***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 An emerging public health strategy is to enhance children ’s opportunities to be physically active during school break periods . The aim of this study was to evaluate the effects of the Lunchtime Enjoyment Activity and Play ( LEAP ) school playground intervention on primary school children ’s  quality of life ( QOL ) , enjoyment and participation in physical activity ( PA ) . Methods This study consisted of a movable/recycled material s intervention that included baseline , a 7-week post-test and an 8-month follow-up data collection phase . Children within an intervention school ( n = 123 ) and a matched control school ( n = 152 ) aged 5-to-12-years-old were recruited for the study . Children ’s PA was measured using a combination of pedometers and direct observation ( SOPLAY ) . Quality of life , enjoyment of PA and enjoyment of lunchtime activities were assessed in the 8 - 12 year children . A multi-level mixed effect linear regression model was applied in STATA ( version 12.0 ) using the xtmixed comm and to fit linear mixed models to each of the variables to examine whether there was a significant difference ( p < 0.05 ) between the intervention and control school at the three time points ( pre , post and follow-up ) . Results Significant overall interaction effects ( group × time ) were identified for children ’s mean steps and distance ( pedometers ) in the intervention school compared to the control school . Intervention school children also spent significantly higher proportions within specified target areas engaged in higher PA intensities in comparison to the control school at both the 7-week post-test and 8-month follow-up . A short-term treatment effect was revealed after 7-weeks for children ’s physical health scale QOL , enjoyment of PA and enjoyment of intra-personal play activities . Conclusions Examining the effects of this school playground intervention over a school year suggested that the introduction of movable/recycled material s can have a significant , positive long-term intervention effect on children ’s PA . The implication s from this simple , low-cost intervention provide impetus for schools to consider introducing the concept of a movable/recycled material s intervention on a wider scale within primary school setting s . Trial registration Australian and New Zeal and Clinical Trials Registration Number : ACTRN12613001155785 Background : To investigate whether changing the play environment in primary schools to one that includes greater risk and challenge increases physical activity and reduces body mass index ( BMI ) .Subjects/ Methods : A 2-year cluster r and omised controlled trial was undertaken in 16 New Zeal and schools ( years 1–8 ) . Intervention schools ( n=8 ) re design ed their play environments to encourage imaginative and independent free play by increasing opportunities for risk and challenge ( for example , rough- and -tumble play ) , reducing rules and adding new playground components ( for example , loose parts ) . Control schools ( n=8 ) were asked to not change their play environment . A qualified playworker rated all school play environments at baseline and 1 year . Primary outcomes were moderate-to-vigorous physical activity ( 7-day accelerometry ) and BMI z-score , collected in 840 children at baseline , 1 and 2 years . Data were analysed using generalised estimating equations . Results : Multiple changes were made to the school play environments result ing in a significant difference in overall play evaluation score between intervention and control schools of 4.50 ( 95 % confidence interval : 1.82 to 7.18 , P=0.005 ) , which represents a substantial improvement from baseline values of 19.0 ( s.d . 3.2 ) . Overall , schools liked the intervention and reported many benefits , including increased physical activity . However , these beliefs did not translate into significant differences in objective ly measured physical activity , either as counts per minute ( for example , 35 ( −51 to 120 ) during lunch break ) or as minutes of moderate-to-vigorous physical activity ( 0.4 , −1.1 to 2.0 ) . Similarly , no significant differences were observed for BMI , BMI z-score or waist circumference at 1 or 2 years ( all P>0.321 ) . Conclusions : Altering the school play environment to one that promoted greater risk and challenge for children did not increase physical activity , nor subsequently alter body weight . Although schools embraced the concept of adding risk and challenge in the playground , our findings suggest that children may have been involved in different , rather than additional activities OBJECTIVE To investigate the effect of a seven-month , school-based cluster-r and omized controlled trial on academic performance in 10-year-old children . METHODS In total , 1129 fifth- grade children from 57 elementary schools in Sogn og Fjordane County , Norway , were cluster-r and omized by school either to the intervention group or to the control group . The children in the 28 intervention schools participated in a physical activity intervention between November 2014 and June 2015 consisting of three components : 1 ) 90min/week of physically active educational lessons mainly carried out in the school playground ; 2 ) 5min/day of physical activity breaks during classroom lessons ; 3 ) 10min/day physical activity homework . Academic performance in numeracy , reading and English was measured using st and ardized Norwegian national tests . Physical activity was measured objective ly by accelerometry . RESULTS We found no effect of the intervention on academic performance in primary analyses ( st and ardized difference 0.01 - 0.06 , p>0.358 ) . Subgroup analyses , however , revealed a favorable intervention effect for those who performed the poorest at baseline ( lowest tertile ) for numeracy ( p=0.005 for the subgroup∗group interaction ) , compared to controls ( st and ardized difference 0.62 , 95 % CI 0.19 - 1.07 ) . CONCLUSIONS This large , rigorously conducted cluster RCT in 10-year-old children supports the notion that there is still inadequate evidence to conclude that  increased physical activity in school enhances academic achievement in all children . Still , combining physical activity and learning seems a viable model to stimulate learning in those academically weakest schoolchildren OBJECTIVES : Comprehensive school health ( CSH ) is a multifaceted approach to health promotion . A key objective of CSH is to foster positive health behaviors outside of school . This study examined the 2-year change in physical activity during and after school among students participating in a CSH intervention in Edmonton , Alberta , Canada . METHODS : This was a quasi-experimental , pre – post trial with a parallel , nonequivalent control group . Intervention schools had to be located in socioeconomically disadvantaged neighborhoods . In the spring of 2009 and 2011 ,  pedometer recordings ( 7 full days ) and demographic data were collected from cross-sectional sample s of fifth grade students from 10 intervention schools and 20 comparison schools . A total of 1157 students participated in the study . Analyses were adjusted for potential confounders and the clustered design . RESULTS : Relative to 2009 , children in 2011 were more active on schools days ( 1172 steps per day ; P < .001 ) and on weekends ( 1450 steps per day ; P < .001 ) . However , the increase in mean steps between 2009 and 2011 was greater in CSH intervention schools than in comparison schools ( school days : 1221 steps per day ; P = .009 ; weekends : 2001 steps per day ; P = .005 ) . These increases remained significant after adjusting for gender and overweight status . CONCLUSIONS : These findings provide evidence of the effectiveness of CSH to affect children ’s  physical activity during and outside of school . Results of this study justify broader implementation of effective CSH interventions for physical activity promotion and obesity prevention in the long term Objective To investigate the effectiveness of a school based intervention to increase physical activity , reduce sedentary behaviour , and increase fruit and vegetable consumption in children . Design Cluster r and omised controlled trial . Setting 60 primary schools in the south west of Engl and . Participants Primary school children who were in school year 4 ( age 8 - 9 years ) at recruitment and baseline assessment , in year 5 during the intervention , and at the end of year 5 ( age 9 - 10 ) at follow-up assessment . Intervention The Active for Life Year 5 ( AFLY5 ) intervention consisted of teacher training , provision of lesson and child-parent interactive homework plans , all material s required for lessons and homework , and written material s for school newsletters and parents . The intervention was delivered when children were in school year 5 ( age 9 - 10 years ) . Schools allocated to control received st and ard teaching . Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day , accelerometer assessed minutes of sedentary behaviour per day , and reported daily consumption of servings of fruit and vegetables . Results 60 schools with more than 2221 children were recruited ; valid data were available for fruit and vegetable consumption for 2121 children , for accelerometer assessed physical activity and sedentary behaviour for 1252 children , and for secondary outcomes for between 1825 and 2212 children for the main analyses . None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group . The difference in means comparing the intervention group with the control group was –1.35 ( 95 % confidence interval –5.29 to 2.59 ) minutes per day for moderate to vigorous physical activity , –0.11 ( –9.71 to 9.49 ) minutes per day for sedentary behaviour , and 0.08 ( –0.12 to 0.28 ) servings per day for fruit and vegetable consumption . The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account : self reported time spent in screen viewing at the weekend ( –21 ( –37 to –4 ) minutes per day ) , self reported servings of snacks per day ( –0.22 ( –0.38 to –0.05 ) ) , and servings of high energy drinks per day ( –0.26 ( –0.43 to –0.10 ) ) were all reduced . Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results . Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity , decreasing sedentary behaviour , and increasing fruit and vegetable consumption in primary school children . Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level , as well as at the school environment level . These findings have relevance for research ers , policy makers , public health practitioners , and doctors who are involved in health promotion , policy making , and commissioning services . Trial registration Current Controlled Trials IS RCT N50133740 Background Physical inactivity is recognised as a public health concern within children and interventions to increase physical activity are needed . GreatFun2Run was a school-based healthy lifestyles intervention that showed positive changes in physical activity levels and body composition immediately post-intervention . The purpose of this paper was to examine whether these changes in physical activity and body composition were maintained 18 - 20 months after the intervention ended . Method Participants ( n = 589 , aged 7 - 11 yrs ) from 4 intervention and 4 control schools took part in the 10-month intervention , of which 421 ( 71 % ) were present for follow-up . The intervention comprised a CD-rom learning and teaching re source for teachers ; an interactive website for pupils , teachers and parents ; two highlight physical activity events ( 1 mile school runs/walks ) ; a local media campaign ; and a summer activity wall planner and record . R and omisation was not possible because of local media content . Outcome measures were objective ly measured physical activity ( pedometers and accelerometers ) and body composition variables ( body mass index , waist circumference , estimated percent body fat , and sum of skinfolds ) . Teacher interviews and participant focus groups were conducted . Multi-level modelling was employed for the data analysis . Results Both control and intervention participants had increased their physical activity at follow-up but there was no group by time interaction ( control : 2726 steps per day increase ; intervention 3404 steps per day increase , p > .05 ) . There were significant increases in estimated percent body fat , sum of skinfolds , waist circumference and body mass index ( BMI ) with increasing age . In the control group , there was evidence for a plateauing in the rate of change in all body composition variables with increasing age , except BMI . In contrast , significant interaction terms suggest that the rate of change in waist circumference , BMI and BMI SDS continued to increase with age in the intervention group . Teacher interviews suggested that because of time pressures , competing re sources , curriculum dem and s and staff changes the majority of teachers had not continued to use the re sources . Conclusions While the intervention initially produced positive changes in physical activity levels and body composition , these changes were not sustained once the intervention ended . Facilitating long-term health behaviour change in children remains a challenge 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 M 
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Results Overall evidence ratings for interventions implemented within school setting s were : no evidence of effects on moderate-to-vigorous physical activity ( MVPA ) and inconclusive evidence of effects on sedentary time .
In relation to the TEO , expansion of PA appeared to be the most promising intervention type for MVPA , with moderate evidence of effect , whereas extension and enhancement of PA opportunity demonstrated no evidence of effect .