Effect of Applying Best Practices for Physical Activity and Screen Time to Family Childcare Homes.

INTRODUCTION: Early childcare has been identified as an influential setting for children's physical activity. Our objective was to determine whether children aged 2 to 5 years had more accelerometer-measured minutes of physical activity when caregivers in their family childcare home (FCCH) adhered to best practices for physical activity and screen time. METHODS: We analyzed baseline 2-day observation data collected by using the Environment and Policy Assessment and Observation measure from a cluster-randomized trial. Multilevel linear regression models assessed the association between caregivers' meeting best practices for physical activity and screen time and children's time spent sedentary or in moderate-to-vigorous physical activity (MVPA). RESULTS: All FCCH caregivers (N = 120) in our study were female, and 67.5% were Hispanic. Participating children (N = 349) were 52.1% female and 57.4% Hispanic. A higher score among caregivers for physical activity best practices was associated with more MVPA (B = 0.79; 95% CI, 0.02 to 1.56; P = .04) for children and less sedentary time (B = -2.07; 95% CI, -3.94 to -0.19; P = .04). A higher caregiver score for screen time best practices was associated with less sedentary time (B = -2.07; 95% CI, -3.94 to -0.19; P = .04) and more MVPA time (B = 0.65; 95% CI, 0.03 to .27; P = .04). Children in homes where caregivers offered them 60 minutes or more of outdoor play and participated in outdoor physical activity had more MVPA and less sedentary time. We found no association between various screen-time best practices and children's sedentary time. DISCUSSION: Children with caregivers who used more best practices for physical activity and screen time had higher activity levels and spent less time sedentary. These findings could help policy makers and people caring for young children modify existing policies and develop programs to help early childhood caregivers implement best practices to promote children's physical activity.

Feasibility, Acceptability, and Preliminary Efficacy of a Recess-Based Fitness Intervention in Elementary School Children.

Although fitness may benefit cognition in youth, most attention has been given to cardiorespiratory fitness despite the health benefits of muscular fitness. Few studies have examined interventions that incorporate both cardiorespiratory and muscular fitness or have been offered during school recess. Furthermore, most fitness intervention studies examining cognitive outcomes have not reported on implementation information. The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary efficacy on fitness and cognition of a recess intervention in elementary school children. Two schools were randomized to either a 3-month cardiorespiratory and muscular fitness intervention (15 minutes/weekday during recess) or control condition (standard recess activities). Process evaluation (feasibility and acceptability) measures were recorded daily (research staff questionnaire), weekly (accelerometer and heart rate monitors), and post-intervention (participant and school-staff questionnaires). Preliminary efficacy measures included pre- and post-intervention inhibition/attention, working memory, and cardiorespiratory and muscular fitness scores. Some feasibility and acceptability measures were favorable (88% of the lessons were implemented, 78% of the lessons were implemented as planned, and the majority of students and school staff were satisfied with most aspects of the intervention). However, intensity adherence during the intervention sessions based on accelerometry (% of time spent in moderate-to-vigorous activity: 41.7 ± 14.5) and participation (19.4% attendance rate) were lower than expected. Preliminary efficacy of the intervention on cognitive and fitness outcomes was not demonstrated. This study provided evidence that some aspects of the fitness intervention were acceptable during school recess. However, important implementation factors (i.e., intervention exposure) should be targeted to improve youth fitness programs offered during this school setting.

Feasibility of Integrating Physical Activity Into Early Education Learning Standards on Preschooler's Physical Activity Levels.

BACKGROUND: For a health behavior intervention to be sustainable within preschool centers, the intervention should be implemented by classroom teachers. Unfortunately, teachers are constrained by demands such as meeting early childhood education standards. Therefore, the purpose of this pilot study was to examine the feasibility and preliminary efficacy of integrating a health behavior intervention into early education learning standards on physical activity (PA), diet, and sleep (PADS) behavior of preschoolers. METHODS: Two preschool centers were randomized to either the PADS (children, n = 60) or the control (CON; children, n = 54) group. The PADS intervention consisted of PADS lesson plans and activities embedded into Massachusetts early learning standards and were implemented for 4 days per week for 12 weeks. The CON preschool participated in their usual curriculum. PA was assessed using accelerometers for 7 consecutive days at baseline, 6 weeks, and 12 weeks. Other outcome variables were assessed with parental surveys at baseline and 12 weeks. RESULTS: Significant group by time interactions were observed for moderate to vigorous PA (percentage of time) during the preschool day (PADS: baseline = 10.6% (4.2%), 12 wk = 13.2% (2.3%); CON: baseline = 12.4% (3.9%), 12 wk = 11.2% (3.6%); P = .02). CONCLUSION: This pilot study provides preliminary evidence that integrating health behaviors into learning standards is feasible and potentially an effective way for increasing preschoolers' PA levels.

Effect of a culturally-tailored mother-daughter physical activity intervention on pre-adolescent African-American girls' physical activity levels.

Positive parent-child attachment can be determined by opportunities for the child to interact with his/her parent and can influence a child's physical activity (PA) behavior. Therefore, an intervention that provides children and their parent more time to interact positively could impact children's PA. We examined the efficacy of a 12-week mother-daughter intervention on African-American girls' PA levels. In Spring of 2013 and 2014, mother-daughter dyads (n = 76) from Springfield, MA, were randomly assigned to one of three groups [child-mother (CH-M, n = 28), child alone (CH, n = 25), or control (CON, n = 23)] that participated in an afterschool culturally-tailored dance intervention (60 min/day, 3 days/week, 12 weeks). Girls in the CH-M group participated in the intervention with their maternal figure, while girls in the CH group participated in the intervention alone. CON group participants received weekly health-related newsletters. PA was assessed with accelerometers for seven days at baseline, 6-weeks, and 12-weeks. Hierarchical linear modeling was used to examine rates of change in PA. During the afterschool intervention time, girls in the CH-M group displayed a significantly steeper rate of increase in their percent time spent in vigorous PA compared to both the CON (γ = 0.80, p < 0.001) and the CH group (χ2 (1)=13.01, p < 0.001). Mothers in the CH-M group displayed a significantly steeper rate of increase in their percent time spent in total daily moderate-to-vigorous PA compared to CH group's mothers (γ = 0.07, p = 0.01). This culturally-tailored mother-daughter afterschool intervention influenced African-American girls' afterschool hour PA levels, but not total daily PA. Trial Registration: Study is registered at www.clinicaltrials.govNCT01588379.

Socio-Cultural and Environmental Factors that Influence Weight-Related Behaviors: Focus Group Results from African-American Girls and Their Mothers.

African-American girls experience higher rates of obesity than other youth and are more likely to live in environments that may inhibit healthy lifestyles. Focus groups with African-American girls (14.2 ± 2.36 years) and their mothers were conducted to explore socio-cultural and physical factors within the home, neighborhood, and school environments that influence physical activity (PA) and food choices (i.e., availability and accessibility). Being active at home was dependent on availability of unstructured PA, possibility of activity with family/friends/pet, structured sports in the community, and perceived safety of neighborhood. Girls reported unhealthy foods and excessive snacking as issues at home while citing choice of school meals vs. vending machine items and easy accessibility to fast food restaurants as concerns at school. Learning more about the PA and food environments is a fundamental step to develop effective and innovative, environmental strategies to address unhealthy weight-related behaviors in this population.

Behavioral Effects of a Locomotor-Based Physical Activity Intervention in Preschoolers.

BACKGROUND: Poor adaptive learning behaviors (ie, distractibility, inattention, and disruption) are associated with behavior problems and underachievement in school, as well as indicating potential attention-deficit hyperactivity disorder. Strategies are needed to limit these behaviors. Physical activity (PA) has been suggested to improve behavior in school-aged children, but little is known about this relationship in preschoolers. This study examined the effects of a PA intervention on classroom behaviors in preschool-aged children. METHODS: Eight preschool classrooms (n = 71 children; age = 3.8 ± 0.7 y) with children from low socioeconomic environments were randomized to a locomotor-based PA (LB-PA) or unstructured free playtime (UF-PA) group. Both interventions were implemented by classroom teachers and delivered for 30 minutes per day, 5 days per week for 6 months. Classroom behavior was measured in both groups at 3 time points, whereas PA was assessed at 2 time points over a 6-month period and analyzed with hierarchical linear modeling. RESULTS: Linear growth models showed significant decreases in hyperactivity (LB-PA: -2.58 points, P = .001; UF-PA: 2.33 points, P = .03), aggression (LB-PA: -2.87 points, P = .01; UF-PA: 0.97 points, P = .38) and inattention (LB-PA: 1.59 points, P < .001; UF-PA: 3.91 points, P < .001). CONCLUSIONS: This research provides promising evidence for the efficacy of LB-PA as a strategy to improve classroom behavior in preschoolers.

Process evaluation of a culturally-tailored physical activity intervention in African-American mother-daughter dyads.

The purpose of this study was to describe process evaluation data including intervention fidelity, dosage, quality, participant responsiveness, and program reach for the Mothers And dauGhters daNcing togEther Trial (MAGNET) in Springfield, MA, in Spring 2013 and 2014. Seventy-six mother-daughter dyads were randomized to the mother-daughter group (CH-M, n = 28), the child-only group (CH, n = 25), or the health education group (CON, n = 23). CH-M consisted of 60 min of moderate-to-vigorous culturally-tailored dance classes for dyads. CH consisted of dance classes for the child. All groups received homework tutoring and weekly health newsletters. Process evaluation data were assessed at each intervention session (three days/week, 6-months) with semi-structured questionnaires by researchers. CH dance classes were slightly longer (58.2 ± 3.5 min) than CH-M (54.4 ± 5.5 min). In both groups, participants spent the majority of the dance intervention in light intensity physical activity (PA). Participants in the CH-M group enjoyed participating in MAGNET > 90% of the time. Mothers (92%) indicated that they wanted to continue dance as a form of PA. Mothers expressed that transportation, time commitment, and assessments were barriers to participation. Participants suggested future interventions should include longer intervention length and more communications between research staff and mothers. The MAGNET intervention matched the originally intended program in most aspects. A lower intervention dose was delivered to the CH-M group potentially due to barriers described by mothers. Because mother-daughter interventions have shown minimal effects on increasing PA, it is imperative that researchers utilize process evaluation data to shape future studies.

Cross-Validation of Two Accelerometers for Assessment of Physical Activity and Sedentary Time in Preschool Children.

PURPOSE: The purpose of this study was to cross-validate previously developed Actiwatch (AW; Ekblom et al. 2012) and AcitGraph (AG; Sirard et al. 2005; AG-P, Pate et al. 2006) cut-point equations to categorize free-living physical activity (PA) of preschoolers using direct observation (DO) as the criterion measure. A secondary aim was to compare output from the AW and the AG from previously developed equations. METHODS: Participants' (n = 33; age = 4.4 ± 0.8 yrs; females, n=12) PA was directly observed for three 10-min periods during the preschool-day while wearing the AW (nondominant wrist) and AG (waist). Device specific cut-points were used to reduce the AW-E (Ekblom et al. 2012) and AG (AG-S, Sirard et al. 2005; AG-P, Pate et al. 2006) data into intensity categories. Spearman correlations (rsp) and agreement statistics were used to assess associations between the DO intensity categories and device data. Mixed model regression was used to identify differences in times spent in activity intensity categories. RESULTS: There was a significant correlation between AW and AG output across all data (rsp = 0.41, p < .0001) and both were associated with the DO intensity categories (AW: rsp = 0.47, AG: rsp = 0.47; p < .001). At the individual level, all devices demonstrated relatively low sensitivity but higher specificity. At the group level, AW-E and AG-P provided similar estimates of time spent in moderate-to-vigorous PA (MVPA, AW-E: 4.7 ± 4.1, AG-P: 4.4 ± 3.3), compared with DO (5.1 ± 3.5). CONCLUSION: The AW-E and AG-P estimated times spent in MVPA were similar to DO, but the weak agreement statistics indicate that neither device cut-point equations provided accurate estimates at the individual level.

Associations among physical activity, screen time, and sleep in low socioeconomic status urban girls.

Insufficient sleep is associated with higher risk of poor health outcomes in low socioeconomic status (SES) urban elementary age girls. Decreased physical activity (PA) and increased screen time may be associated with poor sleep. This study examined if PA and screen time are associated with sleep in girls from a low SES urban community. Baseline data from 7 to 12 year-old girls (n = 55) from two interventions conducted in Springfield, MA between 2012 and 2015 were used. PA was measured via accelerometry for seven days. Screen time and sleep were assessed via validated questionnaires. Sleep was also assessed via accelerometry in a subsample of girls (n = 24) for 7 days. Associations among PA, screen time, and sleep were analyzed using multiple linear regression. More minutes of screen time per day (p = 0.01, r2 = 0.35, r2 adjusted = 0.23) was associated with worse sleep quality (ß = 0.50, p = 0.02). There were negative correlations between PA and the number of awakenings per night (r = - 0.45, p = 0.04) and between counts per minute and sleep fragmentation (r = - 0.65, p = 0.002) assessed by accelerometer. In this population, increased screen time was associated with worse sleep quality and decreased PA was correlated with more awakenings per night and higher sleep fragmentation. These findings suggest that screen time and PA may be modifiable risk factors for interventions seeking to improve sleep in this population.

Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association.

Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible deleterious consequences of excess sedentary behavior is rapidly evolving, with the epidemiology-based literature ahead of potential biological mechanisms that might explain the observed associations. This American Heart Association science advisory reviews the current evidence on sedentary behavior in terms of assessment methods, population prevalence, determinants, associations with cardiovascular disease incidence and mortality, potential underlying mechanisms, and interventions. Recommendations for future research on this emerging cardiovascular health topic are included. Further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes.

Energy Expenditure for 70 Activities in Children and Adolescents.

BACKGROUND: Thirty-five percent of the activities assigned MET values in the Compendium of Energy Expenditures for Youth were obtained from direct measurement of energy expenditure (EE). The aim of this study was to provide directly measured EE for several different activities in youth. METHODS: Resting metabolic rate (RMR) of 178 youths (80 females, 98 males) was first measured. Participants then performed structured activity bouts while wearing a portable metabolic system to directly measure EE. Steady-state oxygen consumption data were used to compute activity METstandard (activity VO2/3.5) and METmeasured (activity VO2/measured RMR) for the different activities. RESULTS: Rates of EE were measured for 70 different activities and ranged from 1.9 to 12.0 METstandard and 1.5 to 10.0 METmeasured. CONCLUSION: This study provides directly measured energy cost values for 70 activities in children and adolescents. It contributes empirical data to support the expansion of the Compendium of Energy Expenditures for Youth.

Feasibility and Effects of Short Activity Breaks for Increasing Preschool-Age Children's Physical Activity Levels.

BACKGROUND: We examined the effects of short bouts of structured physical activity (SBS-PA) implemented within the classroom setting as part of designated gross-motor playtime on preschoolers PA. METHODS: Preschools were randomized to SBS-PA (centers, N = 5; participants, N = 141) or unstructured free playtime (UPA) (centers, N = 5; participants, N = 150). SBS-PA consisted of structured PA implemented in the classroom during the first 10 minutes of gross-motor playtime followed by 20 minutes of free playtime. UPA consisted of 30 minutes of unstructured free playtime. Teachers implemented both conditions for 5 days/week for 6 months. PA was assessed with accelerometers (preschool-day) and direct observation (30-minute sessions). Generalized linear mixed models were used to examine the impact of the intervention. RESULTS: Regarding the 30-minute sessions, significant group main effects were observed for intervals spent at light (p < .001) and moderate-to-vigorous PA (MVPA, p < .001). Regarding the preschool-day PA, significant group by visit interaction was observed for percent time spent in total preschool-day MVPA (F (2, 254) = 3.54, p = .03). Percent of time spent in MVPA significantly decreased in both groups at 3 months and at 6 months. CONCLUSION: SBS-PA can be implemented in classroom settings; however, further research is needed to examine its impact on preschoolers PA levels.

Objective Analysis of Preschoolers' Physical Activity Patterns During Free Playtime.

BACKGROUND: The purpose of this study was to examine the temporal patterns of preschoolers' physical activity (PA) levels during a typical outdoor free playtime. METHODS: Baseline playtime accelerometer counts (4.3 ± 0.8 days) from 3 preschool PA intervention studies were used (n = 326 children, age = 4.0 ± 0.8 years). Data were collected using 15-second epochs and classified into sedentary, light, or moderate-to-vigorous physical activity (MVPA). Patterns of change during playtime were analyzed using orthogonal polynomial comparisons. RESULTS: For all ages, there was a U-shaped pattern of change for the percent of epochs classified as sedentary [F(1, 323) = 47.12, P < .001) and an inverted U-shaped pattern of change for the percent of epochs classified as MVPA [F(1,323) = 32.15, P < .001]. Age-stratified analyses indicated that the 3-year-olds maintained the decrease in sedentary time [F(2,323) = 6.408, P = .002] and the increase in MVPA [F(2,323) = 3.2, P = .04] to a greater extent than the 4- and 5-year-olds. CONCLUSIONS: Preschool children gradually became more active during the first 10 to 15 minutes of outdoor gross motor playtime and less active over the final 10 to 15 minutes of playtime. During the second half of playtime 3-year-olds maintained these changes to a greater degree than 4- and 5-year-olds.

Intervention fidelity in a teacher-led program to promote physical activity in preschool-age children.

OBJECTIVE: To examine protocol fidelity among teachers involved in a six-month cluster-randomized physical activity (PA) intervention. METHODS: In 2011, preschools in Springfield, MA were randomized to short bouts of structured PA (SBS-PA, n=5) or unstructured playtime (UPA, n=5). SBS-PA provided structured PA in the classroom during the first 10 min of gross-motor playtime followed by 20 min of unstructured playtime. UPA consisted of 30 min of unstructured playtime. All teachers (SBS-PA and UPA) received a written study protocol and 1.5h of training. SBS-PA also received videos to use to lead structured PA and 1.5 additional hours of training. Study fidelity and process evaluation were assessed twice weekly via semi-structured questionnaire. RESULTS: Only 56.6% of SBS-PA and 75.2% of UPA free playtimes lasted for 30 min; 86.3% of SBS-PA teachers implemented structured PA during the first 10 min of gross-motor playtime but only 67.2% delivered the intervention as instructed. Only 68.5% of SBS-PA teachers implemented the 20-minute unstructured playtime. SBS-PA teachers reported that time limitations was a major barrier in implementing the designed intervention. Pre-post changes in PA did not differ between groups. CONCLUSION: Limited fidelity to intervention protocol likely impacted study findings. Future studies should focus on strategies to improve adherence among intervention leaders.

Facilitators, barriers, and components of a culturally tailored afterschool physical activity program in preadolescent African American girls and their mothers.

OBJECTIVES: Traditional physical activity (PA) programs have not been effective in increasing PA in African American girls. Currently, there is limited information regarding the components of PA programs that drive participation in African American girls. The purpose of our investigation was to describe the facilitators, barriers, and components of a culturally tailored afterschool PA program that will potentially inspire the participation of African American mother-daughter dyads. METHODS: Six focus groups (n=12 mother-daughter dyads; daughters, 7-10 yrs in age) were conducted between March and May 2012. Focus group semi-structured interviews were transcribed, coded, and systematically analyzed using NVivo. RESULTS: Mothers reported a preference for non-traditional (dancing, household chores) types of PA. While daughters preferred to participate in both dance-based and traditional types (walking, riding bikes) of PA. Participants felt that the use of a culturally tailored dance program would be appealing because it highlights the cultural and historical legacy of the African American culture. Mothers wanted programs that would allow them time to spend with their daughters. Top three dance styles that mothers wanted to participate in were African, hip-hop, and Salsa/samba, while daughters reported that they would enjoy participating in hip-hop, African, and jazz. The most common responses given for resources needed for participating in a culturally tailored afterschool dance program were the location of the program, transportation, and childcare for siblings. CONCLUSIONS: Our investigation highlights some cultural factors related to facilitators and barriers of PA that should be addressed in designing PA studies for African American girls and their mothers.

Energy cost of common activities in children and adolescents.

BACKGROUND: The Compendium of Energy Expenditures for Youth assigns MET values to a wide range of activities. However, only 35% of activity MET values were derived from energy cost data measured in youth; the remaining activities were estimated from adult values. PURPOSE: To determine the energy cost of common activities performed by children and adolescents and compare these data to similar activities reported in the compendium. METHODS: Thirty-two children (8-11 years old) and 28 adolescents (12-16 years) completed 4 locomotion activities on a treadmill (TRD) and 5 age-specific activities of daily living (ADL). Oxygen consumption was measured using a portable metabolic analyzer. RESULTS: In children, measured METs were significantly lower than compendium METs for 3 activities [basketball, bike riding, and Wii tennis (1.1-3.5 METs lower)]. In adolescents, measured METs were significantly lower than compendium METs for 4 ADLs [basketball, bike riding, board games, and Wii tennis (0.3-2.5 METs lower)] and 3 TRDs [2.24 m · s(-1), 1.56 m · s(-1), and 1.34 m · s(-1) (0.4-0.8 METs lower)]. CONCLUSION: The Compendium of Energy Expenditures for Youth is an invaluable resource to applied researchers. Inclusion of empirically derived data would improve the validity of the Compendium of Energy Expenditures for Youth.

Accuracy of accelerometer regression models in predicting energy expenditure and METs in children and youth.

This study examined the validity of commonly used regression equations for the Actigraph and Actical accelerometers in predicting energy expenditure (EE) in children and adolescents. Sixty healthy (8-16 yrs) participants completed four treadmill (TM) and five self-paced activities of daily living (ADL). Four Actigraph (AG) and three Actical (AC) regression equations were used to estimate EE. Bias (± 95% CI) and root mean squared errors were used to assess the validity of the regression equations compared with indirect calorimetry. For children, the Freedson (AG) model accurately predicted EE for all activities combined and the Treuth (AG) model accurately predicted EE for TM activities. For adolescents, the Freedson model accurately predicted EE for TM activities and the Treuth model accurately predicted EE for all activities and for TM activities. No other equation accurately estimated EE. The percent agreement for the AG and AC equations were better for light and vigorous compared with moderate intensity activities. The Trost (AG) equation most accurately classified all activity intensity categories. Overall, equations yield inconsistent point estimates of EE.

Effects of locomotor skill program on minority preschoolers' physical activity levels.

This pilot study examined the effects of a teacher-taught, locomotor skill (LMS)-based physical activity (PA) program on the LMS and PA levels of minority preschooler-aged children. Eight low-socioeconomic status preschool classrooms were randomized into LMS-PA (LMS-oriented lesson plans) or control group (supervised free playtime). Interventions were delivered for 30 min/day, five days/week for six months. Changes in PA (accelerometer) and LMS variables were assessed with MANCOVA. LMS-PA group exhibited a significant reduction in during-preschool (F (1,16) = 6.34, p = .02, d = 0.02) and total daily (F (1,16) = 9.78, p = .01, d = 0.30) percent time spent in sedentary activity. LMS-PA group also exhibited significant improvement in leaping skills, F (1, 51) = 7.18, p = .01, d = 0.80). No other, significant changes were observed. The implementation of a teacher-taught, LMS-based PA program could potentially improve LMS and reduce sedentary time of minority preschoolers.

Design and baseline characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study.

BACKGROUND: Most preschool centers provide two 30-min sessions of gross-motor/outdoor playtime per preschool day. Within this time frame, children accumulate most of their activity within the first 10 min. This paper describes the design and baseline participant characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study. The STEP study is a cluster randomized controlled study designed to examine the effects of short bouts of structured physical activity (SBS-PA) implemented within the classroom setting as part of designated gross-motor playtime on during-school physical activity (PA) in preschoolers. METHODS/DESIGN: Ten preschool centers serving low-income families were randomized into SBS-PA versus unstructured PA (UPA). SBS-PA schools were asked to implement age-appropriate 10 min structured PA routines within the classroom setting, twice daily, followed by 20 min of usual unstructured playtime. UPA intervention consisted of 30 min of supervised unstructured free playtime twice daily. Interventions were implemented during the morning and afternoon designated gross-motor playtime for 30 min/session, five days/week for six months. Outcome measures were between group difference in during-preschool PA (accelerometers and direct observation) over six-months. Ten preschool centers, representing 34 classrooms and 315 children, enrolled in the study. The average age and BMI percentile for the participants was 4.1 ± 0.8 years and 69th percentile, respectively. Participants spent 74% and 6% of their preschool day engaged in sedentary and MVPA, respectively. DISCUSSION: Results from the STEP intervention could provide evidence that a PA policy that exposes preschoolers to shorter bouts of structured PA throughout the preschool day could potentially increase preschoolers' PA levels.

A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low-income African American girls: Stanford GEMS.

OBJECTIVE: To test a 2-year community- and family-based obesity prevention program for low-income African American girls: Stanford GEMS (Girls' health Enrichment Multi-site Studies). DESIGN: Randomized controlled trial with follow-up measures scheduled at 6, 12, 18, and 24 months. SETTING: Low-income areas of Oakland, California. PARTICIPANTS: African American girls aged 8 to 10 years (N=261) and their parents or guardians. INTERVENTIONS: Families were randomized to one of two 2-year, culturally tailored interventions: (1) after-school hip-hop, African, and step dance classes and a home/family-based intervention to reduce screen media use or (2) information-based health education. MAIN OUTCOME MEASURE: Changes in body mass index (BMI). RESULTS: Changes in BMI did not differ between groups (adjusted mean difference [95% confidence interval] = 0.04 [-0.18 to 0.27] per year). Among secondary outcomes, fasting total cholesterol level (adjusted mean difference, -3.49 [95% confidence interval, -5.28 to -1.70] mg/dL per year), low-density lipoprotein cholesterol level (-3.02 [-4.74 to -1.31] mg/dL per year), incidence of hyperinsulinemia (relative risk, 0.35 [0.13 to 0.93]), and depressive symptoms (-0.21 [-0.42 to -0.001] per year) decreased more among girls in the dance and screen time reduction intervention. In exploratory moderator analysis, the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline (P = .02) and/or those whose parents or guardians were unmarried (P = .01). CONCLUSIONS: A culturally tailored after-school dance and screen time reduction intervention for low-income, preadolescent African American girls did not significantly reduce BMI gain compared with health education but did produce potentially clinically important reductions in lipid levels, hyperinsulinemia, and depressive symptoms. There was also evidence for greater effectiveness in high-risk subgroups of girls.