Feasibility and Effectiveness of Using Wearable Activity Trackers in Youth: A Systematic Review

Preliminary field validity of ActiGraph-based energy expenditure estimation in wheelchair users with spinal cord injury

STUDY DESIGN

Cross-sectional validation study.

OBJECTIVES

To develop a raw acceleration signal-based random forest (RF) model for predicting total energy expenditure (TEE) in manual wheelchair users (MWUs) and evaluate the preliminary field validity of this new model, along with four existing models published in prior literature, using the Doubly Labeled Water (DLW) method.

SETTING

General community and research institution in Pittsburgh, USA.

METHODS

A total of 78 participants' data from two previous studies were used to develop the new RF model. A seven-day cross-sectional study was conducted to collect participants' free-living physical activity and TEE data, resting metabolic rate, demographics, and anthropometrics. Ten MWUs with spinal cord injury (SCI) completed the study, with seven participants having valid data for evaluating the preliminary field validity of the five models.

RESULTS

The RF model achieved a mean absolute error (MAE) of 0.59 ± 0.60 kcal/min and a mean absolute percentage error (MAPE) of 23.6% ± 24.3% on the validation set. For preliminary field validation, the five assessed models yielded MAE from 136 kcal/day to 1141 kcal/day and MAPE from 6.1% to 50.2%. The model developed by Nightingale et al. in 2015 achieved the best performance (MAE: 136 ± 96 kcal/day, MAPE: 6.1% ± 4.7%), while the RF model achieved comparable performance (MAE: 167 ± 99 kcal/day, MAPE: 7.4% ± 5.1%).

CONCLUSIONS

Two existing models and our newly developed RF model showed good preliminary field validity for assessing TEE in MWUs with SCI and the potential to detect lifestyle change in this population. Future large-scale field validation studies and model iteration are recommended.

Effect of wearable activity trackers on physical activity in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical inactivity in children and adolescents has become a pressing public health concern. Wearable activity trackers can allow self-monitoring of physical activity behaviour and promote autonomous motivation for exercise. However, the effects of wearable trackers on physical activity in young populations remain uncertain.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Embase, SPORTDiscus, and Web of Science for publications from database inception up to Aug 30, 2023, without restrictions on language. Studies were eligible if they were randomised controlled trials or clustered randomised controlled trials that examined the use of wearable activity trackers to promote physical activity, reduce sedentary behaviours, or promote overall health in participants with a mean age of 19 years or younger, with no restrictions on health condition or study settings. Studies were excluded if children or adolescents were not the primary intervention cohort, or wearable activity trackers were not worn on users' bodies to objectively track users' physical activity levels. Two independent reviewers (WWA and FR) assessed eligibility of studies and contacted authors of studies if more information was needed to assess eligibility. We also searched reference lists from relevant systematic reviews and meta-analyses. Systematic review software Covidence was used for study screening and data extraction. Study characteristics including study setting, participant characteristics, intervention characteristics, comparator, and outcome measurements were extracted from eligible studies. The two primary outcomes were objectively measured daily steps and moderate-to-vigorous physical activity. We used a random-effects model with Hartung-Knapp adjustments to calculate standardised mean differences. Between-study heterogeneity was examined using Higgins I2 and Cochran Q statistic. Publication bias was assessed using Egger's regression test. This systematic review was registered with PROSPERO, CRD42023397248.

FINDINGS

We identified 9619 studies from our database research and 174 studies from searching relevant systematic reviews and meta-analyses, of which 105 were subjected to full text screening. We included 21 eligible studies, involving 3676 children and adolescents (1618 [44%] were female and 2058 [56%] were male, mean age was 13·7 years [SD 2·7]) in our systematic review and meta-analysis. Ten studies were included in the estimation of the effect of wearable activity trackers on objectively measured daily steps and 11 were included for objectively measured moderate-to-vigorous physical activity. Compared with controls, we found a significant increase in objectively measured daily steps (standardised mean difference 0·37 [95% CI 0·09 to 0·65; p=0·013]; Q 47·60 [p<0·0001]; I2 72·7% [95% CI 53·4 to 84·0]), but not for moderate-to-vigorous physical activity (-0·08 [-0·18 to 0·02; p=0·11]; Q 10·26 [p=0·74]; I2 0·0% [0·0 to 53·6]).

INTERPRETATION

Wearable activity trackers might increase daily steps in young cohorts of various health statuses, but not moderate-to-vigorous physical activity, highlighting the potential of wearable trackers for motivating physical activity in children and adolescents. More rigorously designed trials that minimise missing data are warranted to validate our positive findings on steps and to explore possible long-term effects.

FUNDING

The Hong Kong University Grants Committee and Seed Fund for Basic Research of the University of Hong Kong.

The effect of behavioral activation play therapy in adolescents with depression: A study protocol for a randomized controlled trial

BACKGROUND

Depression is a common psychological problem in adolescents worldwide. Although the World Health Organization recommends that members of this population engage in physical activity to reduce depressive symptoms, compliance with this recommendation is often low. Furthermore, although behavioral activation (BA) is recommended as a treatment for adolescents with depression, the reported effect size is small. Compared with traditional exercises, gamified physical activity (GPA) can be particularly appealing to adolescents because it is perceived as an enjoyable experience. In this study, we integrated BA and GPA to create behavioral activation play therapy (BAPT). We designed a clinical trial to investigate the feasibility, acceptability, and effectiveness of this treatment in adolescents with depression.

METHODS

This study is a randomized controlled trial (RCT) with a three-arm, assessor-blinded design, conducted to validate the effectiveness and applicability of BAPT for treating adolescent with depression. We will recruit 258 participants and randomly assign them to a BAPT group, BA group, or GPA group using a ratio of 1:1:1. Based on conventional strategies for treatment and care, the three groups will receive nine BAPT sessions, nine BA sessions, or nine GPA sessions, respectively. We will compare the outcomes of the BAPT with those of the BA and GPA interventions.

DISCUSSION

This is the first RCT to explore the effectiveness and applicability of BAPT in adolescents with depression. This study will provide evidence that may help to decrease depressive symptoms in adolescents, and will demonstrate the treatment effectiveness in terms of increasing levels of physical activity, reducing the rate of non-suicidal self-injury behaviors, and improving sleep quality. We will also assess the presence of side effects and the treatment adherence of patients receiving BAPT.

TRIAL REGISTRATION

Trial registration: Chinese Clinical Trial Registry, ChiCTR2300072671. Registered on 20 June 2023.

Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study

BACKGROUND

Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population.

OBJECTIVE

This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity.

METHODS

After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework.

RESULTS

Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback.

CONCLUSIONS

Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth's desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations.

Wearable Devices Beyond Activity Trackers in Youth With Obesity: Summary of Options

Background: Current treatment protocols to prevent and treat pediatric obesity focus on prescriptive lifestyle interventions. However, treatment outcomes are modest due to poor adherence and heterogeneity in responses. Wearable technologies offer a unique solution as they provide real-time biofeedback that could improve adherence to and sustainability of lifestyle interventions. To date, all reviews on wearable devices in pediatric obesity cohorts have only explored biofeedback from physical activity trackers. Hence, we conducted a scoping review to (1) catalog other biofeedback wearable devices available in this cohort, (2) document various metrics collected from these devices, and (3) assess safety and adherence to these devices. Methods: This scoping review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Fifteen eligible studies examined the use of biofeedback wearable devices beyond activity trackers in pediatric cohorts, with an emphasis on feasibility of these devices. Results: Included studies varied in sample sizes (15-203) and in ages 6-21 years. Wearable devices are being used to capture various metrics of multicomponent weight loss interventions to provide more insights about glycemic variability, cardiometabolic function, sleep, nutrition, and body fat percentage. High safety and adherence rates were reported among these devices. Conclusions: Available evidence suggests that wearable devices have several applications aside from activity tracking, which could modify health behaviors through real-time biofeedback. Overall, these devices appear to be safe and feasible so as to be employed in various settings in the pediatric age group to prevent and treat obesity.

Using Consumer Wearable Devices to Profile Postoperative Complications After Pediatric Appendectomy

INTRODUCTION

Markers of postoperative recovery in pediatric patients are difficult for parents to evaluate after hospital discharge, who use subjective proxies to assess recovery and the onset of complications. Consumer-grade wearable devices (e.g., Fitbit) generate objective recovery data in near real time and thus may provide an opportunity to remotely monitor postoperative patients and identify complications beyond the initial hospitalization. The aim of this study was to use daily step counts from a Fitbit to compare recovery in patients with complications to those without complications after undergoing appendectomy for complicated appendicitis.

METHODS

Children ages 3-17 years old undergoing laparoscopic appendectomy for complicated appendicitis were recruited. Patients wore a Fitbit device for 21 d after operation. After collection, patient data were included in the analysis if minimum wear-time criteria were achieved. Postoperative complications were identified through chart review, and step count trajectories for patients recovering with and without complications were compared. Additionally, to account for the patients experiencing a complication on different postoperative days, median daily step count for pre- and post-complication were analyzed.

RESULTS

Eighty-six patients with complicated appendicitis were enrolled in the study, and fourteen children developed a postoperative complication. Three patients were excluded because they did not meet the minimum wear time requirements. Complications were divided into abscesses (n = 7, 64%), surgical site infections (n = 2, 18%), and other, which included small bowel obstruction and Clostridioides difficile infection (n = 2, 18%). Patients presented with a complication on mean postoperative day 8, while deviation from the normative recovery trajectory was evident 4 d prior. When compared to children with normative recovery, the patients with surgical complications experienced a slower increase in step count postoperatively, but the recovery trajectory was specific to each complication type. When corrected for day of presentation with complication, step count remained low prior to the discovery of the complication and increased after treatment resembling the normative recovery trajectory.

CONCLUSIONS

This study profiled variations from the normative recovery trajectory in patients with complication after appendectomy for complicated appendicitis, with distinct trajectory patterns by complication type. Our findings have potentially profound clinical implications for monitoring pediatric patients postoperatively, particularly in the outpatient setting, thus providing objective data for potentially earlier identification of complications after hospital discharge.

Gamification to Promote Physical Activity in Youth and Mothers With Obesity

PURPOSE

Physical inactivity and sugar-sweetened beverage (SSB) consumption are associated with obesity. Gamification and self-monitoring to promote physical activity in youth is unknown, but evidence of effectiveness is present in adults. This study examined the effects of a gamification intervention on increased steps per day among parent-adolescent dyads with obesity compared with digital self-monitoring and if self-monitored SSB intake differed between these arms.

METHODS

Youth ages 10-16 years and their mothers (N = 39 pairs), both with obesity, were randomized to a self-monitoring (N = 18) or a self-monitoring plus gamification arm (N = 21) for 9 weeks. The step goal was set and incrementally increased each week and was measured with Fitbit devices. Mixed effects linear regression examined changes in steps and SSB consumption per day, per week by study arm.

RESULTS

During run-in, mothers averaged 8317 and youth 7508 steps per day. Compared with self-monitoring alone, gamification did not increase daily steps in mothers or youth beyond baseline levels. On average, SSB intake decreased in mothers by approximately 0.5 servings per day; occurred in both arms and persisted throughout the intervention.

CONCLUSION

Gamification did not promote physical activity levels in mother-youth dyads with obesity. SSB intake declined in mothers with obesity in both study arms.

Feasibility of wearable activity tracking devices to measure physical activity and sleep change among adolescents with chronic pain-a pilot nonrandomized treatment study

Purpose

Personal informatics devices are being used to measure engagement in health behaviors in adults with chronic pain and may be appropriate for adolescent use. The aim of this study was to evaluate the utilization of a wearable activity tracking device to measure physical activity and sleep among adolescents attending a three-week, intensive interdisciplinary pain treatment (IIPT) program. We also assessed changes in physical activity and sleep from baseline to the treatment phase.

Methods

Participants (57.1% female, average age 15.88, SD = 1.27) wore an activity tracking device three weeks prior to starting and during the treatment program.

Results

Of 129 participants contacted, 47 (36.4%) agreed to participate. However, only 30 (64%) complied with the instructions for using the device prior to programming and during program participation. Preliminary analyses comparing averages from 3-weeks pre-treatment to 3-weeks during treatment indicated increases in daily overall activity minutes, daily step counts, and minutes of moderate to vigorous physical activity (by 353%), as well as a corresponding decrease in sedentary minutes. There was more missing data for sleep than anticipated.

Conclusions

Wearable activity tracking devices can be successfully used to measure adolescent physical activity in-person, with more difficulty obtaining this information remotely. Adolescents with chronic pain experience improvements in objective measurements of physical activity over the course of a 3-week IIPT program. Future studies may want to spend more time working with pediatric patients on their understanding of how to use trackers for sleep and physical activity.

Effectiveness of utilizing step-monitoring devices to prevent and treat obesity in children and adolescents: A systematic review and meta-analysis

Background

Children and adolescents who are overweight and obese represent a growing public health issue. The use of step-monitoring devices as an intervention tool may be a simple, cost-effective, and easily replicable solution for addressing obesity in children and adolescents. No prior systematic reviews have evaluated the effectiveness of utilizing step-monitoring devices as an intervention method for obesity in children and adolescents.

Methods

Previous studies on using step-monitoring devices to prevent and treat obesity in children and adolescents were identified in the following databases: Web of Science, EMBASE, PubMed, Cochrane Library, SPORTDiscus, and SCOPUS. The search period for each database ranged from the year of their inception to 8 March 2023 (updated in June 2024). Meta-analyses were performed for mean differences (MDs) in body mass index (BMI), BMI z-score (BMI-Z), body fat, waist circumference, and body weight.

Results

From 12,907 relevant records, 23 studies were included in this meta-analysis. The included studies were mainly at low risk of bias, except for blinding. Step-monitoring device-based interventions had significant effects in reducing BMI-Z (MD -0.06; 95% CI -0.10 to -0.02), body fat (MD -0.95%; 95% CI -1.35 to -0.54), and body weight (MD -1.23 kg; 95% CI -2.36 to -0.10). However, there was no significant effect on BMI (MD -0.16 kg/m2; 95% CI -0.55 to 0.22) and waist circumference (MD -0.33 cm; 95% CI -1.23 to 0.58). Subgroup analyses indicated that participants who were overweight or obese showed greater intervention effects on BMI and BMI-Z compared to participants with normal weight. The programs with an intervention duration of ≤6 months presented a greater intervention effect on BMI-Z than those with an intervention duration of more than 6 months. The programs that established goals had a greater intervention effect on body fat than those that did not.

Conclusions

Step-monitoring devices may be an effective and generalizable intervention tool for the prevention and treatment of obesity in children and adolescents. Future studies should further explore how to set step goals and the duration of interventions to achieve better intervention effects.

Maintaining healthy lifestyle through fitness app use: A parallel mediation model from a nationwide survey

Objective

Adolescents face various health challenges due to academic pressures and sedentary lifestyles. Establishing healthy habits during this critical period is essential for long-term well-being. With the widespread use of fitness apps, understanding their impact on adolescent health behaviors and the underlying mechanisms is crucial. Guided by social support theory and social comparison theory, this study examined the influence of WeRun, a fitness app within WeChat, on adolescents' adoption of healthy lifestyles. It investigated the correlation between WeRun usage and healthy behaviors, as well as the underlying mechanisms driving this relationship.

Methods

A cross-sectional survey was conducted across 31 provinces and metropolitans in China, utilizing a random cluster sampling approach targeting high school and freshman students aged 15-24 (N = 1312). A parallel mediation model was employed to test the hypotheses.

Results

The analysis showed that WeRun use positively predicted both social support and social comparison. Meanwhile, both social support and social comparison were positively associated with healthy lifestyles. Additionally, WeRun use could not directly predict healthy lifestyles. However, WeRun use indirectly predicted healthy lifestyles via social support and social comparison.

Conclusions

The study's findings revealed the pivotal roles of social support and social comparison as mediating variables in the relationship between adolescents' WeRun usage and adoption of healthy lifestyles. The results contributed to the current comprehension of the mechanisms linking app utilization to health-promoting behaviors. Furthermore, it provided valuable insights for promoting adolescent health and informed improved design strategies for fitness apps.

Ethical considerations in using sensors to remotely assess pediatric health behaviors

Sensors, including accelerometer-based and electronic adherence monitoring devices, have transformed health data collection. Sensors allow for unobtrusive, real-time sampling of health behaviors that relate to psychological health, including sleep, physical activity, and medication-taking. These technical strengths have captured scholarly attention, with far less discussion about the level of human touch involved in implementing sensors. Researchers face several subjective decision points when collecting health data via sensors, with these decisions posing ethical concerns for users and the public at large. Using examples from pediatric sleep, physical activity, and medication adherence research, we pose critical ethical questions, practical dilemmas, and guidance for implementing health-based sensors. We focus on youth given that they are often deemed the ideal population for digital health approaches but have unique technology-related vulnerabilities and preferences. Ethical considerations are organized according to Belmont principles of respect for persons (e.g., when sensor-based data are valued above the subjective lived experiences of youth and their families), beneficence (e.g., with sensor data management and sharing), and justice (e.g., with sensor access and acceptability among minoritized pediatric populations). Recommendations include the need to increase transparency about the extent of subjective decision making with sensor data management. Without greater attention to the human factors involved in sensor research, ethical risks could outweigh the scientific promise of sensors, thereby negating their potential role in improving child health and care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Promoting child and adolescent health through wearable technology: A systematic review

Background

Wearable technology is used in healthcare to monitor the health of individuals. This study presents an updated systematic literature review of the use of wearable technology in promoting child and adolescent health, accompanied by recommendations for future research.

Methods

This review focuses on studies involving children and adolescents aged between 2 and 18 years, regardless of their health condition or disabilities. Studies that were published from 2016 to 2024, and which met the inclusion criteria, were extracted from four academic databases (i.e. PubMed, Cochrane, Embase, and Web of Science) using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol. Data on intervention purposes, interventions deployed, intervention duration, measurements, and the main outcomes of the studies were collected.

Results

A total of 53 studies involving 14,852 participants were reviewed. They focused on various aspects, including the ownership and use of wearable devices (n = 3), the feasibility (n = 22), effectiveness (n = 4), and adherence (n = 2) of intervention strategies, or a combination of multiple aspects (n = 22). Among the interventions deployed, Fitbit was the most frequently used, featuring in 26 studies, followed by ActiGraph (n = 11). In intervention studies, the majority of studies focused on pre-morbidity prevention (n = 26) and the treatment of illnesses (n = 20), with limited attention given to postoperative monitoring (n = 4).

Conclusions

The use of wearable technology by children and adolescents has proven to be both feasible and effective for health promotion. This systematic review summarizes existing research by exploring the use of wearable technology in promoting health across diverse youth populations, including healthy and unhealthy individuals. It examines health promotion at various stages of the disease continuum, including pre-disease prevention, in-disease treatment, and postoperative monitoring. Additionally, the review provides directions for future research.

Feasibility and Preliminary Effectiveness of the INSPIRE Pilot Study for Adolescent Girls

INTRODUCTION

This pilot study evaluated the feasibility and preliminary effectiveness of the Intervention to Support Physical Activity Independence and Routine Everyday program.

METHOD

This quasi-experimental single-group pretest/posttest study included adolescent girls (n = 15) who received a Fitbit Inspire 2 wearable activity tracker and participated in the seven-week Intervention to Support Physical Activity Independence and Routine Everyday program on a college campus in the Midwest. Feasibility outcomes included intervention participation, fidelity, and satisfaction. Preliminary effectiveness outcomes included moderate-to-vigorous physical activity, cardiorespiratory fitness, and resting heart rate.

RESULTS

For intervention sessions, the mean attendance rate was 83.42%, the mean minutes of moderate-to-vigorous physical activity was 62.03, and the mean satisfaction score was 28.90. Moderate-to-vigorous physical activity and resting heart rate improved significantly from baseline to postintervention, but cardiorespiratory fitness did not.

DISCUSSION

Results suggest the need for a pilot randomized controlled trial to improve cardiorespiratory fitness and incorporating an objective measure of moderate-to-vigorous physical activity.

Validation of the Activ8 Activity Monitor for Monitoring Postures, Motions, Transfers, and Steps of Hospitalized Patients

Sedentary behaviors and low physical activity among hospitalized patients have detrimental effects on health and recovery. Wearable activity monitors are a promising tool to promote mobilization and physical activity. However, existing devices have limitations in terms of their outcomes and validity. The Activ8 device was optimized for the hospital setting. This study assessed the concurrent validity of the modified Activ8. Hospital patients performed an activity protocol that included basic (e.g., walking) and functional activities (e.g., room activities), with video recordings serving as the criterion method. The assessed outcomes were time spent walking, standing, upright, sedentary, and newly added elements of steps and transfers. Absolute and relative time differences were calculated, and Wilcoxon and Bland-Altman analyses were conducted. Overall, the observed relative time differences were lower than 2.9% for the basic protocol and 9.6% for the functional protocol. Statistically significant differences were detected in specific categories, including basic standing (p < 0.05), upright time (p < 0.01), and sedentary time (p < 0.01), but they did not exceed the predetermined 10% acceptable threshold. The modified Activ8 device is a valid tool for assessing body postures, motions, steps, and transfer counts in hospitalized patients. This study highlights the potential of wearable activity monitors to accurately monitor and promote PA among hospital patients.

Feasibility of recruiting adolescents into a prospective cohort study of the effects of social isolation during COVID-19

BACKGROUND

Social connection and loneliness in adolescence are increasingly understood as critical influences on adult mental and physical health. The unique impact of the social isolation imposed by the COVID-19 lockdown on emerging adults is therefore expected to be especially profound. We sought to investigate the feasibility of using ecological momentary assessment (EMA) and wearable accelerometers to characterize the effects of social isolation and/or loneliness experienced by adolescents during the COVID-19 pandemic.

METHODS

We recruited 19 participants aged 13-18 from an Adolescent Medicine practice in Atlanta, GA. Participants completed surveys at baseline and throughout a 2-week study period using EMA regarding their degree of social isolation, loneliness, family functioning, school climate, social media use, and COVID-19 experiences surrounding their physical, mental, and social domains. Six participants agreed to wear an activity tracker and heart rate measurement device for 14 days to monitor their emotional state and physical health. Participant feedback was collected via open-ended exit interviews. Feasibility of recruitment/retention, adherence, and outcome measures were investigated. Implementation was also assessed by evaluating the barriers and facilitators to study delivery. Associations between the social isolation and loneliness variables and all other variables were performed with univariate linear regression analysis with significance set at p < 0.05. The progression criteria were a recruitment rate of > 30% and a retention rate of > 80%.

RESULTS

Progression criteria were met for recruitment (76%) of participants, but not retention (38%). Adherence to EMA survey completion was highly variable with only 54% completing ≥ 1 survey a day, and accelerometry use was not feasible. Social isolation was significantly correlated with lower school climate, higher COVID-19 experiences, higher depression scores, and lower sleep quality. Loneliness also showed a significant correlation with all these factors except COVID-19 experiences.

CONCLUSIONS

EMA and wearable accelerometer use was not feasible in this longitudinal study of adolescents during the COVID-19 pandemic. Future research should further investigate barriers to conducting long-term research with adolescents and the potential effects of the pandemic on subject recruitment and retention.

Feasibility and Utility of a Fitbit Tracker Among Ambulatory Children and Youth With Disabilities

PURPOSE

To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities.

METHOD

Participants (4-17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group.

RESULTS

Participants (N = 157; median age = 10 y; 71% boys; 71% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95% CI, 15.5 to 39.7) and adolescents (mean difference = -21.2; 95% CI, -33.6 to -8.7) than children. More daily steps were taken by boys than girls (mean difference = -1040; 95% CI, -1465 to -615) and individuals with a nonphysical disability than a physical disability (mean difference = -1120; 95% CI, -1474 to -765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school.

CONCLUSION

The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention.

Commercial Smart Watches and Heart Rate Monitors: A Concurrent Validity Analysis

ABSTRACT

Montalvo, S, Martinez, A, Arias, S, Lozano, A, Gonzalez, MP, Dietze-Hermosa, MS, Boyea, BL, and Dorgo, S. Smartwatches and commercial heart rate monitors: a concurrent validity analysis. J Strength Cond Res 37(9): 1802-1808, 2023-The purpose of this study was to explore the concurrent validity of 2 commercial smartwatches (Apple Watch Series 6 and 7) against a clinical criterion device (12-lead electrocardiogram [ECG]) and a field criterion device (Polar H-10) during exercise. Twenty-four male collegiate football players and 20 recreationally active young adults (10 men and 10 women) were recruited and participated in a treadmill-based exercise session. The testing protocol included 3 minutes of standing still (resting), then walking at low intensity, jogging at a moderate intensity, running at a high intensity, and postexercise recovery. The intraclass correlation (ICC 2,k ), and Bland-Altman plot analyses showed a good validity of the Apple Watch Series 6 and Series 7 with increased error (bias) as jogging and running speed increased in the football and recreational athletes. The Apple Watch Series 6 and 7 are highly valid smartwatches at rest and different exercise intensities, with validity decreasing with increased running speed. Strength and conditioning professionals and athletes can confidently use the Apple Watch Series 6 and 7 when tracking heart rate; however, caution must be taken when running at moderate or higher speeds. The Polar H-10 can surrogate a clinical ECG for practical applications.

An SMS Text Message-Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process

BACKGROUND

SMS text message-based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators.

OBJECTIVE

This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity.

METHODS

The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message-based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement.

RESULTS

The background phase revealed that few SMS text message-based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages.

CONCLUSIONS

Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message-based strategies among high-risk adolescents.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1016/j.cct.2023.107117.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

ehealth technology in cardiac exercise therapeutics for pediatric patients with congenital and acquired heart conditions: a summary of evidence and future directions

Many children and adolescents with congenital and acquired heart disease (CHD) are physically inactive and participate in an insufficient amount of moderate-to-vigorous intensity exercise. Although physical activity (PA) and exercise interventions are effective at improving short- and long-term physiological and psychosocial outcomes in youth with CHD, several barriers including resource limitations, financial costs, and knowledge inhibit widespread implementation and dissemination of these beneficial programs. New and developing eHealth, mHealth, and remote monitoring technologies offer a potentially transformative and cost-effective solution to increase access to PA and exercise programs for youth with CHD, yet little has been written on this topic. In this review, a cardiac exercise therapeutics (CET) model is presented as a systematic approach to PA and exercise, with assessment and testing guiding three sequential PA and exercise intervention approaches of progressive intensity and resource requirements: (1) PA and exercise promotion within a clinical setting; (2) unsupervised exercise prescription; and (3) medically supervised fitness training intervention (i.e., cardiac rehabilitation). Using the CET model, the goal of this review is to summarize the current evidence describing the application of novel technologies within CET in populations of children and adolescents with CHD and introduce potential future applications of these technologies with an emphasis on improving equity and access to patients in low-resource settings and underserved communities.

How digital health technologies promote healthy life in the Post-COVID-19 Era: evidences from national survey on Chinese adolescents and youngsters

The rapid development of intelligent technologies coupled with the stay-at-home trends in the Post-COVID-19 Era has significantly changed youth's health behavior as well as reshaped their lifestyles. Digital health technologies (DHTs) have been more and more used for health management among youngsters. However, little was known about the use of DHTs among youths and its consequences on their health, especially in developing countries like China. Inspired by behavior intervention technology (BIT) model, this study examined the underlying mechanisms of use and social interactions of DHTs on Chinese adolescents' and youngsters' healthy lifestyles and mental health, using a representatively national survey among high school and freshman students in China (N = 2,297). It found that use of DHTs had a significantly positive effect on Chinese youths' healthy lifestyles and mental health, with behavioral regulation as a mediator. However, social interactions of DHTs were negatively associated with their mental health. The findings contribute to a better guidance on health promotion, as well as the enhanced design of DHTs' products.

Influence of an 8-Week Exercise Program on Physical, Emotional, and Mental Health in Saudi Adolescents: A Pilot Study

Background and Objectives: Physical activity is essential for adolescents to maintain a healthy lifestyle. The aim of this study was to assess the influence of an 8-week exercise program and motivation on physical activity levels, self-motivation, and mental well-being of adolescents in Saudi Arabia. Moreover, the impact of virtual coaching on physical, emotional, and mental health after an eight-week exercise program was examined. Materials and Methods: Twenty-seven participants, 18 females (67%) and 9 males (33%), with a mean age of 14 ± 2.38 years, were enrolled in eight weeks of pre- and post-intervention between June and August of 2021. The physical activity scale, situational motivation scale, mental health continuum short form, and baseline assessments were completed before and after the eight-week program. The program recommended that adolescents practice aerobic, resistance, and weight-bearing exercises for 60 min daily. Paired mean t-tests were used to compare pre-and post-test results. Results: Participants showed an acceptable physical activity level (5.5 ± 1.4) on a 10-point scale with a significant improvement after the eight-week program (7 ± 1.5; p = 0.013). The situational motivation scale improved from 38.1 ± 16 to 26 ± 19.6 (p = 0.042). The mental health continuum (social and psychological well-being) also significantly improved. Participants who received weekly phone calls showed similar improvement patterns but were not significantly different from those who did not receive calls. Conclusions: A virtually delivered 8-week exercise program for adolescents improved their physical, motivational, and mental health. Providing additional weekly phone calls does not provide additional improvement. Providing adolescents with the needed supervision and motivation enhances their physical activity and mental health.

Fit24, a digital health intervention to reduce type 2 diabetes risk among Hispanic youth: Protocol for a feasibility pilot study

BACKGROUND

Poor physical activity (PA) and sleep behaviors in Hispanic adolescents contributes to increased risk for type 2 diabetes. Commonly owned digital devices and services like smartphones and text-messaging are highly used among adolescents and are promising intervention tools for reaching this age group. Personal activity trackers assess activity and sleep, making them ideal tools for addressing these behaviors. We propose to examine the feasibility of a 12-week intervention that uses theoretically grounded text messages and a Fitbit device to improve PA and sleep among Hispanic adolescents with obesity, as compared to a wait-list control group with a Fitbit device only.

METHODS

Participants (N = 48; 14-16 years) will be randomized (1:1) to the intervention or wait-list control group. Youth in the intervention will receive a Fitbit Charge 5 and daily text messages. Youth in the wait-list control group will receive a Fitbit Charge 5 and information on PA and sleep guidelines.

RESULTS

Feasibility will be examined by collecting process evaluation data on the following criteria: (1) recruit 48 Hispanic adolescents 14-16 years; (2) retain 85% of participants for post-assessments; (3) Fitbit wear ≥4 days/week and respond to 80% of text messages when prompted; (4) ≤10% technical issues; and (5) obtain 80% satisfaction from participants.

DISCUSSION

This study will advance our knowledge on the feasibility of digital prevention strategies to promote PA and sleep behaviors to reduce T2D risk among Hispanic youth. If feasible, this approach has the potential to be a scalable, cost-effective diabetes prevention strategy among high-risk youth.

TRIAL REGISTRATION

NCT04953442, registered on July 8, 2021.

Reporting quality of interventions using a wearable activity tracker to improve physical activity in patients with inflammatory arthritis or osteoarthritis: a systematic review

To assess the reporting quality of interventions aiming at promoting physical activity (PA) using a wearable activity tracker (WAT) in patients with inflammatory arthritis (IA) or hip/knee osteoarthritis (OA). A systematic search was performed in eight databases (including PubMed, Embase and Cochrane Library) for studies published between 2000 and 2022. Two reviewers independently selected studies and extracted data on study characteristics and the reporting of the PA intervention using a WAT using the Consensus on Exercise Reporting Template (CERT) (12 items) and Consolidated Standards of Reporting Trials (CONSORT) E-Health checklist (16 items). The reporting quality of each study was expressed as a percentage of reported items of the total CERT and CONSORT E-Health (50% or less = poor; 51–79% = moderate; and 80–100% = good reporting quality). Sixteen studies were included; three involved patients with IA and 13 with OA. Reporting quality was poor in 6/16 studies and moderate in 10/16 studies, according to the CERT and poor in 8/16 and moderate in 8/16 studies following the CONSORT E-Health checklist. Poorly reported checklist items included: the description of decision rule(s) for determining progression and the starting level, the number of adverse events and how adherence or fidelity was assessed. In clinical trials on PA interventions using a WAT in patients with IA or OA, the reporting quality of delivery process is moderate to poor. The poor reporting quality of the progression and tailoring of the PA programs makes replication difficult. Improvements in reporting quality are necessary.

Recommendations for Identifying Valid Wear for Consumer-Level Wrist-Worn Activity Trackers and Acceptability of Extended Device Deployment in Children

BACKGROUND

Self-reported physical activity is often inaccurate. Wearable devices utilizing multiple sensors are now widespread. The aim of this study was to determine acceptability of Fitbit Charge HR for children and their families, and to determine best practices for processing its objective data.

METHODS

Data were collected via Fitbit Charge HR continuously over the course of 3 weeks. Questionnaires were given to each child and their parent/guardian to determine the perceived usability of the device. Patterns of data were evaluated and best practice inclusion criteria recommended.

RESULTS

Best practices were established to extract, filter, and process data to evaluate device wear, r and establish minimum wear time to evaluate behavioral patterns. This resulted in usable data available from 137 (89%) of the sample.

CONCLUSIONS

Activity trackers are highly acceptable in the target population and can provide objective data over longer periods of wear. Best practice inclusion protocols that reflect physical activity in youth are provided.

Technology-Based Obesity Prevention Interventions Among Hispanic Adolescents in the United States: Scoping Review

BACKGROUND

Given that today's adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions.

OBJECTIVE

The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths.

METHODS

A comprehensive search of Embase and PubMed identified 7 studies that met the inclusion criteria. Data were extracted by 2 independent reviewers.

RESULTS

Of the 7 included studies, half (n=4, 57%) used a randomized control trial design, with equal implementation in school (n=3, 43%) and clinic (n=4, 57%) settings. Studies commonly targeted improvements in diet (n=4, 57%) and physical activity (n=7, 100%), with only 1 (14%) study focused on sedentary behaviors. Just 2 (29%) studies reported the use of behavioral theories or models. Studies focused primarily on youths in early (n=5, 71%) or middle (n=6, 86%) adolescence, and there was limited information reported on socioeconomic status. Only 3 (43%) study conducted formative work, and few (n=3, 43%) reported on acceptability. Only 1 (14%) study reported that materials were available in Spanish and English, and only 1 (14%) study used culturally tailored content. Additionally, 3 (43%) studies used strategies that considered social determinants of health.

CONCLUSIONS

To increase our understanding of the feasibility and effectiveness of technology-based obesity prevention strategies among Hispanic adolescents, there is a need for more feasibility studies that are theoretically grounded and comprehensively report on feasibility-related outcomes. Future studies should also leverage technology to simultaneously address multiple health behaviors beyond diet and physical activity. The result of this review can be used to guide the development of future technology-based obesity prevention strategies among Hispanic adolescents.

TRIAL REGISTRATION

CliniclaTrials.gov NCT04953442; https://clinicaltrials.gov/ct2/show/NCT04953442.

The Use of Wearable Activity Trackers in Schools to Promote Child and Adolescent Physical Activity: A Descriptive Content Analysis of School Staff's Perspectives

BACKGROUND

The school environment is an ideal setting for promoting physical activity (PA). Wearable activity trackers (wearables) have previously been implemented, in research, as intervention tools within the school-environment. However, the large-scale use and acceptance of wearables, in schools, is unknown.

METHODS

This study distributed a cross-sectional survey to school staff to investigate the prevalence of child and adolescent wearable use in schools, including when and how they are used, and school staff's willingness to use them in the future (as implemented by school staff). This survey consisted of between 13 and 22 items, including closed-ended and open-ended questions. Closed-ended responses were displayed descriptively (wearable prevalence and characteristics), and open-ended qualitative responses were categorised using descriptive content analysis (how wearables are used).

RESULTS

1087 school staff provided valid responses. Of those, 896 (82.4%) had never used a wearable as a teaching or support tool for their students, and 120 (11%) currently used- and 71 (6.5%) had previously used- a wearable as a teaching or support tool for their students. When wearables were used, school staff implemented their use regularly and during physical education lessons or throughout the entire school day. Wearables were used to monitor or increase student's PA levels, or for student and staff educational purposes (e.g., academic learning, movement breaks). Most school staff were willing to use a wearable as a teaching or support tool to promote student's PA, and/or learning about PA, in the future.

CONCLUSIONS

This study is the first study to explore the widescale use and acceptance of children and adolescents using wearables in the school-setting. Findings may inform the development of future school-based interventions and public health initiatives for physical activity promotion, using wearables.

Applying the COM-B model to understand wearable activity tracker use in children and adolescents

Aim

Wearable activity trackers (wearables) are increasingly popular intervention tools for increasing child and adolescent physical activity (PA) levels. However, the large-scale habitual use of wearables in children and adolescents is unknown. This study investigated the prevalence of wearable use in children and adolescents, and what factors impact their use.

Subjects and methods

This study utilised a cross-sectional survey and the ‘Capability, Opportunity, Motivation and Behaviour’ (COM-B) model was applied to explore what child/adolescent and parental characteristics impact wearable use. Parents/guardians of 5- to 17-year-olds were invited to complete the survey. The survey was open internationally, and consisted of between 19 and 23 questions, depending on child/adolescent wearable use. Multinomial logistic regression analyses were conducted to explore variables impacting wearable use, in children (5 to 9 years) and adolescents (10 to 17 years).

Results

The survey was completed by 652 parents, representing 831 children/adolescents. Most children/adolescents had never used a wearable (n = 429; 51.6%), and 252 (30.3%) and 150 (18.1%) currently or had previously used a wearable, respectively. Child age and sex, capability, opportunity and motivation for PA were associated with wearable use, and differences were present between child (5 to 9 years) and adolescent (10 to 17 years) wearable use.

Conclusions

This study offers a novel contribution to the understanding of child and adolescent habitual wearable use, and what impacts wearable use in these age groups.

A Digital Educational Intervention With Wearable Activity Trackers to Support Health Behaviors Among Childhood Cancer Survivors: Pilot Feasibility and Acceptability Study

BACKGROUND

Childhood cancer survivors are at increased risk of cardiometabolic complications that are exacerbated by poor health behaviors. Critically, many survivors do not meet physical activity guidelines.

OBJECTIVE

The primary aim was to evaluate the feasibility and acceptability of iBounce, a digital health intervention for educating and engaging survivors in physical activity. Our secondary aims were to assess the change in survivors' physical activity levels and behaviors, aerobic fitness, and health-related quality of life (HRQoL) after participating in the iBounce program.

METHODS

We recruited survivors aged 8 to 13 years who were ≥12 months post cancer treatment completion. The app-based program involved 10 educational modules, goal setting, and home-based physical activities monitored using an activity tracker. We assessed objective physical activity levels and behaviors using cluster analysis, aerobic fitness, and HRQoL at baseline and after the intervention (week 12). Parents were trained to reassess aerobic fitness at home at follow-up (week 24).

RESULTS

In total, 30 participants opted in, of whom 27 (90%) completed baseline assessments, and 23 (77%) commenced iBounce. Our opt-in rate was 59% (30/51), and most (19/23, 83%) of the survivors completed the intervention. More than half (13/23, 57%) of the survivors completed all 10 modules (median 10, IQR 4-10). We achieved a high retention rate (19/27, 70%) and activity tracker compliance (15/19, 79%), and there were no intervention-related adverse events. Survivors reported high satisfaction with iBounce (median enjoyment score 75%; ease-of-use score 86%), but lower satisfaction with the activity tracker (median enjoyment score 60%). Parents reported the program activities to be acceptable (median score 70%), and their overall satisfaction was 60%, potentially because of technological difficulties that resulted in the program becoming disjointed. We did not observe any significant changes in physical activity levels or HRQoL at week 12. Our subgroup analysis for changes in physical activity behaviors in participants (n=11) revealed five cluster groups: most active, active, moderately active, occasionally active, and least active. Of these 11 survivors, 3 (27%) moved to a more active cluster group, highlighting their engagement in more frequent and sustained bouts of moderate-to-vigorous physical activity; 6 (56%) stayed in the same cluster; and 2 (18%) moved to a less active cluster. The survivors' mean aerobic fitness percentiles increased after completing iBounce (change +17, 95% CI 1.7-32.1; P=.03) but not at follow-up (P=.39).

CONCLUSIONS

We demonstrated iBounce to be feasible for delivery and acceptable among survivors, despite some technical difficulties. The distance-delivered format provides an opportunity to engage survivors in physical activity at home and may address barriers to care, particularly for regional or remote families. We will use these pilot findings to evaluate an updated version of iBounce.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12621000259842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12621000259842.

Mediators of Effects on Physical Activity and Sedentary Time in an Activity Tracker and Behavior Change Intervention for Adolescents: Secondary Analysis of a Cluster Randomized Controlled Trial

BACKGROUND

Adolescence is a critical age where steep declines in physical activity and increases in sedentary time occur. Promoting physical activity should therefore be a priority for short- and long-term health benefits. Wearable activity trackers in combination with supportive resources have the potential to influence adolescents' physical activity levels and sedentary behavior. Examining the pathways through which such interventions work can inform which mediators to target in future studies.

OBJECTIVE

The aim of this paper is to examine the impact of the Raising Awareness of Physical Activity (RAW-PA) intervention on potential mediators of behavior change after intervention, and whether these mediated the intervention effects on physical activity and sedentary time at 6-month follow-up.

METHODS

RAW-PA was a 12-week intervention, grounded in social cognitive theory and behavioral choice theory, aimed at increasing physical activity among inactive adolescents through combining a wearable activity tracker with digital resources delivered via a private Facebook group (n=159 complete cases). The targeted potential mediators were identified from previous studies conducted in adolescents and included self-efficacy, peer support, family support, teacher support, self-regulation strategies, barriers, and enjoyment. Outcomes included sedentary time as well as light- and moderate-to-vigorous-intensity physical activity. A series of mixed linear models were used to estimate intervention effects on physical activity and sedentary behavior at follow-up and on potential mediators after intervention and to test whether there were indirect effects of the intervention on physical activity and sedentary behavior via mediators.

RESULTS

Adolescents in the intervention group (n=75) engaged in higher sedentary time and lower light intensity at 6-month follow-up compared to the wait-list controls (n=84). There were no intervention effects for moderate-to-vigorous-intensity physical activity. The intervention group perceived more barriers to physical activity than the wait-list control group at 6-month follow-up (mean adjusted difference=1.77; 95% CI 0.19-3.34; P=.03). However, indirect effects for each outcome were not statistically significant, indicating that perceived barriers to physical activity did not mediate intervention effects for physical activity or sedentary time.

CONCLUSIONS

RAW-PA did not beneficially impact hypothesized mediators in these inactive adolescents, despite strategies being designed to target them. This suggests that the lack of overall intervention effects on physical activity and sedentary time observed in the RAW-PA study could be due to the limited impact of the intervention on the targeted mediators. Future studies should consider different strategies to target theoretically informed potential mediators and identify intervention strategies that effectively target key mediators to improve physical activity among inactive adolescents. Finally, intervention effects according to level of wearable tracker use or level of engagement with the intervention should be explored. This may provide important insights for designing successful wearable activity tracker interventions.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12616000899448; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716&isReview=true.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-016-3945-5.

Accuracy and Precision of Consumer-Grade Wearable Activity Monitors for Assessing Time Spent in Sedentary Behavior in Children and Adolescents: Systematic Review

Background

A large number of wearable activity monitor models are released and used each year by consumers and researchers. As more studies are being carried out on children and adolescents in terms of sedentary behavior (SB) assessment, knowledge about accurate and precise monitoring devices becomes increasingly important.

Objective

The main aim of this systematic review was to investigate and communicate findings on the accuracy and precision of consumer-grade physical activity monitors in assessing the time spent in SB in children and adolescents.

Methods

Searches of PubMed (MEDLINE), Scopus, SPORTDiscus (full text), ProQuest, Open Access Theses and Dissertations, DART Europe E-theses Portal, and Networked Digital Library of Theses and Dissertations electronic databases were performed. All relevant studies that compared different types of consumer-grade monitors using a comparison method in the assessment of SB, published in European languages from 2015 onward were considered for inclusion. The risk of bias was estimated using Consensus-Based Standards for the Selection of Health Status Measurement Instruments. For enabling comparisons of accuracy measures within the studied outcome domain, measurement accuracy interpretation was based on group mean or percentage error values and 90% CI. Acceptable limits were predefined as –10% to +10% error in controlled and free-living settings. For determining the number of studies with group error percentages that fall within or outside one of the sides from previously defined acceptable limits, two 1-sided tests of equivalence were carried out, and the direction of measurement error was examined.

Results

A total of 8 studies complied with the predefined inclusion criteria, and 3 studies provided acceptable data for quantitative analyses. In terms of the presented accuracy comparisons, 14 were subsequently identified, with 6 of these comparisons being acceptable in terms of quantitative analysis. The results of the Cochran Q test indicated that the included studies did not share a common effect size (Q₅=82.86; P<.001). I², which represents the percentage of total variation across studies due to heterogeneity, amounted to 94%. The summary effect size based on the random effects model was not statistically significant (effect size=14.36, SE 12.04, 90% CI −5.45 to 34.17; P=.23). According to the equivalence test results, consumer-grade physical activity monitors did not generate equivalent estimates of SB in relation to the comparison methods. Majority of the studies (3/7, 43%) that reported the mean absolute percentage errors have reported values of <30%.

Conclusions

This is the first study that has attempted to synthesize available evidence on the accuracy and precision of consumer-grade physical activity monitors in measuring SB in children and adolescents. We found very few studies on the accuracy and almost no evidence on the precision of wearable activity monitors. The presented results highlight the large heterogeneity in this area of research.

Trial Registration

PROSPERO CRD42021251922; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251922

Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses

Wearable activity trackers offer an appealing, low-cost tool to address physical inactivity. This systematic review of systematic reviews and meta-analyses (umbrella review) aimed to examine the effectiveness of activity trackers for improving physical activity and related physiological and psychosocial outcomes in clinical and non-clinical populations. Seven databases (Embase, MEDLINE, Ovid Emcare, Scopus, SPORTDiscus, the Cochrane Library, and Web of Science) were searched from database inception to April 8, 2021. Systematic reviews of primary studies using activity trackers as interventions and reporting physical activity, physiological, or psychosocial outcomes were eligible for inclusion. In total, 39 systematic reviews and meta-analyses were identified, reporting results from 163 992 participants spanning all age groups, from both healthy and clinical populations. Taken together, the meta-analyses suggested activity trackers improved physical activity (standardised mean difference [SMD] 0·3-0·6), body composition (SMD 0·7-2·0), and fitness (SMD 0·3), equating to approximately 1800 extra steps per day, 40 min per day more walking, and reductions of approximately 1 kg in bodyweight. Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant. Activity trackers appear to be effective at increasing physical activity in a variety of age groups and clinical and non-clinical populations. The benefit is clinically important and is sustained over time. Based on the studies evaluated, there is sufficient evidence to recommend the use of activity trackers.

Utility of Fitbit devices among children and adolescents with chronic health conditions: a scoping review

Background

While Fitbit® devices were initially intended for leisurely, consumer use, there has been recent interest among scientific and medical communities in the prospective use of Fitbit devices for clinical and research purposes. Those who have chronic health conditions are often required to spend considerable amounts of money and time undergoing physiological tests and activity monitoring to support, stabilize, and manage their health. This disease burden is only amplified in pediatric populations. Devices that are used to collect these data can be invasive, uncomfortable, and disconcerting. Using the Fitbit tracker to acquire such biometric data could ease this burden. Our scoping review seeks to summarize the research that has been conducted on the utilization of Fitbit devices in studies of children and adolescents with chronic health conditions and the feasibility, accuracy, and potential benefits of doing so.

Methods

Searches were conducted on PubMed for articles relating pediatric health to Fitbit device usage (using a Boolean search strategy). The eligibility criteria included trials being clinical and/or randomized controlled and articles being in English. Once articles were obtained, they underwent screening and exclusion processes and were charted for their titles, authors, objectives, results, and respective chronic illnesses. In the subsequent full-text review, further charting was conducted, collecting study designs, Fitbit parameters, feasibility, accuracy, and related health and clinical outcomes.

Results

Fitbit trackers were unanimously demonstrated to be feasible devices in this population for physical activity monitoring and were determined to be potentially beneficial in measuring and improving overall wellbeing and physical health in children with chronic illness. Nevertheless, sufficient evidence was not found in support of Fitbit accuracy. Additional biases were identified against the population of children with chronic health conditions that may further enable inaccurate data.

Conclusions

While Fitbit devices may be beneficial for those interested in improving physical health, discretion is advised for those seeking to collect accurate and/or medically necessitated data. Given the existing literature evaluated, medical-grade technologies are preferred in instances of the latter, as Fitbit devices have not been found to provide reliably accurate data.

Exercise training in paediatric congenital heart disease: fit for purpose?

Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.

Evaluation of Digital Interventions for Physical Activity Promotion: Scoping Review

Background

Digital interventions are interventions supported by digital tools or technologies, such as mobile apps, wearables, or web-based software. Digital interventions in the context of public health are specifically designed to promote and improve health. Recent reviews have shown that many digital interventions target physical activity promotion; however, it is unclear how such digital interventions are evaluated.

Objective

We aimed to investigate evaluation strategies in the context of digital interventions for physical activity promotion using a scoping review of published reviews. We focused on the target (ie, user outcomes or tool performance), methods (ie, tool data or self-reported data), and theoretical frameworks of the evaluation strategies.

Methods

A protocol for this study was preregistered and published. From among 300 reviews published up to March 19, 2021 in Medline, PsycINFO, and CINAHL databases, 40 reviews (1 rapid, 9 scoping, and 30 systematic) were included in this scoping review. Two authors independently performed study selection and data coding. Consensus was reached by discussion. If applicable, data were coded quantitatively into predefined categories or qualitatively using definitions or author statements from the included reviews. Data were analyzed using either descriptive statistics, for quantitative data (relative frequencies out of all studies), or narrative synthesis focusing on common themes, for qualitative data.

Results

Most reviews that were included in our scoping review were published in the period from 2019 to 2021 and originated from Europe or Australia. Most primary studies cited in the reviews included adult populations in clinical or nonclinical settings, and focused on mobile apps or wearables for physical activity promotion. The evaluation target was a user outcome (efficacy, acceptability, usability, feasibility, or engagement) in 38 of the 40 reviews or tool performance in 24 of the 40 reviews. Evaluation methods relied upon objective tool data (in 35/40 reviews) or other data from self-reports or assessments (in 28/40 reviews). Evaluation frameworks based on behavior change theory, including goal setting, self-monitoring, feedback on behavior, and educational or motivational content, were mentioned in 22 out of 40 reviews. Behavior change theory was included in the development phases of digital interventions according to the findings of 20 out of 22 reviews.

Conclusions

The evaluation of digital interventions is a high priority according to the reviews included in this scoping review. Evaluations of digital interventions, including mobile apps or wearables for physical activity promotion, typically target user outcomes and rely upon objective tool data. Behavior change theory may provide useful guidance not only for development of digital interventions but also for the evaluation of user outcomes in the context of physical activity promotion. Future research should investigate factors that could improve the efficacy of digital interventions and the standardization of terminology and reporting in this field.

International Registered Report Identifier (IRRID)

RR2-10.2196/35332

The Effectiveness of Wearable Devices as Physical Activity Interventions for Preventing and Treating Obesity in Children and Adolescents: Systematic Review and Meta-analysis

Background

The prevalence of obesity in children and adolescents remains a global public health issue. Wearable devices may offer new opportunities for prevention and intervention in obesity. Previous systematic reviews have only examined the effect of the wearable device interventions on preventing and treating obesity in adults. However, no systematic review has provided an evaluation of wearable devices as physical activity interventions for preventing and treating obesity in children and adolescents.

Objective

The purpose of this review and meta-analysis was to evaluate the effectiveness of wearable devices as physical activity interventions on obesity-related anthropometric outcomes in children and adolescents.

Methods

Research articles retrieved from PubMed, EMBASE, Cochrane Library, Scopus, and EBSCO from inception to February 1, 2021, were reviewed. The search was designed to identify studies utilizing wearable devices for preventing and treating obesity in children and adolescents. The included studies were evaluated for risk of bias following the Cochrane recommendation. Meta-analyses were conducted to evaluate the effectiveness of wearable devices as physical activity interventions on body weight, body fat, BMI z-score (BMI-Z), BMI, and waist circumference. Subgroup analyses were performed to determine whether the characteristics of the interventions had an impact on the effect size.

Results

A total of 12 randomized controlled trials (3227 participants) were selected for meta-analysis. Compared with the control group, wearable device interventions had statistically significant beneficial effects on BMI (mean difference [MD] –0.23; 95% CI –0.43 to –0.03; P=.03; I²=2%), BMI-Z (MD –0.07; 95% CI –0.13 to –0.01; P=.01; I²=81%), body weight (MD –1.08; 95% CI –2.16 to –0.00; P=.05; I²=58%), and body fat (MD –0.72; 95% CI –1.19 to –0.25; P=.003; I²=5%). However, no statistically significant effect was found on waist circumference (MD 0.55; 95% CI –0.21 to 1.32; P=.16; I²=0%). The subgroup analysis showed that for participants with overweight or obesity (MD –0.75; 95% CI –1.18 to –0.31; P<.01; I²=0%), in the short-term (MD –0.62; 95% CI –1.03 to –0.21; P<.01; I²=0%), wearable-based interventions (MD –0.56; 95% CI –0.95 to –0.18; P<.01; I²=0%) generally resulted in greater intervention effect size on BMI.

Conclusions

Evidence from this meta-analysis shows that wearable devices as physical activity interventions may be useful for preventing and treating obesity in children and adolescents. Future research is needed to identify the most effective physical activity indicators of wearable devices to prevent and treat obesity in children and adolescents.

Development of an Extended-Reality (XR)-Based Intervention to Treat Adolescent Obesity

Public health policies aimed at obesity reduction are more often directed toward adults than children. This is alarming given that rates of childhood obesity have been steadily increasing, and, if not treated early, adolescents with obesity may develop comorbidities into adulthood. Lifestyle-based interventions are the cornerstone of childhood obesity treatment. Recently, extended-reality (XR)-based interventions have been incorporated into the treatment of obesity, and parents and adolescents perceive virtual reality (VR) interventions as a promising approach to increasing physical activity levels and improving eating habits. VR is a tool that fits perfectly with contemporary adolescent culture, which is radically different from that of just two generations ago. It is plausible that an XR-based intervention for treating adolescents with obesity could have a profound influence on obesity management over the long-term. An understanding of adolescents’ preferences, wants, and needs must be considered in the development of new interventions. We suggest that VR interventions can provide a new approach to weight management for children and adolescents and provide recommendations to assess adolescents’, caregivers’, and primary care providers’ needs. These needs could then be used for the development of an XR-based intervention aimed at inducing sustained lifestyle changes in adolescents with obesity.

Exploring Families' Acceptance of Wearable Activity Trackers: A Mixed-Methods Study

Background: The family environment plays a crucial role in child physical activity (PA). Wearable activity trackers (wearables) show potential for increasing children’s PA; however, few studies have explored families’ acceptance of wearables. This study investigated the acceptability of using wearables in a family setting, aligning experiences with components of the Technology Acceptance Model and Theoretical Domains Framework. Methods: Twenty-four families, with children aged 5–9 years, took part in a 5-week study, where all members were provided with a Fitbit Alta HR for 4 weeks. Acceptability was measured using weekly surveys and pre-post-questionnaires. Nineteen families participated in a focus group. Quantitative and qualitative data were integrated using the Pillar Integration Process technique. Results: Pillars reflected (1) external variables impacting wearable use and PA and (2) wearable use, (3) ease of use, (4) usefulness for increasing PA and other health outcomes, (5) attitudes, and (6) intention to use a wearable, including future intervention suggestions. Conclusions: Families found the Fitbit easy to use and acceptable, but use varied, and perceived impact on PA were mixed, with external variables contributing towards this. This study provides insights into how wearables may be integrated into family-based PA interventions and highlights barriers and facilitators of family wearable use.

Intensive Longitudinal Data Collection Using Microinteraction Ecological Momentary Assessment: Pilot and Preliminary Results

Background

Ecological momentary assessment (EMA) uses mobile technology to enable in situ self-report data collection on behaviors and states. In a typical EMA study, participants are prompted several times a day to answer sets of multiple-choice questions. Although the repeated nature of EMA reduces recall bias, it may induce participation burden. There is a need to explore complementary approaches to collecting in situ self-report data that are less burdensome yet provide comprehensive information on an individual’s behaviors and states. A new approach, microinteraction EMA (μEMA), restricts EMA items to single, cognitively simple questions answered on a smartwatch with single-tap assessments using a quick, glanceable microinteraction. However, the viability of using μEMA to capture behaviors and states in a large-scale longitudinal study has not yet been demonstrated.

Objective

This paper describes the μEMA protocol currently used in the Temporal Influences on Movement & Exercise (TIME) Study conducted with young adults, the interface of the μEMA app used to gather self-report responses on a smartwatch, qualitative feedback from participants after a pilot study of the μEMA app, changes made to the main TIME Study μEMA protocol and app based on the pilot feedback, and preliminary μEMA results from a subset of active participants in the TIME Study.

Methods

The TIME Study involves data collection on behaviors and states from 246 individuals; measurements include passive sensing from a smartwatch and smartphone and intensive smartphone-based hourly EMA, with 4-day EMA bursts every 2 weeks. Every day, participants also answer a nightly EMA survey. On non–EMA burst days, participants answer μEMA questions on the smartwatch, assessing momentary states such as physical activity, sedentary behavior, and affect. At the end of the study, participants describe their experience with EMA and μEMA in a semistructured interview. A pilot study was used to test and refine the μEMA protocol before the main study.

Results

Changes made to the μEMA study protocol based on pilot feedback included adjusting the single-question selection method and smartwatch vibrotactile prompting. We also added sensor-triggered questions for physical activity and sedentary behavior. As of June 2021, a total of 81 participants had completed at least 6 months of data collection in the main study. For 662,397 μEMA questions delivered, the compliance rate was 67.6% (SD 24.4%) and the completion rate was 79% (SD 22.2%).

Conclusions

The TIME Study provides opportunities to explore a novel approach for collecting temporally dense intensive longitudinal self-report data in a sustainable manner. Data suggest that μEMA may be valuable for understanding behaviors and states at the individual level, thus possibly supporting future longitudinal interventions that require within-day, temporally dense self-report data as people go about their lives.

A Systematic Review of the Scope of Study of mHealth Interventions for Wellness and Related Challenges in Pediatric and Young Adult Populations

Background

Despite the purported advantages and potential efficacy of mHealth interventions to promote wellness in children, adolescents, and young adults, it is not clear what areas have been explored and the challenges reported in the biomedical literature.

Methods

We conducted a scoping review of publications between 2015 and 2019.

Results

We identified 54 papers that met our inclusion criteria. Studies were conducted in 21 countries and ranged in size from six to 9851 participants (median: 184). A total of 41% of studies enrolled adolescents only (n = 19). Of the seven types of mHealth interventions identified, apps were the most common intervention (59%; n = 32) evaluated and 44% of the studies evaluated two or more interventions. The most common topic of the studies reviewed was sexual and reproductive health (24%; n = 13).

Conclusion

Most pediatric mHealth intervention studies are conducted in adolescents in large part, and sexual and reproductive health is the most commonly studied topic. With the easy and widespread accessibility to smartphone technology, the use of mobile apps for wellness interventions will likely continue to expand to other wellness topics.

Effects of Consumer-Wearable Activity Tracker-Based Programs on Objectively Measured Daily Physical Activity and Sedentary Behavior Among School-Aged Children: A Systematic Review and Meta-analysis

Background

The popularity of consumer-wearable activity trackers has led the scientific community to conduct an increasing number of intervention studies integrating them to promote physical activity (PA) and to reduce sedentary behavior (SB) levels among school-aged children. Therefore, the aim of the present study was to estimate the effects of consumer-wearable activity tracker-based programs on daily objectively measured PA and SB among apparently healthy school-aged children, as well as to compare the influence of participants’ and programs’ characteristics.

Methods

Eligibility criteria were: (1) participants: apparently healthy school-aged children (< 18 years old); (2) intervention: aimed to promote PA and/or to reduce SB incorporating consumer-wearable activity trackers; (3) comparator: baseline measurements and/or a control/traditional group; (4) outcomes: objectively measured daily PA and/or SB levels; (5) study design: pre-experimental, quasi-experimental, and true-experimental trials. Relevant studies were searched from eight databases up to December 2020, as well as from four alternative modes of searching. Based on the Cochrane Risk-of-bias tool 2, the risk of bias was assessed following four domains: (1) randomization process; (2) missing outcome data; (3) measurement of the outcomes; and (4) selection of the reported results. Based on a comprehensive systematic review, meta-analyses of the Cohen’s standardized mean difference (d) and 95% confidence interval (CI) with a random-effects model were conducted to estimate the overall effects, as well as the within- and between-study subgroups analyses effects, of the programs on daily total steps, moderate-to-vigorous PA (MVPA), total PA and SB.

Results

Forty-four publications (i.e., 45 studies) were included in the systematic review (5,620 unique participants; mean age = 12.85 ± 2.84 years) and 40 publications (i.e., 41 studies) in the meta-analysis. Programs had a mean length of 11.78 ± 13.17 weeks and most used a waist-worn consumer-wearable activity tracker (77.78% waist-worn; 22.22% wrist-worn). Programs characteristics were: goal-setting strategies (64.06%); participants’ logbooks (56.25%); counseling sessions (62.50%); reminders (28.13%); motivational strategies (42.19%); and exercise routine (17.19%). Results showed a statistically significant moderate favorable effect on daily total steps (d = 0.612, 95% CI 0.477–0.746), small favorable effect on daily MVPA (d = 0.220, 95% CI 0.134–0.307), trivial favorable effect on daily total PA (d = 0.151, 95% CI 0.038–0.264) and trivial unfavorable effect on daily SB (d = 0.172, 95% CI 0.039–0.305). Subgroups analyses showed a higher effect for daily total steps and daily MVPA levels in females and the physically inactive for daily total steps (p = 0.003–0.044). Programs with educational counseling and/or goal-setting strategies, as well as a greater number of strategies, were more effective for improving children’s daily total steps, and wrist-worn activity trackers were more effective than waist-worn trackers for improving their daily MVPA levels (p = 0.001–0.021).

Conclusions

Consumer-wearable activity tracker-based programs seem to be effective in promoting school-aged children’s daily total steps and MVPA levels, especially for females and those that are physically inactive. These programs should include specific goal-setting, educational counseling, and wrist-worn trackers as especially effective strategies. However, due to the certainty of evidence being from “low” to “moderate”, future well-designed primary research studies about the topic are needed.

PROSPERO: CRD42020222363.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-021-00407-6.

Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study

Background

The effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings.

Objective

To better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program.

Methods

A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior.

Results

Among the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors.

Conclusions

Our study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change.

A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial

Background

Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed.

Objective

This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition.

Methods

Women with a BMI ≥25 kg/m² who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests.

Results

A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m², SD 5.97 kg/m²) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ²₂=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ²₂=7.6; P=.02) and relatedness from preintervention to follow-up (χ²₂=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ²₂=7.0) and group 3 (χ²₂=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable.

Conclusions

The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese.

Trial Registration

ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663

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

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

Process Evaluation of Project FFAB (Fun Fast Activity Blasts): A Multi-Activity School-Based High-Intensity Interval Training Intervention

Introduction: Over the last decade, research into the impact of school-based high-intensity interval training (HIIT) on young people's health has markedly increased. Despite this, most authors have focused on the outcomes of their intervention, rather than the process of how the study was conducted. The aim of our study, therefore, was to conduct a mixed methods process evaluation of Project FFAB (Fun Fast Activity Blasts), a school-based HIIT intervention for adolescents. The objectives were to explore study recruitment, reach, intervention dose, fidelity, participants' experiences, context, and future implementation.

Methods: Recruitment was assessed by comparing the number of students who received study information, to those who provided consent. Reach was described as the number of participants who completed the intervention. Dose was reported via the number of HIIT sessions delivered, total exercise time commitment, HIIT exercise time, and session attendance. Post-intervention focus groups were conducted with intervention participants (n = 33; aged 14.1 ± 0.3 years; mean ± standard deviation). These discussions explored aspects of intervention fidelity (extent that the intervention was delivered as intended); participants' experiences of the HIIT sessions; context (exploration of the nuances of school-based HIIT); and ideas for future implementation.

Results: Recruitment, reach, and dose data indicate that Project FFAB was largely delivered as planned. Focus group data identified a mismatch between perceived vs. prescribed work: rest ratio for the multi-activity HIIT drills. Generally, the HIIT drills were well-received; participants often reported they were fun to complete, and the use of heart rate monitors was helpful for interpreting exercise intensity. Some participants stated that greater variety in the HIIT drills would be preferable. The timing and structure of the HIIT sessions that took place outside of physical education lessons received mixed responses.

Conclusion: Collectively, our study supports the use of school-based HIIT and provides valuable insights into how such interventions can be implemented. Project FFAB could be modified to account for individuals' preferences on when the exercise sessions took place. In addition, a wider range of activities could be included, and the prescribed work: rest ratio of the HIIT drills could be better communicated.

The Preliminary Criterion Validity of the Activ8 Activity Monitor to Measure Physical Activity in Youth Using a Wheelchair

PURPOSE

The aim of this study was to assess the criterion validity of the Activ8 to detect "active wheelchair use" and to distinguish 6 types of wheelchair activities using video recordings as a gold standard.

METHODS

Ten participants who use a manual wheelchair were participants in this study. Data of 2 participants were used for adapting the algorithm and data of 7 participants were used for assessing the criterion validity.

RESULTS

Criterion validity for detecting "active wheelchair use" had a relative time difference of 7.4%, agreement of 96%, sensitivity of 98.3%, and positive predictive value of 90%. Results for distinguishing 6 types of wheelchair activities had an agreement of 73%, sensitivity of 67.1%, and positive predictive value of 65.5%.

CONCLUSIONS

The Activ8 is able to detect "active wheelchair use" in youth using a manual wheelchair. Further development of the algorithm is necessary to distinguish between different types of wheelchair activities.

Using wearable and mobile technology to measure and promote healthy sleep behaviors in adolescents: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to map the evidence related to how consumer-targeted wearable and mobile technology is being used to measure and/or promote sleep among adolescents.

INTRODUCTION

Sleep is a key component of physical and mental health and is required for healthy development in adolescence. Efforts to improve insufficient and poor-quality sleep among adolescents have resulted in limited and temporary enhancements in sleep habits. Since good sleep hygiene is established through the development of daily routines, wearable technology offers a potential solution by providing real-time feedback, allowing adolescents to monitor and manage their sleep habits.

INCLUSION CRITERIA

Studies that focus on adolescents between 13 and 24 years who use mobile or wearable technology to measure and/or promote sleep health will be considered for inclusion.

METHODS

Using a scoping methodology, the authors will conduct a review of studies on the use of commercially available, wearable technology or mobile devices designed to measure and/or improve sleep among adolescents. Literature searched will include published primary studies, reviews, and dissertations from database inception to present. Databases searched will include MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, SPORTDiscus, JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, Scopus, and ProQuest Dissertations and Theses. The search will be conducted using identified keywords and indexed terms, and studies will be limited to the English language. Data extracted will include study population, methods, description of sleep technology reported, sleep outcomes, and strategies used to promote healthy sleep behaviors. Quality assessment of included studies will be conducted to facilitate data mapping and synthesis.

Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years

Background

Several reviews of mobile health (mHealth) physical activity (PA) interventions suggest their beneficial effects on behavior change in adolescents and adults. Owing to the ubiquitous presence of smartphones, their use in mHealth PA interventions seems obvious; nevertheless, there are gaps in the literature on the evaluation reporting processes and best practices of such interventions.

Objective

The primary objective of this review is to analyze the development and evaluation trajectory of smartphone-based mHealth PA interventions and to review systematic theory- and evidence-based practices and methods that are implemented along this trajectory. The secondary objective is to identify the range of evidence (both quantitative and qualitative) available on smartphone-based mHealth PA interventions to provide a comprehensive tabular and narrative review of the available literature in terms of its nature, features, and volume.

Methods

We conducted a scoping review of qualitative and quantitative studies examining smartphone-based PA interventions published between 2008 and 2018. In line with scoping review guidelines, studies were not rejected based on their research design or quality. This review, therefore, includes experimental and descriptive studies, as well as reviews addressing smartphone-based mHealth interventions aimed at promoting PA in all age groups (with a subanalysis conducted for adolescents). Two groups of studies were additionally included: reviews or content analyses of PA trackers and meta-analyses exploring behavior change techniques and their efficacy.

Results

Included articles (N=148) were categorized into 10 groups: commercial smartphone app content analyses, smartphone-based intervention review studies, activity tracker content analyses, activity tracker review studies, meta-analyses of PA intervention studies, smartphone-based intervention studies, qualitative formative studies, app development descriptive studies, qualitative follow-up studies, and other related articles. Only 24 articles targeted children or adolescents (age range: 5-19 years). There is no agreed evaluation framework or taxonomy to code or report smartphone-based PA interventions. Researchers did not state the coding method, used various evaluation frameworks, or used different versions of behavior change technique taxonomies. In addition, there is no consensus on the best behavior change theory or model that should be used in smartphone-based interventions for PA promotion. Commonly reported systematic practices and methods have been successfully identified. They include PA recommendations, trial designs (randomized controlled trials, experimental trials, and rapid design trials), mixed methods data collection (surveys, questionnaires, interviews, and focus group discussions), scales to assess app quality, and industry-recognized reporting guidelines.

Conclusions

Smartphone-based mHealth interventions aimed at promoting PA showed promising results for behavior change. Although there is a plethora of published studies on the adult target group, the number of studies and consequently the evidence base for adolescents is limited. Overall, the efficacy of smartphone-based mHealth PA interventions can be considerably improved through a more systematic approach of developing, reporting, and coding of the interventions.

Exploring the Use of Mobile and Wearable Technology among University Student Athletes in Lebanon: A Cross-Sectional Study

The markets of commercial wearables and health and fitness apps are constantly growing globally, especially among young adults and athletes, to track physical activity, energy expenditure and health. Despite their wide availability, evidence on use comes predominantly from the United States or Global North, with none targeting college student-athletes in low- and middle-income countries. This study was aimed to explore the use of these technologies among student-athletes at the American University of Beirut (AUB). We conducted a cross-sectional survey of 482 participants (average age 20 years) enrolled in 24 teams during Fall 2018; 230 students successfully completed the web-based survey, and 200 provided valid data. Fifty-three (26.5%) have owned a fitness tracker, mostly for self-monitoring. The most popular were Fitbit, Apple Watch, and Garmin. Similarly, 82 students (40%) used apps, primarily MyFitnessPal, Apple Health, and Samsung Health. Nevertheless, many participants discontinued use due to loss of interest or technical issues (breaking, usability, obsolescence, or lack of engagement). Wearable devices were considered superior to mobile phones alone as physical activity monitors. However, forming regular habits made self-monitoring via technology irrelevant. Further research is needed to better understand what motivates continuous use among student-athletes, who could use trackers to improve athletic performance and overall health.