You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Enjoyment mediates effects of a school-based physical-activity intervention.
Abstract 1:
PURPOSE The study evaluated whether targeted changes in factors influencing enjoyment of physical education ( PE ) , physical activity enjoyment , and self-efficacy beliefs about participating in physical activity mediated the effect of the Lifestyle Education for Activity Program ( LEAP ) intervention on participation in physical activity . METHODS High schools ( N=24 ) paired on enrollment size , racial composition , urban or rural location , and class structure were r and omized into control ( N=12 ) or experimental ( N=12 ) groups . Of the 4044 girls enrolled and eligible , 2087 ( 51.6 % ) participated in the measurement component of the study . There were 1038 girls in the control group and 1049 girls in the experimental group . INTERVENTION LEAP was a comprehensive school-based intervention emphasizing changes in instruction and school environment design ed to increase physical activity among black and white adolescent girls . It was organized according to the Coordinated School Health Program and included a PE component with core objectives of promoting enjoyment of PE , physical activity enjoyment , and self-efficacy . RESULTS Latent variable structural equation modeling indicated that : 1 ) the intervention had direct , positive effects on physical activity and factors influencing enjoyment of PE , which subsequently explained the effects of increased physical activity enjoyment and self-efficacy on increased physical activity ; and 2 ) an additional , indirect effect of physical activity enjoyment on physical activity operated by an influence on self-efficacy . CONCLUSIONS Increases in enjoyment partially mediated the positive effect of the LEAP intervention . To our knowledge , we have provided the first experimental evidence from a r and omized controlled trial linking increased enjoyment with increased physical activity among black and white adolescent girls


Title 2:
Couch potatoes to jumping beans: A pilot study of the effect of active video games on physical activity in children
Abstract 2:
The primary objective of this pilot study was to evaluate the effect of active video games on  children 's physical activity levels . Twenty children ( mean ± SD age = 12 ± 1.5 years ; 40 % female ) were r and omised to receive either an active video game up grade package or to a control group ( no intervention ) . Effects on physical activity over the 12-week intervention period were measured using objective  ( Actigraph accelerometer ) and subjective ( Physical Activity Question naire for Children [ PAQ-C ] ) measures . An activity log was used to estimate time spent playing active and non-active video games . Children in the intervention group spent less mean time over the total 12-week intervention period playing all video games compared to those in the control group ( 54 versus 98 minutes/day [ difference = -44 minutes/day , 95 % CI [ -92 , 2 ] ] , p = 0.06 ) . Average time spent in all physical activities measured with an accelerometer was higher in the active video game intervention group compared to the control group ( difference at 6 weeks = 194 counts/min , p = 0.04 , and at 12 weeks = 48 counts/min , p = 0.06).This preliminary study suggests that playing active video games on a regular basis may have positive effects on children 's overall physical activity levels . Further research is needed to confirm if playing these games over a longer period of time could also have positive effects on children 's body weight and body mass index . Trial Registration


Title 3:
The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus.
Abstract 3:
Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists


Title 4:
A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time.
Abstract 4:
OBJECTIVE We examined the feasibility of Dance Dance Revolution ( DDR ) , a dance video game , in participants ' homes , to increase physical activity ( PA ) and to decrease sedentary screen time ( SST ) . METHODS AND PROCEDURES Sixty children ( 7.5 + /- 0.5 years ) were r and omized in a 2:1 ratio to DDR or to wait-list control ( 10-week delay ) . DDR use was logged , PA was measured objective ly by accelerometry . SST was self-reported at weeks 0 and 10 . At week 28 , after both groups had access to DDR , accelerometry and SST were repeated . RESULTS Mean use of DDR was 89 + /- 82 ( range 0 - 660 min ) min per week ( mpw ) . The DDR group showed increased vigorous PA and a reduction in light PA ; the control group showed no increase in moderate and /or vigorous PA ( MVPA ) although they also had a reduction in light PA . Differences between the groups were not observed . The DDR group also reported a decrease in SST of -1.2 + /- 3.7 h per week ( hpw ) ( P < 0.05 ) , whereas the controls reported an increase of + 3.0 + /- 7.7 hpw ( nonsignificant ) . The difference in SST between the groups was significant , with less SST in the DDR group . Between weeks 10 and 28 , numeric reductions in SST were reported in both groups . In the DDR group , SST at week 28 ( 8.8 + /- 6.0 hpw ) was lower than baseline ( 10.5 + /- 5.5 hpw ; P < 0.03 ) . DISCUSSION This pilot study suggests that DDR reduces SST and may facilitate slight increases in vigorous PA . Further study is needed to better characterize children and context s in which DDR may promote a healthy lifestyle


Title 5:
The motivation of children to play an active video game.
Abstract 5:
The purpose of this pilot study was to evaluate the effect of a weekly multiplayer class on the motivation of children aged 9 - 12 years to play an  interactive dance simulation video game ( IDSVG ) at home over a period of 12 weeks . A sample of 27 children was r and omly assigned to ( 1 ) a home group instructed to play the IDSVG at home ; ( 2 ) a multiplayer group instructed to play the IDSVG at home and to participate in a weekly IDSVG multiplayer class . Participants were asked to play the IDSVG as often as they liked and report the playing time daily on a calendar for a 12-week period . Motivation to play was assessed by the playing duration of IDSVG in minutes and the dropout during the study .  Mean age of the 16 children who completed the study was 10.6+/-0.8 years . During the 12-week intervention period , the multiplayer group played approximately twice as many minutes ( 901min ) as the home group ( 376min , p=0.13 ) . Dropout was significantly ( p=0.02 ) lower in the multiplayer group ( 15 % ) than in the home group ( 64 % ) . Our findings suggest that multiplayer classes may increase children 's motivation to play interactive dance simulation video games


Title 6:
Energy costs of physical activities in children and adolescents.
Abstract 6:
PURPOSE The primary aim was to determine the energy expenditure ( EE : kcal.kg(-1).h(-1 ) ) in terms of caloric cost and metabolic equivalents of activities commonly performed by children and adolescents . Secondary aims were to determine at what age and pubertal developmental stage values approach those of adults . METHODS In this descriptive study , 295 volunteer youth 8 - 18 yr of age completed 18 common physical activities ( including rest ) while EE was measured continuously with a portable metabolic system . Three sets of activities were assigned in r and om order for each subject . Activities ranged from television viewing and video game play to running and rope skipping . Pubertal development was estimated from a self-report question naire . RESULTS At rest , VO(2 ) and EE were highest in the youngest children and decreased with advancing age and higher pubertal stage in both genders . The age-adjusted and puberty-adjusted energy expenditure values were generally lower than the compendium MET values for sedentary and moderate activities but were more varied for high-intensity activities . However , the ratio of activity EE to REE was comparable in children and adults . CONCLUSIONS Energy expenditure per kilogram of body mass at rest or during exercise is greater in children than adults and varies with pubertal status , thus using the definition of a MET in the compendium of physical activities without adjustment is inadequate for energy estimation in children , until a child reaches Tanner Stage 5 . However , the ratio of activity EE to resting EE in children appears to be similar or slightly less than in the compendium , suggesting that the compendium MET increments used with our adjusted EE values more closely approximate the true EE of activities in children than present adult norms
AVGs are capable of generating EE  in youth to attain PA guidelines .
Few studies have assessed sustainability of AVG play , which appears to diminish after a short period of time for most players .