Impact of exergaming on young children's school day energy expenditure and moderate-to-vigorous physical activity levels

Energy Expenditure Validation of an Exergame Platform: Ring Fit Adventure Use in Adults with Overweight and Obesity

Objective: This study aims at comparing the energy expenditure (EE) and heart rate (HR) data from Ring Fit Adventure (RFA) with those from indirect calorimetry (COSMED) and a heart rate monitor (Polar FT7). A secondary goal is to evaluate self-reported enjoyment and perceived effort levels. Materials and Methods: Thirty participants (age = 21.8 ± 2.2; body mass index = 31.8 ± 4.4) were recruited for two laboratory visits. The first visit involved baseline measurements. In the second visit, participants performed a 55-minute ad libitum exercise session with the RFA in adventure mode with moderate difficulty. During this session, EE, HR, perceived effort, and enjoyment of physical activity were recorded. Results: Although no statistically significant overestimation of EE was found between the RFA and the metabolic cart, two-way analysis of variance results show a main effect of condition (RFA vs. Polar FT7) on HR (122.8 ± 20.1 bpm and 129.0 ± 18.6 bpm; P = 0.007; ᶯp2 = 0.235). Based on comprehensive statistical evaluations, including the mean absolute percent error, intraclass correlations, typical error of measurement, and limits of agreement, the data suggest that the RFA provides reliable estimates for EE and HR. Overall, participants enjoyed the game considerably (71.3 ± 5.9/80 arbitrary units), and their reported perceived exertion was low. Conclusion: This study underscores that the RFA values are relatively accurate and precise, and thus it can be safely suggested for individuals with overweight and obesity to adopt an active lifestyle.

Effects of exergames on student physical education learning in the context of the artificial intelligence era: a meta-analysis

Whether the application of exergames in physical education (PE) courses can significantly improve student performance in PE learning is still controversial. This review explores the promoting effect of exergames on student PE learning and the conditions in which the effect of exergames can be maximized. Based on the PICOS method, two researchers independently searched the ProQuest database, EBSCO database, Web of Science (WoS) database, PubMed database, Chinese National Knowledge Infrastructure (CNKI) database, Wanfang database, and VIP database, evaluated the literature quality using the Cochrane system evaluation manual, and performed a meta-analysis of the included literature. A total of 16 randomized controlled trials involving 2962 subjects were included in this study. The meta-analysis showed that exergames effectively improved student performance in PE learning (SMD = 0.45, 95% CI: 0.27-0.63, P < 0.00001). Subgroup analysis indicated that better results could be achieved when exergames were introduced in small kindergarten classes and continued for 1-2 months.

Impact of a Bedside Activity Device on the Functional Status of Hospitalized Older Adults: A Randomized Controlled Trial

BACKGROUND

Older adults may have difficulty maintaining their functional capabilities during hospitalization. This pilot study aimed to investigate the impact of a bedside activity device on the functional status of hospitalized older adults.

METHODS

For this single-site randomized controlled trial, 48 participants were recruited between July 2019 and March 2021. Participants were randomized into one of two groups: the intervention group, which was given the use of a bedside activity device plus standard care, and the control group, which received standard care. Katz Index of Independence in Activities of Daily Living (Katz ADL) scores and Timed Up and Go (TUG) test times were used as indicators of functional status and were collected on admission (baseline) and at discharge.Mann-Whitney U and χ 2 tests were used to test for baseline similarities between groups. The Wilcoxon signed rank test was used to determine within-group pre-post changes in TUG and Katz ADL scores. The Mann-Whitney U test was used to determine between-group differences in TUG and Katz ADL change scores.

RESULTS

Within-group pre-post analysis showed significant increases in Katz ADL scores in the intervention group and no significant changes in the control group. TUG times decreased significantly in the intervention group and increased significantly in the control group. Between-group analyses showed significant differences in both TUG and Katz ADL change scores.

CONCLUSION

The use of the bedside activity device in addition to standard care may prevent functional decline and increase independence in performing basic ADLs.

Evaluating Changes in Perceived Enjoyment throughout a 12-Week School-Based Exergaming Intervention

This study assessed whether a high-intensity exergame represents an enjoyable training tool for children in the elementary school setting. Furthermore, it evaluated whether gender, body mass index (BMI), waist-to-height ratio (WHtR), fitness level, weekly physical activity level, and general interest in sports moderate perceived enjoyment during the 12-week intervention. Thirty fifth- and sixth-grade students (10.5 ± 0.7 years; 50% girls) participated in this study. During baseline assessments, anthropometric measurements and a shuttle run test were conducted. Throughout the intervention period, the students participated in 15−20-min exergaming sessions (ES) in the ExerCube twice a week during school hours. Enjoyment was assessed after an ES in weeks 2 and 12. Additionally, enjoyment was evaluated after a physical education (PE) class in week 2. The results reveal no significant changes in enjoyment (p = 0.164) over time. The modest changes over time were significantly affected by BMI (p = 0.027), WHtR (p = 0.007), and weekly activity level (p = 0.016). Compared to the PE class, enjoyment was significantly higher during the ES (p < 0.001). None of the covariates showed a significant effect. Mean HR during the ES reached 87.1 ± 1.9% of students’ individual maximum HR. In conclusion, the ExerCube provides a promising tool for schools to promote enjoyable moderate-to-vigorous physical activity.

Exergaming in patients with a left ventricular assist device: a feasibility study

AIMS

Exercise games (exergames) have been recently proposed as a mode of facilitating physical activity in patients with chronic diseases. Although patients supported with left ventricular assist devices (LVADs) benefit from physical activity, specific LVAD-related issues hinder their ability to exercise properly. The objective of this study was to assess the feasibility and safety of exergaming in LVAD-supported patients.

METHODS AND RESULTS

Eleven LVAD-supported patients were enrolled in a 4 week exergaming programme using Nintendo Wii console with five sport games. Patients were instructed to play for 30 min a day, 5 days a week. Data on exercise capacity and exergaming were collected by using the 6 min walk test (6MWT) and a daily self-report diary, respectively. Feasibility of using the console and its safety was assessed by a semi-structured patient interview. Quality of life was assessed by the Minnesota Living with Heart failure Questionnaire (MLHFQ) and the Cantril's Ladder of Life. Safety was assessed by patient's report in interview and diary. The study group consisted of 10 male patients and 1 female patient, mean age of 67 ± 7 years, of whom 10 were supported with the HeartMate 3 LVAD for a median of 10 (interquartile range 3, 21) months. Baseline exercise capacity assessed by the 6MWT ranged from 240 to 570 m (mean 448 ± 112). After 4 weeks of exergaming, 6MWT distance increased from a mean of 448 ± 112 (evaluated in six patients) to 472 ± 113 m (P = 0.023). Patients' Cantril's Ladder of Life score improved numerically from an average of 6.13 to 7.67, as did their MLHFQ score from 45.9 ± 27 to 38.7 ± 18, with higher and lower scores, respectively, reflecting higher quality of life. No specific LVAD-related safety issues regarding exergaming were reported.

CONCLUSIONS

Exergaming was found to be a safe and feasible mode for encouraging physical activity in LVAD-supported patients and carries a potential for improving exercise capacity and quality of life in these patients. Larger scale studies are warranted to further investigate the effect of exergaming in this patient population.

The Effects of Exergames on Physical and Psychological Health in Young Adults

Objective: This study aims to examine the effects of Kinect-based exergaming on physical (balance and reaction time) and psychosocial health factors (mental well-being and subjective happiness level) in young adults. Materials and Methods: A total of 22 men aged between 18 and 40, who play sedentary videogames at least once a week, were randomly divided into 2 groups to participate in either a Kinect-based exergame program (experimental group, n = 11) or to continue playing sedentary videogames without making any changes (control group, n = 11). The Kinect-based exergame program, including three exergames (Kinect Adventure: Reflex Ridge, Dance Central 3, Kinect Sports: Volleyball), was implemented with the experimental group for 5 weeks, three times a week, and 45 minutes per session. Balance and reaction time were assessed using SportKAT® 4000 Kinesthetic Ability Trainer and FitLight Trainer™ devices, respectively. To measure mental well-being and subjective happiness level, scales with proven psychometric qualities, whose validity and reliability studies were conducted, were used. Results: Results of the study showed statistically significant improvement for the experimental group on the measures of reaction time [t(10) = -4.69, P = 0.001], subjective happiness [t(10) = 8.94, P = 0.000], and mental well-being [t(10) = 4.62, P = 0.001]. In addition, the difference between the groups in reaction time [t(20) = 1.66, P = 0.01], right leg static balance [t(20) = -2.96, P = 0.008], mental well-being [t(20) = 2.77, P = 0.012], and subjective happiness levels (U = 0.50, P = 0.000) was found to be statistically significant in favor of the experimental group. Conclusion: The findings suggest that Kinect-based exergaming positively supports adults' reaction time, mental well-being, and subjective happiness.

Digital technology in physical education: a systematic review of research from 2009 to 2020

Digital media is currently one of the defining topics in discussions about schools and teaching. In this context, there has been a wide range of research in physical education (PE) in areas such as health, gamification, and wearable technologies. This raises the question of the goals pursued by empirical studies regarding the use of digital media in PE. The present systematic review provides an overview of the state of research in English and German on the use of digital media in PE. To this end, the included studies were those published between 2009 and 2020 in journals or edited volumes or as dissertations. They were found in relevant databases, selected based on criterion-guided screening, and transferred to the synthesis. Overall, this systematic review presents the possibilities and limitations of digital media in PE and highlights the goals regarding the use of digital media in PE that are pursued by empirical studies in the categories of physical, cognitive, social, affective, and school framework conditions. While benefits from the usage of digital media in PE—such as in terms of motivation or improving sport-specific motor capabilities and skills—were identified, barriers regarding the preparation of PE teachers were also found. More specifically, the benefits of using digital media to achieve PE-related goals were in the foreground in many of the selected studies. However, only a few specifically addressed learning via media, including topics such as data protection and the effect that viewing images has on students’ self-concepts.

Exercise in Obesity-the Role of Technology in Health Services: Can This Approach Work?

PURPOSE OF REVIEW

Physical activity (PA) is an important strategy to prevent and treat obesity. Electronic health (eHealth) interventions, such as wearable activity monitors and smartphone apps, may promote adherence to regular PA and successful weight loss. This review highlights the evidence for eHealth interventions in promoting PA and reducing weight.

RECENT FINDINGS

Wearables can increase PA and are associated with moderate weight loss in middle/older-aged individuals, with less convincing effects long-term (> 1 year) and in younger people. Data for interventions such as mobile phone applications, SMS, and exergaming are less robust. Investigations of all eHealth interventions are often limited by complex, multi-modality study designs, involving concomitant dietary modification, making the independent contribution of each eHealth intervention on body weight challenging to assess. eHealth interventions may promote PA, thereby contributing to weight loss/weight maintenance; however, further evaluation is required for this approach to be adopted into routine clinical practice.

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.

Comparative Study of Risk Profiles for Non-Communicable Diseases in Urban and Suburb Adolescents in Padang City (Indonesia)

Adolescence is when we still like to experiment and often develop bad habits which may lead to non-communicable diseases (NCDs) in the future. This study aimed to understand the lifestyle at risk of non-communicable diseases in adolescents that live in the urban and rural areas of Padang city. This research method is comparative descriptive with a descriptive-analytical approach, with a total sample of 788 people. The study was conducted from March 2019 to November 2019. Results: A total of 57.77% of respondents in urban areas and 69.54% of respondents in rural areas like to eat junk food. 45.35% urban respondents and 60.21% rural respondents like to consume high-sweetened beverages. 73.4% of urban respondents and 7.6% of rural respondents like to smoke. 80.6% of urban respondents and 87.8% of rural respondents lack physical activity. 59.9% of urban respondents and 49.05% of rural respondents do not like to exercise. 67% of urban respondents and 80.2% of rural respondents sleep late at night. Conclusion: The risk behavior of non-communicable diseases in rural adolescents is higher than in urban adolescents. It is recommended that parents, teachers, and health workers work together to carry out intervention activities for healthy lifestyles for all adolescents.

Bidirectional Relationships among Children's Perceived Competence, Motor Skill Competence, Physical Activity, and Cardiorespiratory Fitness across One School Year

Purpose

The bidirectional associations among children's motor skill competence (MSC), perceived competence (PC), physical activity (PA), and cardiorespiratory fitness (CRF) over time remain unanswered. This study is aimed at discerning the bidirectional relationships among elementary school children's MSC, PC, PA and, CRF over the course of one school year.

Methods

A total of 261 second and third grade children (127 boys, 134 girls; mean_age = 8.27 years; BMI = 18.22 ± 3.71) were recruited from two Texas elementary schools. Approximately 73.56% of participants were White American. Children's baseline data were assessed in September/October in 2012 (Time1), and identical assessments were conducted in April/May in 2013 (Time2). MSC was assessed using product-oriented skill tests (e.g., throw, kick, and jump). PC was assessed via the Pictorial Scale of Perceived Competence for Children. Minutes spent in moderate-to-vigorous PA (MVPA) was assessed using ActiGraph GT3X+ accelerometers for five days, and CRF was assessed by the PACER test. Six age- and body mass index-adjusted cross-lagged panel models were used to test the relationships between the variables.

Results

We observed that T1 MSC significantly predicted T2 MSC (β = 0.59; p < 0.01), T2 CRF (β = 0.28; p < 0.01), and T2 MVPA (β = 0.18; p < 0.01). Children's CRF was a positive predictor for T2 CRF (β = 0.56; p < 0.01) and T2 MSC (β = 0.13; p < 0.05) Additionally, T1 MVPA significantly predicted T2 MVPA (β = 0.30; p < 0.01) and T2 PC (β = −0.14; p < 0.05).

Conclusion

Findings suggested a fully bidirectional relationship between elementary children's MSC and CRF. Other bidirectional relationships among the variables were only partially supported. Educators and health professionals need to emphasize the importance of developing both MSC and CRF to maintain physical health over time.

Physiotherapy and related management for childhood obesity: A systematic scoping review

INTRODUCTION

Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.

METHOD

A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.

RESULTS

From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.

CONCLUSION

When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

The Bibliometric Analysis of the Sustainable Influence of Physical Education for University Students

With the awakening of people's health consciousness, the concept and practice of health promotion has become the main target of health policies throughout the world. In this study, the relationship between physical education and health promotion was examined. Art students from a university in Taoyuan were selected for research, and a total of 320 questionnaires were issued. Invalid and incomplete questionnaires were eliminated, with a total of 227 valid questionnaires. Finally, the LISREL (Linear Structural Relations) model was used to analyze the correlation between various factors and health promotion. The results of the model analysis show that in terms of basic fit, the three factors of physical education (course design, teaching content, and activity design) have a high correlation with the influence of physical education, reaching a significant level (t > 1.96, p < 0.05). In terms of influence on sports participation, the three factors (physiological factors, psychological factors, social factors) of sports participation reached a significant level (t > 1.96, p < 0.05). The two factors of health promotion (physiological health, and mental health and practical ideas) have a high correlation with the influence of health promotion, reaching a significant level (t > 1.96, p < 0.05). In terms of overall mode fit, the overall mode fit standard χ2/Df was 1.344, less than the standard value of 3 or less, and the RMR value was 0.007, indicating that the χ2/DF and RMR result standards were appropriate, and the chi-square value was very sensitive to the sample size. Therefore, there was a positive correlation among physical education, sports participation, and health promotion. In conclusion, physical activities can improve the human body's immune function, reduce the symptoms of chronic diseases, and positively promote health. The research result is important for emphasizing the benefit of sports to art students, and provides reference for improving the quality of school physical education, and the physical and mental health level of people in Taiwan.

The Effects of Physical Activity and Exergaming on Motor Skills and Executive Functions in Children with Autism Spectrum Disorder

Objective: This study aims at investigating the effects of two types of interventions, Sports, Play and Active Recreation for Kids (SPARK) and exergaming (Kinect), on motor skills (MS) and executive functions (EF) in children with autism spectrum disorder (ASD). Materials and Methods: Sixty children, aged 6-10 years were randomly assigned to SPARK (n = 20), Kinect (n = 20), or a control group (n = 20). Children's MS and EF were assessed before and after the intervention. The SPARK and Kinect groups participated in an 8-week intervention; the control group received treatment as usual. Intention-to-treat repeated-measures ANOVA was used to examine the effects of the intervention. Results: For MS, a significant group X time interaction was observed for aiming and catching skills [F(2, 53) = 4.12, P < 0.05]; the SPARK group improved significantly from pre- to post-test compared with the other groups. For EF, a main effect of group was found for correct responses [F(2, 53) = 5.43, P < 0.01]. The Kinect group showed more correct responses than the SPARK and control groups. A main effect of time was significant for conceptual responses [F(1, 53) = 10.61, P < 0.01] and perseverative errors [F(1, 53) = 14.31, P < 0.01]. Conclusion: This study suggests that structured physical activity (PA) interventions that target specific MS improve motor function in children with ASD and exergaming could be effective for improving EF. Future research is needed to untangle the interaction between the type of exercise, traditional PA versus exergaming, and the dose associated with improvements in MS and EF in children with ASD.

Feasibility and Effect of the Exergame BOOSTH Introduced to Improve Physical Activity and Health in Children: Protocol for a Randomized Controlled Trial

Background

Despite the well-known beneficial health effects of physical activity (PA), the majority of Dutch primary school children do not meet the recommended PA guidelines. Although there is growing evidence on the effectiveness of exergames for PA in children, there is limited evidence on their effect on health outcomes, such as cardiovascular health and health-related quality of life (HRQOL), and on factors influencing their effectiveness and feasibility. The exergame BOOSTH uses a wrist-worn activity tracker to measure steps per day. As a reward for the performed PA, children can unlock levels in the online BOOSTH game. In addition, “BOOSTH battle” enables competition between groups.

Objective

This protocol describes a cluster randomized controlled trial in 16 primary schools in the Netherlands investigating the effect of BOOSTH on moderate-to-vigorous PA (MVPA) using accelerometry. Secondary aims are to investigate the feasibility of BOOSTH (mixed methods: questionnaires and focus group interviews) and its effect on cardiovascular risk factors (anthropometrics, blood pressure, and retinal microvasculature) and HRQOL.

Methods

Stratification variables and relevant variables related to outcomes (such as BMI [z-score], sex, age, and parenting style) and/or missingness will be taken into account. Measurements will be performed at baseline and after 3, 6, and 12 months.

Results

The study has received funding from Province Limburg (SAS-2015-04956) and received ethical approval from the Medical Ethics Committee of Maastricht University Medical Centre (METC172043/NL64324.068.17). The results of the analyses are expected to be published in 2021.

Conclusions

With this study, the ability of the exergame BOOSTH to increase PA and improve health in children of primary school age will be investigated. The insights into effectiveness and feasibility will result in scientific and societal recommendations, which could potentially contribute to widespread implementation of exergames for children.

Trial Registration

ClinicalTrials.gov NCT03440580; https://clinicaltrials.gov/ct2/show/NCT03440580.

International Registered Report Identifier (IRRID)

DERR1-10.2196/24035

Comparison of College Students' Blood Pressure, Perceived Exertion, and Psychosocial Outcomes During Virtual Reality, Exergaming, and Traditional Exercise: An Exploratory Study

Objective: Integrating novel technologies, such as virtual reality (VR), into traditional exercise apparatuses (e.g., stationary bikes) may assist in promoting physical activity (PA) participation among young adults. Therefore, this study's purpose was to examine young adults' systolic and diastolic blood pressure (BP) change (BP_post - BP_pre), rating of perceived exertion (RPE), enjoyment, and self-efficacy during VR, exergaming, and traditional stationary cycling sessions. Materials and Methods: Forty-nine college students (34 females; M_age = 23.6 ± 3.4 years; M_BMI = 23.8 ± 3.1 kg/m²) participated in three separate 20-minute stationary cycling sessions: (1) PlayStation 4 VR; (2) Xbox 360 exergaming; and (3) traditional stationary cycling. Participants' systolic and diastolic BP change was measured by using an Omron HEM-705CP digital BP cuff. Further, RPE was assessed by using the modified Borg RPE Scale and enjoyment and self-efficacy were evaluated by using validated questionnaires. Results: A multivariate analysis of variance indicated significant differences for systolic BP change, RPE, enjoyment, and self-efficacy between the three cycling sessions (F(2, 144) = 3.3-32.4, P < 0.05, [Formula: see text] = 0.04-0.3). Specifically, participants had significantly higher enjoyment and self-efficacy and lower RPE during VR cycling compared with the other two cycling sessions despite similar or higher change systolic BP during the VR cycling session. There was no statistically significant change in diastolic BP between the three cycling sessions (P > 0.05). Conclusion: Incorporating VR equipment with traditional stationary cycle ergometers may be favorable when seeking to promote enjoyable PA in college students. To further support VR exercise's efficacy, future studies with more rigorous research designs are warranted.

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.

Impact of a Design-Based Bike Exergame on Young Adults' Physical Activity Metrics and Situational Interest

Purpose: Despite the benefits of commercial exergames, in the practical application, players might not be spending sufficient time in physical activity levels compatible with health outcomes. We adopted a design-based exergame approach to build a bike exergame called Greedy Rabbit. The purpose of this study was to identify the impact of Greedy Rabbit on players' physical activity metrics and situational interest. Method: Sixty undergraduate students were assigned to two groups: an experimental group playing Greedy Rabbit (N = 41) and a control group playing a placebo version of Greedy Rabbit (N = 19). The physical activity metrics measured were maximum oxygen consumption, heart rate and cadence. Results: The experimental group reported higher scores for all physical activity metrics and for two dimensions of situational interest (instant enjoyment and attention demand). Furthermore, the physical activity metrics increased more during the exergame for the experimental group, reaching the standard guidelines for vigorous physical activity. Conclusion: This study demonstrated that a design-based bike exergame might be a good option to enhance players' health-related physical activity outcomes and situational interest.

A Systematic Review of Active Video Games on Youth's Body Composition and Physical Activity

In the past decade, active video games (AVGs) have started to find their way into communities, schools, and homes as a possible solution to promote physical activity (PA) and prevent childhood obesity. However, the evidence regarding its effectiveness on body composition and objectively measured PA in youth remains inconclusive. Thus, a systematic review on this topic is needed. This review synthesizes effects of AVGs on body composition and PA in youth. The initial search yielded 260 articles from 10 databases and 18 randomized-controlled trials were included after evaluating against eligibility and removing duplicates. Overall, AVGs showed positive effects in improving body composition and PA in overweight/obese youth as compared to the control conditions with only 2 studies displaying neutral effects on these outcomes as compared to traditional PA or comparison programs. For healthy youth, more than half of the studies (n = 10) demonstrated neutral effects of AVGs on these outcomes whereas only 6 yielded positive effects compared to the control conditions. Further, one study indicated that the control condition observed greater improvement in body composition compared with an AVG intervention in healthy youth. In summary, AVGs are deemed a promising addition to promote PA and health among overweight/obese youth with the goal of fighting childhood obesity.

Improvements in Physical Activity Levels after the Implementation of an Active-Break-Model-Based Program in a Primary School

The aim of this study was to analyze changes in the physical activity levels in students after implementing an active break (AB)-model-based program during the school day. Forty-four fifth-grade primary school children (24 boys, 20 girls, with a mean age = 10.44 ± 0.45) participated in a 17 week program. After intervention, there was an increase in moderate and vigorous total activity during physical education lessons, non-physical education lessons, and recesses. Intervention programs to encourage physical activity and decrease sedentary time are recommended.

Exercise and Type 1 Diabetes

Diabetes mellitus (DM) is the most common endocrine and metabolic disease caused by absolute or insufficient insulin secretion. Under the context of an aging population worldwide, the number of diabetic patients is increasing year by year. Most patients with diabetes have multiple complications that severely threaten their survival and living quality. DM is mainly divided into type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). T1DM is caused by absolute lack of insulin secretion, so the current treatment for T1DM patients is exogenous insulin replacement therapy. At present, exercise therapy has been widely recognized in the prevention and treatment of diabetes, and regular aerobic exercise has become an important part of T1DM treatment. At the same time, exercise therapy is also used in conjunction with other treatments in the prevention and treatment of diabetic complications. However, for patients with T1DM, exercise still has the risk of hypoglycemia or hyperglycemia. T1DM Patients and specialist physician need to fully understand the effects of exercise on metabolism and implement individualized exercise programs. This chapter reviews the related content of exercise and T1DM.

Acute Effects of Immersive Virtual Reality Exercise on Young Adults' Situational Motivation

The development of innovative technology, such as virtual reality (VR), has provided opportunities for promoting physical activity (PA) in a fun and engaging manner. The purpose of this study was to examine differences in young adults' situational motivation (SM) among immersive VR, non-immersive VR, and traditional stationary cycling sessions. In all, 49 healthy college students (35 females; M_age = 23.6 years, SD = 3.4; M_%BF = 24.0%, SD = 7.5) completed three separate 20 min cycling sessions: (1) immersive VR cycling; (2) non-immersive VR cycling; and (3) traditional cycling. Participants' SM was assessed via the situational motivation scale, which included four subconstructs: intrinsic motivation, identified regulation, external regulation, and amotivation. Repeated measures ANOVAs indicated significant differences for situational motivation between cycling sessions (F (2, 96) = 4.74-53.04, p < 0.01, η_p² = 0.090-0.525). Specifically, participants elicited the highest level of intrinsic motivation in immersive VR cycling compared to the other two sessions. Moreover, participants in both immersive VR and traditional cycling showed greater identified regulation than the non-immersive VR session. Furthermore, participants showed greater external regulation compared to the immersive VR session. In addition, greater amotivation was observed in non-immersive VR compared to the immersive VR session. Findings suggested that immersive VR exercise has the potential to be an attractive exercise alternative, possibly promoting greater PA participation and adherence among young adults.

Effects of School-Based Exergaming on Urban Children's Physical Activity and Cardiorespiratory Fitness: A Quasi-Experimental Study

Background: Modern-day technology is appealing to children. Few studies, however, have conducted longitudinal analyses of a school-based exergaming program’s effect on physical activity (PA) behaviors and fitness in children. Therefore, this study examined the longitudinal effect of an 8-month school-based exergaming intervention on children’s objectively-measured PA and cardiorespiratory fitness (CRF). Materials and Methods: Eighty-one fourth grade students (X¯age = 9.23 ± 0.62; 39 girls; 54.3% African American, 30.9% Non-Hispanic White, 14.8% other) participated in this study from 2014–2015. The intervention school’s children participated in a once-weekly 50-min exergaming intervention during recess throughout the school year, while the control school continued regular recess. Children’s in-school PA and sedentary behavior (SB) were measured with ActiGraphGT3X+ accelerometers, with CRF assessed via the half-mile run. All measurements were taken at baseline, mid-intervention (four months) and post-intervention (eight months). Repeated-measures two-way ANCOVAs using age and race as covariates were conducted to examine between-school differences over time for SB, light PA (LPA), moderate-to-vigorous PA (MVPA), and CRF. Results: Significant time by group interactions were observed for LPA, F(1, 79) = 7.82, η² = 0.09, p < 0.01, and MVPA, F(1, 79) = 4.58, η² = 0.06, p < 0.05, as LPA increased among the control group, while MVPA increased among intervention group. Children in both groups experienced decreased SB during the intervention (intervention: −7.63 min; control: −17.59 min), but demonstrated lower CRF over time (intervention: +46.73 s; control: +61.60 s). Conclusions: Observations suggested that school-based exergaming implementation may be effective in increasing children’s MVPA and decreasing their SB over the course an academic year (i.e., ~eight months). More research is needed, however, to discern how modifications to school-based exergaming might also promote improved CRF in children.

Home-Based Exergaming on Preschoolers' Energy Expenditure, Cardiovascular Fitness, Body Mass Index and Cognitive Flexibility: A Randomized Controlled Trial

PURPOSE

The effects of exergaming-based physical activity (PA) interventions on preschoolers' health outcomes and cognition remain largely unexplored. Therefore, we conducted a randomized controlled trial to discern the effectiveness of a home-based educational exergaming intervention on preschoolers' energy expenditure, fitness, body mass index, and cognition.

METHODS

Participants were 32 preschoolers (16 girls; 59.4% Asian; M_age = 4.72, SD = ±0.73) recruited from the Twin Cities area in Minnesota. During baseline testing, we measured preschooler's daily energy expenditure (EE), cardiovascular fitness, body mass index, and cognitive flexibility using validated instruments. Participants were then randomly assigned to one of two conditions: (1) the exergaming intervention condition; or (2) control condition. The intervention program requested children participate in home-based educational exergaming using the LeapTV gaming console for at least 30 min/session 5 times/week. The control condition asked children to maintain regular PA patterns without any exergaming gameplay. Each condition lasted 12 weeks. We conducted identical outcome assessments for all children at baseline and post-intervention.

RESULTS

Analysis of covariance with repeated measures yielded significant time x group interaction effects for cognitive flexibility, Wilks' Lambda = 0.81, F(1, 29) = 6.98, p = 0.01, η² = 0.19, suggesting children in the exergaming group demonstrated significantly greater increases in cognitive flexibility as compared to those in the control group over time. There were no significant differences for time x group changes between the two groups for EE, Wilks' Lambda = 0.92, F(1, 29) = 2.29, p = 0.14, η² = 0.08; cardiovascular fitness, Wilks' Lambda = 0.96, F(1, 29) = 1.07, p = 0.31, η² = 0.04; and BMI, Wilks' Lambda = 0.99, F(1, 29) = 0.05, p = 0.82, η² = 0.01. However, our data did suggest a marginal effect of time for EE, Wilks' Lambda = 0.89, F(1, 29) = 3.26, p = 0.08, η² = 0.08, indicating that children's daily EE increased from baseline to post-intervention.

CONCLUSIONS

Home-based educational exergaming may positively impact cognitive flexibility in preschoolers. Studies with larger sample sizes in multiple geographic locations are needed, with our study suggesting a longer intervention period might also be warranted.

The Effect of Virtual Reality Games on the Gross Motor Skills of Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials

This review aimed to systematically evaluate the rehabilitatitive effect of Virtual Reality Games (VRGs) for gross motor skills of children with cerebral palsy (CP), and to give scientific grounds for the formulation of rehabilitation therapy for these children. To this end, the literature in Chinese databases (CNKI and Wanfang Data) as well as the databases of other countries (Web of Science, PubMed, EBSCOhost, Informit, Scopus, Science Direct and ProQuest) from the establishment dates of these databases to June 3rd 2019 was retrieved in order to collect randomized controlled trials with regard to the intervention effect of VRGs and traditional therapy on gross motor skills of children with CP, and the literature was screened as per inclusion and exclusion criteria. The PEDro scale was then used to evaluate the methodological quality of the included literature, and the software Review Manager 5.3 was employed to analyze the combined effect size. As a result, 7 randomized controlled trials and 234 children with CP were included. Meta-analysis showed that VRGs could improve gross motor skills of children with CP. Combined effect size of gross motor skills SMD = 0.37 [95% CI = (0.06, 0.68), p = 0.02)]. In conclusion, the VRG intervention program can enhance gross motor skills of children with CP to some extent. In view of the limitations regarding methodologies and the quality and quantity of the literature in this research, more quality randomized controlled trials are needed so as to draw convincing conclusions of effect of VRG intervention on gross motor skill development of children with CP in future studies.

Longitudinal Trajectories of Children's Physical Activity and Sedentary Behaviors on Weekdays and Weekends

BACKGROUND

The objective was to examine changes of children's time spent in sedentary, light physical activity, moderate to vigorous physical activity (MVPA), and estimated energy expenditure (EE) rates during weekdays and weekends across 3 years.

METHODS

An initial sample of 261 children's (mean age = 7.81 y) 5-day physical activity and EE were assessed annually via accelerometry across 3 years using repeated-measures multivariate analysis of variance. The outcome variables were time spent in sedentary, light physical activity, MVPA, and kilocalories per day for weekdays and weekends.

RESULTS

A significant decrease in MVPA and EE occurred during weekdays across the 3 years (P = .01). Only the second-year data demonstrated an increase (+2.49 min) in weekend MVPA (P = .04). Children's sedentary time during weekdays increased significantly in years 1 and 2 (P = .01), yet significantly decreased in the third year (-44.31 min). Children's sedentary time during weekends significantly decreased in the first year (-27.31 min), but increased in the following 2 years (P = .01). Children's light physical activity demonstrated a statistically significant increase in year 2 (+3.75 min) during weekdays (P = .05).

CONCLUSIONS

Children's MVPA and EE generally declined during weekdays but were maintained during weekends across a 3-year time span. Children may benefit most from weekday intervention strategies.

Retired Elite Athletes' Physical Activity, Physiological, and Psychosocial Outcomes During Single- and Double-Player Exergaming

McDonough, DJ, Pope, ZC, Zeng, N, Lee, JE, and Gao, Z. Retired elite athletes' physical activity, physiological, and psychosocial outcomes during single- and double-player exergaming. J Strength Cond Res 33(12): 3220-3225, 2019-Elite athletes (i.e., athletes who play sport professionally) are a population who commonly exceed recommended physical activity (PA) guidelines and have higher health statuses compared with the general population. However, elite athletes transitioning into retirement often become physically inactive given they no longer require long hours of training and competition, and their physiological and psychosocial health suffers as a result. Therefore, this study's purpose was to examine differences in retired elite athletes' acute PA, physiological, and psychosocial outcomes during single- and double-player exergaming. Twenty retired Olympic athletes (18 females; (Equation is included in full-text article.)= 27.3 ± 4.3 years) participated in 2 separate 20-minute exergaming sessions (a): Xbox 360 Reflex Ridge single player and (b) Xbox 360 Reflex Ridge double player. Subjects' situational interest, enjoyment, and self-efficacy were examined using validated questionnaires; rating of perceived exertion (RPE) using the modified Borg RPE scale; and moderate-to-vigorous PA, steps, and energy expenditure tracked using ActiGraph GT3X+ accelerometers. Repeated-measures analysis of variances revealed no significant differences for any outcome between the 2 exercise sessions except for RPE (F (1, 38) = 4.6; p < 0.05; η = 0.11), which was higher in the single-player session compared with the double-player session (10.3 ± 2.3; 8.7 ± 1.6, respectively). Observations indicated double-player exergaming to be perceived as less intense than single-player exergaming despite similar PA and physiological outcomes, suggesting retired elite athletes may better adhere to exergaming in a double-player mode.

Effects of Active Video Games on Children's Psychosocial Beliefs and School Day Energy Expenditure

Purpose: Examine the effects of active video games (AVGs) on children's school-day energy expenditure (EE) and physical activity (PA)-related self-efficacy, social support, and outcome expectancy over 9 months. Method: Participants were 81 fourth grade students ( X ¯ age = 9.23 years, SD = 0.62; 39 girls) from two urban Minnesota elementary schools. A once-weekly 50 min AVG intervention was implemented in the intervention school for 9 months in 2014-2015 while the control school continued regular recess. Children's school-day EE (daily caloric expenditure) and mean daily metabolic equivalent (MET) values were estimated via accelerometry whereas self-efficacy, social support, and outcome expectancy were assessed with psychometrically-validated questionnaires. All measures were completed at baseline and at the 4th and 9th months. Results: We observed significant interaction effects for daily caloric expenditure, F(1, 58) = 15.8, p < 0.01, mean daily MET values, F(1, 58) = 11.3, p < 0.01, and outcome expectancy, F(1, 58) = 4.5, p < 0.05. Specifically, intervention children had greater increases in daily caloric expenditure (91 kilocalorie/day post-intervention group difference), with control children decreasing daily caloric expenditure over time. We observed identical trends for mean daily MET values (0.35 METs/day post-intervention group difference). Interestingly, we observed outcome expectancy to increase in the control children, but decrease among intervention children, at post-intervention (1.35 group difference). Finally, we observed a marginally significant interaction effect for social support, F(1, 58) = 3.104, p = 0.08, with an increase and decrease seen in the intervention and control children, respectively. We observed no interaction or main effects for self-efficacy. Discussion: Observations suggested an AVG intervention contributed to longitudinal increases in school-day EE and social support compared to the control condition. Future research should examine how self-efficacy and outcome expectancy might be promoted during school-based AVG interventions.

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.

Interventions for preventing obesity in children

EDITORIAL NOTE

This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024.

BACKGROUND

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review.

OBJECTIVES

To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI.

MAIN RESULTS

We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update.

AUTHORS' CONCLUSIONS

Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.

Are preschool children active enough in Shanghai: an accelerometer-based cross-sectional study

OBJECTIVE

Engaging in physical activity (PA) plays an important role in promoting physical and mental health, but the PA data for Chinese preschool children are lacking. This study aims to objectively assess the PA levels of preschool children in Shanghai, China and to evaluate their PA levels relative to age-specific recommendations.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study was conducted among preschool children in Shanghai, city of China. There were a total of 303 preschool children (boys, 174; girls, 129) recruited from eight kindergarten classes in the Yangpu and Baoshan Districts of Shanghai.

MAIN OUTCOME MEASURES

Daily PA was assessed using ActiGraph GT3X⁺ accelerometers for seven consecutive days. Children were required to have data from at least 2 weekdays and 1 weekend day, with a minimum daily wear time of 480 min to be included in the analysis.

RESULTS

Preschool children in Shanghai accumulated, on average, 70.9 min of moderate-to-vigorous PA (MVPA) and 168.0 min of total PA (TPA) per day (d). Boys engaged in more MVPA and TPA than girls (72.8 min/day vs 68.3 min/day and 171.9 min/day vs 162.9 min/day, respectively). Overall, 72.9% of the participants met the age-specific recommendations of MVPA, while 35.3% met TPA recommendations.

CONCLUSIONS

Findings of this study warn of the insufficiency of PA in Shanghai preschool children, suggesting there is substantial room to improve their PA.

TRIAL REGISTRATION NUMBER

ChiCTR-OOC-15007439; Results.

Effects of Exergaming on Preschoolers' Executive Functions and Perceived Competence: A Pilot Randomized Trial

Purpose: This study aimed to evaluate the effects of a child-centered exergaming program and a traditional teacher-led physical activity (PA) program on preschoolers’ executive functions and perceived competence. Methods: Sixty children aged 4–5 years from an urban childcare center in China completed an 8-week exergaming/traditional PA intervention. After baseline measurements of executive functions and perceived competence (i.e., perceived physical competence and social acceptance), children were randomly assigned to either an exergaming group or traditional PA group (30 children per group). Exergaming and traditional PA programs were offered 20 min/session by trained instructors for 8 weeks. Post-intervention measures were identical to baseline measures. Results: In general, children’s executive functions, perceived physical competence, and perceived social acceptance were enhanced over time. Analysis of variance revealed significant time by group interaction effects for executive functions, F(1, 58) = 12.01, p = 0.01, and perceived social acceptance, F(1, 58) = 6.04, p = 0.02, indicating that the exergaming intervention group displayed significantly greater increases in executive functions and perceived social acceptance in comparison with traditional PA children. In addition, children’s executive functions and perceived physical and social competence significantly improved from baseline to post-intervention. However, there was no significant difference in the increase of children’s perceived physical competence across groups over time. Conclusion: The results suggested exergaming to be beneficial in enhancing young children’s executive functions and perceived social acceptance compared to the traditional PA program. More diverse samples with a longer intervention duration in preschool children in urban areas are warranted.

Effects of exergaming on motor skill competence, perceived competence, and physical activity in preschool children

BACKGROUND

Few school settings offer opportunities for preschool children to engage in structured physical activity, and only a few studies have been conducted examining exergaming's effectiveness on health outcomes in this age group. This study's purpose, therefore, was to examine a school-based exergaming intervention's effect on preschool children's perceived competence (PC), motor skill competence (MSC), and physical activity versus usual care (recess), as well as to examine gender differences for these outcomes.

METHODS

A total of 65 preschool children from 2 underserved urban schools were assigned to 1 of 2 conditions, with the school as the experimental unit: (1) usual care recess group (8 weeks of 100min of recess/week (5 days × 20 min)) and (2) exergaming intervention group (8 weeks of 100min of exergaming/week (5 days × 20 min) at school). All children underwent identical assessments of PC, MSC, and moderate-to-vigorous physical activity (MVPA) at baseline and at the end of the 8th week.

RESULTS

A significant Group × Time effect was observed for MVPA, F(1, 52) = 4.37, p = 0.04, η p 2  = 0.04, but not for PC, F(1, 52) = 0.83, p = 0.37, η p 2  = 0.02, or MSC, F(1, 52) = 0.02, p = 0.88, η p 2  = 0.00. Specifically, the intervention children displayed significantly greater increased MVPA after 8weeks than the comparison children. Additionally, there was a significant time effect for MSC, F(1, 52) = 15.61, p < 0.01, η p 2  = 0.23, and gender effect for MVPA, F(1, 52) = 5.06, p = 0.02, η p 2  = 0.09. Although all preschoolers' MSC improved across time, boys demonstrated greater MVPA than girls at both time points.

CONCLUSION

Exergaming showed a positive effect in promoting preschool children's MVPA at school and has the potential to enhance PC and MSC. More research with larger sample sizes and longer study durations are warranted.

Comparison of College Students' Energy Expenditure, Physical Activity, and Enjoyment during Exergaming and Traditional Exercise

This study evaluated the effects of exergaming on college students’ energy expenditure (EE), moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), rating of perceived exertion (RPE), and enjoyment compared to traditional treadmill exercise, and sex differences. Sixty college students (30 female; X¯_age = 23.6 ± 4.1 years) completed three 20-min exercise sessions on Xbox 360 Kinect Just Dance (Microsoft, Redmond, WA, USA), Xbox 360 Kinect Reflex Ridge (Microsoft, Redmond, WA, USA), and treadmill walking. Their EE and PA were assessed by ActiGraph accelerometers (ActiGraph Co.; Pensacola, FL, USA); RPE every four min; enjoyment via an established scale. Significant exercise-type by sex interaction effects were observed for RPE (p < 0.01): females reported significantly lower RPE during exergaming sessions but significantly higher RPE during treadmill walking. Results revealed significant main effects for all outcomes between exercise sessions (all p < 0.01): treadmill walking resulted in significantly higher metabolic equivalents (METs), MVPA, and EE (p < 0 .01), yet lower LPA (p < 0.01), compared to the two exergaming sessions. Participants’ RPE was significantly higher during treadmill walking than during exergaming sessions, with exergaming eliciting significantly higher enjoyment (all p < 0.01). College students find exergaming more enjoyable and report lower RPE compared to traditional treadmill exercise, though not yet matching the moderate physiological intensity level.

Exergaming for Children and Adolescents: Strengths, Weaknesses, Opportunities and Threats

Exergaming, or active video gaming, has become an emerging trend in fitness, education and health sectors. It is defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). Since exergaming is becoming more popular, claims have been made on the usefulness of exergaming. It has, for example, been entitled as being "the future of fitness" by the American College of Sports Medicine, promoting PA and health in children and adolescents. However, research also suggests that long-term engagement in exergaming is difficult to achieve, and there is a noticeable reservation towards exergaming by parents, teachers and caregivers. To provide an overview and to outline the future directions of exergaming, the aim of this review was to critically illustrate the strengths, weaknesses, opportunities and threats of exergaming to promote PA and health in children and youth. The available evidence indicates that exergaming has the potential to improve health via an increase in PA. However, it seems that this potential is frequently underexploited, and further developments such as customized exergames are needed.

Evaluation of a Walking-Track Intervention to Increase Children's Physical Activity during Primary School Break Times

Despite the known benefits of engaging in daily moderate to vigorous physical activity (MVPA), only 22% of children in England are meeting the recommended guidelines. School break times have been advocated as a key part of children’s daily routines in which their MVPA can be increased. The main aim of this study was to evaluate the effect of installing a walking-track on children’s MVPA during school break times. A mixed method design was employed which allowed for the quantitative measurement of children’s PA at three time points (baseline, mid-intervention (1–5 weeks) and follow-up (6–9 weeks)), using pedometers (n = 81, 5–9 years) and systematic observation (n = 23, 7–9 years). A semi-structured interview (n = 1) was also conducted at 10 weeks’ follow-up. The installation of the walking-track was grounded in a unique set of theoretical constructs to aid the behaviour change of the teachers. Short term positive increases in girls’ and boys’ MVPA and longer term increases in boys’ vigorous PA (VPA) were found. Qualitative data highlighted that boys dominated the walking-track and the inconsistent behaviour of school staff negatively impacted upon children’s MVPA. A set of principles to guide the installment of walking-tracks in school playgrounds are recommended.

Examining Young Children's Physical Activity and Sedentary Behaviors in an Exergaming Program Using Accelerometry

Exergaming has been observed to be a viable supplemental approach in promoting physical activity (PA) among children. However, whether sex differences in PA and sedentary behaviors exist during exergaming is inconsistent. Thus, this study aimed to quantify, via accelerometry, young children's PA and sedentary behaviors during exergaming as well as examine sex differences in these PA and sedentary behaviors during gameplay. In total, 121 first- and second-grade children (mean age = 6.89 ± 0.9 years; 73 girls) were included in the analysis. Children were a part of a large 18-week parent study. Children wore ActiGraph GT1M accelerometers during exergaming play, with four measurements purposively selected from the 28 total exergaming sessions to capture children's PA and sedentary behaviors during exergaming play. Outcome variables included mean percentages of time spent in moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary behavior during each exergaming session. One-way ANOVA was performed to determine whether there were differences in the percentage of time engaged in MVPA, LPA, and sedentary behavior during exergaming by sex. Accelerometry data indicated that children's mean percentage of exergaming time spent in MVPA, LPA, and sedentary behavior were 19.9%, 32.9%, and 47.2%, respectively. However, no sex differences were present. Observations in this study indicated that boys and girls have similar PA levels during exergaming and suggests that features inherent to exergaming may assist in PA promotion among both sexes.

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.

Growth Trajectories of Young Children's Objectively Determined Physical Activity, Sedentary Behavior, and Body Mass Index

PURPOSE

This study examined trajectories in children's physical activity (PA), sedentary behavior, and body mass index (BMI) for both genders, and relationships among these trajectories, from childhood through early adolescence.

METHODS

A total of 261 seconds and third-grade children (135 girls; Meanage = 7.81; 73% White) from two U.S. elementary schools participated in this study. Their objective PA, sedentary behavior, and BMI were measured yearly from 2012 to 2015. The outcome variables were accelerometer-determined daily moderate-to-vigorous PA (MVPA), sedentary behavior, and BMI-calculated as height divided by weight squared. A series of latent growth curve models (LGCM) were employed to analyze the trajectories in the outcome variables and relationships over time through AMOS version 23 in 2017.

RESULTS

The models generally fitted the data well. In detail, children's MVPA increased slightly by the end of the first year and then declined during follow-ups (p < 0.05), with boys having more MVPA time. Sedentary hours increased at 2-year follow-ups (p < 0.05), but decreased slightly at year 3 follow-up in both genders. BMI increased gradually for boys (p < 0.05), particularly in year 3. Trajectories in MVPA were negatively related to BMI trajectories (p < 0.05), and trajectories in MVPA and sedentary behavior did not interact to affect BMI trajectories.

CONCLUSIONS

Maintaining or increasing MVPA and limiting sedentary behavior should be components of efforts to prevent excess weight gain during the transition from childhood to early adolescence. Children's MVPA and sedentary behavior are independent determinants of BMI changes.

Effect of an Active Video Gaming Classroom Curriculum on Health-Related Fitness, School Day Step Counts, and Motivation in Sixth Graders

BACKGROUND

The purpose of this study was to explore the effect of an active video gaming (AVG) classroom curriculum on health-related fitness, school day steps, and motivation in sixth graders.

METHODS

A convenience sample of 65 sixth graders were recruited from 2 classrooms from a school located in the Western United States. One classroom served as the comparison group (n = 32) that participated in active free play, and one classroom served as the intervention group (n = 33) that participated in an AVG curriculum for 30 minutes per day, 3 days per week, for 18 weeks. Cardiorespiratory endurance was assessed using Progressive Aerobic Cardiovascular Endurance Run laps. School day steps were recorded, and motivational variables were collected using questionnaires. Measures were collected at baseline and an 18-week posttest time point.

RESULTS

There was a significant group × time interaction for Progressive Aerobic Cardiovascular Endurance Run laps (b = 20.7 laps; 95% confidence interval, 14.6 to 26.8; P < .001). No statistically significant interactions were found for step counts or any of the motivational variables.

CONCLUSIONS

An 18-week AVG classroom curriculum improved cardiorespiratory endurance relative to the comparison group in sixth graders. This study supports the use of low-cost AVG curricula to improve the health-related fitness of youth.

Reliability of Using Motion Sensors to Measure Children's Physical Activity Levels in Exergaming

OBJECTIVES

This study examined the reliability of two objective measurement tools in assessing children’s physical activity (PA) levels in an exergaming setting.

METHODS

A total of 377 children (190 girls, Mage = 8.39, SD = 1.55) attended the 30-min exergaming class every other day for 18 weeks. Children’s PA levels were concurrently measured by NL-1000 pedometer and ActiGraph GT3X accelerometer, while children’s steps per min and time engaged in sedentary, light, and moderate-to-vigorous PA were estimated, respectively.

RESULTS

The results of intraclass correlation coefficient (ICC) indicated a low degree of reliability (single measures ICC = 0.03) in accelerometers. ANOVA did detect a possible learning effect for 27 classes (p < 0.01), and the single measures ICC was 0.20 for pedometers. Moreover, there was no significant positive relationship between steps per min and time spent in moderate-to-vigorous physical activity (MVPA). Finally, only 1.3% variance was explained by pedometer as a predictor using Hierarchical Linear Modeling to further explore the relationship between pedometer and accelerometer data.

CONCLUSIONS

The NL-1000 pedometers and ActiGraph GT3X accelerometers have low reliability in assessing elementary school children’s PA levels during exergaming. More research is warranted in determining the reliable and accurate measurement information regarding the use of modern devices in exergaming setting.