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      The effect of interventions targeting screen time reduction : A systematic review and meta-analysis

      review-article
      , MPH a , , PhD b , c , , MD, PhD a , d , , MD, PhD e
      Medicine
      Wolters Kluwer Health
      body mass index, meta-analysis, randomized controlled trial, screen time

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          Abstract

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          Abstract

          Previous studies have evaluated the effectiveness of interventions aimed at screen time reduction, but the results have been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to summarize the accumulating evidence of the impact of interventions targeting screen time reduction on body mass index (BMI) reduction and screen time reduction. The PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for RCTs on the effect of interventions targeting screen time reduction. The primary and secondary outcomes were the mean difference between the treatment and control groups in the changes in BMI and changes in screen viewing time. A random effects model was used to calculate the pooled mean differences. Fourteen trials including 2238 participants were assessed. The pooled analysis suggested that interventions targeting screen time reduction had a significant effect on BMI reduction (−0.15 kg/m 2, P < 0.001, I 2 = 0) and on screen time reduction (−4.63 h/w, P = 0.003, I 2 = 94.6%). Subgroup analysis showed that a significant effect of screen time reduction was observed in studies in which the duration of intervention was <7 months and that the types of interventions in those studies were health promotion curricula or counseling. Interventions for screen time reduction might be effective in reducing screen time and preventing excess weight. Further rigorous investigations with larger samples and longer follow-up periods are still needed to evaluate the efficacy of screen time reduction both in children and in adults.

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          Most cited references33

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          Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011.

          To systematically review and provide an informative synthesis of findings from longitudinal studies published since 1996 reporting on relationships between self-reported sedentary behavior and device-based measures of sedentary time with health-related outcomes in adults. Studies published between 1996 and January 2011 were identified by examining existing literature reviews and by systematic searches in Web of Science, MEDLINE, PubMed, and PsycINFO. English-written articles were selected according to study design, targeted behavior, and health outcome. Forty-eight articles met the inclusion criteria; of these, 46 incorporated self-reported measures including total sitting time; TV viewing time only; TV viewing time and other screen-time behaviors; and TV viewing time plus other sedentary behaviors. Findings indicate a consistent relationship of self-reported sedentary behavior with mortality and with weight gain from childhood to the adult years. However, findings were mixed for associations with disease incidence, weight gain during adulthood, and cardiometabolic risk. Of the three studies that used device-based measures of sedentary time, one showed that markers of obesity predicted sedentary time, whereas inconclusive findings have been observed for markers of insulin resistance. There is a growing body of evidence that sedentary behavior may be a distinct risk factor, independent of physical activity, for multiple adverse health outcomes in adults. Prospective studies using device-based measures are required to provide a clearer understanding of the impact of sedentary time on health outcomes. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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            Reducing children's television viewing to prevent obesity: a randomized controlled trial.

            Some observational studies have found an association between television viewing and child and adolescent adiposity. To assess the effects of reducing television, videotape, and video game use on changes in adiposity, physical activity, and dietary intake. Randomized controlled school-based trial conducted from September 1996 to April 1997. Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif. Of 198 third- and fourth-grade students, who were given parental consent to participate, 192 students (mean age, 8.9 years) completed the study. Children in 1 elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use. Changes in measures of height, weight, triceps skinfold thickness, waist and hip circumferences, and cardiorespiratory fitness; self-reported media use, physical activity, and dietary behaviors; and parental report of child and family behaviors. The primary outcome measure was body mass index, calculated as weight in kilograms divided by the square of height in meters. Compared with controls, children in the intervention group had statistically significant relative decreases in body mass index (intervention vs control change: 18.38 to 18.67 kg/m2 vs 18.10 to 18.81 kg/m2, respectively; adjusted difference -0.45 kg/m2 [95% confidence interval [CI], -0.73 to -0.17]; P = .002), triceps skinfold thickness (intervention vs control change: 14.55 to 15.47 mm vs 13.97 to 16.46 mm, respectively; adjusted difference, -1.47 mm [95% CI, -2.41 to -0.54]; P=.002), waist circumference (intervention vs control change: 60.48 to 63.57 cm vs 59.51 to 64.73 cm, respectively; adjusted difference, -2.30 cm [95% CI, -3.27 to -1.33]; P<.001), and waist-to-hip ratio (intervention vs control change: 0.83 to 0.83 vs 0.82 to 0.84, respectively; adjusted difference, -0.02 [95% CI, -0.03 to -0.01]; P<.001). Relative to controls, intervention group changes were accompanied by statistically significant decreases in children's reported television viewing and meals eaten in front of the television. There were no statistically significant differences between groups for changes in high-fat food intake, moderate-to-vigorous physical activity, and cardiorespiratory fitness. Reducing television, videotape, and video game use may be a promising, population-based approach to prevent childhood obesity.
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              Prevention of pediatric overweight and obesity.

              The dramatic increase in the prevalence of childhood overweight and its resultant comorbidities are associated with significant health and financial burdens, warranting strong and comprehensive prevention efforts. This statement proposes strategies for early identification of excessive weight gain by using body mass index, for dietary and physical activity interventions during health supervision encounters, and for advocacy and research.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                July 2016
                08 July 2016
                : 95
                : 27
                : e4029
                Affiliations
                [a ]Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China
                [b ]Department of Bioengineering, The University of Tokyo, Tokyo, Japan
                [c ]Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX
                [d ]State Key Laboratory of Kidney Disease
                [e ]Department of Acupuncture, Chinese People's Liberation Army General Hospital, Beijing, China.
                Author notes
                []Correspondence: Yao He, Fuxing Road 28, Beijing 100853, China (e-mail: yhe301@ 123456x263.net ).
                Article
                04029
                10.1097/MD.0000000000004029
                5058814
                27399085
                be9ca0b7-e746-4be2-b947-099de9c1f7bb
                Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 6 November 2015
                : 4 May 2016
                : 31 May 2016
                Categories
                4400
                Research Article
                Systematic Review and Meta-Analysis
                Custom metadata
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                T

                body mass index,meta-analysis,randomized controlled trial,screen time

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