Ms .ANIMOL ABRAHAM1STYEAR M.Sc NURSINGCHILD HEALTH NURSING2012-2014SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD,TUMKUR-572102

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

Ms .ANIMOL ABRAHAMI YEAR M.Sc.NURSINGSHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD, TUMKUR-572 102.

2NAME OF THE INSTITUTION

SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD, TUMKUR.-572 102.

3COURSE OF STUDY AND SUBJECT

MASTER OF SCIENCE IN NURSINGCHILD HEALTH NURSING

4 DATE OF ADMISSION 10 - 07 – 2012

5 STATEMENT OF THE PROBLEM

‘A STUDY TO ASSESS THE EFFECTIVNESS OF VIDEO ASSISTED TEACHING ON KNOWLEDGE REGARDING HEALTH PROBLEMS DUE TO DECREASED PHYSICAL ACTVITY AMONG SECONDARY SCHOOL CHILDREN IN A SELECTED SCHOOL IN TUMKUR.’

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6.0 BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“Every patient caries his or her own doctor inside”- Albert Schweitzer

Children’s health encompasses the physical, mental, emotional and social

wellbeing not merely the absence of disease or infirmity. Healthy children live in

family, environment and community that provide them an opportunity to reach their

fullest developmental potential.

Child health is fundamental to adult health and wellbeing. When children’s

health is nurtured and supported and there is an absence of physical and mental abuse

or other intentional childhood trauma, the stage is set up for good adulthood less

likely to involve chronic health problems such as overweight / obesity, poor oral

health, diabetes and other chronic physical and mental health problems. Physical

activity during childhood is one of the important aspects which promote better health.1

Health problems associated with decreased physical activity among

adolescence increasing worldwide. The prevalence of hypertension among

adolescents is 4.5% and by the age of 15 more than 25% of obese adolescents have

early signs of diabetes. Among obese youth 70% have at least one risk factor of

cardiovascular disease by the age of 20.2

Physical activity is defined as any bodily movement produced by skeletal

muscles that require energy expenditure. The term “physical activity” should not

mistake as exercise. Exercise is sub category of physical activity that is planned

structured, repetitive and purposeful. Physical activity includes exercise as well as

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other activities which involve bodily movement that are a part of playing, working,

active transportation, house chores and recreational activities.3

Physical activities are vital for child development and lays as a foundation for

a healthy and active life. The benefits of being active for children include promoting

healthy growth and development, building strong bones and muscles, improving

cardiovascular fitness, improving balance, coordination and strength, improving

confidence and self- esteem ,relieving stress, promoting relaxation and providing

opportunities to develop social skills and making friends.4

Today’s children and youth are less active and healthy than ever before. There

are many reasons for this decreased activity which include interpersonal, institutional

and environmental barriers. Inter personal barriers include fear of being teased about

over weight or preferring to do other activities such as playing video games or

watching television and have friends who are inactive or family obligation.

Institutional barrier is heavy school functioning. Environmental barrier include poor

weather or lack of transportation. The most common barrier include lack of time, little

interest and environmental barriers. This physical inactivity leads to many serious

health problems, including diabetes and heart disease.5

Obesity is another aspect that today’s children face. Over weight means that

individuals weight exceeds recommended than a given height and it is an excess of

body fat. When excess weight is in the form of fat health problems like cardiovascular

diseases and diabetes mellitus may develop. Physical activity plays an important role

in the prevention of overweight and obese in childhood, adolescence, and in

adulthood. Puberty and following adolescent period are acknowledged as particularly

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vulnerable times for developing obesity due to sexual maturation, and in many

individuals, a concomitant reduction in physical activity.6

Recent studies show that there is high blood pressure among children and

adolescence and that is linked with epidemic of childhood obesity and sedentary life

styles. Hypertension can cause damage to heart, kidney brain and eyes. Increase in

blood pressure can be prevented and often controlled by change in life style, including

weight reduction and regular physical activity.7

The frequency of diabetes rising around the globe, and studies show that

children are at risk of developing the disease. Worldwide about 350 million people

suffer diabetes mellitus and the number likely to more than double in the next 20

years. Type-2 diabetes can result from excess body weight and physical inactivity and

recently type-2 diabetes has increasingly been reported in children and adolescents.

The global rise of childhood obesity and physical inactivity is widely believed to play

critical role behind diabetes.8

Childhood and adolescence are crucial periods for bone development.

According to Vicente-Rodreguez (2006), the pubertal human skeleton is sensitive to

mechanical stimulation elicited by physical activity.9 Apparent association between

obesity and metal health indicate the role played by physical activity in this area.

Hormones related to stress and anxiety in the body appears to be influenced by

physical activity. So sufficient physical activity during childhood is needed for good

mental health.10

4

There is significant relationship between physical activity with cognitive

performance and academic activity in young people. Overweight children are more

likely to have low grade in academic performance and school dropout also increases.

Overweight have lower quality of life, this may affect the social, emotional and

school functioning. Regular physical activity is necessary for improving this

condition.11

There is medical advice that children and young people should participate, a

minimum of 60 minutes of at least moderate intensity physical activities .About 37 %

of adolescents aged between 11-15 years are interested in physical activity. Although

children have knowledge regarding physical activity, have only less knowledge

regarding health problems due to decreased physical activity. The majority of young

age people (73%) who consider themselves to be about the right weight.12

Nowadays many children are facing health problems due to decreased physical

activity because of prolonged sitting in school, lack of enough space for physical

activity, increased use of television, video gaming and internet. Most of the school

children are not aware of the importance of physical activity for preventing these

health problems. Health teaching should provide for the children regarding health

problems due to physical inactivity and benefits of physical activity. Studies shown

that media based physical education intervention are more effective. Video assisted

teaching consists of videos and images regarding health problems due to decreased

physical activity. This will help the children for better understanding and it also can

promote their interest in teaching.13

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6.2 NEED FOR THE STUDY

Regular physical activity fitness and exercise have potential importance for the

health and well being of all ages. Physical activity has been shown to reduce the risk

of developing or dying from heart diseases, diabetes, colon cancer and high blood

pressure. Despite of well known effect of physical activity most adult and many

children lead a relatively sedentary life style and are not active enough to achieve

these health benefits. Data from National health interview in USA shows that more

than one third of the young people do not regularly engage in vigorous physical

activity. Physical activity decline dramatically over the course of adolesence.14

The recommendation of physical activity for children is to participate at least

60 minutes each day. Global school health survey conducted by WHO in 2007 shows

that physical activity level was significantly lower among female students than males.

Around 25.3% male students are physically active all seven days than 13.8% of

female students. The percentages of male and female students who participate in

insufficient physical activities are 81.6% and 65.5% respectively.15

The overall prevalence of overweight and obesity among urban children in

New Delhi showed that there is an increase from 16% to 24% over a period of

2002- 2007.16 A study carried out among 550 Indian students between 12-18 years in

New Delhi on prevalence of life style associated risk factors. This study shows that

about two fifth (18.3%) of boys and 22.2% of girls are not physically active for the

recommended level. Also 54.4% of boys and 69.3% of girls replied as not being

engaged in sports at school or at home. 18.6%boys and 16.5% girls were overweight

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or obese. Systolic hypertension (B.P>140) was found in 11.82 % boys and 3.03%

girls. Diastolic hypertension (B.P>90) was prevalent in 3.85% boys and 0.43% girls.17

A study was conducted among 1217 school children (5-15years) to assess the

prevalence of hypertension and pre hypertension in Mysore City (2006-2007) shows

that children are suffering problem due to decreased physical activity. Prevalence of

overweight and obesity between 5-15 years is 11.8% and 4.4% respectively. The

prevalence of hypertension was 11% between the ages of 5-15 years. Prevalence of

obesity was 20% and 7.9% among children between 5-10 years and 11-15 years

respectively with either pre hypertension and or hypertension.18

In the United States only 17% of high school students are participating in at

least 60 minutes of physical activity per day and only 33% of high school students are

attending physical education classes each weekday. Female tend to participate less

physical activity than their male counterpart. The rate of obesity tripled from 5%

in1980 to 17.6% in 2006 because of this reasons.19

In Canada over the past 25 years, the overweight or obesity rate of youth aged

12-17 has more than doubled from 14% to 29% and obesity rate tripled from 3% to

9%. Over half of children between 5-17 years old in Canada are not active enough to

full growth and development and became less active as they grow older. About 76%

of Canadian children watch TV read or play computer games after school and almost

all spend three or more hours of weekend day on computer. 4 in10 Canadian children

have at least one risk factor for heart disease due to inactive lifestyle and there is also

increased appearance of type-2 diabetes. 20

7

According to data from National Health And Nutrition Examination Survey

(NHANES 1999-2000) only about one third of students participate in physical

education classes. On the other hand sedentary activities such as television and video

viewing, computer game and internet activities have increased. Average watches 24

hour of television per week.21

A descriptive study conducted on childhood obesity in developing countries

shows that rapidly changing dietary and sedentary life style led to increased

prevalence of childhood obesity among children between 5-17 years in developing

countries with an average of 41.8% in Mexico, 22.1% in Brazil, 22% in India and

19.3% in Argentina. One of the important determinants of childhood obesity is poor

physical activity.22

A cross sectional study was conducted to find out the prevalence of

sustained hypertension among school children aged 11–17 yrs in 2010 and a total

number of 1085 healthy students from the rural and urban schools in hills of northern

India were examined. The result of the study was that about 0.4% was found to be

obese and 3.5% were overweight. After two evaluations it was found out that rates of

elevated blood pressure were significantly high among obese and overweight (high

BMI) than those with normal body mass index. In conclusion nearly 20% of school

children had elevated blood pressure.23

The researcher observed that prevalence of health problems due to decreased

physical activity are increasing day by day and hypothesized that secondary school

children have less knowledge regarding health problem due to decreased physical

activity. If children have adequate knowledge regarding importance of physical

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activity it can be prevented in an early stage. So researcher assumed that video

assisted teaching will be effective to improve their knowledge.

6.3 REVIEW OF LITERATURE

A longitudinal study was conducted to document physical activity in south

Indian schoolchildren aged between 8-15 in 2006 and 2007. Physical activity assessed

by administering questionnaire at base line and follow up in 2006 and 2007.

Frequency and duration of activity was recorded and metabolic equivalent assigned.

For each daily activity and intensity were computed. Children were categorized by

age group, gender and socio-economic status. There was decline in physical activity

over year. Sedentary activities were higher in children aged >11 years, intensity of

moderate to vigorous physical activity was higher in boys than girls. Over one years

physical activity at school significantly decreased (P<0.001). There was also

significant decrease in moderate to vigorous physical activity (P<0.001) with

interaction effects of age group (P<0.001) and gender.24

A cross-sectional study was conducted on prevalence of overweight and

obesity and its associated factors among1208 adolescents in Hyderabad (2003). Data

was collected by questionnaire. The results obtained was the prevalence is

significantly higher (p < 0.05) among adolescents who playing electronic games 3 h/d

(10.4%) or belonged to a high socioeconomic background (14.9% , p <0.001),

whereas it was significantly lower among those participating regularly in outdoor

games 6 h/wk (3.1% , p < 0.004) and household activities 3 h/d (4.7%, p < 0.001).25

9

A cross sectional and prospective study was conducted on elementary school

aged children to determine the association between time spent for outdoor with

objectively measured physical activity and overweight ( 2001-2004) in Melbourne

Australia.188 children aged between 5-6 years old and 360 children aged between 10

-12 years old children were included in study. Baseline parent reports of children’s

time spent out doors were collected. At baseline follow up children’s moderate and

vigorous physical activity (MVPA) was objectively assessed by accelerometer and

BMI Z-score and overweight was calculated from measure height and weight. Result

shows that each additional hour out door on weekend days was associated with an

extra 25 minutes week MVPA among older girls and 20 minutes in boys. The

prevalence of overweight among older children at follow up was 27.4% lower among

those spending more time out door at baseline.26

A cross sectional study was conducted on adolescents to determine effects of

diet, physical activity and sedentary life style on over weight among children

between 11-15 years in California USA . A total of 878 adolescents, 42% of whom

were from minority backgrounds were selected for study. As per centers for Disease

Control and Prevention body mass index-for-age percentiles divided into 2 categories:

normal weight (<85th percentile) and at risk for overweight plus overweight (AR + O)

(>or=85th percentile. Final multivariate models indicated that independent of

socioeconomic status (as assessed by household education level), girls had a greater

risk of being AR + O if they were Hispanic or from another minority background

(odds ratio [OR] = 1.65; 95% confidence interval [CI], 1.09-2.49) and a reduced risk

of being AR + O as minutes per day of vigorous physical activity increased (OR =

0.93; 95% CI, 0.89-0.97). Of the 7 dietary and physical activity variables examined

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in this cross-sectional study, insufficient vigorous physical activity was the only risk

factor for higher body mass index for adolescent boys and girls.27

A longitudinal study conducted on adolescent children to find relationship

between physical activity and blood pressure in UK. 5505 had systolic and diastolic

BP measurements, plus valid accelerometer measures of PA; total PA recorded as

average counts per minute (cpm) over the period of valid recording, and minutes per

day spent in moderate to vigorous PA (MVPA). Small inverse associations were

observed; for systolic BP, beta=-0.44 (95% confidence interval -0.59, -0.28) mm Hg

per 100 cpm, and beta=-0.66 (95% CI -0.92, -0.39) mm Hg per 15 minutes/d MVPA,

adjusting for child's age and gender. When PA variables were modeled together,

associations with total PA were only a little weaker, whereas those with MVPA were

substantially reduced; for systolic BP, beta=-0.42 (95% CI -0.71, -0.13) mm Hg per

100 cpm, and beta=-0.03 (95% CI -0.54, 0.48) mm Hg per 15 minutes/d MVPA. In

conclusion, higher levels of PA were associated with lower BP, and results suggested

that the volume of activity may be more important than the intensity.28

A co relational study was conducted to determine the relationship between

sedentary behaviour and health indicators in school-aged children and youth aged 5-

17 years in USA. Online databases (MEDLINE, EMBASE and PsycINFO), personal

libraries and government documents were searched for relevant studies examining

time spent engaging in sedentary behaviors and six specific health indicators (body

composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem,

pro-social behaviour and academic achievement). 232 studies including 983,840

participants met inclusion criteria and were included in the review. Meta-analysis

was completed for randomized controlled studies that aimed to reduce sedentary time

11

and reported change in body mass index (BMI) as their primary outcome. In this

regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44

to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the

interventions. There is a large body of evidence from all study designs which suggests

that decreasing any type of sedentary time is associated with lower health risk in

youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in

excess of 2 hours is associated with reduced physical and psychosocial health, and

that lowering sedentary time leads to reductions in BMI.29

A cross sectional study was carried out among adolescents regarding over

weight and obesity and related risk factors, in Meerut during the period of October

2003 to march 2004. 2785 adolescents from six public schools were selected for the

study. Magnitude of overweight and obesity assessed with the help of ELIZ health

path way based on body mass index. Prevalence of overweight and obesity was found

to be 19.7% and 5.3% in girls and 18.36% and 10.82% in boys. Obesity was

significantly associated with high intake of junk food (P<0.05), binge eating and

calorie intake (P<0.05), lower physical activity (P<0.05) and prolonged television

watching (P<0.05). Result shows that decreased physical activity and sedentary life

style are importance contributing factors for overweight and obesity30.

A cross sectional study followed by case control was conducted on two

affluent schools in Davangere city, Karnataka to identify the factors influencing

childhood obesity. A total of 1496 school children studying between 5 th and 10th

standard age between 10 -15 years were selected for study. Data on family history of

obesity, diet, snacking habits and physical activity was collected. Out of 1496

children 86 were obese. Prevalence of obesity was more in girls (8.82%) than boys

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(4.42%). Prevalence of obesity increased with increase in age in both boys and girls.

Family history of obesity, snacking of high energy food and lack of physical activity

were important influencing factor for obesity31.

A cross sectional study was conducted to determine self-reported knowledge

and pattern of physical activity among male school students and their teachers in Al

Khobar, Saudi Arabia. The target population consisted of third grade intermediate and

all three grades of male secondary school students. A multistage stratified self-

weighting sampling design was adopted. All students, a total of 1240, in the selected

classes as well as their teachers (142) in the selected schools were included in the

sample. Two sets of self-administered questionnaires were used: one for male students

and the other for teachers. The questionnaire contained demographic data and data on

knowledge and practice of physical activity. The majority of male students knew that

physical activity was protective against some diseases. Both students and teachers had

poor knowledge about the role of physical activity in the prevention of diabetes

mellitus and hypertension (36.6% and 28.8% for students vs. 43.0% and 46.5% for

teachers respectively). Both students and teachers had poor knowledge about the role

of physical activity in the prevention of diabetes mellitus and hypertension. Health

education should concentrate on clarifying this area32.

An experimental study was conducted to investigate Multimedia Assisted

Instruction in Physical Education is functional in the school environment. An

Interactive multimedia CD-ROM program was developed, especially for the needs of

the study, titled «The tree of Health». This intervention trial involved 12 classes (N =

248 students), randomized into 3 groups: Multimedia Assisted Instruction, Traditional

Approach to teaching (TA), and Control. Students were tested using pre and post-tests

13

that measured knowledge of «Health related fitness» subjects. The experiment lasted

12 class hours, two classes per week over six weeks. The results of an analysis of

covariance indicated that there was a significant increase in achievement post-test for

the (MCAI) group when compared to either the (TA) or control groups, F(1, 238) =

13.486, p < .0167; F(1, 238) = 53.872, p < .0167. These results indicate that this new

educational tool is an effective way to introduce health-related physical education

programs for students in typical classroom settings.33

6.4 STATEMENT OF THE PROBLEM

‘A study to assess the effectiveness of video assisted teaching on knowledge

regarding health problems due to decreased physical activity among secondary

school children in a selected school in Tumkur.’

6.5 OBJECTIVES OF THE STUDY

To assess the knowledge regarding health problems due to decreased physical

activity among secondary school children in a selected school in Tumkur.

To evaluate the effectiveness of video assisted teaching on knowledge

regarding health problems due to decreased physical activity among secondary

school children.

To find out the association between pretest level of knowledge and selected

socio demographic variables.

6.6 OPERATIONAL DEFINITIONS

1. Effectiveness: In this study effectiveness refers to the extent to which the

video assisted teaching on knowledge regarding health problem due to

14

decreased physical activity achieved its objectives in improving knowledge of

secondary school children.

2. Video assisted teaching- In this study video assisted teaching refers to

systematically organized teaching to provide information to children regarding

health problems due to decreased physical activity by using audio visual aids

such as LCD projector and video.

3. Health problems- In this study health problems refers to an abnormal or

physiologically imbalanced state of the body due to decreased physical

activity such as obesity, diabetes, hypertension, elevated serum cholesterol

level, depression, and anxiety .

4. Knowledge-In this study the knowledge refers to the correct responses given

by the secondary school children as it is elicited through self administered

knowledge questionnaire.

5.Secondary school children – In this study secondary school children refers to

children who are studying in 8th, 9th and 10th standard.

6.7 ASSUMPTIONS

School children may have limited knowledge on health problems due to

decreased physical activities.

Video assisted teaching may be effective to enhance the knowledge on health

problems due to decreased physical activity among school children.

6.8 HYPOTHESIS

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H1 - There will be significant difference between pretest and post test

knowledge scores regarding health problems due to decreased physical

activity among secondary school children

H2 –There will be significant association between pretest level of knowledge

with selected socio- demographic variables.

6.9 VARIABLES

Independent variable:-video assisted teaching

Dependant variable: - knowledge score

Demographic variables: – Selected socio demographic variables such as age,

gender, education, occupation, income, family size, socio economic status,

residential area etc.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

Data will be collected from secondary school children in selected school in

Tumkur.

7.2 METHOD OF DATA COLLECTION

7.2.1 Research design

Research design: Quasi experimental one group pretest post test design.

7.2.2 Settings of the study

Selected secondary school in Tumkur.

7.2.3 Population

Secondary school children.

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7.2.4 Sample

Children studying in 8th, 9thand 10th standards in a selected school in Tumkur.

7.2.5 Sampling technique

The samples will be selected by simple random sampling.

7.2.6 Sample size

Total sample size for the study is 100 children studying in 8th, 9thand 10th

standard in a selected school in Tumkur.

7.2.7 Sampling criteria

Inclusive criteria

1. Children who are studying in 8 th, 9thand 10th standard in a selected

school in Tumkur.

2. Secondary school children who are willing to participate in the

study.

Exclusive criteria

1. Secondary school children who are not available during the time

of data collection.

7.2.8 Tool for data collection

Data will be collected by using self administered knowledge questionnaire.

Section A - Selected socio- demographic variables.

Section B –Self administered knowledge questionnaire regarding

health problem due to decreased physical activity

7.2.9. Method of data collection

The data will be collected from secondary school children by using self

administered knowledge questionnaire. On the day first pretest will be given to the

17

children and the same day video assisted teaching will be given. On the day eight

posttest will be given to evaluate the effectiveness of video assisted teaching. Written

permission will be taken from the concerned authorities.

7.3. Data analysis and interpretation

Descriptive statistics

Descriptive statistical technique such as frequency, percentage, mean, median

and standard deviation.

Inferential statistics

Chi-square test, paired t- test

7.4 ETHICAL CLEARANCE:

7.4.1. Does the study require any investigation or intervention to be conducted

on patients?

No.

7.4.2. Has ethical clearance been obtained from your institution in case of 7.4?

Yes.

8. BIBLIOGRAPHIC REFERENCE

1. Child health definition. Health work group. First thing first. October 2007;

Available from:

URL:http://www.azftf.gov/whoWeAre/broad/Documents/program

18

2. Health schools- health topics-physical activity ;Available from

:URL:http://www.gov.mb.ca/healthyschools/topics/physical.html#.uj.sybwHrc

3. Global strategy on diet, physical activity and health. Cited on 9 November ,

2012; Available from : URL: www.who.int/dietphysicalactvity

/pa/en/index.html.

4. Physical activity –why physical activity important in early childhood. Cited on

9 November2012;Available

from:URL:http://www.healthykid.nsw.gov.au/teachers_child

care/physical_activity:aspix.

5. lack of exercise for children. August 11, 2011 ; available from : URL:

http://www.livestrong.com/article/370982_lack_of_execise_for_children_/

#ixz<2BmotcD63.

6. Andrew .P. Hills ,Laer Bro Andersen ,Nula .M. Byrne. Physical activity and

obesity in children: Available from URL :http:/ /www. bjsm.bmj.

com/content/4 5/11/866.abstract.

7. A. Rahman Zahini. High blood pressure in children . California child health

care program. Available from : URL:

http://www.education.com/reference/article/ref- high blood pressure children.

8. What are the risk factors of diabetes in children. Available from :URL:

http://www.who.int/features/99/65/en /index.html.

9. 9.Childrenand physical activity a back ground review- descriptive

epidemiology 11 July 2004; Available from:URL: http://www.nice

.org.uk/media/c7c/80/promoting physical activitychildren review

epidemiology.

19

10. Victoria Floriani ,Christine Kennedy. Promotong physical activity in children.

Available

from:URL:http://www.recapark.org/ftp/uploadedfiles/wcm-repark/SPTF/

floriani.pdf.

11. Shane Hall. Social effect of lack of exercise in kids. September 2 2010 :

Available

from:URL:http://www.livestrong.com/article/220973_social_effect_of_lack_o

f _execise_on_kids.

12. Knowledge and attitude towards healthy eating and physical activity. May

2011;Available from:URL:http://www.noo.org.uk.uploads/doc/vid-11171-

attitudes.pdf.

13. Bress .H. Marcus, Leg Ann .H.Forsyth. Physical activity intervention using

mass media, print media and information technology. Available

from :URL:http://www.knowledge transilation.ca/syerv/articles

project2/marus%2520.

14. 14.Physical activity fundamental to preventing disease .Cited June 20

2002 ;Avialable from :URL:http://www.aspe.hbs.gov/health/reports/ physical

activity.

15. 15.Global school health survey-WHO.2007. Triniand report ;Available

from :URL:www.who.int./chip/ Trinidad-GSHS-report-2007.pdf

16. Bharways, Misra, Khurana. Childhood obesity in Asian Indians; Available

from:URL:http://www.ncbi.nlm.gov/pubmed /18296330.

17. Akhil Kant Singh, Ankit Maheswari, Nidhi Sharma , K.Anand. Life style

associated risk factors in adolescents; Available

from:URL:www.medind.nic.in/icb/to6/i10/icbto6i/op901.pdf.

20

18. D.Narayappa, H.S.Rajani,K.B Mahendrappa. Prevalence of hypertension and

pre hypertension among school going children. Karnataka pediatric

journal .vol.25, no.3,4:July –December 2011. Available from:URL:

http://www.japkarnataka.org/c /document_library/get_file%3D9d237da0.4bdf

19. Jill Armayor . Statictics of physical activity. August 11 2011; Available

from:URL:http://www.livestrong.com/article/345926_statistics_of_physical_a

ctvities/#ixzl2bej.

20. Irene Alton. The overweight adolescent .National health and nutrition

examination survey(NHANES). 1999-2000;Available from

:URL:http://www.epi.umn.edu/let/pubs/img/adol-ch7.pdf.

21. Non communicable disease in adolescents. Astrazeneca –young –health

programmen ;Available

from:URL:http://www.jhsph.edu/research/centre_and_institute/centre

_for_adolescent.

22. Gupta .N.Goel, K.Shas , Misra. Child obesity in developing countries;

epidemiology , determinants and prevention. Department of pediatrics ,

children’s hospital of Michagin. Detroit .USA;Available

from:URL:http://www.ncbi.nlm.nib.gov/pubmed 12240243.

23. Avinash Sharma, NeelamGrover, Shayam Kausik. Prevalence of hypertension

in shool children in Shimla. Indian pediatric.2010 ot:47 (10): 873-6 Epub ,

2010 Jan15.

24. .Sumathi ,Swaminathan, Tinku Thomas .Longitudinal trends in physical

activity in selected urban South Indian school children.st. jhon’s national

academy of health science Bangalore.India . Indian J Med Res 134, August,

2011 .

21

25. 25.Factors affecting prevalence of over weight in 12 to 17 years old urban

adolescent in Hyderabad. 2007 July;73(8): Available from:

URL:http://www.ncbi.nlm.ncbi.gov .

26. Cleland .V.Crawford.D, Baus CA. A prospective examination of children’s

time spent out door measured physical activity and overweight. Centre for

activity and nutrition research. Deakin university, 221. Barwood Hwy.

Barwood , Victoria. Australia .

27. Patrick Norman GJ, Cailfas KJ ,Sallis JF, Zabinski MF, Rupp J, Cella J. Diet,

physical activity and sedentary behaviour as risk factor for overweight in

adolescence. University of California , Sandiago state university –Arch

pediatric adolesc Med ; 2004 Apr.158(4).

28. Leary SD, Ness AR, Smith GD, Mattocks C, Dcere K, Blair SN, Riddoh C .

Physical activity and blood pressure in childhood: finding from a population

based study. Department of oral and dental science. University of Bristol UK.

Hypertension :2008 Jan; 51(1).

29. Mark .S.Tremblay , Allana gle Blane , Michellae and Kho, Travis J Saunder ,

Richard , Rachel C Colley, Gray Gold Field , Sarah .C. Gorber. Systematic

review of sedentary behaviour and health indicators in school aged children

and youth. Available from: URL: http://www.ljbnpa.org/content/8/1/98.

30. Jain .S. Pant , Chopra .H, Tiwary R. Obesity among adolescent of affluent

public schools in Meerut. Indian public health ; 2011 July-September 54(3).

31. . S. kumar , D.K Mahabalraj, MS Anuroopa .Prevalence of obesity and its

influencing factors among affluent schools in Davangere city. Jcm January

issue -07by joshy .ind.

22

32. self reported knowledge and patterns of physical activity among male school

student and their teachers in Al Khobar , Saudi Arabia; Available

from :URL:http://www.jfemonline.com/article.asp?ssn.

33. Effects of multimedia computer-assisted instruction(MCAI) on academic

achievement in physical education of Greek primary students. Interactive

Educational Multimedia, Number 10 (April 2005), pp.61-77; Available from :

URL: http://www.ub.edu/multimedia/iem

23