Table 3.

Effectiveness of the programs.

	Activity level				Sedentary time	Program impact
References	Counts/sample	Activity type	% Physical activity	Time physical activity (%)
Torres et al. (35)	1,533 participants 80% reported participating in the program for more than 3 months, 29% attending weekly and 43% monthly, 64% participating in classes AND (71%) Weekly class attendance	97% reported walking on the recreovía, cardiovascular (84%), walking or bicycling as Public Transportation (73%) and (18%), respectively.	-	↑ Number of minutes reported for leisure walking by 30 min compared to controls which has a decrease of 90 min. Recreational users via were more active on accelerometers relative to New users of vigorous 16 min at week ± 40, and at the weekend (79 min of MVPA ± 49) and at weekend 20 min MVPA ratio 225 start 305 finish	-	Positive evidence of the program at the district level with increased physical activity and inclusion of new users in higher levels of physical activity, this program being one of the ways to materialize the public policy.
Dill et al. (36)	↓ 307–240 and from 183 to 123 In second follow-up	_	↓ MV from 39.5 to 39.6%	↓ Total time on bicycle from 104 to 66 min and walking from 107 to 89	_	The active transportation program modifies habits in the population but does not favor an increase in activity during transportation time given the limitations presented in the study.
Prinss et al. (37)	414 participants	↑ in bicycle use 23.2% and 22.8% in each group	-	↑ minutes cycled between groups 85.4 (71.8) and 87.2 (74.9)	-	The effect of the commute program is important for increasing activity times on transportation as a public policy to encourage activity.
Gesell et al. (38)	82 children included	-	↑ Light total physical activity in the out-of-school intervention group (LMV) by 3.0 percentage points (P = 0.006), and 6 percentage points over 12-week study period and decrease in control group ↑ MVPA by a mean of 2.8 percentage points in each measurement period (P = 0.006), with a total increase of 5.6% points over the 12 weeks. The mean difference observed between the two groups of children who had data at week 12 was 10.8 (P = 0.001) percentage points in LMV and 13 percentage points in MVPA (P < 0.001)	.	-	Establishing community recreation centers that incorporate structured physical activity opportunities is associated with significant increases in physical activity during after-school activity time for public school children and could be a promising low-cost approach to improving children's health trajectories cost.
Barradas et al. (39)	1,533 participants.	-	-	↑ Total levels minute of leisure-time PA 158.1 (SD = 230.2) men 187.7 (SD = 245.3) women 145.8 (SD = 222.6) Moderate levels of leisure-time PA 81.9 (SD = 154.5) men 104.4 (SD = 176.8) women 72.5 (SD = 143, 2) Vigorous levels of leisure time PA 76.2 (SD = 160.2) men 83.2 (SD = 160.9) women 73.2 (SD = 159.8)	-	Participants reported elevated levels of both HRQoL and Life Satisfaction LS. Participants who reported higher LS scores also reported higher levels of leisure-time PA. No differences were found in differences between HRQoL scores and leisure-time PA. The second objective of the study was to differentiate levels of HRQoL and LS among Recreovía participants. Participants in Recreovía showed better indices of psychological wellbeing, highlighting the potential of the program to improve physical health.
Goodman et al. (40)	-	↑ 5.81–6.78% prevalence of cycling to work in 2011. Relative effect of 1.09 (95% CI: 1.07, 1.11). ↓ Prevalence of driving to work [−3.01 (−3.13, −2.88)]. 14 out of 18 cities ↑ higher cycling prevalence in 2011	Increased prevalence of walking to work [+1.71 (95% CI 1.62, 1.81)] percentage points lesser extent, of public transport use [+0.32 (0.24, 0.41)] percentage points	-	-	City-level interventions have potential health and environmental benefits, cycling is accompanied by decreased car commuting to work and increased commutation with lifestyle modification. The results indicate that city and cycling city initiatives have so far promoted cycling for healthy commuting and health equity, while also providing environmental benefits.
Simões et al. (41)	10,000 participants	_	The proportion of individuals that reached the LPA guidelines was 25.8%	For those who never participated and began their participation and to reach the levels (OR = 1.61; 95% CI 1.18; 2.20, < 6 months 1.83; 95% CI 1.17; 2.86, p-value = 0.0078) more than 6 months (OR = 5.06; 95% CI 3.34; 7.67, p-value b0.0001)	_	The community-based physical activity intervention had a positive impact on LTPA levels in the population, especially among women. Evaluation of complex programs such as AC-P is feasible, with the study design and flexibility to rapidly fund and implement the study.
Esdaile et al. (42)	720 children the total number of sessions ↑for children enrolled in groups with UEC (Mdn = 7, IQR = 4.25–9, Mean Rank = 387) than for children enrolled in groups with TEC (Mdn = 7, IQR = 3–9, Mean Rank = 352), U = 43,178.5, p = 0, 049 two-tailed	_	_	-	_	Program results suggest that families with overweight children are more likely to enroll in a healthy lifestyle program without weight criteria, in which marketing is aimed at improving healthy lifestyle behaviors, than in a weight management program with specific eligibility criteria. The program is also likely to have eligibility criteria and recruitment materials focused on healthy weight.
Kapinos and Yakusheva (43)	488 students	Dorm 7 houses one of the campus gyms and dorm 2 is only 0.13 miles from dorm 7. Despite exercising more frequently, only females assigned to dorm 2 weighed significantly less in the spring.		Although male students reported exercising more frequently on average, both males and females reported exercising less frequently during the first year compared to the year prior to entering college. Females in dorms 2 and 7 exercised more frequently during the first year.
Hunt et al. (44)	26 children	PACER for walking ↑ median, but the change was not statistically significant (baseline = 11 laps, outcome = 14 laps, Δ = 3.00 laps, p = 0.26). On program break weekends, children accumulated 17.0 min less MVPA (72.4 min, SD = 45.5). And 13.5 min less AFMV (75.9 min, SD = 45.0).	_	89.4 min of AFMV (SD = 38.6) in the program. On days when the program ran but children did not attend, they accumulated 11.3 min less AFMV (78.1 min, SD = 38.0). During the week of the program break, children accumulated 10.0 fewer min of MVPA (79.4 min, SD = 37.3). Program attendance with MVPA was 45 min compared to 24 min for children when they did not attend the program or program break	_	This finding suggests that attendance at a structured summer program may mitigate BMI gain and loss of CRF, the impact of a structured program on weight gain and fitness loss, as well as obesogenic behaviors. Children maintained fitness, BMI, zBMI, and BMI percentile from the beginning to the end of the SLP.by helping children adopt healthier behaviors.
Lee et al. (45)	Out of 165 subjects 68 changed to active transport	41% active transport by bicycle or walking, 58.8% no change	_	_	_	The study notes that the shift from sedentary to active mode is associated with perceived environmental changes, such as shorter travel distance, improved safety conditions on the way to school, and greater availability of programs to support walking to school. This study offers some initial insights into additional factors, beyond the obvious distance factor, associated with mode shift.
Allais et al. (46)	205 individuals (49, 69, and 87 for the easy, health and control groups, respectively).	_	-	↑ Use of stairs at the beginning of the intervention in both the health and easy groups, with stronger effects for the latter but not maintained over time.	_	No differences between the treatment and control groups in the number of times individuals reported playing sports in a week. The stair use Advertisement program did not create a habit of stair use. At best, the effects of the PDPs lasted 2 weeks after the end of the intervention. As mentioned at the end of the Introduction, one effect of programs that encourage investment activities is to encourage the use of stairs.
Zhu et al. (47)	_	-	↑ 24.9–17.5 LPA and ↓ 6.6 to 6.5 MPA	_	↓ 337–281 sitting and ↑ 111–165 sedentary time	Natural experiment with high ecological validity with an intergroup design and a strong comparison group. The intervention group showed less prolonged standing at the workstation. The effect appears to have been sustained for 18 months, with concomitant improvements in cardio-metabolic and productivity outcomes.
Tarp et al. (48)	495 children Structured participation in leisure-time physical activity [odds ratio: 0.79 (0.46–1.36)], differed significantly between intervention and control	_	% MVPA/day [unstandardized beta: −0.17 (– 0.67 to 0.33)], nor mean counts/minute [unstandardized beta: −25 (−58 to 8)].	As for the blood chemistry variables by increase over time, the differences expressed in untransformed scales were −0.03 (−0.12 to 0.06) mmol/l, −0.08 (−0.24 to 0.08) and −0.10 (−0.33 to 0.14) for triglycerides, TC: HDL-c and HOMA-IR, respectively	On non-transformed scales, differences between intervention and control schools were −0.3 (−2.1 to 1.5) mmHg, −0.2 (−1.6 to 1.2) centimeters and −9 (−39 to 20) meters for systolic blood pressure, waist circumference and cardiorespiratory fitness, respectively.	Despite the effectiveness of the intervention over 2 years, tripling curricular physical activity from kindergarten to grade 6. did not result in a significant reduction in the number of children in the classroom or the number of clustered or individual biological risk factors between intervention and control schools, when assessed after 6.5 years.
D'Agostino et al. (49)	2,250 children			Girls who had decreased segregation showed greater improvement in all outcomes cardiovascular activities compared to boys Both non-Hispanic Afro and Hispanics who had decreased segregation	Non-Hispanic Afro showed greater improvements in skinfold thickness, SBPP, and running time, while Hispanics showed greater improvements in BMIP and DBPP 187–126 sg in 400-m run in cardiovascular health 140–104 sg in 400-m run	Worldwide, parks are accessible to the public and should be considered a valuable global resource in the effort to prevent childhood obesity and promote health equity. Effective global public health policy must address health inequalities through targeted prevention strategies and resource-based health equity. The United States suggests that increasing population physical education in public schools is a cost-effective method to reduce the burden of hypertension and reduce the burden of cardiovascular disease attributed to hypertension.
Nicosia and Datar (50)	829 children.		By type of PA, the association of interest was significant only for vigorous PA, but never for moderate PA. For vigorous PA, the coefficient coefficient of the interaction statistically significant (coefficient 12, 5, po0.05), those living outside the facility (coefficient 18.6, po0.05), and only for those who moved (coefficient 12.1, po0.05).	Who had moved recently from those who had not, the association of interest was positive and significant among those who had moved less recently (coefficient 21.7, po0.05), but not among those who had moved more recently. The coefficient was higher among less recent movers who consistently live away from home (coefficient 35.9, po0.01)	_	This study suggests that greater access to PA opportunities in neighborhoods may be an important avenue for increasing PA among adolescents. The focus on children in military families could raise concerns of generalizability. However, the majority of the sample did not meet recommended levels of PA, similar to the general population. The results might not be generalizable to younger children who rely on their parents for PA or to adults with stronger habits. The natural experiment addressed assignment to location in terms of facility and individual-level fixed effects but did not address unobservable facility variables and individual-level fixed effects over time.
Sun et al. (51)	↓ 5,436–1,770 participants	↓ % of time journeys for work and not walking bicycle and bus between 2 and 28% in each, and increase in metro, car and metro from 28 to 33%	_	_	_	Natural experiments are becoming an increasingly popular tool to help transportation and health researchers generate better evidence when real experiments are not possible. The results the context of a developing city provide new evidence of the impact of the new subway on modal commute and active travel, new urban trains or urban rail system does not necessarily encourage increased active travel or reduced car use. Finally, knowledge of urban and transportation planning can help design and develop complex natural experiments on transportation and health.
Mölenberg et al.(52)	171 children participated in the use of 600 m of new spaces	.	Having 600 m of space dedicated for PA % no change in outdoor play in children 6–10 years compared to control	Children aged 10 years played 40 min more and in families with low maternal education level the children played 96 min more during the week	Reducing the distance to 100 meters did not present effects in sedentary behavior or increase in activity	The introduction of spaces dedicated to PA can increase outdoor play time and change in sedentary behaviors for children from more socioeconomically disadvantaged families. 10-year-olds with a nearby PA space played 0.5 h/week more outdoors compared to children without dedicated PA spaces around the house. In the case of children from families with a lower maternal educational level, outdoor play was 1.5 h/week higher. These estimates are larger than those found in the experimental (natural) setting, suggesting that both selection and causal mechanisms may explain the relationship between access to play facilities and physical activity.
Kapinos et al. (53)	1,935 participants Differences in changes according to distance to gym in 5 h per week by proximity	No effect of Proximity to gym on BMI for females, those living within 0.39 miles of a campus gym more likely to exercise frequently (more than 5 h per week), females living 0.39 miles or farther away less likely to exercise frequently.		Proximity to a campus gym had no effect on exercise frequency for males. Males living more than 0.39 miles from the nearest campus gym had significantly lower BMI and those living closer were significantly less likely to exercise.		Exogenous changes in the physical activity environment may lead to changes in weight and related behaviors but we failed to provide clear and robust evidence for such a relationship. Understanding spatial effects is challenging, as simple linear distances may not capture the implicit cost of using nearby physical activity services.
Sharma et al. (54)	210 women	14% increase in the number of women who reported being able to walk at least 10 min 5+ days per week	-	Physical activity for a total of at least 30 min during the past 7 days 3+ days per week from 82 to 113 Walking at least 10 min in a row for the last 7 days from 97 to 125 15% increase in the number of women reporting themselves active for at least 30 min per day 3 or more days per week	–	Programs such as HEAL provide a framework for successfully initiating clinic-community linkages and demonstrate the initial feasibility and acceptability of their implementation. HEAL demonstrates the feasibility of implementing this framework at the clinic and community level, >95% fidelity in program implementation, and acceptability of program strategies. By integrating a primary prevention approach to childhood obesity into the healthcare system, HEAL aims to create a model for system-level approaches to childhood obesity prevention, beginning in pregnancy. The study demonstrated an increase in physical activity among HEAL participants before and after the intervention, each week the women participated in physical activity sessions.
Madsen (55)	6,967,120 students	_	_	Valid BMI data for 6,967,120 students, representing 72.7% of all 5th, 7th, and 9th graders for the years 2001–2008	_	Widespread use of BMI screening and reporting is encouraging, as it reflects the willingness of schools to devote resources to addressing the obesity problem. In addition, research could explore how this type of information could be used more widely with other stakeholders and in policy. In the meantime, schools are likely to reap greater benefits if resources are used o increase opportunities for physical activity and improve nutrition.
Klakk et al. (56)	1,218 (81%), 697 of 773 (90%) from intervention schools and 521 of 734 (71%) but with different measures control	The difference in changes between intervention and control for TC: HDL, WC and CRF was small and insignificant. CRF 896–967 mt int and 893–961 mt cont	Six physical education classes per week significantly changed children's composite CVD risk score in favor of children attending intervention schools.		Mandatory physical education intervention with six lessons per week in public schools may reduce cardiovascular risk factors in children. The effect size observed in this healthy pediatric cohort, with the largest effect in the subgroup with the poorest composite risk score, which encompasses children in need of prevention, underscores the potential for school-based intervention programs.
Aittasalo et al. (57)	↑ 646–1,013 cycling and 309 to 346 walking	↑ Commute to bicycle 36% and walking 11%	_	↑ Commute time from walking and cycling for transport	_	The present study uses a socio-ecological framework in promoting commutation in a way, which has not been used in previous studies. Environmental improvements were part of the city's traffic plans and social and behavioral strategies. In addition, the intervention included several types of workplaces and the feasibility of the protocol related to the social and behavioral strategies had been previously tested.
Stone et al. (58)	856 participants 16.6% participated in daily activity on 2 days, 17.9% on 3 days, and 16.1% on 4 days		19.3% of participants (n = 165) accumulated at least 1 sustained session (≥5 min) of MVPA during the school week. The proportion varied among the 16 participating schools (0–45%). Most children (74.5%) accumulated 1 session, while 18.2 and 3.7% accumulated 2 and 3 sessions, respectively; only 6 children (3.6% of the sample) accumulated 4 sessions	The overall intensity of their activity was activity was higher and they accumulated significantly more minutes of moderate to vigorous activity throughout the school days (MVPAWD) and during the school day period (MVPASD) TPAWD 422. 429 (124,245) to 460,778 (135,477) MWD 437. 5 (140.9) A 463.9 (166.4) MVPAWD 30.2 (13.8)A 34.1 (16.1) MVPASD 15.1 (7.3) 18.0 (8.8)	DPA frequency was positively associated with total physical activity 423,386 (126,369), mean counts and cumulative weekday MVPA minutes (r = 0.10–0.13, p < 0.01). 29.6 (13.5) DAYS	The objective of this paper was to assess whether the Ontario Ministry of Education's daily physical activity policy (DPA) is being effectively implemented in elementary schools. The results show that most schools do not meet the required frequency (5 days) or intensity (maintaining vigorous activity for at least 20 min) of the DPA policy. However, our work demonstrates that frequency and intensity of DPA is positively related to student health behaviors/outcomes. Although our design prevents us from determining cause and effect, a positive relationship between DPA and physical activity/health in children clearly exists. Longitudinal studies are needed to establish whether benefits in students when the policy is effectively implemented.
Azevedo et al. (59)	497 participants (intervention n = 280; control n = 217).	There was no statistical difference between intervention and control participants between follow-up adjusted means for self-efficacy for physical activity or aerobic fitness.	Percentage of light physical activity (mean difference = −2.3%, 95% CI = −4.5 to 0.2, p = 003 MVPA (min.d-1) Basal 52.2 ± 16.4 post 58.2 ± 16.0 diff −5.6 (−13.6 to 2.3)	Light physical activity (min.d-1) basal 205.6 ± 36.0 post 234.3 ± 36.4 diff = −28.7, (95% CI = −46.5 to −10.8, p = 0. 02), MV (min.d-1) Basal 52.2 ± 16.4 post 58.2 ± 16.0 diff −5.6 (−13.6 to 2.3). Total MV activity (counts min-1) basal 892.5 ± 187.2 post 993.0 ± 230.7 diff −100.5 (−193.3 to −7.6)	Sedentary time (min. d-1) BASAL 502.3 ± 66.5 (152) POST 512.7 ± 63.5 (32) percent sedentary time (mean difference = 3.3%, 95% CI = −0.7 to −5.9, p = 0.01)	Implementation of a dance mat exergaming scheme in public high schools was associated with an improvement weight, BMI, body fat percentage and some parameters of health-related quality of life, but not with aerobic capacity, self-efficacy for physical activity or school attendance.
Heinen et al. (60)	4,637 respondents	No statistically significant associations. between proximity to a bike share station and changes in time spent cycling		Reduction in total time spent cycling by 1.98 min per week. Average time spent 8.8% (n = 362) increased their total cycling time by 35 min or more in 1 week, 81.5% (n = 3,356) changed their total cycling time by < 35 min. 9.7% (n = 400) reduced total cycling time by 35 min.		Our results indicate that residential proximity to a bike share station was not significantly associated with a higher level of (intention to) use nor with a greater propensity to increase total time spent bicycling, perhaps due to the older cohort in our sample. Studies have indicated that older people are less likely to adjust their travel behavior compared to the younger age cohort.
Sarmiento et al. (61)	4,925 users Parks with existing recreational pathways n = 994 % 29.9 Parks implementing future recreational pathways n = 147% 29.8 Control parks n = 338% 33	Women aerobic (7.7%), walking (7.0%) and basketball (6.6%). less frequent swinging (0.6%) and running (0.5%), parks with existing Recreovía, aerobic 21.2%). parks with future Recreovía, the main activity skating (5.9%). control parks activity carried out basketball (11.4%). Men soccer (14.3%), basketball (10.1%) and standing (8.5%). least common jogging/running and stretching (0.6%),	Mild Parks with existing recreational trails n = 991% 57.8 Parks implementing future recreational trails = 106% 50.3 control parks n = 144% 44.7 Vigorous: Parks with existing recreational trails n = 287% 16.8 Parks implementing future recreational trails = 39% 18.5 control parks n = 35% 10.9	women parks with existing Recreovía moderate to vigorous physical activity (MVPA), compared to women observed in parks without Recreovía 75 vs. 61%; p-value < 0.00 Males more likely to engage in MVPA in parks without Recreovía vs. parks with Recreovía 71 vs. 65%, (p-value < 0.01) 1		Parks with Recreovía were more likely to be used by women and had a higher percentage of users compared to parks without the Recreovía program. The presence of the Recreovía program was also associated with higher levels of MVPA observed among women. Providing culturally appropriate PA and dance classes and dance classes in public parks on weekends could be a promising strategy to promote PA among women.
McGavock et al. (62)	↑ 405–1,813 and 2,449–4,516 in two follow-ups 4,195 steps in 39 min, 4,796 vs. 3,987 steps during the week	_	_	↑ MVPA in minutes (32 vs. 25 min) and accumulated 27 ± 18 min of MVPA	_	The creation of a trail on a frozen waterway resulted in a significant increase in visitors to a network of urban trails. The activity dose that users achieved while on the frozen waterway was within the range necessary for health benefits. Trail users reported significant health benefits associated with trail use. Frozen waterways are a novel population health intervention to support increased physical activity after the winter vacations.

Effectiveness of the programs, PA, physical activity; LPA, light physical activity; MPA, moderate physical activity; MVPA, moderate-vigorous physical activity; VPA, vigorous physical activity; METS, metabolic equivalents; MVPAWD, moderate-vigorous physical activity week day; MVPASD, moderate-vigorous physical activity school day; DPA, Diary physical activity; HRQoL, health related quality of life; TC, total cholesterol; HDL, high density Lipids; CRF, Cardiorespiratory function; CVD, Cardiovascular Disease; BMI, Body mass index; HEAL, Healthy Eating Active Living; PDPs, Point-of-decision prompts; PACER, walk system measurement.