title: The walking school bus and children's physical activity: a pilot cluster randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the impact of a "walking school bus" program on children's rates of active commuting to school and physical activity.
  
  
  METHODS
  We conducted a pilot cluster randomized controlled trial among 4th-graders from 8 schools in Houston, Texas (N = 149). Random allocation to treatment or control conditions was at the school level. Study staff walked with children to and from school up to 5 days/week. Outcomes were measured the week before (time 1) and during weeks 4 and 5 of the intervention (time 2). The main outcome was the weekly rate of active commuting, and a secondary outcome was moderate-to-vigorous physical activity. Covariates included sociodemographics, distance from home to school, neighborhood safety, child BMI z score, parent self-efficacy/outcome expectations, and child self-efficacy for active commuting. A mixed-model repeated measures regression accounted for clustering by school, and stepwise procedures with backward elimination of nonsignificant covariates were used to identify significant predictors.
  
  
  RESULTS
  Intervention children increased active commuting (mean ± SD) from 23.8% ± 9.2% (time 1) to 54% ± 9.2% (time 2), whereas control subjects decreased from 40.2% ± 8.9% (time 1) to 32.6% ± 8.9% (time 2) (P < .0001). Intervention children increased their minutes of daily moderate-to-vigorous physical activity from 46.6 ± 4.5 (time 1) to 48.8 ± 4.5 (time 2), whereas control children decreased from 46.1 ± 4.3 (time 1) to 41.3 ± 4.3 (time 2) (P = .029).
  
  
  CONCLUSIONS
  The program improved children's active commuting to school and daily moderate-to-vigorous physical activity.
authors.affiliation: US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA. jason.mendoza@bcm.edu
authors.forename: Jason A
authors.initials: JA
authors.lastname: Mendoza
authors.forename: Kathy
authors.initials: K
authors.lastname: Watson
authors.forename: Tom
authors.initials: T
authors.lastname: Baranowski
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Nicklas
authors.forename: Doris K
authors.initials: DK
authors.lastname: Uscanga
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Hanfling
mesh_terms: D002648:Child; D005260:Female; D006293:Health Promotion / Q000639:trends*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D009765:Obesity / Q000517:prevention & control; D012449:Safety; D012574:Schools; D013334:Students / Q000706:statistics & numerical data; D013781:Texas; D014186:Transportation / Q000706:statistics & numerical data*; D016138:Walking