Physical activity is frequently a component of interventions designed to diminish weight gain in children. It is essential to determine whether the energy expenditure (EE) elicited by these interventions is sufficient to reduce the rate of weight gain.
To quantify the EE of the Physical Activity across the Curriculum (PAAC) intervention. This intervention involved two 10-min physically active academic lessons per day, taught by classroom teachers.
We assessed EE of PAAC in 19 males and 19 females using both an indirect calorimeter (IC) (COSMED K4b(2)) and an accelerometer (ActiGraph) (AC). Independent t-tests were used to evaluate gender differences. Dependent t-tests were used to examine the difference between EE assessed by IC and AC. The agreement between EE measured by IC and estimated by AC was evaluated using a Bland-Altman plot. A Pearson correlation between EE measured by IC and estimated by AC was calculated.
There were no significant gender differences for age, BMI, or EE; therefore, analyses by gender were not performed. The mean EE measured by IC was 3.1 +/- 1.0 kcal x min(-1) (3.4 METs). Mean EE estimated by AC (1.8 +/- 0.9 kcal x min(-1)) was significantly lower (P < 0.05) than EE measured by IC (mean underestimation = 1.3 kcal x min(-1)). The Bland-Altman plot suggested increased underestimation with increased levels of EE. The 95% limits of agreement were large (-2.8 to +0.3 kcal x min(-1)). The correlation between EE measured by IC and estimated by AC was r = 0.68 (P < 0.001).
PAAC elicited a level of EE that may prevent excessive weight gain in children. AC significantly underestimated the EE of PAAC lessons and may not provide useful EE estimates in this context.
"This will result in a weekly total of school based physical activity of ~160 minute/week (A + PAAC = 100 minutes; PE = 60 minutes) which is slightly greater than the minimum 150 minutes/week of physical activity for children as recommended by Healthy People 2010 . A + PAAC lessons will provide MVPA with an energy expenditure of 4–5 METs  that will be verified by indirect calorimetry. Some recommendations call for 60 minutes/day of MVPA for health promotion in children . "
[Show abstract][Hide abstract] ABSTRACT: Background
Improving academic achievement and reducing the rates of obesity in elementary school students are both of considerable interest. Increased physical activity during academic instruction time during school offers a potential intervention to address both issues. A program titled “Physical Activity Across the Curriculum” (PAAC) was developed in which classroom teachers in 22 elementary schools were trained to deliver academic instruction using physical activity with a primary aim of preventing increased BMI. A secondary analysis of data assessed the impact of PAAC on academic achievement using the Weschler Individual Achievement Test-II and significant improvements were shown for reading, math and spelling in students who participated in PAAC. Based on the results from PAAC, an adequately powered trial will be conducted to assess differences in academic achievement between intervention and control schools called, “Academic Achievement and Physical Activity Across the Curriculum (A + PAAC).”
Seventeen elementary schools were cluster randomized to A + PAAC or control for a 3-year trial. Classroom teachers were trained to deliver academic instruction through moderate-to-vigorous physical activity with a target of 100+ minutes of A + PAAC activities per week. The primary outcome measure is academic achievement measured by the Weschler Individual Achievement Test-III, which was administered at baseline (Fall 2011) and will be repeated in the spring of each year by assessors blinded to condition. Potential mediators of any association between A + PAAC and academic achievement will be examined on the same schedule and include changes in cognitive function, cardiovascular fitness, daily physical activity, BMI, and attention-to-task. An extensive process analysis will be conducted to document the fidelity of the intervention. School and student recruitment/randomization, teacher training, and baseline testing for A + PAAC have been completed. Nine schools were randomized to the intervention and 8 to control. A random sample of students in each school, stratified by gender and grade (A + PAAC = 370, Control = 317), was selected for outcome assessments from those who provided parental consent/child assent. Baseline data by intervention group are presented.
If successful, the A + PAAC approach could be easily and inexpensively scaled and disseminated across elementary schools to improve both educational quality and health. Funding source: R01- DK85317. Trial registration: US NIH Clinical Trials, http://NCT01699295.
BMC Public Health 04/2013; 13(1):307. DOI:10.1186/1471-2458-13-307 · 2.26 Impact Factor
"The ability to develop and implement an enhanced PE intervention is likely to be critical to any future RCT in this area. Previous studies have noted repeatedly that levels of physical activity during PE are often very low, and have also noted the difficulty in producing sustained increases in intensity of physical activity during PE in children [11,16-18,32]. An essential part of process evaluation of future RCT will be to examine whether or not the 'prescribed' levels of physical activity are actually being reached by children: accelerometry was adequate for this purpose but did not provide teachers or children with real time feedback on the intensity of PE. "
[Show abstract][Hide abstract] ABSTRACT: Randomized controlled trials (RCT) are required to test relationships between physical activity and cognition in children, but these must be informed by exploratory studies. This study aimed to inform future RCT by: conducting practical utility and reliability studies to identify appropriate cognitive outcome measures; piloting an RCT of a 10 week physical education (PE) intervention which involved 2 hours per week of aerobically intense PE compared to 2 hours of standard PE (control).
64 healthy children (mean age 6.2 yrs SD 0.3; 33 boys) recruited from 6 primary schools. Outcome measures were the Cambridge Neuropsychological Test Battery (CANTAB), the Attention Network Test (ANT), the Cognitive Assessment System (CAS) and the short form of the Connor's Parent Rating Scale (CPRS:S). Physical activity was measured habitually and during PE sessions using the Actigraph accelerometer.
Test- retest intraclass correlations from CANTAB Spatial Span (r 0.51) and Spatial Working Memory Errors (0.59) and ANT Reaction Time (0.37) and ANT Accuracy (0.60) were significant, but low. Physical activity was significantly higher during intervention vs. control PE sessions (p < 0.0001). There were no significant differences between intervention and control group changes in CAS scores. Differences between intervention and control groups favoring the intervention were observed for CANTAB Spatial Span, CANTAB Spatial Working Memory Errors, and ANT Accuracy.
The present study has identified practical and age-appropriate cognitive and behavioral outcome measures for future RCT, and identified that schools are willing to increase PE time.
"Furthermore, Howe et al. (2010) note the importance of precisely estimating the energy expenditure of physical activity interventions for children if we are to successfully target excessive weight gain. For these reasons, Honas et al. (2008) "
[Show abstract][Hide abstract] ABSTRACT: There is increasing evidence for the association between physical activity, cardiovascular fitness, fatness, and cognitive function during childhood and adolescence. Evidence also suggests that these variables are linked to academic achievement. Classroom-based physical activity provides a viable approach to improve fitness, body mass index (BMI), cognitive function, and ultimately academic achievement.
Studies examining the relation between physical activity, fitness, fatness, cognitive function, and academic achievement are described. The results of a large-scale, longitudinal, cluster randomized trial to examine the impact of classroom based physical activity on body mass index and academic achievement will be presented.
Overall, the data support the link between physical activity, cognitive function, and academic achievement. The role of physical activity in the classroom was also supported by the Physical Activity Across the Curriculum (PAAC) project. Physically active academic lessons of moderate intensity improved overall performance on a standardized test of academic achievement by 6% compared to a decrease of 1% for controls (p<0.02). Body mass index increased less from baseline to 3 years in students with greater than 75 minutes of PAAC lessons per week (1.8 BMI) compared to students with less than 75 minutes of PAAC per week (2.4 BMI), p<0.00.
Future research examining the effects of physically active academic instruction is warranted. The impact of physically active academic lessons of greater intensity may provide larger benefits for body mass index and academic achievement.
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