Active Video Games in Schools and Effects on Physical Activity and Health: A Systematic Review

Effects of Exergaming on executive function and motor ability in children: A systematic review and meta-analysis

This study aimed to evaluate the effectiveness of Exergaming in improving executive function and motor ability across different groups of children and adolescents. We searched several databases, including PsycINFO, Web of Science, Embase, PubMed, SPORT Discus, Scopus, and the Cochrane Central Register of Controlled Trials, for randomized controlled trial (RCT) studies published from inception until November 25, 2023, to identify studies investigating the effect of Exergaming on motor and executive function in children. The protocol was registered with PROSPERO (CRD42023482281). A total of 37 randomized controlled trials were included in this study. Our results indicate that Exergaming can influence children's cognitive flexibility [SMD = 0.34, 95%CI(0.13,0.55), I2 = 0.0%, P = 0.738], inhibition control [SMD = 0.51, 95%CI (0.30,0.72), I2 = 0.0%, P = 0.473], global cognitive [SMD = 0.87, 95%CI (0.50,1.23), I2 = 0.0%, P = 0.974], working memory [SMD = 0.18, 95%CI(-0.16, 0.52), I2 = 46.5%, P = 0.096], gross motor skills [SMD = 0.82, 95%CI (0.30, 1.35), I2 = 79.1%, P<0.001], fine motor skills [SMD = 0.71, 95%CI (0.22,1.21), I2 = 78.7%, P<0.001], balance [SMD = 0.61, 95%CI (0.34, 0.88), I2 = 59.5%, P = 0.001], and cardiorespiratory [SMD = 0.48, 95%CI (0.16, 0.79), I2 = 58.4%, P = 0.019]. While these findings suggest that Exergaming can promote children's cognitive flexibility, inhibitory control, global cognition and motor abilities, the effect on working memory was not statistically significant. Further high-quality randomized controlled trials are warranted to explore the potential benefits of Exergaming for different groups of children, including those with specific needs.

Motion-based technology to support motor skills screening in developing children: A scoping review

BACKGROUND

Acquiring motor skills is fundamental for children's development since it is linked to cognitive development. However, access to early detection of motor development delays is limited.

AIM

This review explores the use and potential of motion-based technology (MBT) as a complement to support and increase access to motor screening in developing children.

METHODS

Six databases were searched following the PRISMA guidelines to search, select, and assess relevant works where MBT recognised the execution of children's motor skills.

RESULTS

164 studies were analysed to understand the type of MBT used, the motor skills detected, the purpose of using MBT and the age group targeted.

CONCLUSIONS

There is a gap in the literature aiming to integrate MBT in motor skills development screening and assessment processes. Depth sensors are the prevailing technology offering the largest detection range for children from age 2. Nonetheless, the motor skills detected by MBT represent about half of the motor skills usually observed to screen and assess motor development. Overall, research in this field is underexplored. The use of multimodal approaches, combining various motion-based sensors, may support professionals in the health domain and increase access to early detection programmes.

Digital interventions to moderate physical inactivity and/or nutrition in young people: a Cancer Prevention Europe overview of systematic reviews

Background

Strategies to increase physical activity (PA) and improve nutrition would contribute to substantial health benefits in the population, including reducing the risk of several types of cancers. The increasing accessibility of digital technologies mean that these tools could potentially facilitate the improvement of health behaviours among young people.

Objective

We conducted a review of systematic reviews to assess the available evidence on digital interventions aimed at increasing physical activity and good nutrition in sub-populations of young people (school-aged children, college/university students, young adults only (over 18 years) and both adolescent and young adults (<25 years)).

Methods

Searches for systematic reviews were conducted across relevant databases including KSR Evidence (www.ksrevidence.com), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE; CRD). Records were independently screened by title and abstract by two reviewers and those deemed eligible were obtained for full text screening. Risk of bias (RoB) was assessed with the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool. We employed a narrative analysis and developed evidence gap maps.

Results

Twenty-four reviews were included with at least one for each sub-population and employing a range of digital interventions. The quality of evidence was limited with only one of the 24 of reviews overall judged as low RoB. Definitions of "digital intervention" greatly varied across systematic reviews with some reported interventions fitting into more than one category (i.e., an internet intervention could also be a mobile phone or computer intervention), however definitions as reported in the relevant reviews were used. No reviews reported cancer incidence or related outcomes. Available evidence was limited both by sub-population and type of intervention, but evidence was most pronounced in school-aged children. In school-aged children eHealth interventions, defined as school-based programmes delivered by the internet, computers, tablets, mobile technology, or tele-health methods, improved outcomes. Accelerometer-measured (Standardised Mean Difference [SMD] 0.33, 95% Confidence Interval [CI]: 0.05 to 0.61) and self-reported (SMD: 0.14, 95% CI: 0.05 to 0.23) PA increased, as did fruit and vegetable intake (SMD: 0.11, 95% CI: 0.03 to 0.19) (review rated as low RoB, minimal to considerable heterogeneity across results). No difference was reported for consumption of fat post-intervention (SMD: -0.06, 95% CI: -0.15 to 0.03) or sugar sweetened beverages(SSB) and snack consumption combined post-intervention (SMD: -0.02, 95% CI:-0.10 to 0.06),or at the follow up (studies reported 2 weeks to 36 months follow-up) after the intervention (SMD:-0.06, 95% CI: -0.15 to 0.03) (review rated low ROB, minimal to substantial heterogeneity across results). Smartphone based interventions utilising Short Messaging Service (SMS), app or combined approaches also improved PA measured using objective and subjective methods (SMD: 0.44, 95% CI: 0.11 to 0.77) when compared to controls, with increases in total PA [weighted mean difference (WMD) 32.35 min per day, 95% CI: 10.36 to 54.33] and in daily steps (WMD: 1,185, 95% CI: 303 to 2,068) (review rated as high RoB, moderate to substantial heterogeneity across results). For all results, interpretation has limitations in terms of RoB and presence of unexplained heterogeneity.

Conclusions

This review of reviews has identified limited evidence that suggests some potential for digital interventions to increase PA and, to lesser extent, improve nutrition in school-aged children. However, effects can be small and based on less robust evidence. The body of evidence is characterised by a considerable level of heterogeneity, unclear/overlapping populations and intervention definitions, and a low methodological quality of systematic reviews. The heterogeneity across studies is further complicated when the age (older vs. more recent), interactivity (feedback/survey vs. no/less feedback/surveys), and accessibility (type of device) of the digital intervention is considered. This underscores the difficulty in synthesising evidence in a field with rapidly evolving technology and the resulting challenges in recommending the use of digital technology in public health. There is an urgent need for further research using contemporary technology and appropriate methods.

Active Video Game Interventions Targeting Physical Activity Behaviors: Systematic Review and Meta-analysis

BACKGROUND

Research on digital games designed to increase physical activity (PA), also known as exergames or active video games (AVGs), has proliferated over the past 2 decades. As a result, reviews of literature in this field can become outdated, revealing the need for updated high-quality reviews that identify overarching insights. Furthermore, given the significant heterogeneity in AVG research, study inclusion criteria may significantly influence conclusions. To the best of our knowledge, no prior systematic review or meta-analysis has specifically focused on studies of longitudinal AVG interventions targeting increases in PA behaviors.

OBJECTIVE

The aim of this study was to obtain insights into when and why longitudinal AVG interventions are more or less successful for sustained increases in PA, especially for public health.

METHODS

Six databases (PubMed, PsycINFO, SPORTDiscus, MEDLINE, Web of Science, and Google Scholar) were reviewed until December 31, 2020. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, randomized controlled trials had to prominently (>50% of intervention) feature AVG technology, involve repeated AVG exposure, and target changes in PA behavior. Experimental designs had to include ≥2 within- or between-participant conditions with ≥10 participants per condition.

RESULTS

A total of 25 studies published in English between 1996 and 2020 were identified, with 19 studies providing sufficient data for inclusion in the meta-analysis. Our findings indicated that AVG interventions had a moderately positive effect, thereby increasing overall PA (Hedges g=0.525, 95% CI 0.322-0.728). Our analysis showed substantial heterogeneity (I²=87.7%; Q=154.1). The main findings were consistent across all subgroup analyses. The comparison between PA assessment type groups showed a moderate effect for objective measures (Hedges g=0.586, 95% CI 0.321-0.852) and a small effect for subjective measures (Hedges g=0.301, 95% CI 0.049-0.554) but no significant difference between the groups (P=.13). The platform subgroup analysis indicated a moderate effect for stepping devices (Hedges g=0.303, 95% CI 0.110-0.496), combination of handheld and body-sensing devices (Hedges g=0.512, 95% CI 0.288-0.736), and other devices (Hedges g=0.694, 95% CI 0.350-1.039). The type of control group showed a wide range of effects sizes, ranging from a small effect size (Hedges g=0.370, 95% CI 0.212-0.527) for the passive control group (nothing) to a moderate effect size for the conventional PA intervention group (Hedges g=0.693, 95% CI 0.107-1.279) and ultimately to a large effect size for sedentary game as control groups (Hedges g=0.932, 95% CI 0.043-1.821). There was no significant difference among the groups (P=.29).

CONCLUSIONS

AVGs represent a promising tool for PA promotion among the general population and clinical subpopulations. However, significant variabilities in AVG quality, study design, and impact were also detected. Suggestions for improving AVG interventions and related research will be discussed.

TRIAL REGISTRATION

PROSPERO CRD42020204191; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=204191.

Large Estimate Variations in Assessed Energy Expenditure and Physical Activity Levels during Active Virtual Reality Gaming: A Short Report

The purpose of the study was to compare methods for estimating energy expenditure (EE) and physical activity (PA) intensity during a 30 min session of active virtual reality (VR) gaming. Eight individuals (age = 25.4 ± 2.0 yrs) participated, with a maximal oxygen consumption (VO2max) of 41.3 ± 5.7 mL∙kg−1∙min−1. All tests were conducted over two days. An incremental test to determine the VO2max when running was performed on day 1, while 30 min of active VR gaming was performed on day 2. The instruments used for EE estimations and PA measurements were indirect calorimetry, a heart rate (HR) monitor, and waist- and wrist-worn accelerometer. Compared to indirect calorimetry, waist-worn accelerometers underestimated EE (mean difference: −157.3 ± 55.9 kcal, p < 0.01) and PA levels. HR-based equations overestimated EE (mean difference: 114.8 ± 39.0 kcal, p < 0.01 and mean difference: 141.0 ± 81.6 kcal, p < 0.01). The wrist-worn accelerometer was the most accurate in estimating EE (mean difference: 23.9 ± 45.4 kcal, p = 0.95). The large variations in EE have implications for population-based surveillance of PA levels and for clinical studies using active VR gaming.

Testing the Mystic School Mobile Application to Promote Active Commuting to School in Spanish Adolescents: The PACO Study

Active commuting to and/or from school (ACS) is an opportunity to increase daily physical activity (PA) levels in young people. Mobile-device interventions focused on promoting the practice of health-related PA can be more cost-effective than traditional interventions in this population.

OBJECTIVE

To analyze the adolescents' opinion of the mobile application (app) Mystic School, which was designed to promote ACS in Spanish adolescents.

METHODS

A total of 44 students (14-15 years old) from Granada and Jaén participated in the test of the Mystic School app during two phases: phase 1 (n = 10) for 2 weeks and phase 2 (n = 34) for 1 month. Each phase included an app presentation, a follow-up, and focus group sessions. The qualitative analysis was carried out through NVivo software.

RESULTS

In phase 1, adolescents reported improvements in the design and functioning, such as the avatar movement, virtual steps utilities, and multiplayer function. These suggestions were included in phase 2. After phase 2, adolescents reported that it is important to add the possibility of playing without an Internet connection to the game, to include more competitive options, prizes, and to increase the difficulty of the levels. In both phases, problems with the step number counting remained.

CONCLUSION

The Mystic School app can be a useful tool for the physical education teacher to integrate the content from this curriculum related to the promotion of PA, such as ACS.

Active video game on children and adolescents' physical activity and weight management: A network meta-analysis

We synthesized evidence on the effectiveness of active video games (AVGs) versus no AVG-applied comparators on various physical activity (PA) levels and weight management outcomes in children and adolescents. We analyzed the comparative evidence on different sub-categories of AVGs and ranking the best option. An overview of systematic reviews (SRs) and network meta-analysis (NMA) (PROSPERO: CRD42021248499) was employed. A search for relevant literature published in English was conducted in six electronic databases from their inception until April 2021. SRs consisting of randomized control trials (RCTs) and satisfying our PICOS inclusion criteria were included. RCTs included were a comparison of groups among children and adolescents between 6 and 21, where groups with AVG interventions were compared with groups without them. Direct head-to-head pairwise meta-analyses were conducted using weighted mean difference between the two groups, and the comparative effectiveness of different sub-categories of AVGs was analyzed indirectly using NMA. Overall, 17 SRs were identified from the 6036 screened citations. Of these, 350 citations were retrieved, and 12 RCTs were finally included. Compared with no AVG group, AVG groups were shown to be more effective in achieving vigorous, moderate-to-vigorous, and moderate PA levels, and decreased BMI and body fat. NMA showed that rhythmic dance games had the highest probability of being the most effective sub-category for reducing BMI. AVGs are effective in attaining vigorous, moderate to vigorous, and moderate PA levels, and reducing BMI and body fat among children and adolescents. Dance appears to be the best option for reducing BMI among AVG subcategories.

Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial

This study aimed to investigate the effects of a school-based exergame intervention on anthropometric parameters and physical fitness. Fifty-eight students (10.4 ± 0.8 years; 48% girls) were randomized into an intervention (IG) and a control (CG) group. Both groups participated in regular physical education classes during the three-month intervention period. The IG additionally received a 20-minute exergame intervention twice per week. At baseline and following the intervention period, body mass index (BMI) and waist-to-height ratio (WHtR) were assessed. Furthermore, a sprint test (ST), a countermovement jump test (CMJ), and a shuttle run test (SRT) were performed. Due to prescribed quarantine measures, only 34 students (18 IG; 16 CG) were included in the final analysis. A significant group−time interaction was determined in CMJ performance (p < 0.001; η2 = 0.403), with a significant increase (+2.6 ± 2.4 cm; p < 0.001; η2 = 0.315) in the IG and a significant decrease (−2.0 ± 3.1 cm; p = 0.009; η2 = 0.190) in the CG. Furthermore, ST performance significantly improved in the IG (−0.03 ± 0.08 s; p = 0.012; η2 = 0.180) but not in the CG (0.13 ± 0.16 s; p = 0.460; η2 = 0.017), revealing significant interaction effects (p = 0.02; η2 = 0.157). Significant group−time interaction was observed for the SRT (p = 0.046; η2 = 0.122), with a significant increase (+87.8 ± 98.9 m; p = 0.028; η2 = 0.147) in the IG and no changes (−29.4 ± 219.7 m; p = 0.485; η2 = 0.016) in the CG. Concerning BMI (p = 0.157; η2 = 0.063) and WHtR (p = 0.063; η2 = 0.114), no significant interaction effects were detected. School-based exergaming is a suitable tool to influence students’ physical fitness positively.

Using motion capture technology to assess locomotor development in children

OBJECTIVE

Motor and cognitive development share biological background within the prefrontal cortex and cerebellum. Monitoring motor development is relevant to identify children at risk of developmental delays. However, access to timely assessment is prevented by its availability and cost. Affordable motion capture technology may provide an alternative to human assessment.

METHODS

MotorSense uses this technology to guide and assess children executing age-related developmental motor tasks. It incorporates advanced heuristics informed by pattern recognition principles based on the developmental sequences of motor skills. MotorSense was evaluated with 16 4-6 year-old children from a rural primary school.

RESULTS

A total of 506 jumps, 2415 steps and 831 hops were analysed. The analysis illustrates MotorSense Accuracy (MA), recognising jump forward (89.96%), jump high (83.34%), jump sideway (85.63%), hop (74.58%) and jog (92.34%), is as good as the sensor's precision. The analysis of the tasks' execution shows a high level of agreement between human and MotorSense's assessment on jump forward (91%), jump high (99%), jump sideway (93%), hop (94%) and jog (92%).

CONCLUSIONS

MotorSense helps address the shortage of affordable technologies to support the assessment of motor development using graded age-related developmental motor tasks. Furthermore, it could contribute towards the tele-detection of motor developmental delays.

E-&mHealth interventions targeting nutrition, physical activity, sedentary behavior, and/or obesity among children: A scoping review of systematic reviews and meta-analyses

Childhood obesity is a public health concern. Electronic and mobile health (e-&mHealth) approaches can facilitate the delivery of interventions for obesity prevention and treatment. Synthesizing reviews of e-&mHealth interventions to improve weight and weight-related behaviors (physical activity, sedentary behavior, and diet) is useful to characterize the current scope of the literature and identify opportunities for future reviews and studies. Using a scoping review methodology, we aimed to evaluate the breadth and methodological quality of systematic reviews and meta-analyses of e-&mHealth interventions targeting weight and weight-related behaviors in children and adolescents aged <19 years. A systematic search of seven databases was conducted, including reviews published between 2000 and 2019. Review characteristics were extracted, and methodological quality was assessed using the AMSTAR 2 tool. Forty-five systematic reviews and meta-analyses were included. All reviews evaluated intervention efficacy (100%), but few assessed other aspects (20% in total) such as cost-effectiveness. Smartphone applications (47%), text messages (44%), and websites (35%) were the main modalities. Weight (60%), physical activity (51%), and diet (44%) were frequently assessed, unlike sedentary behavior (8%). Most reviews were rated as having critically low or low methodological quality (97%). Reviews that identify the effective active ingredients of interventions and explore metrics beyond efficacy are recommended.

The Effects of Active Video Games on Health-Related Physical Fitness and Motor Competence in Children and Adolescents with Healthy Weight: A Systematic Review and Meta-Analysis

(1) Background: Poor levels of physical fitness and motor skills are problems for today's children. Active video games (AVG) could be an attractive strategy to help address them. The aim was to investigate the effects of AVG on health-related physical fitness and motor competence in children and adolescents with healthy weight. (2) Methods: Randomized and non-randomized controlled trials investigating the effects of AVG programs on health-related physical fitness and motor competence were included. Two different quality assessment tools were used to measure the risk of bias. Twenty articles met the inclusion criteria and the variables of interest were body mass index (BMI), body fat, cardiorespiratory fitness (CRF), muscular fitness and motor competence. (3) Results: AVG interventions seem to have benefits in BMI when lasting longer than 18 weeks (SMD, -0.590; 95% IC, -1.071, -0.108) and in CRF (SMD, 0.438; 95% IC, 0.022, 0.855). AVG seems to be a promising tool to improve muscular fitness and motor competence but the effects are still unclear due to the lack of evidence. (4) Conclusions: AVG seem to be an effective tool for improving some components of health-related physical fitness and motor competence in healthy-weight children and adolescents, but the effect on some fitness components needs further research. Therefore, AVG may be included as a strategy to improve health.

Effects of Graded Exergames on Fitness Performance in Elementary School Children With Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) is a common childhood disorder affecting movement and coordination skills, fitness, and academic performance. Increased physical fitness may have a positive influence on physical and mental health outcomes in children with DCD. Yet, little has been done to develop interventions to improve fitness performance in this group. The purpose of this study was to determine the effects of graded exergames in 7 to 12-year-old children with DCD and typically developing (TD) peers. Participants (32 DCD and 28 TD children) received a 30-min training session twice weekly for 10 weeks. Performance on motor coordination (MABC-2 test), balance, aerobic, and anaerobic fitness tests were assessed at the beginning and end of training. In addition, enjoyment and perception of exertion were measured for each participant during the training period. Both children with DCD and TD children significantly improved on motor coordination, balance, aerobic, and anaerobic fitness at the end of the training. A significant Group by Time interaction was observed on the MABC-2 total [F (1, 55) = 13.19; p < 0.001] and balance scores [F (1, 55) = 26.83; p < 0.0001], with the DCD group demonstrating larger improvements than the TD children. Both groups enjoyed the program throughout the training period even though they rated the training to be of high intensity. These findings indicate that graded exergames may serve as potential treatment for impaired fitness in children with DCD. Regular participation in graded exergames in school settings may be needed to enhance and maintain fitness performance in young children with and without DCD.

Active Video Games for Improving Mental Health and Physical Fitness-An Alternative for Children and Adolescents during Social Isolation: An Overview

The aim of this study was to synthesize the evidence on the effects of active video games (AVGs) on mental health, physical fitness and body composition of children and adolescents. A search was conducted in the following databases: PubMed; MEDLINE (by Ovid); SportDiscus, Cochrane library systematic reviews (CENTRAL) and EMBASE with no language restrictions during October 2020. Reviews on the use of AVGs were included in the study. We use the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) scale to analyze the methodological quality of the studies. Seventeen systematic reviews and meta-analyzes were included on the effects of AVGs with 30 to 4728 children and adolescents of both sexes with ages ranging from 6 to 19 years. In five studies, the population was overweight or obese. Regarding the quality, 12 studies were of moderate quality, two had high quality, two had low quality and one showed very low quality. The analyzed data indicate that the use of AVGs with a frequency of 1 to 3 times a week with durations of between 10 and 90 min per day shows positive effects on mental health and physical functioning. There was moderate quality evidence that AVGs can result in benefits for self-esteem, increased energy expenditure, physical activity and reduced body mass index in children and adolescents who used AVGs in the home environment. Further research is needed on this tool to help in the process of social isolation and consequently in promoting health and well-being.

Physical Therapy Management of Children With Developmental Coordination Disorder: An Evidence-Based Clinical Practice Guideline From the Academy of Pediatric Physical Therapy of the American Physical Therapy Association

BACKGROUND

Developmental coordination disorder (DCD), classified as a neurodevelopmental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), affects approximately 5% to 6% of school-aged children. Characteristics of DCD include poor motor coordination and delayed development of motor skills, not explained by other conditions. Motor deficits negatively affect school productivity, performance in activities of daily living, and recreation participation. Children with coordination problems, at risk for or diagnosed with DCD, should be evaluated by a team of professionals, including a physical therapist (PT).

PURPOSE

This clinical practice guideline (CPG) provides management strategies for PTs and informs clinicians and families about DCD. It links 13 action statements with specific levels of evidence through critical appraisal of the literature and provides recommendations for implementation.

RESULTS/CONCLUSIONS

The DCD CPG addresses examination, referral, first choice and supplemental interventions, discharge, compliance audits, implementation, and research recommendations. Supplemental tools are provided to support PT management.

School-Based Interventions for Promoting Physical Activity Using Games and Gamification: A Systematic Review Protocol

Games and/or gamification seem to be a promising area for educational and health research. These strategies are being increasingly used for improving health indicators, even in educational settings; however, there is little information about these terms within the school to promote physical activity (PA). Objective: the aim of this study is to describe a systematic review protocol of school-based interventions for promoting PA in pre-schoolers, children, and adolescent students using games and gamification. Methods: This review protocol is registered in International prospective register of systematic reviews (PROSPERO) (CRD42019123521). Scientific databases include PubMed, Web of Science, SportDiscus, Cochrane Library, ERIC, and PsycINFO. A standardized procedure will be executed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol (PRISMA-P) checklist for conducting systematic review protocols and the PICOS (Population, Interventions, Comparators, Outcomes, and Study design) tool to address an appropriate search strategy. Detailed information will be extracted, including a quantitative assessment using effect sizes to compare the interventions and a qualitative assessment using the Evaluation of Public Health Practice Projects (EPHPP) tool. Conclusion: This systematic review protocol contributes to establishing future systematic reviews using games and gamification strategies in school settings in order to examine their effect on PA outcomes among youth. Additionally, an update and clarification on the different terms in the school context have been included.

Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years

IMPORTANCE

Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth.

OBJECTIVE

This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community.

METHOD

The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research.

RESULTS

One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners.

CONCLUSIONS AND RECOMMENDATIONS

On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence.

WHAT THIS ARTICLE ADDS

When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.

Effect of practice exergames on the mood states and self-esteem of elementary school boys and girls during physical education classes: A cluster-randomized controlled natural experiment

Reduced physical exercise can impact children's mental health. Use of active electronic games can help promote psychological health. Physical education (PE class) uses different resources, methods, and contents to promote student health. We investigated the effect of exergames on the mood and self-esteem of children and compare it that of with traditional PE classes. From a sample of 213 children (7-11 years old), 140 from 10 classes of the fourth and fifth grades of elementary school (59 boys, 81 girls; mean age 9.41±0.48 years), allocated to an experimental group (EG; n = 68; five clusters) and a PE group (PE; n = 72; five clusters), participated in this experimental controlled study. The EG practiced exergames during three 40-minute classes, and the PE group held three routine curricular PE classes. Brunel's Mood Scale and Rosenberg's Self-Esteem Scale were applied. Repeated measures ANOVA identified differences between sexes and groups. The main results of the EG demonstrated reduced tension in girls (p <0.05; ES: 0.62; 95% CI: 0.17-1.05). Regarding sex comparisons, anger was lower in girls (F: 4.57; p <0.05; ES: 0.61; 95% CI: 0.11-1.11) in the EG. Vigor was higher in girls in the EG than in those in the PE group (F: 5.46; p <0.05; ES: 0.56; 95% CI: 0.12-1.01). The main results of the PE group indicated increased self-esteem in boys (p <0.05; ES: 0.58; 95% CI: 0.08-1.07) and reduction of girls' mental confusion (p <0.05; ES 0.58; 95% CI 0.15-1.06). Thus, exergames impact boys' and girls' self-esteem and mood, as well as traditional physical education classes. Further study on exergames in schools is essential, with long-term effects on physical and mental health. Exergames bring interesting, varied content, technology, and innovation that can increase the attractiveness of physical education.

Prevention of Childhood Obesity: A Position Paper of the Global Federation of International Societies of Paediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN)

Global childhood obesity increased more than 8-fold over 40 years, inducing a very large personal, societal, and economic burden. Effects of available treatments are less than satisfactory; therefore, effective prevention is of high priority. In this narrative review, we explore preventive opportunities. The available evidence indicates large benefits of improving nutrition and lifestyle during early life, such as promoting breast-feeding and improving the quality of infant and early childhood feeding. Promoting healthy eating patterns and limiting sugar-containing beverage consumption from early childhood onwards are of great benefit. Regular physical activity and limited sedentary lifestyle and screen time alone have limited effects but are valuable elements in effective multicomponent strategies. The home environment is important, particularly for young children, and can be improved by educating and empowering families. School- and community-based interventions can be effective, such as installing water fountains, improving cafeteria menus, and facilitating regular physical activity. Reducing obesogenic risk factors through societal standards is essential for effective prevention and limiting socioeconomic disparity; these may comprise food, drink, and physical activity standards for day cares and schools, general food quality standards, front-of-pack food labeling, taxation of unhealthy foods, restriction of food advertisements to children, and others. Effective prevention of childhood obesity is not achieved by single interventions but by integrated multicomponent approaches involving multiple stakeholders that address children, families, and societal standards. Pediatricians and their organizations should be proactive in supporting and empowering families to support their children's health, and in promoting societal measures that protect children.

Trends in Sedentary Behavior, Physical Activity, and Motivation during a Classroom-Based Active Video Game Program

The purpose of this preliminary study was to investigate trends in children's sedentary behavior (SB), physical activity (PA), and motivation during a 12 week classroom-based Active Video Game (AVG) program. A sample of 16 children, recruited from an elementary school, participated in AVG for 30 minutes per school day for 12 consecutive weeks. School day time in SB and PA, in addition to step counts, were assessed across 12 weeks using accelerometers and motivation was assessed via questionnaires. Mixed effects models with a quadratic time parameter were employed to examine time trends. A significant negative trend was observed for SB, while light and vigorous PA and step counts yielded positive trends until approximately 8-9 weeks where a quadratic inflection point was observed (p < 0.001). Regarding motivational variables, enjoyment and social support from teachers significantly increased across 12 weeks (p < 0.05). A 12 week classroom AVG program yielded a positive trend in school day light and vigorous PA and step counts, and a negative trend in SB until 8-9 weeks into the program. This study supports the use of low-cost classroom-based AVG programs to improve children's physical and mental health, but favorable PA trends were attenuated past 8-9 weeks.

Impact of Exergaming on Children's Motor Skill Competence and Health-Related Fitness: A Quasi-Experimental Study

This study was designed to examine the effectiveness of a combined exergaming and physical education (PE) program on children's motor skill competence (MSC) and health-related fitness (HRF) as compared to traditional PE. A total of 261 second- and third-grade children (127 boys; 8.25 ± 0.66 years for male; 8.29 ± 0.74 years for female; 73.6% non-Hispanic white) participated in the nine-month study from 2012 to 2013. Children were assigned to one of the two groups: (a) intervention group (125 min of alternating PE and exergaming weekly); and (b) comparison group (125-min weekly PE). MSC was assessed via product scores in two locomotor and two object control skills. HRF included the cardiorespiratory fitness, musculoskeletal fitness, and body mass index (BMI). A multivariate analysis of variance (MANOVA) was performed to analyze the effect of the combined exergaming⁻PE program on children's MSC and HRF. There were significant group by time interaction effects for BMI, p < 0.01, η² = 0.20; musculoskeletal fitness, p < 0.01, η² = 0.13; and object control skills (the comparison group demonstrating greater improvement), p = 0.01, η² = 0.03. The findings suggest that the combined exergaming program can have a positive effect on children's BMI and musculoskeletal fitness, indicating that exergaming can be an alternative school-based program to supplement traditional PE.

Differences in Step Counts, Motor Competence, and Enjoyment Between an Exergaming Group and a Non-Exergaming Group

OBJECTIVE

The purpose of this study was to examine the effect of an exergaming program on physical activity, motor competence, and enjoyment in preschool children.

MATERIALS AND METHODS

A sample of 65 preschool children was recruited from an urban preschool located in the Western United States. Children were randomly assigned to either an exergaming (n = 36) or a free-play group (n = 29). The intervention was 30 min/day, 5 days/week for 12 weeks for both groups, and all outcome variables were measured once during the final week of the intervention. The exergaming program included three active videogames: GoNoodles, Adventure to Fitness, and Cosmic Kids Yoga. Children in the free-play group were offered a variety of sport activities. School-day step counts were recorded using pedometers, motor competence was assessed by the Test for Gross Motor Development-Edition 3 (TGMD-3), and enjoyment was accessed using one subscale of the Intrinsic Motivational Inventory. A 2 × 2 multivariate analysis of variance (MANOVA) test was employed to examine the differences between sexes and groups on the outcome variables.

RESULTS

The omnibus MANOVA yielded a statistically significant multivariate group main effect (F = 3.71, P = 0.016). Follow-up tests revealed statistically significant differences between groups on average school step counts (mean difference = 785 steps, P = 0.003, d = 0.68) and total TGMD-3 scores (mean difference = 8.7, P = 0.019, d = 0.51), with the exergaming group displaying higher mean scores compared with the free-play group.

CONCLUSION

Young children who were randomly assigned to the exergaming group demonstrated higher school-day step counts and higher motor competence levels compared with the free-play group. These results support the use of this modality in childcare settings.

Physically Active Lessons Improve Lesson Activity and On-Task Behavior: A Cluster-Randomized Controlled Trial of the "Virtual Traveller" Intervention

BACKGROUND

Physically active lessons have not often been assessed with randomized controlled trials.

AIMS

Evaluate the effects of the "Virtual Traveller" (VT) intervention delivered using classroom interactive whiteboards on physical activity, on-task behavior, and student engagement.

METHODS

Participants were 219 children aged 8 to 9 years from 10 schools in Greater London, assessed in a cluster-randomized controlled trial between March 2015 and May 2016. For 6 weeks, intervention children received 10-minute VT sessions three times a week during math and English lessons (VT group: n = 113). Children in control schools received regular teaching (COM group: n = 106). Outcomes were school-day, weekend-day, and lesson-time sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), and on-task behavior and student engagement, assessed at baseline (T0), 2 weeks (T1), and 4 weeks (T2) during the VT intervention and 1 week (T3) and 3 months (T4) postintervention using multilevel modeling.

RESULTS

VT pupils engaged in significantly more school-day MVPA at T1 only, with no other significant differences between groups in overall school-day or weekend-day activity. VT pupils engaged in significantly less SB and more MVPA during lesson time than COM pupils. More on-task behavior was shown in VT pupils than COM pupils but there was no difference in student engagement.

DISCUSSION

VT reduced sedentary behavior and increased physical activity during lesson time but not across overall school or weekend days. VT improved on-task behavior but had no effect on student engagement.

CONCLUSION

Physical activity can be integrated into teaching using interactive whiteboards with no detriment to educational outcomes.

Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation

Background

Active video game (AVG) playing, also known as “exergaming,” is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play.

Objective

The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments.

Methods

In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants’ perceived usability.

Results

The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users’ range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as “good,” while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as “excellent.” We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable.

Conclusions

This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller’s potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial.

Trial Registration

ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf)