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: Aims This study assessed the efficacy of a school-based healthy lifestyle intervention ( Sport for LIFE ) for increasing physical activity , decreasing sedentary behaviour , reducing screen time behaviour , encouraging healthy attitudes and behaviour to nutrition , and reducing body mass index ( BMI ) in 8–9-year-old primary school children from lower socioeconomic background s in Northern Irel and . Methods A non-r and omised controlled trial of 416 children from 24 schools took part . Schools were r and omly assigned to one of two groups , an intervention or control group with 12 schools in each group . The intervention group received a 12-week school-based programme based on social cognitive theory . At baseline and follow-up , groups completed question naires assessing physical activity , screen time behaviour and dietary patterns . On each occasion anthropometric assessment  s of height and weight were taken . Physical activity and sedentary behaviour were measured by accelerometry . Results Significant effects were observed for vigorous , moderate and light activity for the intervention group at follow-up . Sedentary behaviour was significantly reduced for the intervention group but not for the control group . No significant effects of the intervention on BMI , screen time behaviour or attitudes to nutrition , with the exception of non-core foods , were shown . Conclusions The programme was effective in increasing physical activity and reducing sedentary behaviour , however no significant changes in screen time behaviour and attitude to nutrition , with the exception of non-core foods , were observed . Future research ideas are offered for tackling low levels of physical activity in children BakckgroundThe first aim was to examine the effect of the UP4FUN pilot intervention on children ’s total sedentary time . The second aim was to investigate if the intervention had an effect on  children ’s physical activity ( PA ) level . Finally , we aim ed to investigate demographic differences ( i.e. age , gender , ethnicity , living status and having siblings ) between children in the intervention group who improved in sedentary time and PA at post-test and children in the intervention group who worsened in sedentary time and PA at post-test . Methods The six weeks UP4FUN intervention was tested in a r and omized controlled trial with pre-test post-test design with five intervention and five control schools in Belgium and included children of the 5th and 6th grade . The children wore accelerometers for seven days at pre- and post-test . Analyses included children with valid accelerometer data for at least two weekdays with minimum 10h-wearing time and one weekend day with 8h-wearing time . Result Final analyses included 372 children ( 60 % girls , mean age = 10.9 ± 0.7 years ) . There were no significant differences in the change in sedentary time or light PA between intervention and control schools for the total sample or for the subgroup analyses by gender . However , children ( specifically girls ) in the intervention group had a higher decrease in moderate-to-vigorous PA than children in the control group . In the intervention group , children who lived with both parents and children with one or more siblings were less likely to reduce sedentary time after exposure to the intervention . Older children , girls and children who lived with both parents were less likely to increase light PA after the intervention . Conclusion The UP4FUN intervention did not result in an effect on children ’s sedentary time . Based on the high amounts of accelerometer-derived sedentary time in this age group , more efforts are needed to develop strategies to reduce children ’s sedentary time Background The optimal targets and strategies for effectively reducing sedentary behavior among young people are unknown . Intervention research that explores changes in mediated effects as well as in outcome behaviors is needed to help inform more effective interventions . Therefore , the purpose of this study was to examine the mid-intervention mediating effects on children ’s objective ly assessed classroom and total weekday sedentary time in the Transform-Us ! intervention . Methods The results are based on 293 children , aged 7- to 9-years-old at baseline , from 20 schools in Melbourne , Australia . Each school was r and omly allocated to one of four groups , which targeted reducing sedentary time in the school and family setting s ( SB ; n = 74 ) , increasing or maintaining moderate- to vigorous-intensity physical activity in the school and family setting s ( PA ; n = 75 ) , combined SB and PA ( SB + PA ; n = 80 ) , or the current practice control ( C ; n = 64 ) . Baseline and mid-intervention data ( 5–9 months ) were collected in 2010 and analyzed in 2012 . Classroom and total weekday sedentary time was objective ly assessed using ActiGraph accelerometers . The hypothesized mediators including , child enjoyment , parent and teacher outcome expectancies , and child perceived access to st and ing opportunities in the classroom environment , were assessed by question naire . Results The SB + PA group spent 13.3 min/day less in weekday sedentary time at mid-intervention compared to the control group . At mid-intervention , children in the SB group had higher enjoyment of st and ing in class ( 0.9 units ; 5-unit scale ) and all intervention groups had more positive perceptions of access to st and ing opportunities in the classroom environment ( 0.3 - 0.4 units ; 3-unit scale ) , compared to the control group . However , none of the hypothesized mediator variables had an effect on sedentary time ; thus , no mediating effects were observed . Conclusions While beneficial intervention effects were observed on some hypothesized mediating variables and total weekday sedentary time at mid-intervention , no significant mediating effects were found . Given the dearth of existing information , future intervention research is needed that explores mediated effects . More work is also needed on the development of reliable mediator measures that are sensitive to change overtime . Trial registration ACTRN12609000715279IS RCT Objective To investigate the effectiveness of a school based intervention to increase physical activity , reduce sedentary behaviour , and increase fruit and vegetable consumption in children . Design Cluster r and omised controlled trial . Setting 60 primary schools in the south west of Engl and . Participants Primary school children who were in school year 4 ( age 8 - 9 years ) at recruitment and baseline assessment , in year 5 during the intervention , and at the end of year 5 ( age 9 - 10 ) at follow-up assessment . Intervention The Active for Life Year 5 ( AFLY5 ) intervention consisted of teacher training , provision of lesson and child-parent interactive homework plans , all material s required for lessons and homework , and written material s for school newsletters and parents . The intervention was delivered when children were in school year 5 ( age 9 - 10 years ) . Schools allocated to control received st and ard teaching . Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day , accelerometer assessed minutes of sedentary behaviour per day , and reported daily consumption of servings of fruit and vegetables . Results 60 schools with more than 2221 children were recruited ; valid data were available for fruit and vegetable consumption for 2121 children , for accelerometer assessed physical activity and sedentary behaviour for 1252 children , and for secondary outcomes for between 1825 and 2212 children for the main analyses . None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group . The difference in means comparing the intervention group with the control group was –1.35 ( 95 % confidence interval –5.29 to 2.59 ) minutes per day for moderate to vigorous physical activity , –0.11 ( –9.71 to 9.49 ) minutes per day for sedentary behaviour , and 0.08 ( –0.12 to 0.28 ) servings per day for fruit and vegetable consumption . The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account : self reported time spent in screen viewing at the weekend ( –21 ( –37 to –4 ) minutes per day ) , self reported servings of snacks per day ( –0.22 ( –0.38 to –0.05 ) ) , and servings of high energy drinks per day ( –0.26 ( –0.43 to –0.10 ) ) were all reduced . Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results . Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity , decreasing sedentary behaviour , and increasing fruit and vegetable consumption in primary school children . Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level , as well as at the school environment level . These findings have relevance for research ers , policy makers , public health practitioners , and doctors who are involved in health promotion , policy making , and commissioning services . Trial registration Current Controlled Trials IS RCT N50133740 Background Decreasing sedentary activities that involve prolonged sitting may be an important strategy to reduce obesity and other physical and psychosocial health problems in children . The first step to underst and ing the effect of sedentary activities on children ’s health is to objective ly assess these activities with a valid measurement tool . Purpose To examine the validity of the ActivPAL monitor in measuring sitting/lying , st and ing , and walking time , transition counts and step counts in children in a laboratory setting . Methods Twenty five healthy elementary school children ( age 9.9 ± 0.3 years ; BMI 18.2 ± 1.9 ; mean ± SD ) were r and omly recruited across the Auckl and region , New Zeal and . Children were fitted with ActivPAL monitors and observed during simulated free-living activities involving sitting/lying , st and ing and walking , followed by treadmill and over-ground activities at various speeds ( slow , normal , fast ) against video observation ( criterion measure ) . The ActivPAL sit-to-st and and st and -to-sit transition counts and steps were also compared with video data . The accuracy of step counts measured by the ActivPAL was also compared against the New Lifestyles NL-2000 and the Yamax Digi-Walker SW-200 pedometers . Results We observed a perfect correlation between the ActivPAL monitor in time spent sitting/lying , st and ing , and walking in simulated free-living activities with direct observation . Correlations between the ActivPAL and video observation in total numbers of sit-to-st and and st and -to-sit transitions were high ( r = 0.99 ± 0.01 ) . Unlike pedometers , the ActivPAL did not misclassify fidgeting as steps taken . Strong correlations ( r = 0.88 - 1.00 ) between ActivPAL step counts and video observation in both treadmill and over-ground slow and normal walking were also observed . During treadmill and over-ground fast walking and running , the correlations were low ( r = 0.21 - 0.46 ) . Conclusion The ActivPAL monitor is a valid measurement tool for assessing time spent sitting/lying , st and ing , and walking , sit-to-st and and st and -to-sit transition counts and step counts in slow and normal walking . The device did not measure accurately steps taken during treadmill and over-ground fast walking and running in children Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background The UP4FUN intervention is a family-involved school-based intervention aim ing at reducing and breaking up sitting time at home ( with special emphasis on screen time ) , and breaking up sitting time in school among 10–12 year olds in Europe . The purpose of the present paper was to evaluate its short term effects . Methodology /Principal Findings A total of 3147 pupils from Belgium , Germany , Greece , Hungary and Norway participated in a school-r and omized controlled trial . The intervention included 1–2 school lessons per week for a period of six weeks , along with assignments for the children and their parents . Screen time and breaking up sitting time were registered by self-report and total sedentary time and breaking up sitting time by accelerometry . The effect of the intervention on these behaviors was evaluated by multilevel regression analyses . All analyses were adjusted for baseline values and gender . Significance level was p≤0.01 . No significant intervention effects were observed , neither for self-reported TV/DVD or computer/game console time , nor for accelerometer-assessed total sedentary time and number of breaks in sitting time . The intervention group , however , reported more positive attitudes towards ( β = 0.25 ( 95 % CI 0.11 , 0.38 ) ) and preferences/liking for ( β = 0.20 ( 95 % CI 0.08 , 0.32 ) ) breaking up sitting time than the control group . Conclusions / Significance No significant intervention effect on self-reported screen time or accelerometer-assessed sedentary time or breaks in sitting time was observed , but positive effects on beliefs regarding breaking up sitting time were found in favor of the intervention group . Overall , these results do not warrant wider dissemination of the present UP4FUN intervention . Trial Registration International St and ard R and omized Controlled Trial Number Registry IS RCT Background This pragmatic evaluation investigated the effectiveness of the Children ’s Health , Activity and Nutrition : Get Educated ! ( CHANGE ! ) Project , a cluster r and omised intervention to promote healthy weight using an educational focus on physical activity and healthy eating . Methods Participants ( n = 318 , aged 10–11 years ) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011 . This consisted of a teacher-led curriculum , learning re sources , and homework tasks . Primary outcome measures were waist circumference , body mass index ( BMI ) , and BMI z-scores . Secondary outcomes were objective ly-assessed physical activity and sedentary time , and food intake . Outcomes were assessed at 
    Output:
    
agent
Conclusions Multicomponent interventions which also include the use of st and ing desks may be an effective method for reducing  children 's sedentary time  in a school-based intervention .
***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: Aims This study assessed the efficacy of a school-based healthy lifestyle intervention ( Sport for LIFE ) for increasing physical activity , decreasing sedentary behaviour , reducing screen time behaviour , encouraging healthy attitudes and behaviour to nutrition , and reducing body mass index ( BMI ) in 8–9-year-old primary school children from lower socioeconomic background s in Northern Irel and . Methods A non-r and omised controlled trial of 416 children from 24 schools took part . Schools were r and omly assigned to one of two groups , an intervention or control group with 12 schools in each group . The intervention group received a 12-week school-based programme based on social cognitive theory . At baseline and follow-up , groups completed question naires assessing physical activity , screen time behaviour and dietary patterns . On each occasion anthropometric assessment  s of height and weight were taken . Physical activity and sedentary behaviour were measured by accelerometry . Results Significant effects were observed for vigorous , moderate and light activity for the intervention group at follow-up . Sedentary behaviour was significantly reduced for the intervention group but not for the control group . No significant effects of the intervention on BMI , screen time behaviour or attitudes to nutrition , with the exception of non-core foods , were shown . Conclusions The programme was effective in increasing physical activity and reducing sedentary behaviour , however no significant changes in screen time behaviour and attitude to nutrition , with the exception of non-core foods , were observed . Future research ideas are offered for tackling low levels of physical activity in children BakckgroundThe first aim was to examine the effect of the UP4FUN pilot intervention on children ’s total sedentary time . The second aim was to investigate if the intervention had an effect on  children ’s physical activity ( PA ) level . Finally , we aim ed to investigate demographic differences ( i.e. age , gender , ethnicity , living status and having siblings ) between children in the intervention group who improved in sedentary time and PA at post-test and children in the intervention group who worsened in sedentary time and PA at post-test . Methods The six weeks UP4FUN intervention was tested in a r and omized controlled trial with pre-test post-test design with five intervention and five control schools in Belgium and included children of the 5th and 6th grade . The children wore accelerometers for seven days at pre- and post-test . Analyses included children with valid accelerometer data for at least two weekdays with minimum 10h-wearing time and one weekend day with 8h-wearing time . Result Final analyses included 372 children ( 60 % girls , mean age = 10.9 ± 0.7 years ) . There were no significant differences in the change in sedentary time or light PA between intervention and control schools for the total sample or for the subgroup analyses by gender . However , children ( specifically girls ) in the intervention group had a higher decrease in moderate-to-vigorous PA than children in the control group . In the intervention group , children who lived with both parents and children with one or more siblings were less likely to reduce sedentary time after exposure to the intervention . Older children , girls and children who lived with both parents were less likely to increase light PA after the intervention . Conclusion The UP4FUN intervention did not result in an effect on children ’s sedentary time . Based on the high amounts of accelerometer-derived sedentary time in this age group , more efforts are needed to develop strategies to reduce children ’s sedentary time Background The optimal targets and strategies for effectively reducing sedentary behavior among young people are unknown . Intervention research that explores changes in mediated effects as well as in outcome behaviors is needed to help inform more effective interventions . Therefore , the purpose of this study was to examine the mid-intervention mediating effects on children ’s objective ly assessed classroom and total weekday sedentary time in the Transform-Us ! intervention . Methods The results are based on 293 children , aged 7- to 9-years-old at baseline , from 20 schools in Melbourne , Australia . Each school was r and omly allocated to one of four groups , which targeted reducing sedentary time in the school and family setting s ( SB ; n = 74 ) , increasing or maintaining moderate- to vigorous-intensity physical activity in the school and family setting s ( PA ; n = 75 ) , combined SB and PA ( SB + PA ; n = 80 ) , or the current practice control ( C ; n = 64 ) . Baseline and mid-intervention data ( 5–9 months ) were collected in 2010 and analyzed in 2012 . Classroom and total weekday sedentary time was objective ly assessed using ActiGraph accelerometers . The hypothesized mediators including , child enjoyment , parent and teacher outcome expectancies , and child perceived access to st and ing opportunities in the classroom environment , were assessed by question naire . Results The SB + PA group spent 13.3 min/day less in weekday sedentary time at mid-intervention compared to the control group . At mid-intervention , children in the SB group had higher enjoyment of st and ing in class ( 0.9 units ; 5-unit scale ) and all intervention groups had more positive perceptions of access to st and ing opportunities in the classroom environment ( 0.3 - 0.4 units ; 3-unit scale ) , compared to the control group . However , none of the hypothesized mediator variables had an effect on sedentary time ; thus , no mediating effects were observed . Conclusions While beneficial intervention effects were observed on some hypothesized mediating variables and total weekday sedentary time at mid-intervention , no significant mediating effects were found . Given the dearth of existing information , future intervention research is needed that explores mediated effects . More work is also needed on the development of reliable mediator measures that are sensitive to change overtime . Trial registration ACTRN12609000715279IS RCT Objective To investigate the effectiveness of a school based intervention to increase physical activity , reduce sedentary behaviour , and increase fruit and vegetable consumption in children . Design Cluster r and omised controlled trial . Setting 60 primary schools in the south west of Engl and . Participants Primary school children who were in school year 4 ( age 8 - 9 years ) at recruitment and baseline assessment , in year 5 during the intervention , and at the end of year 5 ( age 9 - 10 ) at follow-up assessment . Intervention The Active for Life Year 5 ( AFLY5 ) intervention consisted of teacher training , provision of lesson and child-parent interactive homework plans , all material s required for lessons and homework , and written material s for school newsletters and parents . The intervention was delivered when children were in school year 5 ( age 9 - 10 years ) . Schools allocated to control received st and ard teaching . Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day , accelerometer assessed minutes of sedentary behaviour per day , and reported daily consumption of servings of fruit and vegetables . Results 60 schools with more than 2221 children were recruited ; valid data were available for fruit and vegetable consumption for 2121 children , for accelerometer assessed physical activity and sedentary behaviour for 1252 children , and for secondary outcomes for between 1825 and 2212 children for the main analyses . None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group . The difference in means comparing the intervention group with the control group was –1.35 ( 95 % confidence interval –5.29 to 2.59 ) minutes per day for moderate to vigorous physical activity , –0.11 ( –9.71 to 9.49 ) minutes per day for sedentary behaviour , and 0.08 ( –0.12 to 0.28 ) servings per day for fruit and vegetable consumption . The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account : self reported time spent in screen viewing at the weekend ( –21 ( –37 to –4 ) minutes per day ) , self reported servings of snacks per day ( –0.22 ( –0.38 to –0.05 ) ) , and servings of high energy drinks per day ( –0.26 ( –0.43 to –0.10 ) ) were all reduced . Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results . Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity , decreasing sedentary behaviour , and increasing fruit and vegetable consumption in primary school children . Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level , as well as at the school environment level . These findings have relevance for research ers , policy makers , public health practitioners , and doctors who are involved in health promotion , policy making , and commissioning services . Trial registration Current Controlled Trials IS RCT N50133740 Background Decreasing sedentary activities that involve prolonged sitting may be an important strategy to reduce obesity and other physical and psychosocial health problems in children . The first step to underst and ing the effect of sedentary activities on children ’s health is to objective ly assess these activities with a valid measurement tool . Purpose To examine the validity of the ActivPAL monitor in measuring sitting/lying , st and ing , and walking time , transition counts and step counts in children in a laboratory setting . Methods Twenty five healthy elementary school children ( age 9.9 ± 0.3 years ; BMI 18.2 ± 1.9 ; mean ± SD ) were r and omly recruited across the Auckl and region , New Zeal and . Children were fitted with ActivPAL monitors and observed during simulated free-living activities involving sitting/lying , st and ing and walking , followed by treadmill and over-ground activities at various speeds ( slow , normal , fast ) against video observation ( criterion measure ) . The ActivPAL sit-to-st and and st and -to-sit transition counts and steps were also compared with video data . The accuracy of step counts measured by the ActivPAL was also compared against the New Lifestyles NL-2000 and the Yamax Digi-Walker SW-200 pedometers . Results We observed a perfect correlation between the ActivPAL monitor in time spent sitting/lying , st and ing , and walking in simulated free-living activities with direct observation . Correlations between the ActivPAL and video observation in total numbers of sit-to-st and and st and -to-sit transitions were high ( r = 0.99 ± 0.01 ) . Unlike pedometers , the ActivPAL did not misclassify fidgeting as steps taken . Strong correlations ( r = 0.88 - 1.00 ) between ActivPAL step counts and video observation in both treadmill and over-ground slow and normal walking were also observed . During treadmill and over-ground fast walking and running , the correlations were low ( r = 0.21 - 0.46 ) . Conclusion The ActivPAL monitor is a valid measurement tool for assessing time spent sitting/lying , st and ing , and walking , sit-to-st and and st and -to-sit transition counts and step counts in slow and normal walking . The device did not measure accurately steps taken during treadmill and over-ground fast walking and running in children Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background The UP4FUN intervention is a family-involved school-based intervention aim ing at reducing and breaking up sitting time at home ( with special emphasis on screen time ) , and breaking up sitting time in school among 10–12 year olds in Europe . The purpose of the present paper was to evaluate its short term effects . Methodology /Principal Findings A total of 3147 pupils from Belgium , Germany , Greece , Hungary and Norway participated in a school-r and omized controlled trial . The intervention included 1–2 school lessons per week for a period of six weeks , along with assignments for the children and their parents . Screen time and breaking up sitting time were registered by self-report and total sedentary time and breaking up sitting time by accelerometry . The effect of the intervention on these behaviors was evaluated by multilevel regression analyses . All analyses were adjusted for baseline values and gender . Significance level was p≤0.01 . No significant intervention effects were observed , neither for self-reported TV/DVD or computer/game console time , nor for accelerometer-assessed total sedentary time and number of breaks in sitting time . The intervention group , however , reported more positive attitudes towards ( β = 0.25 ( 95 % CI 0.11 , 0.38 ) ) and preferences/liking for ( β = 0.20 ( 95 % CI 0.08 , 0.32 ) ) breaking up sitting time than the control group . Conclusions / Significance No significant intervention effect on self-reported screen time or accelerometer-assessed sedentary time or breaks in sitting time was observed , but positive effects on beliefs regarding breaking up sitting time were found in favor of the intervention group . Overall , these results do not warrant wider dissemination of the present UP4FUN intervention . Trial Registration International St and ard R and omized Controlled Trial Number Registry IS RCT Background This pragmatic evaluation investigated the effectiveness of the Children ’s Health , Activity and Nutrition : Get Educated ! ( CHANGE ! ) Project , a cluster r and omised intervention to promote healthy weight using an educational focus on physical activity and healthy eating . Methods Participants ( n = 318 , aged 10–11 years ) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011 . This consisted of a teacher-led curriculum , learning re sources , and homework tasks . Primary outcome measures were waist circumference , body mass index ( BMI ) , and BMI z-scores . Secondary outcomes were objective ly-assessed physical activity and sedentary time , and food intake . Outcomes were assessed at 
    Output:
    