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BackgroundPhysical activity is associated with many physical and mental health benefits, however many children do not meet the national physical activity guidelines. While schools provide an ideal setting to promote children’s physical activity, adding physical activity to the school day can be difficult given time constraints often imposed by competing key learning areas. Classroom-based physical activity may provide an opportunity to increase school-based physical activity while concurrently improving academic-related outcomes. The primary aim of this systematic review and meta-analysis was to evaluate the impact of classroom-based physical activity interventions on academic-related outcomes. A secondary aim was to evaluate the impact of these lessons on physical activity levels over the study duration.MethodsA systematic search of electronic databases (PubMed, ERIC, SPORTDiscus, PsycINFO) was performed in January 2016 and updated in January 2017. Studies that investigated the association between classroom-based physical activity interventions and academic-related outcomes in primary (elementary) school-aged children were included. Meta-analyses were conducted in Review Manager, with effect sizes calculated separately for each outcome assessed.ResultsThirty-nine articles met the inclusion criteria for the review, and 16 provided sufficient data and appropriate design for inclusion in the meta-analyses. Studies investigated a range of academic-related outcomes including classroom behaviour (e.g. on-task behaviour), cognitive functions (e.g. executive function), and academic achievement (e.g. standardised test scores). Results of the meta-analyses showed classroom-based physical activity had a positive effect on improving on-task and reducing off-task classroom behaviour (standardised mean difference = 0.60 (95% CI: 0.20,1.00)), and led to improvements in academic achievement when a progress monitoring tool was used (standardised mean difference = 1.03 (95% CI: 0.22,1.84)). However, no effect was found for cognitive functions (standardised mean difference = 0.33 (95% CI: -0.11,0.77)) or physical activity (standardised mean difference = 0.40 (95% CI: -1.15,0.95)).ConclusionsResults suggest classroom-based physical activity may have a positive impact on academic-related outcomes. However, it is not possible to draw definitive conclusions due to the level of heterogeneity in intervention components and academic-related outcomes assessed. Future studies should consider the intervention period when selecting academic-related outcome measures, and use an objective measure of physical activity to determine intervention fidelity and effects on overall physical activity levels.

WHAT'S KNOWN ON THIS SUBJECT: While obesity-promoting eating, sedentary and physical activity behaviors, and increased prevalence of adiposity are evident from early life, few highquality studies have evaluated interventions that seek to influence the development of these behaviors in very early childhood. WHAT THIS STUDY ADDS:This study highlights the receptivity of first-time parents to interventions focused on their new infant' s eating and active play and provides evidence of effectiveness on some obesity-promoting behaviors in very early childhood. abstract OBJECTIVE: To assess the effectiveness of a parent-focused intervention on infants' obesity-risk behaviors and BMI.METHODS: This cluster randomized controlled trial recruited 542 parents and their infants (mean age 3.8 months at baseline) from 62 first-time parent groups. Parents were offered six 2-hour dietitiandelivered sessions over 15 months focusing on parental knowledge, skills, and social support around infant feeding, diet, physical activity, and television viewing. Control group parents received 6 newsletters on nonobesity-focused themes; all parents received usual care from child health nurses. The primary outcomes of interest were child diet (3 3 24-hour diet recalls), child physical activity (accelerometry), and child TV viewing (parent report). Secondary outcomes included BMI z-scores (measured). Data were collected when children were 4, 9, and 20 months of age. RESULTS:Unadjusted analyses showed that, compared with controls, intervention group children consumed fewer grams of noncore drinks (mean difference = -4.45; 95% confidence interval [CI]: -7.92 to -0.99; P = .01) and were less likely to consume any noncore drinks (odds ratio = 0.48; 95% CI: 0.24 to 0.95; P = .034) midintervention (mean age 9 months). At intervention conclusion (mean age 19.8 months), intervention group children consumed fewer grams of sweet snacks (mean difference = -3.69; 95% CI: -6.41 to -0.96; P = .008) and viewed fewer daily minutes of television (mean difference = -15.97: 95% CI: -25.97 to -5.96; P = .002). There was little statistical evidence of differences in fruit, vegetable, savory snack, or water consumption or in BMI z-scores or physical activity.

Context The negative effects of childhood overweight and obesity on quality of life (QOL) have been shown in clinical samples but not yet in population-based community samples. Objective To determine relationships between weight and health-related QOL reported by parent-proxy and child self-report in a population sample of elementary school children. Design, Setting, and Participants Cross-sectional data collected in 2000 within the Health of Young Victorians Study, a longitudinal cohort study commenced in 1997. Individuals were recruited via a random 2-stage sampling design from primary schools in Victoria, Australia. Of the 1943 children in the original cohort, 1569 (80.8%) were resurveyed 3 years later at a mean age of 10.4 years. Main Outcome Measures Health-related QOL using the PedsQL 4.0 survey completed by both parent-proxy and by child self-report. Summary scores for children's total, physical, and psychosocial health and subscale scores for emotional, social, and school functioning were compared by weight category based on International Obesity Task Force cut points. Results Of 1456 participants, 1099 (75.5%) children were classified as not overweight; 294 (20.2%) overweight; and 63 (4.3%) obese. Parent-proxy and child selfreported PedsQL scores decreased with increasing child weight. The parent-proxy total PedsQL mean (SD) score for children who were not overweight was 83.1 (12.5); overweight, 80.0 (13.6); and obese, 75.0 (14.5); PϽ.001. The respective child selfreported total PedsQL mean (SD) scores were 80.5 (12.2), 79.3 (12.8), and 74.0 (14.2); PϽ.001. At the subscale level, child and parent-proxy reported scores were similar, showing decreases in physical and social functioning for obese children compared with children who were not overweight (all PϽ.001). Decreases in emotional and school functioning scores by weight category were not significant. Conclusion The effects of child overweight and obesity on health-related QOL in this community-based sample were significant but smaller than in a clinical sample using the same measure.

The small number and recency of the early childhood obesity‐prevention literature identified in a previous review of interventions to prevent obesity, promote healthy eating, physical activity, and/or reduce sedentary behaviors in 0–5 year olds suggests this is a new and developing research area. The current review was conducted to provide an update of the rapidly emerging evidence in this area and to assess the quality of studies reported. Ten electronic databases were searched to identify literature published from January 1995 to August 2008. Inclusion criteria: interventions reporting child anthropometric, diet, physical activity, or sedentary behavior outcomes and focusing on children aged 0–5 years of age. Exclusion criteria: focusing on breastfeeding, eating disorders, obesity treatment, malnutrition, or school‐based interventions. Two reviewers independently extracted data and assessed study quality. Twenty‐three studies met all criteria. Most were conducted in preschool/childcare (n = 9) or home settings (n = 8). Approximately half targeted socioeconomically disadvantaged children (n = 12) and three quarters were published from 2003 onward (n = 17). The interventions varied widely although most were multifaceted in their approach. While study design and quality varied most studies reported their interventions were feasible and acceptable, although impact on behaviors that contribute to obesity were not achieved by all. Early childhood obesity‐prevention interventions represent a rapidly growing research area. Current evidence suggests that behaviors that contribute to obesity can be positively impacted in a range of settings and provides important insights into the most effective strategies for promoting healthy weight from early childhood.