Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials

Table 2

Evaluation of interventions to reduce sedentary behavior in youth.

Reference		Outcome				Key findings	Demographic disparities	Limitations
		Sedentary behavior	Anthropometric	Other
Sedentary behavior studies
Escobar-Chaves et al. [26]		Self-reported household media environment and media use by children	No detail reported	No detail reported		At 6-month F/U, intervention group was less likely to report TV being ON when nobody was watching (AOR = 0.23, 𝑃<0.05). A trend towards reducing media consumption was also observed in the intervention group.	No detail reported	Self-reported behaviors; small sample size
Robinson [22]		Self-reported media use (TV, video tape,and video game) and other SB (e.g., using computer, doing homework, and reading)	BMI; waist/hip circumference; triceps skinfold thickness	Self-reported PA, cardiorespiratory fitness, and dietary behaviors		Compared to controls, intervention group had significant decreases in anthropometric measures, such as BMI (ADJ DIFF = −0.45 kg/m2; 𝑃=0.002) and triceps skinfold thickness (ADJ DIFF= −1.47 mm; 𝑃=0.002). Intervention group reported reduced TV (𝑃<0.001) and video game (𝑃=0.01) use compared to controls.	No detail reported	Small sample size; snacking while watching TV assessed as a proportion
Robinson and Borzekowski [23]		Self-reported household media environment, media use, and other activities (e.g., using TV, video, computer, doing homework, and talking with parents)	No detail reported	No detail reported		Compared to controls, intervention group significantly reduced weekday TV viewing (95% CI −1.22 to −0.35; 𝑃<.001) and weekday (95% CI −0.48 to −0.01; 𝑃<.05)and Saturday (95% CI −1.04 to −0.01; 𝑃<.05)video game playing.	Greater effects were observed among boys compared to girls	Self-reported behaviors; and intervention conducted in two schools
Physical activity studies
Slootmaker et al. [27]		Self-reported time spent sedentary (TV, computer)	BMI; waist/hip circumference; skinfold thickness (biceps, triceps, subscapular, and suprailiac)	Self-reported PA; determinants of PA; aerobic fitness		Boys in the intervention group showed significant reduction in sedentary time (−1801 min/week, −3545 to −57, 95% CI; 𝑃=0.04), after 5-month F/U.	SB change was maintained in boys at 5-month F/U	Self-reported behaviors; insufficient power due to high dropout rate and separation of analyses
Sedentary behavior and physical activity studies
Epstein et al. [21]		Self-reported sedentary activities (e.g., TV, computer use, and talking on phone)	Percent over weight; PBF; waist/hip circumferences	Physical work capacity; activity preference; compliance and choice		At 6-month F/U, the Sedentary group had greater decrease in percentage overweight than did the Combined and Exercise groups (−18.7 versus −10.3 and −8.7; 𝑃<0.05) and greater decrease in PBF (−4.7 versus −1.3; 𝑃<0.05).	No detail reported	Self-report; lack of blinding
Epstein et al. [20]		Self-reported SB (TV viewing)	BMI; percent overweight	Psychological measures, adherence to diet, and PA questionnaire		Boys showed larger decrease in percentage overweight than girls in Combined (F = 8.98; 𝑃<0.001) and Increased activity (F = 4.45; 𝑃<0.025) groups. At 6-month F/U, boys showed BMI decrease of −1.76 ± 1.86 in Combined group and 0.65 ± 1.37 in Increased activity group. Girls showed BMI increase of 1.00 ± 1.73 for Combined group and decrease of 0.27 ± 1.37 in Increased activity group.	Treatment was more effective on boys, and they had better treatment adherence compared to girls	No detail reported
Jones et al. [28]		Self- reported sedentary activities (TV, video, computer/video games)	No detail reported	Self-reported calcium intake; PA; osteoporosis knowledge		Relative to control schools, the intervention significantly reduced duration of student daily TV/video watching (mean difference between I and C = 12.11 min; 95% CI, 11.74 to 12.48; 𝑃=0.05) and total daily sedentary activity (mean difference between I and C = 16.99 min; 95% CI, 16.59 to 17.50; 𝑃=0.04).	No detail reported	Evaluation at two points only; a small number of groups randomized to treatment conditions; self-reported; limited information on covariates
Robinson et al. [29]		Self-reported media use (TV, videotapes, and video games) and eating with TV on	BMI; waist circumference	Insulin and glucose levels; lipid levels		Intervention group showed trends towards BMI decrease (ADJ DIFF = −0.32 kg/m2; 95% CI, −0.11 to 0.12), waist circumference decrease (ADJ DIFF = −0.63 cm; 95% CI, −1.92 to 0.67), and reduced TV, videotape, and video game use (ADJ DIFF = −4.96 hrs/week; 95% CI, −11.41 to 1.49).	Type 2 diabetes disproportionately affects girls and AAs; some of greatest increases in childhood obesity among AA girls	Self-reported behaviors
Salmon et al. [30]		Self-reported screen behaviors (TV, computer, and electronic games)	BMI	PA accelerometer; self-reported enjoyment of PA; FMS; body image; food intake		Significant intervention effect on BM in BM/FMS group compared to controls, maintained at 6- and 12-month followup (AOR = 0.38; 𝑃<0.05). BM group reported highest levels of TV viewing compared to other groups (𝑃<0.05).	No findings related to anthropometric measures or SB	Self-report; Thepubertal staging not assessed; sample size underpowered; randomization by class
Simon et al. [31]		Self-reported SB (e.g., TV, computer)	BMI; PBF	Self-reported PA; PA self-efficacy, social support, and intention		In the intervention group, high SB (>3 hrs/day) was reduced in girls (OR = 0.54; 95% CI, 0.38 to 0.77) and boys (OR = 0.52; 95% CI 0.35 to 0.76).	No detail reported	Self-reported behavior; lack of time to assess intervention effect on health outcomes
Sedentary behavior, physical activity and diet studies
Gortmaker et al. [32]		Self-reported media use (TV and video viewing)	BMI; triceps skinfold thickness	Self-reported PA and dietary intake		Intervention reduced TV hrs among girls and boys (𝑃<0.001). In intervention group, obesity prevalence was significantly reduced in girls compared to controls (23.6% to 20.3%), and each hr of TV reduction predicted reduced obesity prevalence (OR = 0.85; 95% CI, 0.75 to 0.97; 𝑃=0.02).	Largest intervention effects observed among AA girls with obesity prevalence significantly reduced. No significant differences observed among boys or Hispanic girls.	Self-reported behavior; participation rate of student at baseline was 65% due to required written consent
Sacher et al. [33]		Self-reported sedentary activities (e.g., TV, computer)	BMI; PBF; waist circumference	Cardiovascular fitness; self-esteem; self-reported PA		At 6-month F/U, intervention group participants had reduced waist circumference 𝑧-score (−0.47; 𝑃<0.0001) and BMI 𝑧-score (−0.23; <0.0001) compared to controls	No detail reported	Lack of blinding; selective dropout; short followup

F/U, duration of follow-up after intervention completed; TV, television; AOR, adjusted odds ratio; SB, sedentary behavior; PA, physical activity; BMI, body mass index; ADJ DIFF, adjusted difference; CI, confidence interval; min, minutes; PBF, percent body fat; hrs, hours; AA, African American; FMS, fundamental movement skills; BM, behavioural modification; OR, odds ratio.