Prevalence and correlates of exergaming in youth

Virtual fitness buddy ecosystem: a mixed reality precision health physical activity intervention for children

6-11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact.

Children's Physiological and Perceptual Responses to Sports Exergames When Played in Different Positions

Today's children are prone to becoming involved in exergames, but their positions during play have not been sufficiently investigated to determine whether the positions they adopt result in equal responses. The design of this study involved the collection of physiological and perceptual responses (i.e., heart rate (HR), rating of perceived exertion, and enjoyment score) during exergames in three different sports (bowling, tennis, and boxing) with players in different positions (sitting and standing). The participants played each game for 10 min while their HR was recorded. After the gameplay, each perceptual response was retrieved. The results revealed a significant increase in HR above rest during exergaming overall (p < 0.001). Standing gameplay resulted in a significantly higher HR (p < 0.001) than seated gameplay. Compared to tennis and bowling, boxing produced the highest physiological response (p < 0.001) and perceived exertion (p < 0.05) in both positions. The participants perceived all the sports exergames to be enjoyable, as their enjoyment scores did not significantly differ for each game (p > 0.5). For all the variables, no statistically significant differences between genders were identified (p > 0.5). This home-based intervention demonstrated that sports exergames are not only enjoyable; overall, they can provide at least moderately intense physical activity, whether played seated or standing.

Exergaming and education: a relational model for games selection and evaluation

Exergaming, or technology-driven physical exercise, has gained popularity in recent years. Its applications include physical education, health promotion, and rehabilitation. Although studies have obtained promising results regarding the positive effects of exergaming, the outcomes of exergaming for different populations remain undetermined. Inconsistencies in the literature on this topic have multiple potential explanations, including the content and demand of the exergames and the capability of the exergamer. A model with a sound theoretical framework is required to facilitate matching between games and gamers. This article proposes a relational model based on a matrix of Bloom's taxonomy of learning domains and the performance components of exergames. Appropriate matching of the physical demands of an exergame and the ability of the exergamer would enhance the effective usage of exergaming for individuals with various needs. This theory-based exergame model is developed to promote the general development, physical status, and psychosocial well-being of students, older adults, and individuals with rehabilitation needs. This model may provide a resource for future research on the application, effectiveness, and design of exergaming.

Exergaming Among Young Adults in Canada: Longitudinal Study

BACKGROUND

Exergaming may be an important option to support an active lifestyle, especially during pandemics.

OBJECTIVE

Our objectives were: (i) to explore whether exergaming status from before to during the COVID-19 pandemic (stopped, started, sustained exergaming, never-exergamed) related to changes in walking, moderate-to-vigorous physical activity (MVPA), or meeting MVPA guidelines; and (ii) among past-year exergamers, to describe change in minutes/week exergaming from before to during the pandemic.

METHODS

681 participants (M(SD) age=33.6(0.5), 41% male) from the 22-year NDIT study provided data on walking, MVPA, and exergaming before (2017-20) and during the COVID-19 pandemic (2021). Physical activity (PA) change scores were described by exergaming status.

RESULTS

62.4% of participants never exergamed, 8.2% started exergaming during the pandemic, 19.7% stopped, and 9.7% sustained exergaming. Declines were observed in all three PA indicators in all four groups. Among the more salient findings: (i) participants who started exergaming during COVID-19 reported the highest MVPA levels before and during the pandemic and declined the least (mean -35 minutes/week) (ii) sustained exergamers reported the lowest MVPA levels during the pandemic (median 66 minutes/week), and they declined the most in MVPA (mean change of -92 minutes/week) and in meeting MVPA guidelines (-23.6%). During the pandemic, starters reported 85 minutes of exergaming/week and sustained exergamers increased exergaming by a median 60 minutes/week.

CONCLUSIONS

Although starting and sustaining exergaming did not appear to help exergamers maintain pre-pandemic PA levels, exergaming can contribute a substantial proportion of total PA in young adults and may still represent a useful option to promote PA during pandemics.

CLINICALTRIAL

Not applicable.

Is excessive smartphone use associated with weight status and self-rated health among youth? A smart platform study

BACKGROUND

In Canada, it is recommended that youth limit screen time to less than two hours per day, yet, the majority of youth are reportedly spending a significantly higher amount of time in front of a screen. This is particularly concerning given that these recommendations do not take into account smartphone devices, which is the most common screen time technology of choice for the younger generations. This study implements an innovative approach to understanding screen time behavior and aims to investigate the unique relationship between smartphone specific screen time and physical health outcomes.

METHODS

This cross-sectional study is part of the Smart Platform, a digital epidemiological and citizen science initiative. 436 youth citizen scientists, aged 13-21 years, provided all data via their own smartphones using a custom-built smartphone application. Participants completed a 124-item baseline questionnaire which included validated self-report surveys adapted to collect data specifically on smartphone use (internet use, gaming, and texting), demographic characteristics, and physical health outcomes such as weight status and self-rated health. Binary regression models determined the relationship between smartphone use and physical health outcomes.

RESULTS

Overall participants reported excessive smartphone use in all categories. 11.4% and 12% of the 436 youth participants reported using their smartphone excessively (greater than 2 h per day) during the week and weekend respectively for gaming and were over 2 times more likely than their peers to fall within an overweight/obese BMI status. Excessive weekend gaming was also associated with self-rated health where participants were over 2 times more likely than their peers to report poor self-rated health.

CONCLUSIONS

The results indicate that excessive screen time on smartphones does have complex associations with youth health. Further investigation with more robust study designs is needed to inform smartphone-specific screen time guidelines for youth.

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.

Does Dynamic Tailoring of A Narrative-Driven Exergame Result in Higher User Engagement among Adolescents? Results from A Cluster-Randomized Controlled Trial

Physical activity interventions for youth are direly needed given low adherence to physical activity guidelines, but many interventions suffer from low user engagement. Exergames that require bodily movement while played may provide an engaging form of physical activity intervention but are not perceived as engaging to all. This study aimed to evaluate whether dynamic tailoring in a narrative-driven mobile exergame for adolescents played in leisure settings, can create higher user engagement compared to a non-tailored exergame. A cluster-randomized controlled trial assessed differences in user engagement between a dynamically tailored (based on an accelerometer sensor integrated in a T-shirt) and non-tailored condition. In total, 94 participants (M age = 14.61 ± 1.93; 35% female) participated and were assigned to one of the two conditions. User engagement was measured via a survey and game metric data. User engagement was low in both conditions. Narrative sensation was higher in the dynamically tailored condition, but the non-tailored condition showed longer play-time. User suggestions to create a more appealing game included simple and more colorful graphics, avoiding technical problems, more variety and shorter missions and multiplayer options. Less cumbersome or more attractive sensing options than the smart T-shirt may offer a more engaging solution, to be tested in future research.

A Systematic Review and Narrative Synthesis of Exercise Interventions to Manage Fatigue Among Children, Adolescents, and Young Adults with Cancer

Exercise is known to improve fatigue among adult cancer patients however there is limited understanding of this relationship in children, adolescents, and young adults (AYA) with cancer. The aim is to evaluate the effect of exercise on fatigue outcomes among children and AYA with cancer and to identify important parameters of exercise (frequency, intensity, time, type, and setting), which may be relevant for future intervention design. A systematic search of PubMed, MedLine, CENTRAL, Embase, and Web of Science databases was conducted in December 2019, for studies within the last decade, reporting the effect of exercise on fatigue among cancer patients and survivors 0-24 years of age. Quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) and "Before/After Studies with No Control Group" scales. Seventeen studies (n = 681 participants) were included, of which six were randomized controlled trials (RCTs), and the remaining being pilot (n = 5) or feasibility studies (n = 6). Across studies there was great heterogeneity in intervention delivery, frequency (range: 1-7 days a week), time (range: 10-60 minutes), and duration (range: 3-24 weeks). A positive effect of exercise on fatigue was observed, however, most changes in fatigue were not statistically significant. Exercise is beneficial for reducing fatigue in young cancer patients. However, due to the heterogeneity and quality of existing interventions, firm conclusions about the most effective mode and format of exercise intervention cannot be drawn. There is a need for more definitive large-scale RCTs that can provide data of sufficient quality.

Exergaming and Aquatic Exercises Affect Lung Function and Weight Loss in Obese Children

We investigated the effect of exergames and aquatic exercises on lung function and weight loss in obese children. Sixty-one obese male primary-school children were randomly allocated to video game, aquatic exercise, and control groups. Lung functions and anthropometric variables were measured before and after the intervention and after one month (follow-up). In the video game group, an Xbox Kinect game was played for 60 min during three sessions a week. The aquatic aerobic exercise was performed three times per week and consisted of a warm-up, main exercises, and a cool down phase. For the video game group, there was a significant reduction in body weight between (i) pre- and (ii) post-intervention and follow-up. In the aquatic exercise group, there was a significant reduction in body weight between pre- and post-intervention and between pre-intervention and follow-up. Both exercise groups improved the waist/hip ratio index compared to the control group. Forced vital capacity was significantly improved in the follow-up of the video game group and the aquatic exercise group compared to the control group. A significant improvement was found in forced expiratory volume in the first second at post-intervention and follow-up in the video game and the aquatic exercise groups. Exergames and aquatic exercises improved weight loss and lung function in obese children.

Development and Validation of the Reasons to Exergame (RTEX) Scale in Young Adults: Exploratory Factors Analysis

Background

Exergaming is associated with positive health benefits; however, little is known about what motivates young people to exergame.

Objective

This study aimed to develop a new Reasons to Exergame (RTEX) scale and describe its psychometric properties (Study 1) including test-retest reliability (Study 2). We also examined the test-retest reliability of self-report exergaming behavior measures (Study 2).

Methods

We identified scale items in consultation with experts. In Study 1, we conducted an Exploratory Factor Analysis of RTEX and examined how the factors identified relate to exergaming frequency and intensity in a population-based sample of 272 young adults. In Study 2, we examined the test-retest reliability of RTEX factors and self-report measures of past-week exergaming frequency and intensity among 147 college students.

Results

We identified four factors in RTEX: exergaming for fitness, exergaming for enjoyment, preferring exergaming over other gaming options, and choosing exergaming over competing interests (eg, sports). Test-retest reliability of RTEX factors (ICC 0.7-0.8) and self-report exergaming frequency (ICC 0.4-0.9) was adequate. Exergaming for fitness and enjoyment were positively associated with the frequency of exergaming with friends and family, and with exergaming intensity. Preferring exergaming over other gaming options and choosing exergaming over competing interests (eg, sports) were not related to exergaming behavior.

Conclusions

RTEX is a psychometrically sound scale with four factors that measure reasons to exergame. Replication of these findings is needed in larger, more diverse samples.

Game on: a cycling exergame can elicit moderate-to-vigorous intensity. A pilot study

Objectives

The aims of this pilot study were to investigate oxygen uptake (V̇O₂) while playing a cycling exergame to assess exercise intensity to determine its potential as a feasible exercise alternative to improve aerobic fitness, and to assess the validity of using heart rate (HR) to estimate V̇O₂ in exergaming.

Methods

Five males (age: 32±8; peak oxygen uptake (V̇O_2peak): 47.9±7.8 mL·kg⁻¹·min⁻¹) and five females (age: 27±3; V̇O_2peak: 33.9±4.6 mL·kg⁻¹·min⁻¹) played the cycling exergame ‘Pedal Tanks’ for 45 min, with measurements of HR and V̇O₂.

Results

Average and peak V̇O₂ during exergaming were 61.7±10.1% and 78.3±11.7% of V̇O_2peak, respectively, whereas average and peak HR were 80.0±9.4% and 91.5%±6.7% of HR_peak. There was a strong positive correlation between V̇O₂ and HR for all participants (p<0.05) although estimated V̇O₂ from HR was 9% higher than that measured during exergaming.

Conclusion

Our preliminary data suggest that the cycling exergame we investigated can elicit moderate-to-vigorous intensities and may therefore be a viable alternative to conventional aerobic exercise. The exercise intensity during exergaming was overestimated when using HR alone.

Exergaming in Youth and Young Adults: A Narrative Overview

Because of rapid evolution in exergaming technology and content, the literature on the benefits of exergaming needs ongoing review. Updated syntheses incorporating high-quality critical assessments of included articles can provide cutting-edge evidence to drive research and practice. The objectives were to summarize evidence from systematic reviews and meta-analyses on the association between exergaming and (1) physical activity (PA), sedentary behavior and energy expenditure (EE); and (2) body composition, body mass index (BMI), and other weight-related outcomes among persons younger than 30 years; and to summarize recommendations in the articles retained. The Elton B. Stephens Co. (ESBSCO) database for reviews was searched from January 1995 to July 2019. Data on study characteristics, findings, and recommendations for future research, game design, and intervention development were extracted from articles that met the inclusion criteria, quality scores were attributed to each article, and a narrative overview of the evidence was undertaken. Twenty-eight reviews, with 5-100 articles per review, were identified. Seventeen assessed the evidence on the association between exergaming and PA, EE, and/or sedentary behavior, and 11 examined the association with body composition, BMI, or other weight-related outcomes. There was substantial heterogeneity across reviews in objectives, definitions, and methods. A positive relationship between exergaming and EE is well documented, but whether exergaming increases PA or changes body composition is not established. The reviews retained also provide evidence that exergaming is a healthier alternative to sedentary behavior and that it can be an exciting enjoyable pastime for youth, which adds variety in PA options for health and dietary interventions. Exergaming is likely more physically health promoting than traditional videogames because of higher EE and possibly improved physical fitness and body composition. Longitudinal studies are needed to assess if exergaming reduces sedentary time, has other health benefits, or is a sustainable behavior. We recommend that exergaming interventions be designed using behavior change theory, and that future reviews use standard review criteria and include recommendations for research, game design, and intervention development.

EXERGAMES IN ADOLESCENTS: ASSOCIATED FACTORS AND POSSIBLE REDUCTION IN SEDENTARY TIME

OBJECTIVE

To describe the use of exergames, associated factors and to quantify the time attributed to the use of exergames within the time spent on video games in a sample of adolescents from Curitiba, Paraná, Brazil.

METHODS

This was a cross-sectional study that evaluated frequency and weekly volume of physical activities using the Physical Activity Questionnaire for Adolescents. Weekly frequency and daily time of use of exergames and videogames were self-reported. Mann-Whitney and Kruskal Wallis tests were used to compare the time spent playing exergames, and Poisson regression was used to test the associations (p<0.05).

RESULTS

495 adolescents were interviewed (51.3% girls), predominantly aged between 12 and 13 years (41.3%), under/normal weight (60.4%), medium socioeconomic status (39.8 %) and from public schools (69.3%). Most of the participants did not have video games in their bedroom (74.3%) and did not reach recommended levels of physical activity (55.5%). One in five adolescents used exergames (16.4%). Age (RP: 0.54; 95%CI 0.30-0.97, p=0.039) and having a console in the bedroom (RP: 1.89; 95%CI 1.27- 2.81, p=0.002) were associated with exergame use. Male sex (X_: 195.0; AIQ: 486.3; p=0.024) practice of leisure time physical activity (X_: 160.0; AIQ: 350.0; p=0.048) were associated with weekly volume of exergame use.

CONCLUSIONS

Overall, less than two out of ten adolescents used exergames, and the use was higher among young adolescents and those who had a console in their bedrooms. Volume of use was higher among boys and those performing more than five hours of leisure time physical activity per week. In addition, a considerable part of the time devoted to the use of video games, was in fact, destined to the use of exergames.

Active Gaming Prevalence and Correlates by Type of Day in Spanish Youth

BACKGROUND

Active gaming has emerged as a new option to foster physical activity in youth. The aim of this study was to estimate the prevalence of active gaming in adolescents, to determine differences between active and nonactive gamers by type of day, and to examine predictors of being an active gamer.

METHODS

A cross-sectional study was conducted with 3095 Spanish adolescents aged 12 to 18 years who self-reported their involvement in moderate to vigorous physical activity, sedentary behaviors, and active gaming. Those engaging in active gaming for at least 10 minutes per day were considered active gamers. Student's 2-tailed t tests, chi-square test, and binomial logistic regression were performed.

RESULTS

About 25.9% of the adolescents were active gamers. They were younger, had higher body mass index, and spent more time on moderate to vigorous physical activity, television viewing, and sedentary video games with computer/console than nonactive gamers. There were more active gamers on weekends than on weekdays. On weekdays, more males than females were active gamers. Adolescents who did not meet sleep time guidelines were more likely to be active gamers on weekdays, whereas on weekends, being a girl, overweight/obese, and having a high socioeconomic status were predictors of being an active gamer.

CONCLUSION

Because active gaming may contribute to meeting physical activity guidelines, the present findings could enable better targeting of physical activity promotion programs.

Factors Associated with Sustained Exergaming: Longitudinal Investigation

Background

Exergaming is technology-driven physical activity (PA) which, unlike traditional video game play, requires that participants be physically active to play the game. Exergaming may have potential to increase PA and decrease sedentary behavior in youth, but little is known about sustained exergaming.

Objective

The objectives of this study were to describe the frequency, correlates, and predictors of sustained exergaming.

Methods

Data were available in AdoQuest (2005-11), a longitudinal investigation of 1843 grade 5 students in Montréal, Canada. This analysis used data from grade 9 (2008-09) and 11 (2010-11). Participants at Time 1 (T1; mean age 14 years, SD 0.8 ) who reported past-week exergaming (n=186, 19.1% of AdoQuest sample) completed mailed self-report questionnaires at Time 2 (T2; mean age 16 years, SD 0.8). Independent sociodemographic, psychological, and behavioral correlates (from T2)/predictors (from T1 or earlier) were identified using multivariable logistic regression.

Results

Of 186 exergamers at T1, 81 (44%) reported exergaming at T2. Being female and having higher introjected regulation (ie, a type of PA motivation indicative of internalizing PA as a behavior) were independent correlates. None of the predictors investigated were associated with sustained exergaming.

Conclusions

Almost half of grade 9 exergamers sustained exergaming for 2 years. Exergaming may be a viable approach to help adolescents engage in and sustain PA during adolescence. Sex and PA motivation may be important in the sustainability of exergaming.

Gaming- a bane or a boon-a systematic review

Recent trends show online/video games, have shifted from being just recreational in nature, to hazardous even resulting in the gamer's death like the blue whale game. The aim of the study is to examine associations between video/online gaming and its implication on the biopsychosocial domains of the user. Online databases were studied on gaming and its effect on behaviour, general and mental health from 1997-2017. The PICO guidelines, PRISMA flow diagram and the Rayyan software was used in identifying relevant studies. Cross referencing was done with the co-authors. A total of 41 studies were included in the final analysis. The choice of the video game is influenced by age, gender, parental mediation, as well as the players' and the game's characteristics. Excessive gaming affects both the individual himself and their interpersonal relationships, with 'internet addiction' being added as a diagnosis under DSM V. Despite its several negative consequences, over the past decade, researchers have now started to acknowledge the benefits of gamification in social, educational and even in the health sector, irrespective of the individual's age. There is a need to develop cross cultural database to understand the impact of addictive and/or promotive use of games on the biopsychosocial factors of the gamer.

Reconceptualizing the Link Between Screen Time When Gaming with Physical Activity and Sedentary Behavior

With public health concerns surrounding rates of sedentary behavior (SB), there is often speculation on the role of screen time (in which "computer gaming" is commonly encompassed) as a key contributor to this epidemic. We argue that these assertions are based upon a number of problematic assumptions. Particularly, the notion that screen time necessitates inactivity or SB can be refuted based on the empirical literature. In addition, digital gaming as one so-called problematic screen-time behavior consists of a failed assumption that all games proffer equivalent physical affordances. We argue that these assumptions should be revisited, in which a reconceptualization of screen-time activities (with specific reference to gaming) and its link with inactivity and/or SB should be a key agenda. Within this, we introduce a conceptual model of how this may be realized, with the intention that this may offer a practical guide for researchers, and indeed for health professionals in this field.

A 12-week randomized controlled pilot study of dance exergaming in a group: Influence on psychosocial factors in adolescent girls

Dance exergaming, which involves playing an interactive video game that requires the player to make upper and lower body movements by dancing to music, may provide a social physical activity experience that positively impacts psychosocial health. The objective of this randomized controlled study was to examine the effects of group-based dance exergaming on adolescent girls' psychosocial health including enjoyment, subjective health, perceived peer support, and health-related quality of life. Forty-one adolescents with overweight/obesity were randomly assigned to a 12-week dance exergaming intervention or to a control group. Peer support, subjective health, and health-related quality of life (HRQOL) were assessed pre- and post-intervention, and intervention participants rated enjoyment after each exergaming session. Repeated measures analysis of covariance models controlling for age and baseline body mass index were used to examine condition differences. Results indicated that subjective health improved in the exergaming condition more than control (p = .02). Ratings of peer conflict after the intervention were significantly different by condition (p = .01), with peer conflict stabilizing in the exergaming group and worsening in the control group. There was no difference by condition for HRQOL. Enjoyment remained high throughout the intervention. In summary, group exergaming improved subjective health, stabilized peer conflict, and provided an enjoyable physical activity experience for overweight adolescent girls.

Gender differences in risk factors for cigarette smoking initiation in childhood

INTRODUCTION

We investigated whether established risk factors for initiating cigarette smoking during adolescence (parents, siblings, friends smoke; home smoking rules, smokers at home, exposure to smoking in cars, academic performance, susceptibility to smoking, depressive symptoms, self-esteem, school connectedness, use of other tobacco products) are associated with initiation in preadolescents, and whether the effects of these factors differ by gender.

METHODS

In spring 2005, baseline data were collected in self-report questionnaires from 1801 5th grade students including 1553 never-smokers (mean age=10.7years), in the longitudinal AdoQuest I Study in Montréal, Canada. Follow-up data were collected in the fall and spring of 6th grade (2005-2006). Poisson regression analyses with robust variance estimated the effects of each risk factor on initiation and additive interactions with gender were computed to assess the excess risk of each risk factor in girls compared to boys.

RESULTS

101 of 1399 participants in the analytic sample (6.7% of boys; 7.7% of girls) initiated smoking during follow-up. After adjustment for age, gender and maternal education, all risk factors except academic performance and school connectedness were statistically significantly associated with initiation. Paternal and sibling smoking were associated with initiation in girls only, and girls with lower self-esteem had a significant excess risk of initiating smoking in 6th grade.

CONCLUSIONS

Risk factors for smoking initiation in preadolescents mirror those in adolescents; their effects do not differ markedly by gender. Preventive programs targeting children should focus on reducing smoking in the social environment and the dangers of poly-tobacco use.

Predictors of Cigarette Smoking Initiation in Early, Middle, and Late Adolescence

PURPOSE

Little is known about age-related differences in risk factors for cigarette smoking initiation. We identified predictors of initiation in early, middle, and late adolescence from among sociodemographic factors, indicators of smoking in the social environment, psychological characteristics, lifestyle indicators, and perceived need for cigarettes.

METHODS

Data were drawn from a longitudinal study of 1,801 children recruited at age 10-11 years from 29 elementary schools in Montreal, Canada. Multivariable logistic regression within a generalized estimating equations framework was used to identify predictors among never smokers across three 2-year windows: age 11-13 years (n = 1,221); age 13-15 years (n = 737); and age 15-17 years (n = 690).

RESULTS

Among the 18 risk factors investigated, two differed across age. Friends' smoking, a strong risk factor in early adolescence (odds ratio [95% confidence interval] = 5.78 [3.90-8.58]), lost potency in late adolescence (1.83 [1.31-2.57]). Depressive symptoms, a risk factor in early and middle adolescence (1.60 [1.26-2.02] and 1.92 [1.45-2.54], respectively), were inversely associated in late adolescence (.76 [.58-1.00]). Sex, TV viewing, and weight-related goals were not associated with initiation at any age. All other factors were significant in two or three age groups.

CONCLUSIONS

Most risk factors for smoking initiation were stable across age. Tobacco control interventions may be robust for risk factors across age groups and may not need adjustment. At all ages, interventions should focus on eliminating smoking in the social environment and on reducing the availability of tobacco products.

Twelve weeks of dance exergaming in overweight and obese adolescent girls: Transfer effects on physical activity, screen time, and self-efficacy

BACKGROUND

Given the low levels of physical activity (PA) among adolescent girls in the US, there is a need to identify tools to motivate increased PA. Although there is limited evidence that adolescents transfer PA from one context to another context, exergames (i.e., video games that require gross motor activity) may act as a gateway to promote overall PA outside of game play. The purpose of this study was to examine potential transfer effects (i.e., influences on external behaviors and psychological constructs) of a 12-week exergaming intervention on adolescent girls' PA, screen-time, and self-efficacy towards PA, as well as the intrinsic motivation of exergaming.

METHODS

Participants were 37 girls aged 14-18 years (65% African American, 35% White) who were overweight or obese (body mass index ≥ 85th percentile) and were recruited from the community via school, physicians, news media, and social media sites. Adolescents were randomly assigned to a 12-week group exergaming intervention (thirty-six 60 min sessions of group-based dance exergaming in a research laboratory using Kinect for Xbox 360) or to a no-treatment control group. Outcome variables included objectively measured PA (total) and self-reported leisure-time PA (discretionary time only) 1-week before vs. 1-week after the intervention; selected type and intensity of PA when placed in a gym setting for 30 min ("cardio free choice"); screen-time; self-efficacy towards PA; and intrinsic motivation towards exergaming.

RESULTS

Attendance to the exergaming sessions was high (80%). Compared to the control group, the intervention group self-reported an increase in PA (p = 0.035) and fewer hours watching TV/videos (p = 0.01) after the intervention, but there were no significant differences in sedentary, light, moderate, or vigorous PA measured by accelerometry. The intervention group significantly improved self-efficacy towards PA (p = 0.028). The intervention group highly rated intrinsic motivation towards exergaming.

CONCLUSION

Twelve weeks of exergaming was associated with positive impacts on adolescent girls' self-reported PA, television viewing, self-efficacy, and intrinsic motivation. Future research is warranted to leverage exergames as an enjoyable, motivating, and effective PA tool.

Physiological and Perceived Responses in Different Levels of Exergames in Elite Athletes

OBJECTIVE

Exergames have been suggested to increase the public's physical activity and to benefit cardiovascular health, particularly among the youth. However, not many studies compared the physiological and perceived responses between exergames and the authentic sports especially for elite athletes. This study aimed to investigate the physiological and perceived responses in different levels of Nintendo^® Wii Fit™ U rowing exergames in one group of elite rowing athletes.

MATERIALS AND METHODS

All participants were asked to perform the authentic rowing on the indoor rowing machine on the first day and to play the rowing exergames on the second day, in three levels with 1 hour rest between levels. Oxygen consumption (VO₂), lactate concentration, heart rate (HR), rating of perceived exertion (RPE), and muscle soreness scale (MSS) of the elite athletes were measured in three levels of rowing exergames and were compared with those measured in indoor rowing.

RESULTS

Percentages of HR ranged from 57% to 64% and from 67% to 82% of peak HR in males and females, respectively. Percentages of RPE and MSS obtained from the three levels of rowing exergames ranged from 34% to 55% and from 2% to 33% of the peak RPE and the peak MSS, respectively, in authentic rowing.

CONCLUSION

Physiological and perceived responses of elite rowing athletes could not reach their highest response in authentic rowing even for the hard level of exergames. This study contributed direct data on the physiological benefits of exergames against authentic rowing.

Acute Cognitively Engaging Exergame-Based Physical Activity Enhances Executive Functions in Adolescents

The study aimed to elucidate the influence of cognitive engagement comprised in an acute bout of exergame-based physical activity on executive functions (inhibition, cognitive flexibility) in adolescents. Therefore, the level of cognitive engagement and the intensity of physical activity were systematically varied across three experimental conditions. Sixty-five healthy male adolescents (13-16 years) were randomly assigned to one of three conditions: (a) physical activity with high levels of cognitive engagement during active video gaming, (b) physical activity with low levels of cognitive engagement during active video gaming, (c) sedentary with low levels of cognitive engagement during passive video watching. Manipulation checks, including subjective and objective operationalizations of cognitive engagement, were applied. Executive functions were assessed before and after each condition using the D-KEFS design fluency test. Results showed that cognitive engagement, operationalized by subjects' ratings and heart rate variability, differed between conditions. The physical activity condition with a high level of cognitive engagement resulted in significantly better performance in cognitive flexibility compared to conditions with low levels of cognitive engagement. Regarding benefits for executive functions in male adolescents, the results indicate that acute physical activity with high cognitive engagement could be more efficient than physical activity of the same intensity with low cognitive engagement. Even though further evidence is needed, these results extend previous research and suggest a methodological approach for measuring cognitive engagement.

The Narrative Impact of Active Video Games on Physical Activity Among Children: A Feasibility Study

BACKGROUND

Active video games (AVGs) capable of inducing physical activity offer an innovative approach to combating childhood obesity. Unfortunately, children's AVG game play decreases quickly, underscoring the need to identify novel methods for player engagement. Narratives have been demonstrated to influence behaviors.

OBJECTIVE

The objective of this study was to test the hypothesis that a narrative would motivate increased AVG play, though a feasibility study that investigated the motivational effect of adding a previously developed narrative cutscene to an originally nonnarrative AVG, Nintendo Wii Sports Resort: Swordplay Showdown.

METHODS

A total of 40 overweight and obese 8- to 11-year-olds equally divided by sex played the AVG. Half (n=20) were randomly assigned to a narrative group that watched the narrative cutscene before game play. The other half played the game without watching it.

RESULTS

Children in the narrative group had significantly (P<.05) more steps per 10-second period (mean 3.2, SD 0.7) and overall (mean 523, SD 203) during game play compared with the nonnarrative group (10-second period: mean 2.7, SD 0.7; overall: mean 366, SD 172).

CONCLUSIONS

The AVG with narrative induced increased physical activity. Additional research is needed to understand the mechanisms through which narrative increases physical activity during AVG game play.

Impact of Nintendo Wii Games on Physical Literacy in Children: Motor Skills, Physical Fitness, Activity Behaviors, and Knowledge

Physical literacy is the degree of fitness, behaviors, knowledge, and fundamental movement skills (agility, balance, and coordination) a child has to confidently participate in physical activity. Active video games (AVG), like the Nintendo Wii, have emerged as alternatives to traditional physical activity by providing a non-threatening environment to develop physical literacy. This study examined the impact of AVGs on children’s (age 6–12, N = 15) physical literacy. For six weeks children played one of four pre-selected AVGs (minimum 20 min, twice per week). Pre and post measures of motivation, enjoyment, and physical literacy were completed. Results indicated a near significant improvement in aiming and catching (p = 0.06). Manual dexterity significantly improved in males (p = 0.001), and females felt significantly less pressured to engage in PA (p = 0.008). Overall, there appears to be some positive impact of an AVG intervention on components of physical literacy.

Children's Movement Skills When Playing Active Video Games

Active video games (AVGs) may be useful for movement skill practice. This study examined children's skill execution while playing Xbox Kinect™ and during movement skill assessment. Nineteen children (10 boys, 9 girls; M age = 7.9yr., SD = 1.4) had their skills assessed before AVG play and then were observed once a week for 6 wk. while playing AVGs for 50min. While AVG play showed evidence of correct skill performance (at least 30–50% of the time when playing table tennis, tennis, and baseball), nearly all skills were more correctly performed during skill assessment (generally more than 50% of the time). This study may help researchers to better understand the role AVGs could play in enhancing real life movement skills.

Playing Active Video Games may not develop movement skills: An intervention trial

BACKGROUND

To investigate the impact of playing sports Active Video Games on children's actual and perceived object control skills.

METHODS

Intervention children played Active Video Games for 6 weeks (1 h/week) in 2012. The Test of Gross Motor Development-2 assessed object control skill. The Pictorial Scale of Perceived Movement Skill Competence assessed perceived object control skill. Repeated measurements of object control and perceived object control were analysed for the whole sample, using linear mixed models, which included fixed effects for group (intervention or control) and time (pre and post) and their interaction. The first model adjusted for sex only and the second model also adjusted for age, and prior ball sports experience (yes/no). Seven mixed-gender focus discussions were conducted with intervention children after programme completion.

RESULTS

Ninety-five Australian children (55% girls; 43% intervention group) aged 4 to 8 years (M 6.2, SD 0.95) participated. Object control skill improved over time (p = 0.006) but there was no significant difference (p = 0.913) between groups in improvement (predicted means: control 31.80 to 33.53, SED = 0.748; intervention 30.33 to 31.83, SED = 0.835). A similar result held for the second model. Similarly the intervention did not change perceived object control in Model 1 (predicted means: control: 19.08 to 18.68, SED = 0.362; intervention 18.67 to 18.88, SED = 0.406) or Model 2. Children found the intervention enjoyable, but most did not perceive direct equivalence between Active Video Games and 'real life' activities.

CONCLUSIONS

Whilst Active Video Game play may help introduce children to sport, this amount of time playing is unlikely to build skill.

Smoking in Video Games: A Systematic Review

INTRODUCTION

Video games are played by a majority of adolescents, yet little is known about whether and how video games are associated with smoking behavior and attitudes. This systematic review examines research on the relationship between video games and smoking.

METHODS

We searched MEDLINE, psycINFO, and Web of Science through August 20, 2014. Twenty-four studies met inclusion criteria. Studies were synthesized qualitatively in four domains: the prevalence and incidence of smoking imagery in video games (n = 6), video game playing and smoking behavior (n = 11), video game addiction and tobacco addiction (n = 5) and genre-specific game playing and smoking behavior (n = 3).

RESULTS

Tobacco content was present in a subset of video games. The literature is inconclusive as to whether exposure to video games as a single construct is associated with smoking behavior. Four of five studies found an association between video game addiction and smoking. For genre-specific game playing, studies suggest that the type of game played affected association with smoking behavior.

CONCLUSIONS

Research on how playing video games influences adolescents' perceptions of smoking and smoking behaviors is still in its nascence. Further research is needed to understand how adolescents respond to viewing and manipulating tobacco imagery, and whether engaging in game smoking translates into changes in real-world attitudes or behavior. Smoking imagery in video games may contribute to normalizing adolescent smoking.

IMPLICATIONS

A large body of research has shown that smoking imagery in a variety of media types contributes to adolescent smoking uptake and the normalization of smoking behavior, and almost 90% of adolescents play video games, yet there has never been a published systematic review of the literature on this important topic. This is the first systematic review to examine the research on tobacco and video games.We found that tobacco imagery is indeed present in video games, the relationship between video game playing and smoking remains unclear, there appears to be a correlation between problem gaming and smoking and the genre of games may play a role in adolescent smoking behavior.

Building a Better Mousetrap (Exergame) to Increase Youth Physical Activity

Although exergames have been demonstrated to induce moderate levels of physical activity (PA) if played as designed, there is conflicting evidence on use of exergaming leading to increased habitual PA. Exergames have increased PA in some home and school studies, but not others. Exergames have been used in community centers to good effect, but this has not generally been validated with research. PA from exergames may be enhanced by innovative use of sensors, "fun"-enhancing procedures, tailored messaging, message framing, story or narrative, goal setting, feedback, and values-based messaging. Research is needed on PA-enhancing procedures used within exergames for youth to provide a firmer foundation for the design and use of exergames in the future.

Associations between active video gaming and other energy-balance related behaviours in adolescents: a 24-hour recall diary study

Background

Active video games may contribute to reducing time spent in sedentary activities, increasing physical activity and preventing excessive weight gain in adolescents. Active video gaming can, however, only be beneficial for weight management when it replaces sedentary activities and not other physical activity, and when it is not associated with a higher energy intake. The current study therefore examines the association between active video gaming and other energy-balance-related behaviours (EBRBs).

Findings

Adolescents (12–16 years) with access to an active video game and who reported to spend at least one hour per week in active video gaming were invited to participate in the study. They were asked to complete electronic 24-hour recall diaries on five randomly assigned weekdays and two randomly assigned weekend-days in a one-month period, reporting on time spent playing active and non-active video games and on other EBRBs. Findings indicated that adolescents who reported playing active video games on assessed days also reported spending more time playing non-active video games (Median = 23.6, IQR = 56.8 minutes per week) compared to adolescents who did not report playing active video games on assessed days (Median = 10.0, IQR = 51.3 minutes per week, P < 0.001 (Mann Whitney test)). No differences between these groups were found in other EBRBs. Among those who played active video games on assessed days, active video game time was positively yet weakly associated with TV/DVD time and snack consumption. Active video game time was not significantly associated with other activities and sugar-sweetened beverages intake.

Conclusions

The results suggest that it is unlikely that time spent by adolescents in playing active video games replaces time spent in other physically active behaviours or sedentary activities. Spending more time playing active video games does seem to be associated with a small, but significant increase in intake of snacks. This suggests that interventions aimed at increasing time spent on active video gaming, may have unexpected side effects, thus warranting caution.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0192-6) contains supplementary material, which is available to authorized users.

High-tech tools for exercise motivation: use and role of technologies such as the internet, mobile applications, social media, and video games

IN BRIEF The majority of patients with type 2 diabetes are not active at recommended levels, and many do not have access to behavior change programs to support lifestyle change. Thus, tools and programs designed to promote the adoption and maintenance of physical activity using technology may be helpful. This article reviews the evidence regarding the use of technology tools such as the Internet, mobile applications, social media, and video games and provides suggestions for evaluating the potential benefit of such tools for behavior change.

Narrative in Exergames: Thoughts on Procedure, Mechanism, and Others

Narratives are stories with a beginning, middle, and end that provide information about the characters and plot. Exergames are videogames that require players to move or exercise. Narratives and exergames have seldom been examined together. Based on my review of the literature, there are five potential opportunities narratives could bring to exergames: Enhanced engagement with characters and with the plot, increased motivation, repeated play sessions, and better behavioral consequence. However, the rewards offered by these possibilities may be offset by the challenges they pose. These challenges include the difficulty in fully integrating narratives into the gameplay, the players' limited information processing capacity, difficulty in measurement, the lack of full understanding of the player-character identification process, and the narrative saturation effects. Innovative research is needed to bridge the two potentially important domains.

Problematizing "play-for-health" discourses through children's photo-elicited narratives

There are growing concerns in many industrialized Western societies about declining opportunities for children to play, and fears that this will have adverse health consequences for them. Informed by anti-obesity efforts, public health institutions have recently begun to advance active forms of play as a way of improving children's physical health; however, promoting play for physical health might reshape meanings of play for children. We conducted photography and interview sessions with 25 Canadian children aged 7 to 11 years to examine their representations of play. Our findings suggest that for children, (a) play is an end in itself, (b) play involves but is more than active play, (c) there is ambivalence about scheduled play, and (d) risk is considered a pleasurable component of play. These findings point to a dissonance between children's play promoted for physical health and the meaning of play for children as emotionally contingent, intrinsically motivated, and purposeless.

The effect of dance mat exergaming systems on physical activity and health-related outcomes in secondary schools: results from a natural experiment

BACKGROUND

Exergaming has been proposed as an innovative method for physical activity promotion. However, large effectiveness studies are rare. In January 2011, dance mat systems were introduced in secondary schools in two districts in England with the aim of promoting an innovative opportunity for physical activity. The aim of this natural experiment was to examine the effect of introducing the dance mat exergaming systems on physical activity and health-related outcomes in 11-13 year old students using a non-randomised controlled design and mixed methods.

METHODS

Participants were recruited from five schools in intervention districts (n = 280) and two schools in neighbouring control districts (n = 217). Data on physical activity (accelerometer), anthropometrics (weight, BMI and percentage of body fat), aerobic fitness (20-m multistage shuttle run test), health-related quality of life (Kidscreen questionnaire), self-efficacy (children's physical activity self-efficacy survey), school attendance, focus groups with children and interviews with teachers were collected at baseline and approximately 12 months follow-up.

RESULTS

There was a negative intervention effect on total physical activity (-65.4 cpm CI: -12.6 to -4.7), and light and sedentary physical activity when represented as a percentage of wear time (Light: -2.3% CI: -4.5 to 0.2; Sedentary: 3.3% CI: 0.7 to 5.9). However, compliance with accelerometers at follow-up was poor. There was a significant positive intervention effect on weight (-1.7 kg, 95% CI: -2.9 to -0.4), BMI (-0.9 kg/m2, 95% CI: -1.3 to -0.4) and percentage of body fat (-2.2%, 95% CI: -4.2 to -0.2). There was also evidence of improvement in some health-related quality of life parameters: psychological well-being (2.5, 95% CI: 0.1 to 4.8) and autonomy and parent relation (4.2, 95% CI: 1.4 to 7.0).

CONCLUSIONS

The implementation of a dance mat exergaming scheme was associated with improvement in anthropometric measurements and parameters of health-related quality of life. However, the mechanisms of these benefits are unclear as there was insufficient data from physical activity to draw robust conclusions. Qualitative findings suggest that there was declining support for the initiative over time, meaning that potential benefits may not have been achieved.

Fostering adherence to injectable disease-modifying therapies in multiple sclerosis

Multiple sclerosis requires long-term management, often with disease-modifying therapies. Poor medication adherence, especially to injectables, can increase relapse and hospitalisation rates and consume healthcare resources. We discuss adherence definitions and terminology and its prevalence in multiple sclerosis (MS). Typical causes of poor adherence in patients with MS include: insufficient efficacy or tolerability, concurrent disorders, and consequences of MS (e.g., forgetfulness, depression, fatigue and poor motor skills). Ways to improve adherence rates are reviewed, focusing on interdisciplinary healthcare teams, good communication between healthcare workers and patients (and their families), ongoing support and digital tools to promote adherence. We consider open communication and continuing education to be key, and that MS nurses have a pivotal role in ensuring patients' adherence to MS medicines.

Are field-based exergames useful in preventing childhood obesity? A systematic review

Exergames have started to find their way into field-based settings, such as schools, communities and homes, as a possible solution to curbing physical inactivity and childhood obesity. However, a clear view of the effects of field-based exergaming on children's obesity-related outcomes is lacking. Hence, a systematic review on this topic is warranted. This review synthesizes the impact of field-based exergames on children's physical and psychosocial outcomes. A total of 34 articles conducted in field-based settings were identified from 104 peer-reviewed publications that investigated the effects of exergames. Upon screening, these articles met the inclusion criteria and a high inter-rater agreement for inclusion was reached between the authors. The effects of field-based exergames on children's habitual physical activity (PA) and obesity-related outcomes (e.g. weight loss, body composition) remain unclear due to design problems, measurement issues and other methodology concerns. In addition, exergame is appealing to children, although strategies are warranted to sustain their interests. In summary, exergames are desirable as a promising addition to promote PA and health. Professionals may integrate exergames at field settings to promote a physically active lifestyle among children with the goal of curbing childhood obesity.

Screen media usage, sleep time and academic performance in adolescents: clustering a self-organizing maps analysis

Screen media usage, sleep time and socio-demographic features are related to adolescents' academic performance, but interrelations are little explored. This paper describes these interrelations and behavioral profiles clustered in low and high academic performance. A nationally representative sample of 3,095 Spanish adolescents, aged 12 to 18, was surveyed on 15 variables linked to the purpose of the study. A Self-Organizing Maps analysis established non-linear interrelationships among these variables and identified behavior patterns in subsequent cluster analyses. Topological interrelationships established from the 15 emerging maps indicated that boys used more passive videogames and computers for playing than girls, who tended to use mobile phones to communicate with others. Adolescents with the highest academic performance were the youngest. They slept more and spent less time using sedentary screen media when compared to those with the lowest performance, and they also showed topological relationships with higher socioeconomic status adolescents. Cluster 1 grouped boys who spent more than 5.5 hours daily using sedentary screen media. Their academic performance was low and they slept an average of 8 hours daily. Cluster 2 gathered girls with an excellent academic performance, who slept nearly 9 hours per day, and devoted less time daily to sedentary screen media. Academic performance was directly related to sleep time and socioeconomic status, but inversely related to overall sedentary screen media usage. Profiles from the two clusters were strongly differentiated by gender, age, sedentary screen media usage, sleep time and academic achievement. Girls with the highest academic results had a medium socioeconomic status in Cluster 2. Findings may contribute to establishing recommendations about the timing and duration of screen media usage in adolescents and appropriate sleep time needed to successfully meet the demands of school academics and to improve interventions targeting to affect behavioral change.

Personal, social, and game-related correlates of active and non-active gaming among dutch gaming adolescents: survey-based multivariable, multilevel logistic regression analyses

BACKGROUND

Playing video games contributes substantially to sedentary behavior in youth. A new generation of video games-active games-seems to be a promising alternative to sedentary games to promote physical activity and reduce sedentary behavior. At this time, little is known about correlates of active and non-active gaming among adolescents.

OBJECTIVE

The objective of this study was to examine potential personal, social, and game-related correlates of both active and non-active gaming in adolescents.

METHODS

A survey assessing game behavior and potential personal, social, and game-related correlates was conducted among adolescents (12-16 years, N=353) recruited via schools. Multivariable, multilevel logistic regression analyses, adjusted for demographics (age, sex and educational level of adolescents), were conducted to examine personal, social, and game-related correlates of active gaming ≥1 hour per week (h/wk) and non-active gaming >7 h/wk.

RESULTS

Active gaming ≥1 h/wk was significantly associated with a more positive attitude toward active gaming (OR 5.3, CI 2.4-11.8; P<.001), a less positive attitude toward non-active games (OR 0.30, CI 0.1-0.6; P=.002), a higher score on habit strength regarding gaming (OR 1.9, CI 1.2-3.2; P=.008) and having brothers/sisters (OR 6.7, CI 2.6-17.1; P<.001) and friends (OR 3.4, CI 1.4-8.4; P=.009) who spend more time on active gaming and a little bit lower score on game engagement (OR 0.95, CI 0.91-0.997; P=.04). Non-active gaming >7 h/wk was significantly associated with a more positive attitude toward non-active gaming (OR 2.6, CI 1.1-6.3; P=.035), a stronger habit regarding gaming (OR 3.0, CI 1.7-5.3; P<.001), having friends who spend more time on non-active gaming (OR 3.3, CI 1.46-7.53; P=.004), and a more positive image of a non-active gamer (OR 2, CI 1.07-3.75; P=.03).

CONCLUSIONS

Various factors were significantly associated with active gaming ≥1 h/wk and non-active gaming >7 h/wk. Active gaming is most strongly (negatively) associated with attitude with respect to non-active games, followed by observed active game behavior of brothers and sisters and attitude with respect to active gaming (positive associations). On the other hand, non-active gaming is most strongly associated with observed non-active game behavior of friends, habit strength regarding gaming and attitude toward non-active gaming (positive associations). Habit strength was a correlate of both active and non-active gaming, indicating that both types of gaming are habitual behaviors. Although these results should be interpreted with caution because of the limitations of the study, they do provide preliminary insights into potential correlates of active and non-active gaming that can be used for further research as well as preliminary direction for the development of effective intervention strategies for replacing non-active gaming by active gaming among adolescents.

Rationale and design of active play @ home: a parent-led physical activity program for children with and without disability

BACKGROUND

Compared to other children, those with disability have additional challenges to being physically active. Prader-Willi Syndrome is a genetic form of childhood obesity that is characterized by hypotonia, growth hormone deficiency, behavioral, and cognitive disability. In children, the low prevalence of this syndrome (1 in 10,000 to 15,000 live births) makes group-based physical activity interventions difficult. In contrast, the home environment presents a natural venue to establish a physical activity routine for this population. This manuscript describes the design of a parent-led physical activity intervention incorporating playground and interactive console-based games to increase physical activity participation in youth with and without Prader-Willi Syndrome.

METHODS/DESIGN

The study participants will be 115 youth ages 8-15 y (45 with the syndrome and 70 without the syndrome but categorized as obese). The study will use a parallel design with the control group receiving the intervention after serving as control. Participants will be expected to complete a physical activity curriculum 4 days a week for 6 months including playground games 2 days a week and interactive console games 2 days a week. Parents will be trained at baseline and then provided with a curriculum and equipment to guide their implementation of the program. Tips related to scheduling and coping with barriers to daily program implementation will be provided. Throughout, parents will be contacted by phone once a week (weeks 1-4) and then every other week to receive support in between visits. Measurements of children and parents will be obtained at baseline, 12 weeks, and at the end (week 24) of the intervention. Children main outcomes include physical activity (accelerometry), body composition (dual x-ray absorptiometry), motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency), quality of life and physical activity self-efficacy (questionnaires). Intervention compliance will be monitored using mail-in daily self-report checklists.

DISCUSSION

This parent-guided physical activity intervention aims to increase physical activity by using a curriculum that builds physical activity related self-confidence through the development and/or enhancement of motor skill competency. Ultimately, helping children develop these skills as well as joy in being physically active will translate into sustained behavior change.

TRIAL REGISTRATION

Current Controlled Trial: NCT02058342.

Feasibility of an Active Game Program in a Dutch Pre-Vocational High School Setting

OBJECTIVE

This study examined the use of an active gaming program in a pre-vocational school over a 1-year period.

SUBJECTS AND METHODS

Three hundred students (mean age, 13.3 years; range, 12-18 years) were invited to participate and exposed to the active game program called E-sportszone, in which they could participate during the school day and after school. Attendance to E-sportszone was assessed by objectively monitoring over a 1-year period and self-report. Questionnaires about E-sportszone attendance, physical activity (PA), and sedentary behavior and underlying psychosocial determinants were administered at baseline and after 1 year.

RESULTS

Forty-two percent of the students attended the E-sportszone at least once. Attendance over the year varied from 1 day through 114 days (median, 3 days) with a peak during the E-sportszone marathon that was organized. Multivariate analysis showed boys used the E-sportszone more than girls (odds ratio [OR] 2.8) and older students were less likely to be users than younger students (OR 0.4). Furthermore, students who had a more positive attitude toward PA (OR 1.5) or who had higher scores on intention to use the E-sportszone (OR 1.5) were more likely to engage in active gaming than those who had lower scores.

CONCLUSIONS

A substantial group of at-risk students (i.e., high body mass index, low PA, and high level of sedentary behavior) used the E-sportszone at least once. However, frequency of usage was low, resulting in limited contribution to PA behavior. Long-term use was challenging, and future studies should focus on strategies to encourage continued use of active games in this type of pre-vocational school setting.

Active Screen Time Among U.S. Youth Aged 9-18 Years, 2009

OBJECTIVE

This study documented the prevalence of active screen time (i.e., screen time that includes active games, exercise or dance videos, or TV exercise programs) and identified characteristics associated with it among youth 9-18 years of age.

SUBJECTS AND METHODS

This cross-sectional study was conducted on a convenience sample of 1,165 youth using the 2009 Styles Surveys; data were weighted to approximate the Current Population Survey. We calculated descriptive statistics and conducted multivariable logistic regression to identify characteristics associated with active screen time by estimating adjusted odds ratio (aOR) and 95 percent confidence intervals (CIs).

RESULTS

The sample comprised 51.4 percent boys, and almost 60 percent were non-Hispanic white. The prevalence of active screen time ≥1 hour/day was 31.2 percent on a typical school day and 41.6 percent on a typical weekend day. Logistic regression revealed youth with physical activity of 3-5 days/week had higher odds of active screen time ≥1 hour/day compared with youth with no physical activity (aOR school day=2.8, 95 percent CI 1.5-5.2; aOR weekend day=2.3, 95 percent CI 1.4-3.9). Certain characteristics (i.e., sex, age group, race/ethnicity, income, and sedentary screen time) were significantly associated with active screen time ≥1 hour/day, but associations were inconsistent for school and weekend days.

CONCLUSIONS

Three in 10 youth are engaging in at least 1 hour of active screen time on school days, and about 4 in 10 youth are engaging in at least one hour on weekend days. Understanding the use of active screen time and associated characteristics are important for developing interventions addressing screen time and physical activity.