human
***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: We previously reported that calcium intake enhanced the leg bone response to physical activity of preschool children in a 12-month r and omized trial of calcium supplementation and physical activity . To determine whether the intervention-induced changes in leg bone mineral content and size were maintained through the subsequent 12-month follow-up period , total body bone measurements by DXA and 20 % distal tibia pQCT bone measurements were obtained at 24 months ( 12 months post-intervention ) . Children also were measured for height and weight , and accelerometer readings were obtained in a subset of children at 18 and 24 months ( 6 and 12 months post-intervention ) . Regression analyses were performed controlling for covariates and indicated that increases from 12 to 24 months were greater in the gross motor ( GM ) activity group ( bone loading , large muscle exercises ) vs. fine motor ( FM ) activity group ( arts and crafts program ) for arm bone area ( BA ) ( P < 0.01 ) , total body ( P=0.04 ) and arm ( P < 0.01 ) bone mineral content ( BMC ) . There were no differences in BA or BMC changes from 12 to 24 months by calcium supplementation . Differences in tibia periosteal circumference by pQCT persisted at 24 months ( GM 51.4 + /- 0.4 mm vs. FM 50.2 + /- 0.4 mm , P=0.03 ) with a trend for greater endosteal circumferences in the children in the GM vs. FM groups at both 12 and 24 months ( both , P=0.08 ) . There were no significant differences in cortical area or thickness by activity or supplement group at 24 months . Children in the GM group had greater accelerometer counts/day ( P=0.04 ) and more time in vigorous activity ( P=0.05 ) at 18 months compared to FM group . No differences in accelerometer readings were noted at 24 months . In conclusion , we found higher activity levels in children r and omized to gross motor vs. fine motor activities 6 months after the intervention program ceased . Whether the greater periosteal circumference that was observed 12 months post-intervention was a persistent biological bone effect or due to persistently higher activity levels is not known Background Little is known about preschool-aged children ’s levels of  physical activity ( PA ) over the course of the day . Using time-stamped data , we describe the levels and patterns of PA in a population -based sample of four-year-old British children . Methods Within the Southampton Women ’s Survey the PA levels of 593 4-year-old children ( 51 % female ) were measured using ( Actiheart ) accelerometry for up to 7 days . Three outcome measures : minutes spent sedentary ( < 20 cpm ) ; in light ( LPA : ≥20 – 399 cpm ) and in moderate-to-vigorous activity ( MVPA : ≥400 cpm ) were derived . Average daily activity levels were calculated and then segmented across the day ( morning , afternoon and evening ) . MVPA was log-transformed . Two-level r and om intercept models were used to analyse associations between activity level and temporal and demographic factors . Results Children were active for 67 % ( mean 568.5 SD 79.5 minutes ) of their daily registered time on average , with 88 % of active time spent in LPA . All children met current UK guidelines of 180 minutes of daily activity . There were no differences in children ’s average daily levels of sedentary activity and LPA by temporal and demographic factors : differences did emerge when activity was segmented across the day . Sex differences were largest in the morning , with girls being more sedentary , spending fewer minutes in LPA and 18 % less time in MVPA than boys . Children were more sedentary and less active ( LPA and MVPA ) in the morning if they attended childcare full-time compared to part-time , and on weekend mornings compared to weekdays . The reverse was true for weekend afternoons and evenings . Children with more educated mothers were less active in the evenings . Children were less sedentary and did more MVPA on summer evenings compared to winter evenings . Conclusions Preschool-aged children meet current physical activity guidelines , but with the majority of their active time spent in LPA , investigation of the importance of activity intensity in younger children is needed . Activity levels over the day differed by demographic and temporal factors , highlighting the need to consider temporality in future interventions . Increasing girls ’ morning activity and providing opportunities for daytime activity in winter months may be worthwhile Objective To assess the effect of a governmentally-led center based child care physical activity program ( Youp’là Bouge ) on child motor skills . Patients and methods We conducted a single blinded cluster r and omized controlled trial in 58 Swiss child care centers . Centers were r and omly selected and 1:1 assigned to a control or intervention group . The intervention lasted from September 2009 to June 2010 and included training of the educators , adaptation of the child care built environment , parental involvement and daily physical activity .  Motor skill was the primary outcome and body mass index ( BMI ) , physical activity and quality of life secondary outcomes . The intervention implementation was also assessed . Results At baseline , 648 children present on the motor test day were included ( age 3.3 ± 0.6 , BMI 16.3 ± 1.3 kg/m2 , 13.2 % overweight , 49 % girls ) and 313 received the intervention . Relative to children in the control group ( n = 201 ) , children in the intervention group ( n = 187 ) showed no significant increase in motor skills ( delta of mean change ( 95 % confidence interval : -0.2 ( −0.8 to 0.3 ) , p = 0.43 ) or in any of the secondary outcomes . Not all child care centers implemented all the intervention components . Within the intervention group , several predictors were positively associated with trial outcomes : 1 ) free-access to a movement space and parental information session for motor skills 2 ) highly motivated and trained educators for BMI 3 ) free-access to a movement space and purchase of mobile equipment for physical activity ( all p < 0.05 ) . Conclusion This “ real-life ” physical activity program in child care centers confirms the complexity of implementing an intervention outside a study setting and identified potentially relevant predictors that could improve future programs . Trial registration Clinical trials.gov Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Exercise has been found to be effective for prevention of weight gain and maintenance of a stable weight in adults . The objective of this study was to evaluate the effect of a school-based aerobic exercise program on the obesity indexes of preschool children . Subjects were 292 second-year elementary school pupils from 2 kindergartens in Hat Yai municipality , Songkhla province , southern Thail and . A specially design ed exercise program , including a 15-min walk before beginning the morning class and a 20-min aerobic dance session after the afternoon nap , 3 times a week , was conducted for 29.6 wk . Weight , height , and triceps skinfold thickness were measured 4 times . At the end of the study , the prevalence of obesity , using 95th percentile National Center for Health Statistics triceps-skinfold-thickness cutoffs , of both the exercise and control groups decreased . That of the exercise group decreased from 12.2 % at baseline to 8.8 % ( Wilcoxon signed-rank test , P = 0.058 ) , whereas that of the control group decreased from 11.7 % to 9.7 % ( Wilcoxon signed-rank test , P = 0.179 ) . A sex difference in the response of body mass index ( BMI ) to exercise was observed . Girls in the exercise group had a lower likelihood of having an increasing BMI slope than the control girls did ( odds ratio : 0.32 ; 95 % CI : 0.18 , 0.56 ) . In conclusion , our study suggests that a 29.6-wk school-based exercise program can prevent BMI gain in girls and may induce a remission of obesity in preschool-age children The aim of this study was to assess the feasibility , acceptability and potential efficacy of a physical activity program for preschool children . A 20-week , 2-arm parallel cluster r and omized controlled pilot trial was conducted . The intervention comprised structured activities for children and professional development for staff . The control group participated in usual care activities , which included design ated inside and outside playtime . Primary outcomes were movement skill development and objective ly measured physical activity . At follow-up , compared with children in the control group , children in the intervention group showed greater improvements in movement skill proficiency , with this improvement statically significant for overall movement skill development ( adjust diff . = 2.08 , 95 % CI 0.76 , 3.40 ; Cohen 's d = 0.47 ) and significantly greater increases in objective ly measured physical activity ( counts per minute ) during the preschool day ( adjust diff . = 110.5 , 95 % CI 33.6 , 187.3 ; Cohen 's d = 0.46 ) . This study demonstrates that a physical activity program implemented by staff within a preschool setting is feasible , acceptable and potentially efficacious In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Background Over the last decades , a decline in motor skills and in physical activity and an increase in obesity has been observed in children . However , there is a lack of data in young children . We tested if differences in  motor skills and in physical activity  according to weight or gender were already present in 2- to 4-year-old children . Methods Fifty-eight child care centers in the French part of Switzerl and were r and omly selected for the Youp'là bouge study .  Motor skills were assessed by an obstacle course including 5 motor skills , derived from the Zurich Neuromotor Assessment test . Physical activity was measured with accelerometers ( GT1 M , Actigraph , Florida , USA ) using age-adapted cut-offs .  Weight status was assessed using the International Obesity Task Force criteria ( healthy weight vs overweight ) for body mass index ( BMI ) . Results Of the 529 children ( 49 % girls , 3.4 ± 0.6 years , BMI 16.2 ± 1.2 kg/m2 ) , 13 % were overweight . There were no significant weight status-related differences in the single skills of the obstacle course , but there was a trend ( p = 0.059 ) for a lower performance of overweight children in the overall motor skills score . No significant weight status-related  differences in child care-based physical activity  were observed . No gender-related differences were found in the overall motor skills score , but boys performed better than girls in 2 of the 5 motor skills ( p ≤ 0.04 ) . Total physical activity as well as time spent in moderate-vigorous and in vigorous activity during child care were 12 - 25 % higher and sedentary activity 5 % lower in boys compared to girls ( all p < 0.01 ) . Con 
    Output:
    
agent
Physical activity interventions were consistently ( > 60 % of studies ) associated with improved motor and cognitive development , and psychosocial and cardiometabolic health .
Across observational studies , physical activity was consistently associated with favourable motor development , fitness , and bone and skeletal health .
For intensity , light- and moderate-intensity physical activity were not consistently associated with any health indicators , whereas moderate- to vigorous-intensity , vigorous-intensity , and total physical activity were consistently favourably associated with multiple health indicators .
Across study design s , consistent favourable associations with health indicators were observed for a variety of types of physical activity , including active play , aerobic , dance , prone position ( infants ; ≤1 year ) , and structured/organized .
Apart from ≥30 min/day of the prone position for infants , the most favourable frequency and duration of physical activity was unclear .
However , more physical activity appeared better for health .
Conclusions Specific types of physical activity , total physical activity , and physical activity of at least moderate- to vigorous-intensity were consistently favourably associated with multiple health indicators .
***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: We previously reported that calcium intake enhanced the leg bone response to physical activity of preschool children in a 12-month r and omized trial of calcium supplementation and physical activity . To determine whether the intervention-induced changes in leg bone mineral content and size were maintained through the subsequent 12-month follow-up period , total body bone measurements by DXA and 20 % distal tibia pQCT bone measurements were obtained at 24 months ( 12 months post-intervention ) . Children also were measured for height and weight , and accelerometer readings were obtained in a subset of children at 18 and 24 months ( 6 and 12 months post-intervention ) . Regression analyses were performed controlling for covariates and indicated that increases from 12 to 24 months were greater in the gross motor ( GM ) activity group ( bone loading , large muscle exercises ) vs. fine motor ( FM ) activity group ( arts and crafts program ) for arm bone area ( BA ) ( P < 0.01 ) , total body ( P=0.04 ) and arm ( P < 0.01 ) bone mineral content ( BMC ) . There were no differences in BA or BMC changes from 12 to 24 months by calcium supplementation . Differences in tibia periosteal circumference by pQCT persisted at 24 months ( GM 51.4 + /- 0.4 mm vs. FM 50.2 + /- 0.4 mm , P=0.03 ) with a trend for greater endosteal circumferences in the children in the GM vs. FM groups at both 12 and 24 months ( both , P=0.08 ) . There were no significant differences in cortical area or thickness by activity or supplement group at 24 months . Children in the GM group had greater accelerometer counts/day ( P=0.04 ) and more time in vigorous activity ( P=0.05 ) at 18 months compared to FM group . No differences in accelerometer readings were noted at 24 months . In conclusion , we found higher activity levels in children r and omized to gross motor vs. fine motor activities 6 months after the intervention program ceased . Whether the greater periosteal circumference that was observed 12 months post-intervention was a persistent biological bone effect or due to persistently higher activity levels is not known Background Little is known about preschool-aged children ’s levels of  physical activity ( PA ) over the course of the day . Using time-stamped data , we describe the levels and patterns of PA in a population -based sample of four-year-old British children . Methods Within the Southampton Women ’s Survey the PA levels of 593 4-year-old children ( 51 % female ) were measured using ( Actiheart ) accelerometry for up to 7 days . Three outcome measures : minutes spent sedentary ( < 20 cpm ) ; in light ( LPA : ≥20 – 399 cpm ) and in moderate-to-vigorous activity ( MVPA : ≥400 cpm ) were derived . Average daily activity levels were calculated and then segmented across the day ( morning , afternoon and evening ) . MVPA was log-transformed . Two-level r and om intercept models were used to analyse associations between activity level and temporal and demographic factors . Results Children were active for 67 % ( mean 568.5 SD 79.5 minutes ) of their daily registered time on average , with 88 % of active time spent in LPA . All children met current UK guidelines of 180 minutes of daily activity . There were no differences in children ’s average daily levels of sedentary activity and LPA by temporal and demographic factors : differences did emerge when activity was segmented across the day . Sex differences were largest in the morning , with girls being more sedentary , spending fewer minutes in LPA and 18 % less time in MVPA than boys . Children were more sedentary and less active ( LPA and MVPA ) in the morning if they attended childcare full-time compared to part-time , and on weekend mornings compared to weekdays . The reverse was true for weekend afternoons and evenings . Children with more educated mothers were less active in the evenings . Children were less sedentary and did more MVPA on summer evenings compared to winter evenings . Conclusions Preschool-aged children meet current physical activity guidelines , but with the majority of their active time spent in LPA , investigation of the importance of activity intensity in younger children is needed . Activity levels over the day differed by demographic and temporal factors , highlighting the need to consider temporality in future interventions . Increasing girls ’ morning activity and providing opportunities for daytime activity in winter months may be worthwhile Objective To assess the effect of a governmentally-led center based child care physical activity program ( Youp’là Bouge ) on child motor skills . Patients and methods We conducted a single blinded cluster r and omized controlled trial in 58 Swiss child care centers . Centers were r and omly selected and 1:1 assigned to a control or intervention group . The intervention lasted from September 2009 to June 2010 and included training of the educators , adaptation of the child care built environment , parental involvement and daily physical activity .  Motor skill was the primary outcome and body mass index ( BMI ) , physical activity and quality of life secondary outcomes . The intervention implementation was also assessed . Results At baseline , 648 children present on the motor test day were included ( age 3.3 ± 0.6 , BMI 16.3 ± 1.3 kg/m2 , 13.2 % overweight , 49 % girls ) and 313 received the intervention . Relative to children in the control group ( n = 201 ) , children in the intervention group ( n = 187 ) showed no significant increase in motor skills ( delta of mean change ( 95 % confidence interval : -0.2 ( −0.8 to 0.3 ) , p = 0.43 ) or in any of the secondary outcomes . Not all child care centers implemented all the intervention components . Within the intervention group , several predictors were positively associated with trial outcomes : 1 ) free-access to a movement space and parental information session for motor skills 2 ) highly motivated and trained educators for BMI 3 ) free-access to a movement space and purchase of mobile equipment for physical activity ( all p < 0.05 ) . Conclusion This “ real-life ” physical activity program in child care centers confirms the complexity of implementing an intervention outside a study setting and identified potentially relevant predictors that could improve future programs . Trial registration Clinical trials.gov Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Exercise has been found to be effective for prevention of weight gain and maintenance of a stable weight in adults . The objective of this study was to evaluate the effect of a school-based aerobic exercise program on the obesity indexes of preschool children . Subjects were 292 second-year elementary school pupils from 2 kindergartens in Hat Yai municipality , Songkhla province , southern Thail and . A specially design ed exercise program , including a 15-min walk before beginning the morning class and a 20-min aerobic dance session after the afternoon nap , 3 times a week , was conducted for 29.6 wk . Weight , height , and triceps skinfold thickness were measured 4 times . At the end of the study , the prevalence of obesity , using 95th percentile National Center for Health Statistics triceps-skinfold-thickness cutoffs , of both the exercise and control groups decreased . That of the exercise group decreased from 12.2 % at baseline to 8.8 % ( Wilcoxon signed-rank test , P = 0.058 ) , whereas that of the control group decreased from 11.7 % to 9.7 % ( Wilcoxon signed-rank test , P = 0.179 ) . A sex difference in the response of body mass index ( BMI ) to exercise was observed . Girls in the exercise group had a lower likelihood of having an increasing BMI slope than the control girls did ( odds ratio : 0.32 ; 95 % CI : 0.18 , 0.56 ) . In conclusion , our study suggests that a 29.6-wk school-based exercise program can prevent BMI gain in girls and may induce a remission of obesity in preschool-age children The aim of this study was to assess the feasibility , acceptability and potential efficacy of a physical activity program for preschool children . A 20-week , 2-arm parallel cluster r and omized controlled pilot trial was conducted . The intervention comprised structured activities for children and professional development for staff . The control group participated in usual care activities , which included design ated inside and outside playtime . Primary outcomes were movement skill development and objective ly measured physical activity . At follow-up , compared with children in the control group , children in the intervention group showed greater improvements in movement skill proficiency , with this improvement statically significant for overall movement skill development ( adjust diff . = 2.08 , 95 % CI 0.76 , 3.40 ; Cohen 's d = 0.47 ) and significantly greater increases in objective ly measured physical activity ( counts per minute ) during the preschool day ( adjust diff . = 110.5 , 95 % CI 33.6 , 187.3 ; Cohen 's d = 0.46 ) . This study demonstrates that a physical activity program implemented by staff within a preschool setting is feasible , acceptable and potentially efficacious In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Background Over the last decades , a decline in motor skills and in physical activity and an increase in obesity has been observed in children . However , there is a lack of data in young children . We tested if differences in  motor skills and in physical activity  according to weight or gender were already present in 2- to 4-year-old children . Methods Fifty-eight child care centers in the French part of Switzerl and were r and omly selected for the Youp'là bouge study .  Motor skills were assessed by an obstacle course including 5 motor skills , derived from the Zurich Neuromotor Assessment test . Physical activity was measured with accelerometers ( GT1 M , Actigraph , Florida , USA ) using age-adapted cut-offs .  Weight status was assessed using the International Obesity Task Force criteria ( healthy weight vs overweight ) for body mass index ( BMI ) . Results Of the 529 children ( 49 % girls , 3.4 ± 0.6 years , BMI 16.2 ± 1.2 kg/m2 ) , 13 % were overweight . There were no significant weight status-related differences in the single skills of the obstacle course , but there was a trend ( p = 0.059 ) for a lower performance of overweight children in the overall motor skills score . No significant weight status-related  differences in child care-based physical activity  were observed . No gender-related differences were found in the overall motor skills score , but boys performed better than girls in 2 of the 5 motor skills ( p ≤ 0.04 ) . Total physical activity as well as time spent in moderate-vigorous and in vigorous activity during child care were 12 - 25 % higher and sedentary activity 5 % lower in boys compared to girls ( all p < 0.01 ) . Con 
    Output:
    