***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: OBJECTIVE To evaluate the effectiveness of a program to increase walking to and from school . DESIGN A cluster r and omised controlled trial . SETTING 24 primary public schools in inner west Sydney , Australia . PARTICIPANTS 1996 students aged 10 - 12 years and their parents . INTERVENTION A two-year multi-component program included classroom activities , development of school Travel Access Guides , parent newsletters and improving environments with local councils . MEASURES Two measures were used : a survey completed by students on how they travelled to and from school over five days , and a survey completed by their parents on how their child travelled to and from school in a usual week . RESULTS The percentage of students who walked to and from school increased in both the intervention and control schools . Data from parent surveys found that 28.8 % of students in the intervention group increased their walking , compared with 19 % in the control group ( a net increase of 9.8 % , p=0.05 ) . However this effect was not evident in the student data . CONCLUSION The study produced a mixed result , with a high variation in travel patterns from school to school . Intervention research should address the complexity of multiple factors influencing student travel to school with a focus on changing local environments and parents ' travel to work BACKGROUND The purpose of this study was to determine the effectiveness of Ready for Recess : an elementary school recess intervention targeting staff training ( ST ) and providing recreational equipment ( EQ ) . METHODS Ready for Recess had 4 intervention schools : 1 ) EQ+ST , 2 ) EQ , 3 ) ST , and 4 ) control . Moderate-to-vigorous physical activity ( MVPA )  was assessed with accelerometers at the four schools in 257 3rd- to 6th- grade children . R and om intercept models for overweight/obese ( OWOB ) and healthy weight ( HW ) for boys and girls separately , examined change in percentage of time spent in MVPA during recess across EQ+ST , EQ , and ST compared with the control from baseline to postintervention . RESULTS HW boys receiving EQ+ST increased MVPA by 19.4 % , OWOB boys receiving ST increased MVPA by 4.5 % , OWOB girls receiving EQ-ST increased MVPA by 6.0 % , while HW girls receiving EQ decreased MVPA by 13.6 % in comparison with the control . CONCLUSIONS Ready for Recess represents a possible means to increase MVPA in OWOB girls/boys , population s least likely to meet MVPA recommendations . However , the effect of the intervention was not uniform across all subgroups Background To evaluate the impact of a walking school bus ( WSB ) program on student transport in a low-income , urban neighborhood . Methods The design was a controlled , quasi-experimental trial with consecutive cross-sectional assessment s. The setting was three urban , socioeconomically disadvantaged , public elementary schools ( 1 intervention vs. 2 controls ) in Seattle , Washington , USA . Participants were ethnically diverse students in kindergarten-5th grade ( aged 5–11 years ) . The intervention was a WSB program consisting of a part-time WSB coordinator and parent volunteers . Students ' method of transportation to school was assessed by a classroom survey at baseline and one-year follow-up . The Pearson Chi-squared test compared students transported to school at the intervention versus control schools at each time point . Due to multiple testing , we calculated adjusted p-values using the Ryan-Holm stepdown Bonferroni procedure . McNemar 's test was used to examine the change from baseline to 12-month follow-up for walking versus all other forms of school transport at the intervention or control schools . Results At baseline , the proportions of students ( n = 653 ) walking to the intervention ( 20 % + /- 2 % ) or control schools ( 15 % + /- 2 % ) did not differ ( p = 0.39 ) . At 12-month follow up , higher proportions of students ( n = 643 , p = 0.001 ) ) walked to the intervention ( 25 % + /- 2 % ) versus the control schools ( 7 % + /- 1 % ) . No significant changes were noted in the proportion of students riding in a car or taking the school bus at baseline or 12-month follow up ( all p > 0.05 ) . Comparing baseline to 12-month follow up , the numbers of students who walked to the intervention school increased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . In contrast , the numbers of students who walked to the control schools decreased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . Conclusion A WSB program is a promising intervention among urban , low-income elementary school students that may promote favorable changes toward active transport to school . Trial Registration Clinical Trials.gov Background This paper reports the primary outcomes of the Healthy Opportunities for Physical Activity and Nutrition ( HOP'N ) after-school project , which was an effectiveness trial design ed to evaluate the prevention of childhood obesity through building the capacity of after-school staff to increase physical activity ( PA ) and fruit and vegetable ( FV ) opportunities . Methods We conducted a three-year , nested cross-sectional group r and omized controlled effectiveness trial . After a baseline assessment year ( 2005 - 2006 ) , schools and their after-school programs were r and omized to the HOP'N after-school program ( n = 4 ) or control ( n = 3 ) , and assessed for two subsequent years ( intervention year 1 , 2006 - 2007 ; intervention year 2 , 2007 - 2008 ) . Across the three years , 715 fourth grade students , and 246 third and fourth grade after-school program participants were included in the study . HOP'N included community government human service agency ( Cooperative Extension ) led community development efforts , a three-time yearly training of after-school staff , daily PA for 30 minutes following CATCH guidelines , a daily healthful snack , and a weekly nutrition and PA curriculum ( HOP'N Club ) . Child outcomes included change in age- and gender-specific body mass index z-scores ( BMI z ) across the school year and PA during after-school time measured by accelerometers . The success of HOP'N in changing after-school program opportunities was evaluated by observations over the school year of after-school program physical activity sessions and snack FV offerings . Data were analyzed in 2009 . Results The intervention had no impact on changes in BMI z.  Overweight/obese children attending HOP'N after-school programs performed 5.92 minutes more moderate-to-vigorous PA per day after intervention , which eliminated a baseline year deficit of 9.65 minutes per day ( p < 0.05 ) compared to control site overweight/obese children . Active recreation program time at HOP'N sites was 23.40 minutes ( intervention year 1 , p = 0.01 ) and 14.20 minutes ( intervention year 2 , p = 0.10 ) greater than control sites . HOP'N sites and control sites did not differ in the number of FV offered as snacks . Conclusions The HOP'N program had a positive impact on overweight/obese children 's PA and after-school active recreation time . Trial registration NCT01015599 Background : An increased prevalence of overweight/obesity among children has led to school district level policies to  increase physical activity ( PA )  among elementary school students . Interventions are needed that increase activity levels without sacrificing time spent in academics . Objectives : We evaluated a policy implementation intervention for to increase in-school PA in elementary schools in Forsyth County , North Carolina , in a r and omized study with a delayed intervention control group . Methods : The study included third- through fifth- grade classrooms in eight elementary schools .  Instant Recess ® was used to introduce 10-minute PA breaks in classrooms on schedules determined by teachers . Direct observation was used to measure activity levels , other student behaviors , and teacher behaviors related to  PA in the classrooms . Results : Twenty-eight visits to schools were made during the spring and fall semesters of 2009 . At baseline 11 % to 44 % of intervention and control schools were engaged in classroom-based PA . PA  increased from baseline to spring follow-up in intervention schools and was maintained the following fall . Control schools  decreased PA  from baseline to spring and  increased PA  once they began the intervention . Students in classrooms engaged in Instant Recess exhibited statistically significant increases in light ( 51 % ) and moderate-intensity ( 16 % ) PA and increases in time spent in on-task behavior ( 11 % ) . Control schools experienced similar benefits after they began implementing Instant Recess . Conclusions : Instant Recess is useful for increasing PA and improving behavior among elementary school children . Additional research may be needed to underst and how to create policies supporting classroom activity breaks and how to assess policy adherence BACKGROUND Physical Activity Across the Curriculum ( PAAC ) was a three-year cluster r and omized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children . METHODS Twenty-four elementary schools were cluster r and omized to the Physical Activity Across the Curriculum intervention or served as control .  All children in grade s two and three were followed to grade s four and five .  Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers . Body Mass Index was the primary outcome , daily Physical activity and academic achievement were secondary outcomes . RESULTS The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9 , respectively ( NS ) . However , change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum . Schools with > or = 75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had < 75 min of Physical Activity Across the Curriculum ( 1.8+/-1.8 vs. 2.4+/-2.0 , p=0.02 ) . Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores . CONCLUSIONS The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children . Additionally , 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index BACKGROUND Less than half of elementary children meet the physical activity recommendations of 30 to 60 minutes of moderate-to-vigorous physical activity ( MVPA ) on a daily basis . Recess provides the single biggest opportunity for children to accumulate MVPA . This study explored whether a teacher 's social prompting to be active during recess alone and modeling of active recess-time games alone may increase the amount of MVPA children accumulate during recess . METHODS Three demographically matched schools were r and omly assigned to receive a social prompting intervention , modeling intervention , or to serve as a comparison group . Pre- and postintervention physical activity data was collected utilizing accelerometers . RESULTS Compared with preintervention , MVPA during recess increased significantly in the social prompting group and decreased significantly in the modeling group . There were no significant changes in the comparison group . There was a significant interaction between time and intervention : pre- to postintervention change between interventions was significant for modeling versus comparison and modeling versus social prompting , but not for social prompting versus comparison . CONCLUSIONS Modeling was not an effective strategy for increasing MVPA during recess . Social prompting may be an effective strategy for increasing MVPA during recess . However , larger studies are needed to determine whether social prompting increases MVPA during recess . In light of evidence suggesting that MVPA is linked to lower obesity rates , and a substantial number of health and academic benefits , social prompting may be a useful strategy to further explore to address the childhood obesity epidemic , and improve students ' health and academic outcomes The primary responsibility for engaging children in opportunities to be physically active and learn physical skills rests with school physical education . This study evaluated the effects of a combined health-related curriculum and inservice program on the quantity and quality of  elementary school  physical education lessons . Seven schools ( N = 28 fourth- grade classes ) in one district were r and omly assigned to one of three conditions : 10 classes were taught in their usual manner by classroom teachers ( Control [ CO ] ) ; 10 classes were taught by trained classroom teachers ( TT ) who received inservice training and follow-up consultations ; and  8 classes were taught by physical education specialists ( PES ) hired by the research project .  Student activity level , curriculum context , and teacher behavior were directly observed and coded during a sample of 112 lessons over an 8-month period . Results indicated significant differences in both the frequency and mean length of classes ( PES , 26.7 min ; TT , 23.4 min ; CO , 18.9 min ) . Additionally , the curriculum and inservice program equipped trained classroom teachers to provide significantly better classes than were provided by controls in terms of student activity engagement , lesson context , and active instructional behavior , though their classes did not match the quality of those taught by the physical education specialists . This study is unique in its use of direct observation of lessons to assess a curriculum and inservice intervention IMPORTANCE Identifying community-based programs that increase physical activity among diverse youth could yield sustainable tools to reduce obesity and obesity disparities . OBJECTIVE To evaluate the impact of a community-based after-school soccer and youth development program , America SCORES , on students ' physical activity , weight status , and fitness . DESIGN Cluster-r and omized trial . Study measures were collected in the fall ( baseline ) , winter ( midpoint ) , and spring ( end point ) of the 2009 - 2010 school year . SETTING After-school programs in 6 schools within a large urban school district . PARTICIP 
    Output:
    
These findings indicate that interventions in active travel and classrooms setting s positively influence youth PA .