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: Background Exergaming has been proposed as an innovative method for physical activity promotion . However , large effectiveness studies are rare . In January 2011 , dance mat systems  were introduced in secondary schools in two districts in Engl and with the aim of promoting an innovative opportunity for physical activity . The aim of this natural experiment was to examine the effect of introducing the dance mat exergaming systems on physical activity and health-related outcomes in 11–13 year old students using a non-r and omised controlled design and mixed methods . Methods Participants were recruited from five schools in intervention districts ( n = 280 ) and two schools in neighbouring control districts ( n = 217 ) .  Data on physical activity ( accelerometer ) , anthropometrics ( weight , BMI and percentage of body fat ) , aerobic fitness ( 20-m multistage shuttle run test ) , health-related quality of life ( Kidscreen question naire ) , self-efficacy ( children ’s physical activity self-efficacy survey ) , school attendance , focus groups with children and interviews with teachers were collected at baseline and approximately 12 months follow-up . Results There was a negative intervention effect on total physical activity ( -65.4 cpm CI : -12.6 to -4.7 ) , and light and sedentary physical activity when represented as a percentage of wear time ( Light : -2.3 % CI : -4.5 to 0.2 ; Sedentary : 3.3 % CI : 0.7 to 5.9 ) . However , compliance with accelerometers at follow-up was poor . There was a significant positive intervention effect on weight ( -1.7 kg , 95 % CI : -2.9 to -0.4 ) , BMI ( -0.9 kg/m2 , 95 % CI : -1.3 to -0.4 ) and percentage of body fat ( -2.2 % , 95 % CI : -4.2 to -0.2 ) . There was also evidence of improvement in some health-related quality of life parameters : psychological well-being ( 2.5 , 95 % CI : 0.1 to 4.8 ) and autonomy and parent relation ( 4.2 , 95 % CI : 1.4 to 7.0 ) . Conclusions The implementation of a dance mat exergaming scheme was associated with improvement in anthropometric measurements and parameters of health-related quality of life . However , the mechanisms of these benefits are unclear as there was insufficient data from physical activity to draw robust conclusions . Qualitative findings suggest that there was declining support for the initiative over time , meaning that potential benefits may not have been achieved INTRODUCTION Few interventions have been successful in reducing the physical activity decline typically observed among adolescents . The aim of this paper is to report the 24-month effectiveness of a multicomponent school-based intervention ( Physical Activity 4 Everyone ) in reducing the decline in moderate to vigorous physical activity ( MVPA ) among secondary school students in disadvantaged areas of New South Wales , Australia . STUDY DESIGN A cluster RCT was conducted in five intervention and five control schools with follow-up measures taken at 24 months post-r and omization . SETTING / PARTICIPANTS The trial was undertaken within secondary schools located in disadvantaged communities in New South Wales , Australia . INTERVENTION A multicomponent school-based intervention based on the Health Promoting Schools Framework was implemented . The intervention consisted of seven physical activity promotion strategies that targeted the curriculum ( teaching strategies to increase physical activity in physical education lessons , student physical activity plans , and modification of school sport program ) ; school environment ( recess/lunchtime activities , school physical activity policy ) ; parents ( parent newsletters ) ; and community ( community physical activity provider promotion ) . Six additional strategies supported school implementation of the physical activity intervention strategies . MAIN OUTCOME MEASURE Minutes per day spent in MVPA , objective ly measured by accelerometer . RESULTS Participants ( N=1,150 , 49 % male ) were a cohort of students aged 12 years ( Grade 7 ) at baseline ( March-June 2012 ) and 14 years ( Grade 9 ) at follow-up ( March-July 2014 ) . At 24-month follow-up , there were significant effects in favor of the intervention group for daily minutes of MVPA . The adjusted mean difference in change in daily MVPA between groups was 7.0 minutes ( 95 % CI=2.7 , 11.4 , p<0.002 ) ( analysis conducted December 2014-February 2015 ) . Sensitivity analyses based on multiple imputation were consistent with the main analysis ( 6.0 minutes , 95 % CI=0.6 , 11.3 , p<0.031 ) . CONCLUSIONS The intervention was effective in increasing adolescents ' minutes of MVPA , suggesting that implementation of the intervention by disadvantaged schools has the potential to slow the decline in physical activity . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry ACTRN12612000382875 Background Although school-based interventions to promote physical activity in adolescents have been suggested in several recent review s , questions have been raised regarding the effects of the strategies and the methodology applied and for whom the interventions are effective . The aim of the present study was to investigate effects of a school-based intervention program : the HEalth in Adolescents ( HEIA ) study , on change in physical activity , and furthermore , to explore whether potential effects varied by gender , weight status , initial physical activity level and parental education level . Methods This was a cluster r and omized controlled 20 month intervention study which included 700 11-year-olds . Main outcome -variable was mean count per minute ( cpm ) derived from ActiGraph accelerometers ( Model 7164/GT1 M ) . Weight and height were measured objective ly . Adolescents reported their pubertal status in a question naire and parents reported their education level on the consent form . Linear mixed models were used to test intervention effects and to account for the clustering effect of sampling by school . Results The present study showed an intervention effect on overall physical activity at the level of p = 0.05 with a net effect of 50 cpm increase from baseline to post intervention in favour of the intervention group ( 95 % CI −0.4 , 100 ) . Subgroup analyses showed that the effect appeared to be more profound among girls ( Est 65 cpm , CI 5 , 124 , p = 0.03 ) and among participants in the low-activity group ( Est 92 cpm , CI 41 , 142 , p < 0.001 ) , as compared to boys and participants in the high-activity group , respectively . Furthermore , the intervention affected physical activity among the normal weight group more positively than among the overweight , and participants with parents having 13–16 years of education more positively than participants with parents having either a lower or higher number of years of education . The intervention seemed to succeed in reducing time spent sedentary among girls but not among boys . Conclusions A comprehensive but feasible , multi-component school-based intervention can affect physical activity patterns  in adolescents by increasing overall physical activity . This intervention effect seemed to be more profound in girls than boys , low-active adolescents compared to high-active adolescents , participants with normal weight compared to the overweight , and for participants with parents of middle education level as opposed to those with high and low education levels , respectively . An implementation of the HEIA intervention components in the school system may have a beneficial effect on public health by increasing overall physical activity among adolescents and possibly among girls and low-active adolescents in particular The aims of this study were to investigate whether  physical activity ( PA ) and sedentary time ( ST )  in 9- and 15-year-olds differed between 2005 - 2006 and 2011 - 2012 ( secular change ) , and to investigate changes in PA and ST from age 9 to 15 ( longitudinal change ) . In 2005 - 2006 , we invited nationally representative sample s of Norwegian 9- ( n=1470 ) and 15-year-olds ( n=1348 ) to participate . In 2011 - 2012 , we invited a new nationally representative sample of 9-year-olds ( n=1945 ) , whereas 15-year-olds ( n=1759 ) were invited to participate either based on previous participation in 2005 - 2006 or from a r and om sample of schools . We assessed PA and ST objective ly using accelerometers . In 2011 - 2012 , both 9- and 15-year-olds spent more time sedentary ( ≥35.7 min/d , P<.001 ) and less time in light PA ( ≥35.2 min/d , P<.001 ) compared to their peers in 2005 - 2006 . Nine-year-old girls also spent less time in moderate-to-vigorous PA ( MVPA ) ( 4.2 min/d , P=.041 ) . In both age groups , the proportion accumulating an average of 60 min/d of MVPA did not differ between the two cohorts . From age 9 to 15 , girls and boys decreased their time spent in LPA ( ≥106.7 min/d , P<.001 ) and in MVPA ( ≥20.8 min/d , P<.001 ) . During the same period , ST increased by a mean of > 2 h/d ( P<.011 ) . We observed an adverse secular change in PA from 2005 - 2006 to 2011 - 2012 among 9- and 15-year-olds , and a large decline in PA in the participants followed longitudinally from age 9 to 15 years Background Globally , adolescent girls ’  physical activity ( PA ) levels are low . The ‘ Girls Active ’ secondary school-based programme , developed by the Youth Sport Trust , aims to increase PA in adolescent girls . This paper explores the effectiveness of the ‘ Girls Active ’ school-based PA programme . Methods A r and om sample of girls aged 11–14 from 20 secondary schools ( Midl and s , UK ) participated in a two-arm cluster r and omised controlled trial . Ten schools received Girls Active and 10 continued with usual practice . Measurements were taken at baseline , seven- and 14-month follow-up . Primary outcome : wrist-worn accelerometer measured moderate- to vigorous-intensity PA ( MVPA ) .  Secondary outcomes : overall PA , light PA , sedentary time , body composition , and psychosocial outcomes . Generalised estimating equations , adjusted for school cluster and potential confounders , were used and A priori subgroup analysis was undertaken . Micro-costing and cost-consequence analyses were conducted using bespoke collection methods on programme delivery information . Outcomes for the cost-consequence analysis were health related quality of life measured by the Child Health Utility-9D and service use . Results Overall , 1752 pupils participated , 1211 ( 69.1 % ) provided valid 14-month accelerometer data . No difference in MVPA ( mins/day ; 95 % confidence intervals ) was found at 14 months ( 1.7 ; -0.8 to 4.3 ) , there was at seven months ( 2.4 ; 0.1 to 4.7 ) . Subgroup analyses showed significant intervention effects on 14-month in larger schools ( 3.9 ; 1.39 to 6.09 ) and in White Europeans ( 3.1 ; 0.60 to 6.02 ) and in early maturers ( 5.1 ; 1.69 to 8.48 ) at seven months . The control group did better in smaller schools at 14-months ( -4.38 ; -7.34 to -1.41 ) . Significant group differences were found in 14-month identified motivation ( -0.09 ; -0.18 to -0.01 ) and at seven months in : overall PA ( 1.39 mg/day ; 0.1 to 2.2 ) , after-school sedentary time ( -4.7 ; -8.9 to -0.6 ) , whole day ( 5.7 ; 1.0 to 10.5 ) and school day ( 4.5 ; 0.25 to 8.75 ) light PA , self-esteem . Small , statistically significant , differences in some psychosocial variables favoured control schools . Micro-costing demonstrated that delivering the programme result ed in a range of time and financial costs at each school . Cost-consequence analysis demonstrated no effect of the programme for health related quality of life or service use . Conclusions Compared with usual practice , ‘ Girls Active ’ did not affect 14-month MVPA.Trial registration IS RCT Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making . However , there are no structured reporting requirements for studies of this design to assist authors , editors , and readers . The authors developed and tested a checklist of criteria related to threats to the internal and external validity of observational longitudinal studies . The checklist criteria concerned recruitment , data collection , biases , and data analysis and descriptive issues relevant to study rationale , study population , and generalizability . Two raters independently assessed 49 r and omly selected articles describing stroke research published from 1999 to 2003 in six journals : American Journal of Epidemiology , Journal of Epidemiology and Community Health , Stroke , Annals of Neurology , Archives of Physical Medicine and Rehabilitation , and American Journal of Physical Medicine and Rehabilitation . On average , 17 of the 33 checklist criteria were reported . Criteria describing the study design were better reported than those related to internal validity . No relation was found between study type ( etiologic or prognostic ) or word count and quality of reporting . A flow diagram for summarizing participant flow through a study was developed . Editors and authors should consider using a checklist and flow diagram when reporting on observational longitudinal research Objective To examine whether physical activity ( PA ) and sedentary time ( ST ) in primary school-aged 
    Output:
    
agent
The relative decline in MVPA affects both sexes from an early age ; however , it is greater among girls .
***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 Exergaming has been proposed as an innovative method for physical activity promotion . However , large effectiveness studies are rare . In January 2011 , dance mat systems  were introduced in secondary schools in two districts in Engl and with the aim of promoting an innovative opportunity for physical activity . The aim of this natural experiment was to examine the effect of introducing the dance mat exergaming systems on physical activity and health-related outcomes in 11–13 year old students using a non-r and omised controlled design and mixed methods . Methods Participants were recruited from five schools in intervention districts ( n = 280 ) and two schools in neighbouring control districts ( n = 217 ) .  Data on physical activity ( accelerometer ) , anthropometrics ( weight , BMI and percentage of body fat ) , aerobic fitness ( 20-m multistage shuttle run test ) , health-related quality of life ( Kidscreen question naire ) , self-efficacy ( children ’s physical activity self-efficacy survey ) , school attendance , focus groups with children and interviews with teachers were collected at baseline and approximately 12 months follow-up . Results There was a negative intervention effect on total physical activity ( -65.4 cpm CI : -12.6 to -4.7 ) , and light and sedentary physical activity when represented as a percentage of wear time ( Light : -2.3 % CI : -4.5 to 0.2 ; Sedentary : 3.3 % CI : 0.7 to 5.9 ) . However , compliance with accelerometers at follow-up was poor . There was a significant positive intervention effect on weight ( -1.7 kg , 95 % CI : -2.9 to -0.4 ) , BMI ( -0.9 kg/m2 , 95 % CI : -1.3 to -0.4 ) and percentage of body fat ( -2.2 % , 95 % CI : -4.2 to -0.2 ) . There was also evidence of improvement in some health-related quality of life parameters : psychological well-being ( 2.5 , 95 % CI : 0.1 to 4.8 ) and autonomy and parent relation ( 4.2 , 95 % CI : 1.4 to 7.0 ) . Conclusions The implementation of a dance mat exergaming scheme was associated with improvement in anthropometric measurements and parameters of health-related quality of life . However , the mechanisms of these benefits are unclear as there was insufficient data from physical activity to draw robust conclusions . Qualitative findings suggest that there was declining support for the initiative over time , meaning that potential benefits may not have been achieved INTRODUCTION Few interventions have been successful in reducing the physical activity decline typically observed among adolescents . The aim of this paper is to report the 24-month effectiveness of a multicomponent school-based intervention ( Physical Activity 4 Everyone ) in reducing the decline in moderate to vigorous physical activity ( MVPA ) among secondary school students in disadvantaged areas of New South Wales , Australia . STUDY DESIGN A cluster RCT was conducted in five intervention and five control schools with follow-up measures taken at 24 months post-r and omization . SETTING / PARTICIPANTS The trial was undertaken within secondary schools located in disadvantaged communities in New South Wales , Australia . INTERVENTION A multicomponent school-based intervention based on the Health Promoting Schools Framework was implemented . The intervention consisted of seven physical activity promotion strategies that targeted the curriculum ( teaching strategies to increase physical activity in physical education lessons , student physical activity plans , and modification of school sport program ) ; school environment ( recess/lunchtime activities , school physical activity policy ) ; parents ( parent newsletters ) ; and community ( community physical activity provider promotion ) . Six additional strategies supported school implementation of the physical activity intervention strategies . MAIN OUTCOME MEASURE Minutes per day spent in MVPA , objective ly measured by accelerometer . RESULTS Participants ( N=1,150 , 49 % male ) were a cohort of students aged 12 years ( Grade 7 ) at baseline ( March-June 2012 ) and 14 years ( Grade 9 ) at follow-up ( March-July 2014 ) . At 24-month follow-up , there were significant effects in favor of the intervention group for daily minutes of MVPA . The adjusted mean difference in change in daily MVPA between groups was 7.0 minutes ( 95 % CI=2.7 , 11.4 , p<0.002 ) ( analysis conducted December 2014-February 2015 ) . Sensitivity analyses based on multiple imputation were consistent with the main analysis ( 6.0 minutes , 95 % CI=0.6 , 11.3 , p<0.031 ) . CONCLUSIONS The intervention was effective in increasing adolescents ' minutes of MVPA , suggesting that implementation of the intervention by disadvantaged schools has the potential to slow the decline in physical activity . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry ACTRN12612000382875 Background Although school-based interventions to promote physical activity in adolescents have been suggested in several recent review s , questions have been raised regarding the effects of the strategies and the methodology applied and for whom the interventions are effective . The aim of the present study was to investigate effects of a school-based intervention program : the HEalth in Adolescents ( HEIA ) study , on change in physical activity , and furthermore , to explore whether potential effects varied by gender , weight status , initial physical activity level and parental education level . Methods This was a cluster r and omized controlled 20 month intervention study which included 700 11-year-olds . Main outcome -variable was mean count per minute ( cpm ) derived from ActiGraph accelerometers ( Model 7164/GT1 M ) . Weight and height were measured objective ly . Adolescents reported their pubertal status in a question naire and parents reported their education level on the consent form . Linear mixed models were used to test intervention effects and to account for the clustering effect of sampling by school . Results The present study showed an intervention effect on overall physical activity at the level of p = 0.05 with a net effect of 50 cpm increase from baseline to post intervention in favour of the intervention group ( 95 % CI −0.4 , 100 ) . Subgroup analyses showed that the effect appeared to be more profound among girls ( Est 65 cpm , CI 5 , 124 , p = 0.03 ) and among participants in the low-activity group ( Est 92 cpm , CI 41 , 142 , p < 0.001 ) , as compared to boys and participants in the high-activity group , respectively . Furthermore , the intervention affected physical activity among the normal weight group more positively than among the overweight , and participants with parents having 13–16 years of education more positively than participants with parents having either a lower or higher number of years of education . The intervention seemed to succeed in reducing time spent sedentary among girls but not among boys . Conclusions A comprehensive but feasible , multi-component school-based intervention can affect physical activity patterns  in adolescents by increasing overall physical activity . This intervention effect seemed to be more profound in girls than boys , low-active adolescents compared to high-active adolescents , participants with normal weight compared to the overweight , and for participants with parents of middle education level as opposed to those with high and low education levels , respectively . An implementation of the HEIA intervention components in the school system may have a beneficial effect on public health by increasing overall physical activity among adolescents and possibly among girls and low-active adolescents in particular The aims of this study were to investigate whether  physical activity ( PA ) and sedentary time ( ST )  in 9- and 15-year-olds differed between 2005 - 2006 and 2011 - 2012 ( secular change ) , and to investigate changes in PA and ST from age 9 to 15 ( longitudinal change ) . In 2005 - 2006 , we invited nationally representative sample s of Norwegian 9- ( n=1470 ) and 15-year-olds ( n=1348 ) to participate . In 2011 - 2012 , we invited a new nationally representative sample of 9-year-olds ( n=1945 ) , whereas 15-year-olds ( n=1759 ) were invited to participate either based on previous participation in 2005 - 2006 or from a r and om sample of schools . We assessed PA and ST objective ly using accelerometers . In 2011 - 2012 , both 9- and 15-year-olds spent more time sedentary ( ≥35.7 min/d , P<.001 ) and less time in light PA ( ≥35.2 min/d , P<.001 ) compared to their peers in 2005 - 2006 . Nine-year-old girls also spent less time in moderate-to-vigorous PA ( MVPA ) ( 4.2 min/d , P=.041 ) . In both age groups , the proportion accumulating an average of 60 min/d of MVPA did not differ between the two cohorts . From age 9 to 15 , girls and boys decreased their time spent in LPA ( ≥106.7 min/d , P<.001 ) and in MVPA ( ≥20.8 min/d , P<.001 ) . During the same period , ST increased by a mean of > 2 h/d ( P<.011 ) . We observed an adverse secular change in PA from 2005 - 2006 to 2011 - 2012 among 9- and 15-year-olds , and a large decline in PA in the participants followed longitudinally from age 9 to 15 years Background Globally , adolescent girls ’  physical activity ( PA ) levels are low . The ‘ Girls Active ’ secondary school-based programme , developed by the Youth Sport Trust , aims to increase PA in adolescent girls . This paper explores the effectiveness of the ‘ Girls Active ’ school-based PA programme . Methods A r and om sample of girls aged 11–14 from 20 secondary schools ( Midl and s , UK ) participated in a two-arm cluster r and omised controlled trial . Ten schools received Girls Active and 10 continued with usual practice . Measurements were taken at baseline , seven- and 14-month follow-up . Primary outcome : wrist-worn accelerometer measured moderate- to vigorous-intensity PA ( MVPA ) .  Secondary outcomes : overall PA , light PA , sedentary time , body composition , and psychosocial outcomes . Generalised estimating equations , adjusted for school cluster and potential confounders , were used and A priori subgroup analysis was undertaken . Micro-costing and cost-consequence analyses were conducted using bespoke collection methods on programme delivery information . Outcomes for the cost-consequence analysis were health related quality of life measured by the Child Health Utility-9D and service use . Results Overall , 1752 pupils participated , 1211 ( 69.1 % ) provided valid 14-month accelerometer data . No difference in MVPA ( mins/day ; 95 % confidence intervals ) was found at 14 months ( 1.7 ; -0.8 to 4.3 ) , there was at seven months ( 2.4 ; 0.1 to 4.7 ) . Subgroup analyses showed significant intervention effects on 14-month in larger schools ( 3.9 ; 1.39 to 6.09 ) and in White Europeans ( 3.1 ; 0.60 to 6.02 ) and in early maturers ( 5.1 ; 1.69 to 8.48 ) at seven months . The control group did better in smaller schools at 14-months ( -4.38 ; -7.34 to -1.41 ) . Significant group differences were found in 14-month identified motivation ( -0.09 ; -0.18 to -0.01 ) and at seven months in : overall PA ( 1.39 mg/day ; 0.1 to 2.2 ) , after-school sedentary time ( -4.7 ; -8.9 to -0.6 ) , whole day ( 5.7 ; 1.0 to 10.5 ) and school day ( 4.5 ; 0.25 to 8.75 ) light PA , self-esteem . Small , statistically significant , differences in some psychosocial variables favoured control schools . Micro-costing demonstrated that delivering the programme result ed in a range of time and financial costs at each school . Cost-consequence analysis demonstrated no effect of the programme for health related quality of life or service use . Conclusions Compared with usual practice , ‘ Girls Active ’ did not affect 14-month MVPA.Trial registration IS RCT Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making . However , there are no structured reporting requirements for studies of this design to assist authors , editors , and readers . The authors developed and tested a checklist of criteria related to threats to the internal and external validity of observational longitudinal studies . The checklist criteria concerned recruitment , data collection , biases , and data analysis and descriptive issues relevant to study rationale , study population , and generalizability . Two raters independently assessed 49 r and omly selected articles describing stroke research published from 1999 to 2003 in six journals : American Journal of Epidemiology , Journal of Epidemiology and Community Health , Stroke , Annals of Neurology , Archives of Physical Medicine and Rehabilitation , and American Journal of Physical Medicine and Rehabilitation . On average , 17 of the 33 checklist criteria were reported . Criteria describing the study design were better reported than those related to internal validity . No relation was found between study type ( etiologic or prognostic ) or word count and quality of reporting . A flow diagram for summarizing participant flow through a study was developed . Editors and authors should consider using a checklist and flow diagram when reporting on observational longitudinal research Objective To examine whether physical activity ( PA ) and sedentary time ( ST ) in primary school-aged 
    Output:
    