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:
Increasing active travel to school: are we on the right track? A cluster randomised controlled trial from Sydney, Australia.
Abstract 1:
OBJECTIVE To evaluate the effectiveness of a program to increase walking to and from school . DESIGN A cluster r and omised controlled trial . SETTING 24 primary public schools in inner west Sydney , Australia . PARTICIPANTS 1996 students aged 10 - 12 years and their parents . INTERVENTION A two-year multi-component program included classroom activities , development of school Travel Access Guides , parent newsletters and improving environments with local councils . MEASURES Two measures were used : a survey completed by students on how they travelled to and from school over five days , and a survey completed by their parents on how their child travelled to and from school in a usual week . RESULTS The percentage of students who walked to and from school increased in both the intervention and control schools . Data from parent surveys found that 28.8 % of students in the intervention group increased their walking , compared with 19 % in the control group ( a net increase of 9.8 % , p=0.05 ) . However this effect was not evident in the student data . CONCLUSION The study produced a mixed result , with a high variation in travel patterns from school to school . Intervention research should address the complexity of multiple factors influencing student travel to school with a focus on changing local environments and parents ' travel to work


Title 2:
“Walk in to Work Out”: a randomised controlled trial of a self help intervention to promote active commuting
Abstract 2:
Study objective : To determine if a self help intervention , delivered via written interactive material s ( the “ Walk in to Work Out ” pack ) , could increase  active commuting behaviour ( walking and cycling ) . Design : R and omised controlled trial . The intervention group received the “ Walk in to Work Out ” pack , which contained written interactive material s based on the transtheoretical model of behaviour change , local information about distances and routes , and safety information . The control group received the pack six months later . Focus groups were also conducted after six months . Setting : Three workplaces in the city of Glasgow , Scotl and , UK . Participants : 295 employees who had been identified as thinking about , or doing some irregular , walking or cycling to work . Main results : The intervention group was almost twice as likely to increase walking to work as the control group at six months ( odds ratio of 1.93 , 95 % confidence intervals 1.06 to 3.52 ) . The intervention was not successful at increasing cycling . There were no distance travelled to work , gender , or age influences on the results . Twenty five per cent ( 95 % confidence intervals 17 % to 32 % ) of the intervention group , who received the pack at baseline , were regularly actively commuting at the 12 month follow up . Conclusion : The “ Walk in to Work Out ” pack was successful in increasing walking but not cycling . The environment for cycling must be improved before cycling will become a popular option


Title 3:
Randomised controlled trial of site specific advice on school travel patterns
Abstract 3:
Aims : To evaluate the effect of site specific advice from a school travel coordinator  on school travel patterns . Methods : Cluster r and omised controlled trial of children attending 21 primary schools in the London boroughs of Camden and Islington . A post-intervention survey measured the proportion of children walking , cycling , or using public transport for travel to school , and the proportion of parents/carers very or quite worried about traffic and abduction . The proportion of schools that developed and implemented travel plans was assessed . Results : One year post-intervention , nine of 11 intervention schools and none of 10 control schools had travel plans . Proportions of children walking , cycling , or using public transport on the school journey were similar in intervention and control schools . The proportion of parents who were very or quite worried about traffic danger was similar in the intervention ( 85 % ) and control groups ( 87 % ) . However , after adjusting for baseline and other potential confounding factors we could not exclude the possibility of a modest reduction in parental concern about traffic danger as a result of the intervention . Conclusions : Having a school travel coordinator increased the production of school travel plans but there was no evidence that this changed travel patterns or reduced parental fears . Given the uncertainty about effectiveness , the policy of providing school travel coordinators should only be implemented within the context of a r and omised controlled trial


Title 4:
Pilot evaluation of a walking school bus program in a low-income, urban community
Abstract 4:
Background To evaluate the impact of a walking school bus ( WSB ) program on student transport in a low-income , urban neighborhood . Methods The design was a controlled , quasi-experimental trial with consecutive cross-sectional assessment s. The setting was three urban , socioeconomically disadvantaged , public elementary schools ( 1 intervention vs. 2 controls ) in Seattle , Washington , USA . Participants were ethnically diverse students in kindergarten-5th grade ( aged 5–11 years ) . The intervention was a WSB program consisting of a part-time WSB coordinator and parent volunteers . Students ' method of transportation to school was assessed by a classroom survey at baseline and one-year follow-up . The Pearson Chi-squared test compared students transported to school at the intervention versus control schools at each time point . Due to multiple testing , we calculated adjusted p-values using the Ryan-Holm stepdown Bonferroni procedure . McNemar 's test was used to examine the change from baseline to 12-month follow-up for walking versus all other forms of school transport at the intervention or control schools . Results At baseline , the proportions of students ( n = 653 ) walking to the intervention ( 20 % + /- 2 % ) or control schools ( 15 % + /- 2 % ) did not differ ( p = 0.39 ) . At 12-month follow up , higher proportions of students ( n = 643 , p = 0.001 ) ) walked to the intervention ( 25 % + /- 2 % ) versus the control schools ( 7 % + /- 1 % ) . No significant changes were noted in the proportion of students riding in a car or taking the school bus at baseline or 12-month follow up ( all p > 0.05 ) . Comparing baseline to 12-month follow up , the numbers of students who walked to the intervention school increased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . In contrast , the numbers of students who walked to the control schools decreased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . Conclusion A WSB program is a promising intervention among urban , low-income elementary school students that may promote favorable changes toward active transport to school . Trial Registration Clinical Trials.gov


Title 5:
Active transportation to school over 2 years in relation to weight status and physical activity.
Abstract 5:
OBJECTIVE To prospect ively examine potential benefits of active commuting to school on measures of weight status and physical activity in a sample of youth . RESEARCH METHODS AND PROCEDURES A cohort of students from seven elementary schools was measured four times -- in the fall and spring of fourth grade ( N = 1083 ) and fifth grade ( N = 924 ) . Participants were classified as active ( walking , biking , or skateboarding to school almost every day for baseline analyses or at least 2 d/wk for analyses of consistent active commuting ) or non-active commuters to school . Accelerometers were used to measure physical activity . Height , weight , and skinfolds were objective ly assessed . RESULTS Boys who actively commuted to school had lower BMI ( p < 0.01 ) and skinfolds ( p < 0.05 ) than non-active commuters to school in the fourth grade . Active commuting to school over 2 years was not associated with BMI change or overweight status . DISCUSSION Walking and cycling to school may contribute to preventing excessive weight gain , or leaner children may walk or cycle to school


Title 6:
Effect of Australia's Walk to Work Day Campaign on Adults' Active Commuting and Physical Activity Behavior
Abstract 6:
Purpose . To determine whether  Australia  's Walk to Work Day media campaign result ed in behavioral change among targeted groups . Methods . Pre- and postcampaign telephone surveys of a cohort of adults aged 18 to 65 years ( n = 1100 , 55 % response rate ) were r and omly sample d from Australian major metropolitan areas . Tests for dependent sample s were applied ( McNemar χ2 or paired t-test ) . Results . Among participants who did not usually actively commute to work was a significant decrease in “ car only ” use and an increase in walking combined with public transport . Among those who were employed was a significant increase in total time walking ( + 16 min/wk ; t [ 780 ] = 2.04 , p < .05 ) and in other moderate physical activity ( + l20 min/wk ; t [ 1087 ] = 4.76 , p < .005 ) , result ing in a significant decrease in the proportion who were “ inactive ” ( χ2 ( 1 ) = 6.1 , p < .05 ) . Conclusion . Although nonexperimental , the Walk to Work Day initiative elicited short-term changes in targeted behaviors among target groups . Reinforcement by integrating worksite health promotion strategies may be required for sustained effects


Title 7:
Promoting active transport in a workplace setting: evaluation of a pilot study in Australia.
Abstract 7:
Promoting active transport is an increasingly important focus of recent health promotion initiatives addressing the major public health concerns of car dependence , decreased levels of physical activity and environmental health . Using active transport that relies less on the use of private cars and more on alternatives such as walking , cycling and public transport has the potential to increase population levels of physical activity and to improve the environment . Over 12 months , a combined social and individualized marketing campaign was delivered to a cohort of r and omly selected health service employees ( n = 68 ) working at a health care facility in inner-city Sydney , Australia . Pre- and post-intervention surveys measured changes in mode of transport , awareness of active transport and attitudes towards mode of transport . Following the intervention , we found there was a reduction in the proportion of participants who drove to work 5 days per week and a decrease in trips travelled by car on weekends . In addition , there was high awareness of the intervention amongst participants and their underst and ing of the concept of active transport improved from 17.6 % at baseline to 94.1 % at the follow-up survey ( p < 0.01 ) . There was also a significant shift in attitudes , which suggested increased positive regard for active transport . Our findings suggest that a combined social and individualized marketing campaign in the workplace setting can increase the use of active transport for the journey to work and trips on weekends . However , before these findings are widely applied , the intervention needs to be tested in a controlled study with a larger sample size
A r and omised controlled trial in the workplace setting , conducted in a pre-selected group who were already contemplating or preparing for active travel , found improved health-related quality of life on some sub scales , and increased walking .
AUTHORS ' CONCLUSIONS There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode .