , and depressive symptoms ( -0.21 [ -0.42 to -0.001 ] per year ) decreased more among girls in the dance and screen time reduction intervention . In exploratory moderator analysis , the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline ( P = .02 ) and /or those whose parents or guardians were unmarried ( P = .01 ) . CONCLUSIONS A culturally tailored after-school dance and screen time reduction intervention for low-income , preadolescent African American girls did not significantly reduce BMI gain compared with health education but did produce potentially clinical ly important reductions in lipid levels , hyperinsulinemia , and depressive symptoms . There was also evidence for greater effectiveness in high-risk subgroups of girls Background Childhood obesity and physical inactivity are increasing dramatically worldwide . Children of low socioeconomic status and /or children of migrant background are especially at risk . In general , the overall effectiveness of school-based programs on health-related outcomes has been disappointing . A special gap exists for younger children and in high risk groups . Methods / Design This paper describes the rationale , design , curriculum , and evaluation of a multicenter preschool r and omized intervention study conducted in areas with a high migrant population in two out of 26 Swiss cantons . Twenty preschool classes in the German ( canton St. Gallen ) and another 20 in the French ( canton Vaud ) part of Switzerl and were separately selected and r and omized to an intervention and a control arm by the use of opaque envelopes . The multidisciplinary lifestyle intervention aim ed to increase physical activity and sleep duration , to reinforce healthy nutrition and eating behaviour , and to reduce media use . According to the ecological model , it included children , their parents and the teachers . The regular teachers performed the majority of the intervention and were supported by a local health promoter . The intervention included physical activity lessons , adaptation of the built infrastructure ; promotion of regional extracurricular physical activity ; playful lessons about nutrition , media use and sleep , funny homework cards and information material s for teachers and parents . It lasted one school year . Baseline and post-intervention evaluations were performed in both arms . Primary outcome measures included BMI and aerobic fitness ( 20 m shuttle run test ) . Secondary outcomes included total ( skinfolds , bioelectrical impedance ) and central ( waist circumference ) body fat , motor abilities ( obstacle course , static and dynamic balance ) , physical activity and sleep duration ( accelerometry and question naires ) , nutritional behaviour and food intake , media use , quality of life and signs of hyperactivity ( question naires ) , attention and spatial working memory ability ( two vali date d tests ) . Research ers were blinded to group allocation . Discussion The purpose of this paper is to outline the design of a school-based multicenter cluster r and omized , controlled trial aim ing to reduce body mass index and to increase aerobic fitness in preschool children in culturally different parts of Switzerl and with a high migrant population .Trial Registration Trial Registration : clinical trials.gov Exergames are videogames that require gross motor activity , thereby combining gaming with physical activity . This study examined the role of competitive versus cooperative exergame play on short-term changes in executive function skills , following a 10-week exergame training intervention .  Fifty-four low-income overweight and obese African American adolescents were r and omly assigned to a competitive exergame condition , a cooperative exergame condition , or a no-play control group . Youths in the competitive exergame condition improved in executive function skills more than did those in the cooperative exergame condition and the no-play control group . Weight loss during the intervention was also significantly positively correlated with improved executive function skills . The findings link competitive exergame play to beneficial cognitive outcomes for at-risk ethnic minority adolescents to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely PURPOSE This study was conducted to determine the effect of physical education class enrollment and physical activity on academic achievement in middle school children . METHODS Participants were 214 sixth- grade students r and omly assigned to physical education during either first or second semesters .  Moderate and vigorous physical activity ( MVPA ) ( number of 30-min time blocks ) outside of school was assessed using the 3-d physical activity recall ( 3DPAR ) . The 3DPAR time blocks were converted to ordinal data with scores of 1 ( no activity ) , 2 ( some activity ) , or 3 ( activity meeting Healthy People 2010 guidelines ) . Academic achievement was assessed using grade s from four core academic classes and st and ardized test scores ( Terra Nova percentiles ) . RESULTS Grade s were similar regardless of whether students were enrolled in physical education during first or second semesters . Physical education classes averaged only 19 min of MVPA . Students who either performed some or met Healthy People 2010 guidelines for vigorous activity had significantly higher grade s ( P < 0.05 ) than students who performed no vigorous activity in both semesters . Moderate physical activity did not affect grade s. St and ardized test scores were not significantly related to physical education class enrollment or physical activity levels . CONCLUSION Although academic achievement was not significantly related to physical education enrollment , higher grade s were associated with vigorous physical activity , particularly activity meeting recommended Healthy People 2010 levels Background The prevalence of childhood obesity has increased rapidly during the last three decades in the Netherl and s. It is assumed that mainly environmental factors have contributed to this trend . Parental overweight and low social economic status are risk factors for childhood obesity . Childhood obesity affects self-esteem and has negative consequences on cognitive and social development . Obese children tend to become obese adults , which increases the risk for developing cardiovascular complications , type 2 diabetes mellitus , and psychosocial problems . Additionally , the secretion of several gastrointestinal hormones , responsible for appetite and food intake , is impaired in obese subjects . Weight reduction through lifestyle changes in order to change health risks is , until now , suggested as the preferred treatment for childhood obesity . The objective of this study is the effect evaluation of a family-based cognitive behavioral multidisciplinary lifestyle treatment . The intervention aims to establish long-term weight reduction and stabilization , reduction of obesity-related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques . Study design / Methods In this r and omized clinical trial newly presented children with obesity ( 8 - 17 years old ) are divided , by r and omization , in an intervention and  control  group , both consisting of 40 obese children . The intervention is carried out in groups of 8 - 11 children , and consists of respectively 7 and 5 separate group meetings for the children and their parents and 1 joint group meeting of 2 ½ hours . Main topics are education on nutrition , self-control techniques , social skills , physical activity and improvement of self-esteem . The control group is given advice on physical activity and nutrition . For normal data comparison , data were collected of 40 normal-weight children , 8 - 17 years old . Discussion Because of the increasing prevalence of childhood obesity and the impact on the individual as well as on society , prevention and treatment of obesity in children is of great importance . For evaluation of short- and long-term effects of the treatment , measurements are taken before and after 3 months of treatment , and after 12 and 24 months follow-up . During these visits clinical and biochemical data are determined , cardiovascular fitness tests are performed and quality of life question naires are completed . Trial registration International St and ard R and omised Controlled Trial Number Register IS RCT 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 
    Output:
    
No evidence suggested an effect of any lifestyle intervention on reading , vocabulary and language achievements , attention , inhibitory control and simultaneous processing .
No study provided evidence of the effect of lifestyle interventions on future success .
Multicomponent interventions targeting physical activity and healthy diet could benefit general school achievement , whereas a physical activity intervention delivered for childhood weight management could benefit mathematics achievement , executive function and working memory .
Although the effects are small , a very large number of children and adolescents could benefit from these interventions .