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Randomized Controlled Trial of a Primary Care and Home-Based Intervention for Physical Activity and Nutrition Behaviors: PACE+ for Adolescents
Abstract
OBJECTIVE: Many adolescents do not meet national guidelines for participation in regular moderate or vigorous physical activity (PA); limitations on sedentary behaviors; or dietary intake of fruits and vegetables, fiber, or total dietary fat. This study evaluated a health care-based intervention to improve these behaviors. DESIGN: Randomized controlled trial. SETTING: Primary care with follow-up at home. PARTICIPANTS: Eight hundred seventy-eight adolescent girls and boys aged 11 to 15 years. INTERVENTIONS: Two experimental conditions: (1) Primary care, office-based, computer-assisted diet and PA assessment and stage-based goal setting followed by brief health care provider counseling and 12 months of monthly mail and telephone counseling and (2) a comparison condition addressing sun exposure protection. MAIN OUTCOME MEASURES: Minutes per week of moderate plus vigorous PA measured by self-report and accelerometer; self-report of days per week of PA and sedentary behaviors; and percentage of energy from fat and servings per day of fruits and vegetables measured by three 24-hour diet recalls. Body mass index (calculated as weight in kilograms divided by the square of height in meters) was a secondary outcome. RESULTS: Compared with adolescents in the sun protection condition, girls and boys in the diet and PA intervention significantly reduced sedentary behaviors (intervention vs control change, 4.3 to 3.4 h/d vs 4.2 to 4.4 h/d for girls, respectively [P = .001]; 4.2 to 3.2 h/d vs 4.2 to 4.3 h/d for boys, respectively [P = .001]). Boys reported more active days per week (intervention vs control change: 4.1 to 4.4 d/wk vs 3.8 to 3.8 d/w, respectively [P = .01]), and the number of servings of fruits and vegetables for girls approached significance (intervention vs control change, 3.5 to 4.2 servings/d vs 3.5 to 3.9 servings/d, respectively [P = .07]). No intervention effects were seen with percentage of calories from fat or minutes of PA per week. Percentage of adolescents meeting recommended health guidelines was significantly improved for girls for consumption of saturated fat (intervention vs control change, 23.4% to 41.0% vs 18.5% to 31%, respectively [relative risk, 1.33; 95% confidence interval, 1.01-1.68]) and for boys' participation in d/wk of PA (intervention vs control change, 45.3% to 55.4% vs 41.9% to 38.0%, respectively [relative risk, 1.47; 95% confidence interval, 1.19-1.75]). No between-group differences were seen in body mass index. CONCLUSIONS: Improvements in some diet, PA, and sedentary behaviors in adolescents can be enabled through the use of a 1-year, integrated intervention using the computer, health provider counseling, mail, and telephone. The amount of intervention received may contribute to its efficacy.
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“Currently available evidence suggests that counseling may have beneficial effects on physical activity and sedentary behaviors in the pediatric primary care setting although there is no evidence of its use in the emergency department. 37,38”
From Association of Physical Activity, Sports, and Screen Time With Adolescent Behaviors in Youth Who Visit the Pediatric Emergency Department (2022) · cites this paper as [37]
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Metadata
- Authors
- Patrick, K., Calfas, K. J., Norman, G. J., Zabinski, M. F., Sallis, J. F., Rupp, J., Covin, J., & Cella, J.
- Affiliations
- University of California San Diego (US)
- Kaiser Permanente (US)
- Venue
- Archives of Pediatrics & Adolescent Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2006-02-01
- Volume
- 160
- Issue
- 2
- Pages
- 128
- ISSN
- 1072-4710 (ISSN-L)
- OpenAlex
- W2134620602
- Cited by
- 208
- References
- 52
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2022: 7 · 2021: 9 · 2020: 11 · 2019: 3 · 2018: 7 · 2017: 9 · 2016: 22 · 2015: 10 · 2014: 12 · 2013: 24 · 2012: 15
- FWCI
- 10.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kaiser Permanente
- University of California, San Diego
- National Cancer Institute (R01CA098861, R01CA081495)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- adolescent physical activity, sedentary behavior, nutrition behavior, fruit and vegetable intake, dietary fat intake, home-based counseling, telephone counseling, primary care intervention, goal setting, sun protection, body mass index, accelerometer-measured activity, computer-based testing, saturated fat intake, health behavior change, school-based intervention, family intervention, community-based intervention
- MeSH terms
- Adolescent, Child, Feeding Behavior, Female, Home Care Services, Humans, Male, Motor Activity, Primary Health Care, Health Behavior
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