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 This study aim ed to evaluate the associations of selected demographic , individual , social , and environmental factors with moderate-to-vigorous physical activity ( MVPA ) in a sample of children and adolescents . Methods  MVPA  was assessed among youth ( n = 294 ) 10 - 17-years-old using the ActiGraph accelerometer . Youth completed measures of demographic and individual variables related to physical activity ( PA ) , perceived social support by parents and peers , and perceived neighborhood characteristics . Parents completed the long-form of the International Physical Activity Question naire . The Physical Activity and Media Inventory was used to measure the home environment and Geographical Information Systems software was used to measure the physical neighborhood environment . Bivariate correlations and hierarchical multiple regression were conducted stratified by gender . Results Boys participated in significantly more MVPA than girls . In hierarchical analyses , peer support , home PA equipment , and temperature were significantly associated with MVPA among boys whereas distance to the school they attended was associated with MVPA among girls . The final models accounted for 25 % and 15 % of the variance in MVPA among boys and girls , respectively . Conclusions Important differences exist among the individual , social , and environmental factors related to MVPA between boys and girls . Boys ' levels of activity appear to be influenced by factors closely linked to unstructured and social types of activities whereas girls ' activities relate to internal and external barriers as well as their proximity to their schools . The prospect i ve contribution of these important individual , social , and environmental factors to changes in MVPA among children and adolescents remains to be determined BACKGROUND Sedentary activities such as video gaming are independently associated with obesity .  Active video games , in which players physically interact with images on screen , may help increase physical activity and improve body composition . OBJECTIVE The aim of this study was to evaluate the effect of active video games over a 6-mo period on weight , body composition , physical activity , and physical fitness . DESIGN We conducted a 2-arm , parallel , r and omized controlled trial in Auckl and , New Zeal and . A total of 322 overweight and obese children aged 10 - 14 y , who were current users of sedentary video games , were r and omly assigned at a 1:1 ratio to receive either an active video game up grade package ( intervention , n = 160 ) or to have no change ( control group , n = 162 ) . The primary outcome was the change from baseline in body mass index ( BMI ; in kg/m(2 ) ) . Secondary outcomes were changes in percentage body fat , physical activity , cardiorespiratory fitness , video game play , and food snacking . RESULTS At 24 wk , the treatment effect on BMI ( -0.24 ; 95 % CI : -0.44 , -0.05 ; P = 0.02 ) favored the intervention group . The change ( ±SE ) in BMI from baseline increased in the control group ( 0.34 ± 0.08 ) but remained the same in the intervention group ( 0.09 ± 0.08 ) . There was also evidence of a reduction in body fat in the intervention group ( -0.83 % ; 95 % CI : -1.54 % , -0.12 % ; P = 0.02 ) . The change in daily time spent playing active video games at 24 wk increased ( 10.03 min ; 95 % CI : 6.26 , 13.81 min ; P < 0.0001 ) with the intervention accompanied by a reduction in the change in daily time spent playing nonactive video games ( -9.39 min ; 95 % CI : -19.38 , 0.59 min ; P = 0.06 ) . CONCLUSION An active video game intervention has a small but definite effect on BMI and body composition in overweight and obese children . This trial was registered in the Australian New Zeal and Clinical Trials Registry at http://www.anzctr.org.au/ as ACTRN12607000632493 Background and aims : Home-based exercise is a viable solution for frail elderly individuals with difficulties in reaching exercise facilities outside home . The aim of this study was to determine the effects of a home-based video exercise program on physiological performance , functional capacity and health-related quality of life . Methods : Community-dwelling frail women ≥75 yrs , receiving public home care , were r and omized into a training group ( n=30 ) and a control group ( n=31 ) . Participants exercised for 26 minutes , three times per week for five months . Both groups received a bi-weekly telephone call . The effect of intervention was evaluated by the physical performance test , mobility-tiredness score , maximal isometric h and grip and biceps strength , lower limb explosive power , repeated chair rise ( 5 times ) , 10-m maximal walking-speed , semi-t and em balance , and health-related quality of life , as measured by EQ-5D and self-rated health . Results : Twenty-five participants ( 83 % ) in the training group and 28 ( 90 % ) in the control group completed the project  . Adherence to the training protocol was on average 89.2 % . At follow-up , between-group analysis revealed a significant difference only in EQ-5D ( valued by time-trade-off tariffs ) , result ing from a significant decrease observed in the control group and a trend towards an increase in the training group ( p=0.082 ) . Significant within-group improvements , ranging from 8–35 % , were also observed for the physical performance test , mobility-tiredness score , h and grip , biceps strength , chair rise , and 10-m maximal walking-speed in the training group , and for walking-speed and self-rated health in the control group . Conclusions : These results suggest that home-based training for frail older women using an exercise video induces lasting health-related quality -of-life ( EQ-5D ) . In addition , a tendency towards improvements in physiological performance and functional capacity was observed Background The family food environment is an important influence in the development of children ’s dietary habits . Research suggests that influences of current dietary behaviour and behaviour change may differ . The aims of this paper were to : ( 1 ) investigate the association between the food environment at baseline and change in  children ’s saturated fat intake ; and ( 2 ) to explore whether a change in the food environment was associated with a change in  children ’s saturated fat intake . MethodS econdary analysis of a 12 week cluster r and omised controlled trial in 133 4 - 13 year old children . Families were r and omly allocated to parental education regarding changing to reduced-fat dairy foods or a comparison non-dietary behaviour . The interventions were family focused . Parents received education from a dietitian in 3x30minute sessions to facilitate behaviour change . Parents completed a comprehensive question naire capturing three domains of the food environment – Parent knowledge and attitudes ; shaping practice s ; and behaviours and role modelling .  Children ’s dietary intake was assessed via multiple 24-hour recalls at baseline and week 12 . Changes in the family food environment and primary outcome ( saturated fat ) were calculated . Hierarchical linear regression models were performed to explore the association between baseline and change in food environment constructs and change in saturated fat intake . St and ardised Beta are presented ( p<0.05 ) . Results After adjustments for child and family demographics , higher levels of perceived food availability ( β=-0.2 ) at baseline was associated with greater reduction in saturated fat intake , where as higher perceived responsibility ( β=0.2 ) , restriction ( β=0.3 ) and pressure to eat ( β=0.3 ) were associated with lesser change in saturated fat . An increase in nutrition knowledge ( β=-0.2 ) , perceived responsibility ( β=-0.3 ) and restriction ( β=-0.3 ) from baseline to week 12 were associated with greater reduction in saturated fat intake . Conclusions The present study was one of the first to quantify changes in the family food environment , and identify a number of factors which were associated with a positive dietary change . Because interventions focus on behaviour change , the findings may provide specific targets for intervention strategies in the future . Trial registration Australia New Zeal and Clinical Trials Registry ACTRN12609000453280 OBJECTIVE : This naturalistic study tests whether children receiving a new ( to them ) active video game  spontaneously engage in more physical activity than those receiving an inactive video game  , and whether the effect would be greater among children in unsafe neighborhoods , who might not be allowed to play outside . METHODS : Participants were children 9 to 12 years of age , with a BMI > 50th percentile , but < 99th percentile ; none of these children a medical condition that would preclude physical activity or playing video games . A r and omized clinical trial assigned children to receiving 2 active or 2 inactive video games , the peripherals necessary to run the games , and a Wii console .  Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment . Neighborhood safety was assessed with a 12 item vali date d question naire . RESULTS : There was no evidence that children receiving the active video games were more active in general , or at anytime , than children receiving the inactive video games . The outcomes were not moderated by parent perceived neighborhood safety , child BMI z score , or other demographic characteristics . CONCLUSIONS : These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children OBJECTIVE The aims of the study were to evaluate the long-term effects of a home-based smoking prevention program ' Smoke-free Kids ' during preadolescence on smoking initiation during adolescence and to test the potential moderating role of parental smoking , socioeconomic status , and asthma . METHOD In 2008 , 1478 9 - 11year old children and their mothers were recruited from 418 elementary schools in the Netherl and s. An independent statistician r and omly allocated schools to one of the two conditions using a 1:1 ratio ( single blind ) : 728 children in the intervention and 750 in the control condition . The intervention condition received five activity modules , including a communication sheet for mothers , by mail at four-week intervals and one booster module one year after baseline . The control condition received a fact-based intervention only . Intention-to-treat analysis was performed on 1398 non-smoking children at baseline . RESULTS In the intervention 10.8 % of the children started smoking compared to 12 % in the control condition . This difference was non-significant ( odds ratio=0.90 , 95 % confidence interval=0.63 - 1.27 ) . No moderating effects were found . CONCLUSION No effects on smoking initiation after 36months were found . Perhaps , the program was implemented with children that were too young . Programs closer to the age of smoking onset should be tested OBJECTIVE To examine associations between television viewing , sugar-sweetened beverage consumption , eating out , physical activity , and body weight change over 1 year . DESIGN Secondary data analysis from r and omized intervention trial . SETTING Households in the community . PARTICIPANTS Adults ( n = 153 ) and adolescents ( n = 72 ) from the same households . INTERVENTION Households were r and omized to a home-based obesity prevention intervention or to a no-intervention control group for a 1-year period . MAIN OUTCOME MEASURES Self-reported television viewing ( TV ) hours , diet , and physical activity . Body mass index ( BMI ) computed from measured weight and height ( primary outcome measure ) . ANALYSIS Mixed-model regression . RESULTS Among adolescents , a significant prospect i ve association was observed between decreases in television viewing hours and lower BMI z score at 1-year follow-up ( decreased TV hours : BMI z score mean = 0.65 ; no change or increase TV hours : BMI z score = 0.92 ; P < .02 ) . No significant prospect i ve associations were observed among adults . CONCLUSIONS AND IMPLICATION S Reducing television viewing may be an effective strategy to prevent excess weight gain among adolescents Even when adults meet physical activity guidelines , sitting for prolonged periods can compromise metabolic health .  Television ( TV ) time and objective measurement studies show deleterious associations , and breaking up sedentary time is beneficial .  Sitting time , TV time , and time sitting in automobiles increase premature mortality risk . Further evidence from prospect i ve studies , intervention trials , and population -based behavioral studies is required Background : Self-efficacy is a person 's confidence in being able to successfully perform a specific activity or behavior . Self-efficacy has been shown to influence exercise capacity in patients post myocardial infa rct ion , but has not been fully explored in patients with heart failure ( HF ) . This study examined the impact of performance of a single treadmill exercise test and participation in a 3-month program of walking and resistance exercise on self-efficacy in HF patients . Methods : 24 patients were r and omized to either a home-based walking and resistance exercise program or usual care for 3 months . Prior to enrollment into the exercise program all participants performed a single treadmill exercise test with respiratory gas analysis .  Self-efficacy question naires were completed at 3 time points , 1 ) prior to performance of an exercise treadmill test ; 2 ) immediately after completing an exercise test ; and 3 ) at the end of a 3-month exercise program . Results : Self-efficacy for walking ( p = 0.07 ) , climbing ( p = 0.17 ) , lifting ( p = 0.73 ) and general activity ( p = 0.15 ) did not improve after performance of a single treadmill exercise test and usual care . However , self-efficacy for walking increased after 3 months of a walking and resistance exercise program . ( p = 0.04 ) . Conclusions : The findings from this study suggest that in patients with stable m 
    Output:
    
agent
Interventions that reduced sedentary time by using TV limiting devices were shown to be effective for children but the results were limited for adults .
Overall , large exercise equipment ( ie .
treadmills ) , and prominent exergaming material s ( exergaming bike , dance mats ) were found to be more effective than smaller devices .
Observational studies revealed that location and quantity of televisions correlated with SD behavior with the latter having a greater effect on girls .
This was similarly found for the quantity of PA equipment which also correlated with behavior in females .
***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 This study aim ed to evaluate the associations of selected demographic , individual , social , and environmental factors with moderate-to-vigorous physical activity ( MVPA ) in a sample of children and adolescents . Methods  MVPA  was assessed among youth ( n = 294 ) 10 - 17-years-old using the ActiGraph accelerometer . Youth completed measures of demographic and individual variables related to physical activity ( PA ) , perceived social support by parents and peers , and perceived neighborhood characteristics . Parents completed the long-form of the International Physical Activity Question naire . The Physical Activity and Media Inventory was used to measure the home environment and Geographical Information Systems software was used to measure the physical neighborhood environment . Bivariate correlations and hierarchical multiple regression were conducted stratified by gender . Results Boys participated in significantly more MVPA than girls . In hierarchical analyses , peer support , home PA equipment , and temperature were significantly associated with MVPA among boys whereas distance to the school they attended was associated with MVPA among girls . The final models accounted for 25 % and 15 % of the variance in MVPA among boys and girls , respectively . Conclusions Important differences exist among the individual , social , and environmental factors related to MVPA between boys and girls . Boys ' levels of activity appear to be influenced by factors closely linked to unstructured and social types of activities whereas girls ' activities relate to internal and external barriers as well as their proximity to their schools . The prospect i ve contribution of these important individual , social , and environmental factors to changes in MVPA among children and adolescents remains to be determined BACKGROUND Sedentary activities such as video gaming are independently associated with obesity .  Active video games , in which players physically interact with images on screen , may help increase physical activity and improve body composition . OBJECTIVE The aim of this study was to evaluate the effect of active video games over a 6-mo period on weight , body composition , physical activity , and physical fitness . DESIGN We conducted a 2-arm , parallel , r and omized controlled trial in Auckl and , New Zeal and . A total of 322 overweight and obese children aged 10 - 14 y , who were current users of sedentary video games , were r and omly assigned at a 1:1 ratio to receive either an active video game up grade package ( intervention , n = 160 ) or to have no change ( control group , n = 162 ) . The primary outcome was the change from baseline in body mass index ( BMI ; in kg/m(2 ) ) . Secondary outcomes were changes in percentage body fat , physical activity , cardiorespiratory fitness , video game play , and food snacking . RESULTS At 24 wk , the treatment effect on BMI ( -0.24 ; 95 % CI : -0.44 , -0.05 ; P = 0.02 ) favored the intervention group . The change ( ±SE ) in BMI from baseline increased in the control group ( 0.34 ± 0.08 ) but remained the same in the intervention group ( 0.09 ± 0.08 ) . There was also evidence of a reduction in body fat in the intervention group ( -0.83 % ; 95 % CI : -1.54 % , -0.12 % ; P = 0.02 ) . The change in daily time spent playing active video games at 24 wk increased ( 10.03 min ; 95 % CI : 6.26 , 13.81 min ; P < 0.0001 ) with the intervention accompanied by a reduction in the change in daily time spent playing nonactive video games ( -9.39 min ; 95 % CI : -19.38 , 0.59 min ; P = 0.06 ) . CONCLUSION An active video game intervention has a small but definite effect on BMI and body composition in overweight and obese children . This trial was registered in the Australian New Zeal and Clinical Trials Registry at http://www.anzctr.org.au/ as ACTRN12607000632493 Background and aims : Home-based exercise is a viable solution for frail elderly individuals with difficulties in reaching exercise facilities outside home . The aim of this study was to determine the effects of a home-based video exercise program on physiological performance , functional capacity and health-related quality of life . Methods : Community-dwelling frail women ≥75 yrs , receiving public home care , were r and omized into a training group ( n=30 ) and a control group ( n=31 ) . Participants exercised for 26 minutes , three times per week for five months . Both groups received a bi-weekly telephone call . The effect of intervention was evaluated by the physical performance test , mobility-tiredness score , maximal isometric h and grip and biceps strength , lower limb explosive power , repeated chair rise ( 5 times ) , 10-m maximal walking-speed , semi-t and em balance , and health-related quality of life , as measured by EQ-5D and self-rated health . Results : Twenty-five participants ( 83 % ) in the training group and 28 ( 90 % ) in the control group completed the project  . Adherence to the training protocol was on average 89.2 % . At follow-up , between-group analysis revealed a significant difference only in EQ-5D ( valued by time-trade-off tariffs ) , result ing from a significant decrease observed in the control group and a trend towards an increase in the training group ( p=0.082 ) . Significant within-group improvements , ranging from 8–35 % , were also observed for the physical performance test , mobility-tiredness score , h and grip , biceps strength , chair rise , and 10-m maximal walking-speed in the training group , and for walking-speed and self-rated health in the control group . Conclusions : These results suggest that home-based training for frail older women using an exercise video induces lasting health-related quality -of-life ( EQ-5D ) . In addition , a tendency towards improvements in physiological performance and functional capacity was observed Background The family food environment is an important influence in the development of children ’s dietary habits . Research suggests that influences of current dietary behaviour and behaviour change may differ . The aims of this paper were to : ( 1 ) investigate the association between the food environment at baseline and change in  children ’s saturated fat intake ; and ( 2 ) to explore whether a change in the food environment was associated with a change in  children ’s saturated fat intake . MethodS econdary analysis of a 12 week cluster r and omised controlled trial in 133 4 - 13 year old children . Families were r and omly allocated to parental education regarding changing to reduced-fat dairy foods or a comparison non-dietary behaviour . The interventions were family focused . Parents received education from a dietitian in 3x30minute sessions to facilitate behaviour change . Parents completed a comprehensive question naire capturing three domains of the food environment – Parent knowledge and attitudes ; shaping practice s ; and behaviours and role modelling .  Children ’s dietary intake was assessed via multiple 24-hour recalls at baseline and week 12 . Changes in the family food environment and primary outcome ( saturated fat ) were calculated . Hierarchical linear regression models were performed to explore the association between baseline and change in food environment constructs and change in saturated fat intake . St and ardised Beta are presented ( p<0.05 ) . Results After adjustments for child and family demographics , higher levels of perceived food availability ( β=-0.2 ) at baseline was associated with greater reduction in saturated fat intake , where as higher perceived responsibility ( β=0.2 ) , restriction ( β=0.3 ) and pressure to eat ( β=0.3 ) were associated with lesser change in saturated fat . An increase in nutrition knowledge ( β=-0.2 ) , perceived responsibility ( β=-0.3 ) and restriction ( β=-0.3 ) from baseline to week 12 were associated with greater reduction in saturated fat intake . Conclusions The present study was one of the first to quantify changes in the family food environment , and identify a number of factors which were associated with a positive dietary change . Because interventions focus on behaviour change , the findings may provide specific targets for intervention strategies in the future . Trial registration Australia New Zeal and Clinical Trials Registry ACTRN12609000453280 OBJECTIVE : This naturalistic study tests whether children receiving a new ( to them ) active video game  spontaneously engage in more physical activity than those receiving an inactive video game  , and whether the effect would be greater among children in unsafe neighborhoods , who might not be allowed to play outside . METHODS : Participants were children 9 to 12 years of age , with a BMI > 50th percentile , but < 99th percentile ; none of these children a medical condition that would preclude physical activity or playing video games . A r and omized clinical trial assigned children to receiving 2 active or 2 inactive video games , the peripherals necessary to run the games , and a Wii console .  Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment . Neighborhood safety was assessed with a 12 item vali date d question naire . RESULTS : There was no evidence that children receiving the active video games were more active in general , or at anytime , than children receiving the inactive video games . The outcomes were not moderated by parent perceived neighborhood safety , child BMI z score , or other demographic characteristics . CONCLUSIONS : These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children OBJECTIVE The aims of the study were to evaluate the long-term effects of a home-based smoking prevention program ' Smoke-free Kids ' during preadolescence on smoking initiation during adolescence and to test the potential moderating role of parental smoking , socioeconomic status , and asthma . METHOD In 2008 , 1478 9 - 11year old children and their mothers were recruited from 418 elementary schools in the Netherl and s. An independent statistician r and omly allocated schools to one of the two conditions using a 1:1 ratio ( single blind ) : 728 children in the intervention and 750 in the control condition . The intervention condition received five activity modules , including a communication sheet for mothers , by mail at four-week intervals and one booster module one year after baseline . The control condition received a fact-based intervention only . Intention-to-treat analysis was performed on 1398 non-smoking children at baseline . RESULTS In the intervention 10.8 % of the children started smoking compared to 12 % in the control condition . This difference was non-significant ( odds ratio=0.90 , 95 % confidence interval=0.63 - 1.27 ) . No moderating effects were found . CONCLUSION No effects on smoking initiation after 36months were found . Perhaps , the program was implemented with children that were too young . Programs closer to the age of smoking onset should be tested OBJECTIVE To examine associations between television viewing , sugar-sweetened beverage consumption , eating out , physical activity , and body weight change over 1 year . DESIGN Secondary data analysis from r and omized intervention trial . SETTING Households in the community . PARTICIPANTS Adults ( n = 153 ) and adolescents ( n = 72 ) from the same households . INTERVENTION Households were r and omized to a home-based obesity prevention intervention or to a no-intervention control group for a 1-year period . MAIN OUTCOME MEASURES Self-reported television viewing ( TV ) hours , diet , and physical activity . Body mass index ( BMI ) computed from measured weight and height ( primary outcome measure ) . ANALYSIS Mixed-model regression . RESULTS Among adolescents , a significant prospect i ve association was observed between decreases in television viewing hours and lower BMI z score at 1-year follow-up ( decreased TV hours : BMI z score mean = 0.65 ; no change or increase TV hours : BMI z score = 0.92 ; P < .02 ) . No significant prospect i ve associations were observed among adults . CONCLUSIONS AND IMPLICATION S Reducing television viewing may be an effective strategy to prevent excess weight gain among adolescents Even when adults meet physical activity guidelines , sitting for prolonged periods can compromise metabolic health .  Television ( TV ) time and objective measurement studies show deleterious associations , and breaking up sedentary time is beneficial .  Sitting time , TV time , and time sitting in automobiles increase premature mortality risk . Further evidence from prospect i ve studies , intervention trials , and population -based behavioral studies is required Background : Self-efficacy is a person 's confidence in being able to successfully perform a specific activity or behavior . Self-efficacy has been shown to influence exercise capacity in patients post myocardial infa rct ion , but has not been fully explored in patients with heart failure ( HF ) . This study examined the impact of performance of a single treadmill exercise test and participation in a 3-month program of walking and resistance exercise on self-efficacy in HF patients . Methods : 24 patients were r and omized to either a home-based walking and resistance exercise program or usual care for 3 months . Prior to enrollment into the exercise program all participants performed a single treadmill exercise test with respiratory gas analysis .  Self-efficacy question naires were completed at 3 time points , 1 ) prior to performance of an exercise treadmill test ; 2 ) immediately after completing an exercise test ; and 3 ) at the end of a 3-month exercise program . Results : Self-efficacy for walking ( p = 0.07 ) , climbing ( p = 0.17 ) , lifting ( p = 0.73 ) and general activity ( p = 0.15 ) did not improve after performance of a single treadmill exercise test and usual care . However , self-efficacy for walking increased after 3 months of a walking and resistance exercise program . ( p = 0.04 ) . Conclusions : The findings from this study suggest that in patients with stable m 
    Output:
    