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: OBJECTIVE To evaluate the feasibility , acceptability , and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children . DESIGN Six-month , 2-arm , parallel-group , pilot r and omized controlled trial . SETTING Low-income , racial/ethnic minority community . PARTICIPANTS Twenty-one children in grade s 4 and 5 with a body mass index at or above the 85th percentile . INTERVENTIONS The treatment intervention consisted of an after-school soccer program . The " active placebo " control intervention consisted of an after-school health education program . MAIN OUTCOME MEASURES Implementation , acceptability , body mass index , physical activity measured using accelerometers , reported television and other screen time , self-esteem , depressive symptoms , and weight concerns . RESULTS All 21 children completed the study . Compared with children receiving health education , children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily , moderate , and vigorous physical activity at 3 months . CONCLUSION An after-school team soccer program for overweight children can be a feasible , acceptable , and efficacious intervention for weight control BACKGROUND Underst and ing the factors that influence physical activity behavior is important in the design of intervention programs targeted at youth . METHODS A prospect i ve study design was used to identify the predictors of vigorous physical activity ( VPA ) ( > or = 6 METs ) and moderate and vigorous physical activity ( MVPA ) ( > or = 3 METs ) among 202 rural , predominantly African-American children . Selected social-cognitive determinants of physical activity were assessed via question naire in the fifth grade . Participation in VPA and MVPA was assessed via the previous day physical activity recall 1 year later in the sixth grade . RESULTS For girls , participation in community sports , self-efficacy in overcoming barriers , enjoyment of school physical education , race ( white > black ) , and perception of mother 's activity level ( active vs inactive ) were significant predictors of VPA . For  MVPA , participation in community sports and self-efficacy in overcoming barriers were significant predictors . For boys , self-efficacy in overcoming barriers was the only significant predictor of VPA , while beliefs regarding activity outcomes and participation in community sports were significant predictors of MVPA . CONCLUSION Social-cognitive constructs such as physical activity self-efficacy , access to community physical activity outlets , and positive beliefs regarding physical activity outcomes are important predictors of future physical activity behavior among rural , predominantly African-American children Objective : To estimate total energy intake and the energy gap — the daily imbalance between energy intake and expenditure — associated with discretionary behaviors of adolescents , namely their leisure active behaviors ( playing or participating in sports and heavy chores ) , leisure sedentary behaviors ( television ( TV ) viewing and playing video and computer games ) , productive sedentary behaviors ( reading or doing homework ) . Design : Prospect i ve observational study . Participants : A total of 538 students ( mean age at baseline=11.7 years ) from public schools in the Boston area studied prospect ively from the fall of 1995 to the spring of 1997 . Measurements : Anthropometric assessment including height and weight , dietary assessment using a youth food frequency question  naire and measures of TV , video , reading/doing homework and youth physical activity .  Results : We estimate the change in total energy intake for each hour change in discretionary activity using regression methods . A 1-h increase in watching TV is associated with a 106 kcal h−1 increase in total energy intake ( 95 % confidence interval ( CI ) : 61–150 kcal day−1 ) . A similar change of 92 kcal h−1 ( 95 % CI : 37–147 kcal day−1 ) is seen with playing video and computer games . The change in energy intake associated with an hour change in physical activity is 292 kcal h−1 ( 95 % CI : 262–321 kcal day−1 ) . No significant change is associated with reading/doing homework . Assuming that typical energy expenditures are associated with these behaviors , reading/doing homework appears to be an ‘ energy neutral ’ activity , whereas watching TV and playing video and computer games is associated with an energy surplus . If we assume that physical activity levels are moderate ( 3.5 METs ) , then this is also an energy surplus activity . If physical activity is assumed to be vigorous for the entire time allotted ( > 6.0 METs ) , an energy deficit could be achieved . We vali date d these estimates by calculating regressions predicting change in weight . Results indicate that each hour increase in TV viewing is associated with a weight increase of 0.38 kg ( 95 % CI : 0.17–0.59 kg ) , with no significant associations for the other behaviors . A model with change in BMI as the dependent variable produced similar results . Conclusion : Watching TV is an activity associated with a daily energy surplus . Although physical activity is thought of as an energy deficit activity , our estimates do not support this hypothesis . Reading/doing homework is the only discretionary activity examined which appears to be clearly energy neutral . The differential impacts of these discretionary behaviors on energy intake and the energy gap are discussed in relation to food-related advertisements aim ed at children and adolescents OBJECTIVE This study compared correlates of  physical activity ( PA )  among African-American and white girls of different weight groups to guide future interventions . RESEARCH METHODS AND PROCEDURES Participants were 1015 girls ( mean age , 14.6 years ; 45 % African-American ) from 12 high schools in South Carolina who served as control subjects for a school-based intervention .  Post-intervention measures obtained at the end of ninth grade were used . PA was measured using the Three-Day PA Recall , and a question naire measured social-cognitive and environmental variables thought to mediate PA . Height and weight were measured , and BMI was calculated . Girls were stratified by race and categorized into three groups , based on BMI percentiles for girls from CDC growth charts : normal ( BMI < 85th percentile ) , at risk ( BMI , 85th to 94th percentile ) , and overweight ( BMI > or = 95th percentile ) . Girls were further divided into active and low-active groups , based on a vigorous PA st and ard ( average of one or more 30-minute blocks per day per 3-day period ) . Mixed-model ANOVA was used to compare factors among groups , treating school as a r and om effect RESULTS None of the social-cognitive or environmental variables differed by weight status for African-American or white girls . Perceived behavioral control and sports team participation were significantly higher in girls who were more active , regardless of weight or race group . In general , social-cognitive variables seem to be more related to activity in white girls , whereas environmental factors seem more related to activity in African-American girls . DISCUSSION PA interventions should be tailored to the unique needs of girls based on PA levels and race , rather than on weight status alone OBJECTIVE To assess different aspects of physical fitness and physical activity in obese and nonobese Flemish youth . RESEARCH METHODS AND PROCEDURES A r and om sample of 3214 Flemish schoolchildren was selected and divided into an " obese " and " nonobese " group based on body mass index and sum of skinfolds . Physical fitness was assessed by the European physical fitness test battery . Physical activity  was estimated by a modified version of the Baecke Question naire . RESULTS Obese subjects had inferior performances on all tests requiring propulsion or lifting of the body mass ( st and ing-broad jump , sit-ups , bent-arm hang , speed shuttle run , and endurance shuttle run ) compared with their nonobese counterparts ( p < 0.001 ) . In contrast , the obese subjects showed greater strength on h and grip ( p < 0.001 ) . Both groups had similar levels of leisure-time physical activity ; however , nonobese boys had a higher sport index than their obese counterparts ( p < 0.05 ) . DISCUSSION Results of this study show that obese subjects had poorer performances on weight-bearing tasks , but did not have lower scores on all fitness components . To encourage adherence to physical activity in obese youth , it is important that activities are tailored to their capabilities . Results suggest that weight-bearing activities should be limited at the start of an intervention with obese participants and alternative activities that rely more on static strength used UNLABELLED Decreased fitness and increased fatness are relevant factors for decreased cardiovascular and bone health in children . One way to increase physical activity and hence fitness and to reduce the risk for overweight might be sports club participation ( SCP ) . PURPOSE To investigate the association of SCP with fatness and fitness in children in general and in those with increased risk for overweight and /or low fitness . METHODS A cross-sectional study was conducted in a r and om sample of 502 first- and fifth- grade primary school children . Fitness components were determined by 10 motor tests and body fatness by the sum of four skinfolds . SCP was defined as participation of at least once a week . RESULTS Two thirds of all children were participating in a sports club . Girls ' and boys ' participation rate as well as those of overweight children and of children with overweight parents were comparable to their respective normal weight peers . In contrast , children from migrant families ( odds ratio = 0.31 ; 95 % confidence interval = 0.20 - 0.48 ) and from inactive parents ( odds ratio = 0.16 ; 95 % confidence interval = 0.05 - 0.45 ) participated significantly less ( all P < 0.001 ) . SCP was associated with endurance ( 0.53 > beta > 0.37 , all P < 0.05 ) and partly with speed , strength , and coordination ( 0.41 > beta > 0.18 , all P < 0.05 ) . In overweight children and in children from overweight parents and migrant families , this association was not found . There was no association between SCP and fatness in any of the groups . CONCLUSIONS SCP rates were high and were associated with higher levels of most fitness components in children . Participation rates were lower for children of migrant families and children from inactive parents . In addition , the association between SCP and fitness components was not found in overweight children and in children from overweight parents and migrant families BACKGROUND To investigate the prevalence of overweight and obesity in an adolescent group representative of a rural Mediterranean area and to determine possible associations with energy and nutrient intakes and levels of physical exercise . METHODS A representative sample of adolescents was drawn from the secondary school of Torre Pacheco ( Murcia ) , a rural Mediterranean area located in the southeast of Spain . The population selected ( 331 adolescents aged 14 - 18 years ) , was divided into two groups : normal-weight subjects with a body mass index less than 23 kg/m2 and overweight or obese subjects with a body mass index of 23 kg/m2 or more . Weight , height , abdominal and hip perimeters , triceps skinfold , and upper arm circumference were measured . A prospect i ve 7-consecutive-days food record and physical activity question naire were completed . RESULTS Overweight boys and girls had an apparently lower energy intake ( P = 0.001 and P = 0.042 , respectively ) , and carbohydrate intake ( P = 0.000 , P = 0.032 ) than their normal-weight counterparts , but they tended to underreport more often . Overweight boys derived a greater percentage of their energy from fat ( P = 0.049 ) and less from carbohydrate ( P = 0.016 ) than their normal-weight counterparts . Among girls , the percentage of energy derived from fat increased with body mass index ( r = 0.210 , P = 0.008 ) , whereas fiber intake decreased ( r = -0.145 ; P = 0.041 ) . Overweight and obesity were negatively related to physical activity level only among boys ( P = 0.033 ) . CONCLUSION There is a high prevalence of overweight and obesity in the adolescent population studied ( 48.2 % in boys and 30.7 % in girls ) . The study shows an association between overweight and obesity and nutrient intake and activity level Aims : Although childhood obesity is becoming increasingly prevalent , treatment options are limited and the continued development of effective treatment strategies is necessary . It is equally important to explore involvement of other re sources in society , such as sports associations . This study was design ed to investigate the possibility of reducing the degree of obesity in obese children by focusing on physical activity as an intervention . Methods : Seventy-six children ( 40 boys ) aged 8—12 years ( mean age 10.5 years , mean body mass index ( BMI ) 28.9 , st and ard deviation ( SD ) 3.0 ; mean BMI z-score 3.24 , SD 0.49 ) were invited to participate in a one-week sports camp and six-month support system . After the camp a sports coach from a local sports club supported the child during participation in a chosen sport for six months . Weight , height , body composition ( using dual energy x-ray absorptiometry and magnetic resonance imaging ) , and lifestyle ( using a question naire ) were measured at baseline and after 12 months . Data were pooled from two camps , one with a self-selected control group and one r and omized controlled trial . Results : Twelve months after the camp the intervention group had a significant decrease in BMI z-score ( baseline BMI z-score 3.22 ; follow up 3.10 , p = 0.023 ) . The control group also reduced their BMI z-score ( baseline BMI z-score 3.27 ; follow up 3.18 , p = 0.022 ) . No differences were found in baseline values , follow-up values , or changes in BMI 
    Output:
    
agent
It is unclear from these results whether sports programs , as currently offered , protect youth from becoming overweight or obese .
***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 feasibility , acceptability , and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children . DESIGN Six-month , 2-arm , parallel-group , pilot r and omized controlled trial . SETTING Low-income , racial/ethnic minority community . PARTICIPANTS Twenty-one children in grade s 4 and 5 with a body mass index at or above the 85th percentile . INTERVENTIONS The treatment intervention consisted of an after-school soccer program . The " active placebo " control intervention consisted of an after-school health education program . MAIN OUTCOME MEASURES Implementation , acceptability , body mass index , physical activity measured using accelerometers , reported television and other screen time , self-esteem , depressive symptoms , and weight concerns . RESULTS All 21 children completed the study . Compared with children receiving health education , children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily , moderate , and vigorous physical activity at 3 months . CONCLUSION An after-school team soccer program for overweight children can be a feasible , acceptable , and efficacious intervention for weight control BACKGROUND Underst and ing the factors that influence physical activity behavior is important in the design of intervention programs targeted at youth . METHODS A prospect i ve study design was used to identify the predictors of vigorous physical activity ( VPA ) ( > or = 6 METs ) and moderate and vigorous physical activity ( MVPA ) ( > or = 3 METs ) among 202 rural , predominantly African-American children . Selected social-cognitive determinants of physical activity were assessed via question naire in the fifth grade . Participation in VPA and MVPA was assessed via the previous day physical activity recall 1 year later in the sixth grade . RESULTS For girls , participation in community sports , self-efficacy in overcoming barriers , enjoyment of school physical education , race ( white > black ) , and perception of mother 's activity level ( active vs inactive ) were significant predictors of VPA . For  MVPA , participation in community sports and self-efficacy in overcoming barriers were significant predictors . For boys , self-efficacy in overcoming barriers was the only significant predictor of VPA , while beliefs regarding activity outcomes and participation in community sports were significant predictors of MVPA . CONCLUSION Social-cognitive constructs such as physical activity self-efficacy , access to community physical activity outlets , and positive beliefs regarding physical activity outcomes are important predictors of future physical activity behavior among rural , predominantly African-American children Objective : To estimate total energy intake and the energy gap — the daily imbalance between energy intake and expenditure — associated with discretionary behaviors of adolescents , namely their leisure active behaviors ( playing or participating in sports and heavy chores ) , leisure sedentary behaviors ( television ( TV ) viewing and playing video and computer games ) , productive sedentary behaviors ( reading or doing homework ) . Design : Prospect i ve observational study . Participants : A total of 538 students ( mean age at baseline=11.7 years ) from public schools in the Boston area studied prospect ively from the fall of 1995 to the spring of 1997 . Measurements : Anthropometric assessment including height and weight , dietary assessment using a youth food frequency question  naire and measures of TV , video , reading/doing homework and youth physical activity .  Results : We estimate the change in total energy intake for each hour change in discretionary activity using regression methods . A 1-h increase in watching TV is associated with a 106 kcal h−1 increase in total energy intake ( 95 % confidence interval ( CI ) : 61–150 kcal day−1 ) . A similar change of 92 kcal h−1 ( 95 % CI : 37–147 kcal day−1 ) is seen with playing video and computer games . The change in energy intake associated with an hour change in physical activity is 292 kcal h−1 ( 95 % CI : 262–321 kcal day−1 ) . No significant change is associated with reading/doing homework . Assuming that typical energy expenditures are associated with these behaviors , reading/doing homework appears to be an ‘ energy neutral ’ activity , whereas watching TV and playing video and computer games is associated with an energy surplus . If we assume that physical activity levels are moderate ( 3.5 METs ) , then this is also an energy surplus activity . If physical activity is assumed to be vigorous for the entire time allotted ( > 6.0 METs ) , an energy deficit could be achieved . We vali date d these estimates by calculating regressions predicting change in weight . Results indicate that each hour increase in TV viewing is associated with a weight increase of 0.38 kg ( 95 % CI : 0.17–0.59 kg ) , with no significant associations for the other behaviors . A model with change in BMI as the dependent variable produced similar results . Conclusion : Watching TV is an activity associated with a daily energy surplus . Although physical activity is thought of as an energy deficit activity , our estimates do not support this hypothesis . Reading/doing homework is the only discretionary activity examined which appears to be clearly energy neutral . The differential impacts of these discretionary behaviors on energy intake and the energy gap are discussed in relation to food-related advertisements aim ed at children and adolescents OBJECTIVE This study compared correlates of  physical activity ( PA )  among African-American and white girls of different weight groups to guide future interventions . RESEARCH METHODS AND PROCEDURES Participants were 1015 girls ( mean age , 14.6 years ; 45 % African-American ) from 12 high schools in South Carolina who served as control subjects for a school-based intervention .  Post-intervention measures obtained at the end of ninth grade were used . PA was measured using the Three-Day PA Recall , and a question naire measured social-cognitive and environmental variables thought to mediate PA . Height and weight were measured , and BMI was calculated . Girls were stratified by race and categorized into three groups , based on BMI percentiles for girls from CDC growth charts : normal ( BMI < 85th percentile ) , at risk ( BMI , 85th to 94th percentile ) , and overweight ( BMI > or = 95th percentile ) . Girls were further divided into active and low-active groups , based on a vigorous PA st and ard ( average of one or more 30-minute blocks per day per 3-day period ) . Mixed-model ANOVA was used to compare factors among groups , treating school as a r and om effect RESULTS None of the social-cognitive or environmental variables differed by weight status for African-American or white girls . Perceived behavioral control and sports team participation were significantly higher in girls who were more active , regardless of weight or race group . In general , social-cognitive variables seem to be more related to activity in white girls , whereas environmental factors seem more related to activity in African-American girls . DISCUSSION PA interventions should be tailored to the unique needs of girls based on PA levels and race , rather than on weight status alone OBJECTIVE To assess different aspects of physical fitness and physical activity in obese and nonobese Flemish youth . RESEARCH METHODS AND PROCEDURES A r and om sample of 3214 Flemish schoolchildren was selected and divided into an " obese " and " nonobese " group based on body mass index and sum of skinfolds . Physical fitness was assessed by the European physical fitness test battery . Physical activity  was estimated by a modified version of the Baecke Question naire . RESULTS Obese subjects had inferior performances on all tests requiring propulsion or lifting of the body mass ( st and ing-broad jump , sit-ups , bent-arm hang , speed shuttle run , and endurance shuttle run ) compared with their nonobese counterparts ( p < 0.001 ) . In contrast , the obese subjects showed greater strength on h and grip ( p < 0.001 ) . Both groups had similar levels of leisure-time physical activity ; however , nonobese boys had a higher sport index than their obese counterparts ( p < 0.05 ) . DISCUSSION Results of this study show that obese subjects had poorer performances on weight-bearing tasks , but did not have lower scores on all fitness components . To encourage adherence to physical activity in obese youth , it is important that activities are tailored to their capabilities . Results suggest that weight-bearing activities should be limited at the start of an intervention with obese participants and alternative activities that rely more on static strength used UNLABELLED Decreased fitness and increased fatness are relevant factors for decreased cardiovascular and bone health in children . One way to increase physical activity and hence fitness and to reduce the risk for overweight might be sports club participation ( SCP ) . PURPOSE To investigate the association of SCP with fatness and fitness in children in general and in those with increased risk for overweight and /or low fitness . METHODS A cross-sectional study was conducted in a r and om sample of 502 first- and fifth- grade primary school children . Fitness components were determined by 10 motor tests and body fatness by the sum of four skinfolds . SCP was defined as participation of at least once a week . RESULTS Two thirds of all children were participating in a sports club . Girls ' and boys ' participation rate as well as those of overweight children and of children with overweight parents were comparable to their respective normal weight peers . In contrast , children from migrant families ( odds ratio = 0.31 ; 95 % confidence interval = 0.20 - 0.48 ) and from inactive parents ( odds ratio = 0.16 ; 95 % confidence interval = 0.05 - 0.45 ) participated significantly less ( all P < 0.001 ) . SCP was associated with endurance ( 0.53 > beta > 0.37 , all P < 0.05 ) and partly with speed , strength , and coordination ( 0.41 > beta > 0.18 , all P < 0.05 ) . In overweight children and in children from overweight parents and migrant families , this association was not found . There was no association between SCP and fatness in any of the groups . CONCLUSIONS SCP rates were high and were associated with higher levels of most fitness components in children . Participation rates were lower for children of migrant families and children from inactive parents . In addition , the association between SCP and fitness components was not found in overweight children and in children from overweight parents and migrant families BACKGROUND To investigate the prevalence of overweight and obesity in an adolescent group representative of a rural Mediterranean area and to determine possible associations with energy and nutrient intakes and levels of physical exercise . METHODS A representative sample of adolescents was drawn from the secondary school of Torre Pacheco ( Murcia ) , a rural Mediterranean area located in the southeast of Spain . The population selected ( 331 adolescents aged 14 - 18 years ) , was divided into two groups : normal-weight subjects with a body mass index less than 23 kg/m2 and overweight or obese subjects with a body mass index of 23 kg/m2 or more . Weight , height , abdominal and hip perimeters , triceps skinfold , and upper arm circumference were measured . A prospect i ve 7-consecutive-days food record and physical activity question naire were completed . RESULTS Overweight boys and girls had an apparently lower energy intake ( P = 0.001 and P = 0.042 , respectively ) , and carbohydrate intake ( P = 0.000 , P = 0.032 ) than their normal-weight counterparts , but they tended to underreport more often . Overweight boys derived a greater percentage of their energy from fat ( P = 0.049 ) and less from carbohydrate ( P = 0.016 ) than their normal-weight counterparts . Among girls , the percentage of energy derived from fat increased with body mass index ( r = 0.210 , P = 0.008 ) , whereas fiber intake decreased ( r = -0.145 ; P = 0.041 ) . Overweight and obesity were negatively related to physical activity level only among boys ( P = 0.033 ) . CONCLUSION There is a high prevalence of overweight and obesity in the adolescent population studied ( 48.2 % in boys and 30.7 % in girls ) . The study shows an association between overweight and obesity and nutrient intake and activity level Aims : Although childhood obesity is becoming increasingly prevalent , treatment options are limited and the continued development of effective treatment strategies is necessary . It is equally important to explore involvement of other re sources in society , such as sports associations . This study was design ed to investigate the possibility of reducing the degree of obesity in obese children by focusing on physical activity as an intervention . Methods : Seventy-six children ( 40 boys ) aged 8—12 years ( mean age 10.5 years , mean body mass index ( BMI ) 28.9 , st and ard deviation ( SD ) 3.0 ; mean BMI z-score 3.24 , SD 0.49 ) were invited to participate in a one-week sports camp and six-month support system . After the camp a sports coach from a local sports club supported the child during participation in a chosen sport for six months . Weight , height , body composition ( using dual energy x-ray absorptiometry and magnetic resonance imaging ) , and lifestyle ( using a question naire ) were measured at baseline and after 12 months . Data were pooled from two camps , one with a self-selected control group and one r and omized controlled trial . Results : Twelve months after the camp the intervention group had a significant decrease in BMI z-score ( baseline BMI z-score 3.22 ; follow up 3.10 , p = 0.023 ) . The control group also reduced their BMI z-score ( baseline BMI z-score 3.27 ; follow up 3.18 , p = 0.022 ) . No differences were found in baseline values , follow-up values , or changes in BMI 
    Output:
    