Texting to Increase Physical Activity Among Teenagers (TXT Me!): Rationale, Design, and Methods Proposal

See Me, Hear Me, Know Me: Perspectives on Diet and Physical Activity Influences among Teens Living in Rural Texas Communities

Teens in rural communities are at greater risk of obesity than teens in urban areas. Diet and physical activity influence obesity risk. Understanding their perspectives is an important step in intervention design. This qualitative investigation explored teen perspectives on how living in a rural community influenced their diet and physical activity choices. Forty parent-teen pairs were recruited. Data collection included surveys and telephone interviews. This paper reports teen perspectives identified in the first interview. Thematic analysis was used to code and analyze the data. Findings revealed that the primary factor driving teens' diet and physical activity behaviors was the teens themselves. They clearly understood their role in the choices they made, although they acknowledged not always making the healthiest choice. This belief was driven by their motivation to engage in healthy behaviors, which was influenced by the perceived benefits derived from making healthy choices and from the synergistic relationship between diet and physical activity. Diet and physical activity, in turn, were influenced by the environment, particularly the home, social, and community environments. Family and friends were particularly influential, as well as resource availability. These findings can serve as a foundation for designing interventions tailored to this population.

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.

Ability of the Sport Education Model to Promote Healthy Lifestyles in University Students: A Randomized Controlled Trial

Although studies on sports performance, leadership abilities, group cohesion, and learning motivation have revealed that the sport education model contributes considerably to the development of healthy lifestyles, few studies have explored the development of healthy lifestyles from an educational intervention perspective. This study fills this gap in the literature. In addition, studies have mostly recruited elementary or middle school students; few have explored the effectiveness of sport education for college students. To fill this gap, this study conducted quasi-experimental research on university students by using different teaching strategies, with healthy lifestyles as the dependent variable. The research participants consisted of 95 students from Ming Chuang University distributed to an experimental group or control group. The experimental group was taught using the sport education model; the control group was taught using direct instruction. The results indicate that the sport education model has a stronger ability to promote healthy lifestyles than conventional teaching. Additionally, the results suggest that teachers should apply specific teaching strategies to cultivate and reinforce exercise habits and healthy behaviors among students. On the basis of the results, the researchers suggest that physical education teachers establish effective teaching strategies and promote healthy lifestyles to students.

Text Messages and Financial Incentives to Increase Physical Activity in Adolescents With Prediabetes and Type 2 Diabetes: Web-Based Group Interviews to Inform Intervention Design

BACKGROUND

Physical activity is a major component of treatment for adolescents with obesity and prediabetes or type 2 diabetes; however, sedentary behavior remains pervasive. An SMS text message-based intervention paired with financial incentives may be an effective way to promote physical activity in this population.

OBJECTIVE

This study aims to obtain end-user feedback on SMS text message content and assess the acceptability of a planned SMS text messaging intervention with financial incentives to motivate youth with prediabetes or type 2 diabetes to increase physical activity.

METHODS

Adolescents with overweight or obesity and prediabetes or type 2 diabetes who attended a large academic pediatric endocrinology clinic were recruited to participate in group interviews (2-4/group) via videoconferencing. Participants were asked to share their thoughts on the use of SMS text messages and financial incentives to remind and motivate them to be more physically active. They rated and provided feedback on specific messages to be used in clinical trials. Participants were also asked about their personal experience with rewards to motivate behavior change and their anticipated reactions to rewards provided for goal attainment (gain-framing) versus those provided and then taken away if a goal was not met (loss-framing). The interviews were conducted by 2 trained interviewers and a note-taker. Content analysis was used to explore themes.

RESULTS

Group interviews were completed with 20 participants (11/20, 55% women; 15/20, 75% with type 2 diabetes; 5/20, 25% with prediabetes) with a mean age of 15 (SD 1; range 12-18) years and a mean BMI of 41 (SD 5) kg/m² (all >95th percentile for age and sex). Most participants were non-Hispanic Black (14/20, 70%) and 10% (2/20) were Hispanics. Participants frequently cited near-continuous smartphone use and agreed that SMS text messages would serve as good reminders to be physically active, but the consensus about the need for short messages was strong. Favorable content included references to what they were likely to be doing when messages were sent (eg, homework or watching television) and messages that were upbeat or informative. Specific physical activity suggestions were rated favorably. Attitudes toward financial incentives varied, with differing opinions about whether loss-framed incentives would be motivating or discouraging. Many participants highlighted the role of intrinsic, rather than extrinsic, motivation in achieving and sustaining behavior change.

CONCLUSIONS

The engagement of adolescents with obesity and diabetes or prediabetes allowed for the refinement of SMS text messages for our planned intervention, with an emphasis on short, upbeat, relatable, and informative messages. Although an SMS text messaging intervention using financial incentives to motivate youth with prediabetes or type 2 diabetes to be more physically active is theoretically acceptable, the impact on actual activity levels in this population requires prospective evaluation in a clinical trial.

Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents

PURPOSE OF REVIEW

This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity.

RECENT FINDINGS

Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.

Concept Analysis of Relatedness in Physical Activity Among Adolescents

AIM

This analysis seeks to clarify the concept of relatedness in physical activity (PA) among adolescents.

BACKGROUND

Health-related behavior research highlights the importance of focusing on individual psychological needs such as relatedness in PA to improve adolescents' motivation toward PA. Although relatedness in PA has been associated with PA participation among adolescents, a thorough analysis of the concept is lacking. Conceptual clarification of relatedness in the context of PA is needed for promoting consistency between conceptual and operational definitions and refining empirical measurement.

DESIGN

The 6-steps of Rodgers' (2000) evolutionary method of concept analysis was used to analyze the data and identify attributes, surrogate/related terms, antecedents, and consequences of the relatedness concept.

METHOD

Several databases were used to extract relevant articles. A total of 113 were identified. Forty articles met the inclusion criteria. In addition, twenty-six articles were included through other sources. The review process yielded a final set of 66 articles.

RESULT

A refined definition of relatedness in PA is an adolescent's perception of feeling socially connected with significant people in a reciprocal, caring, and trusting relationship that is a self-system process and promotes a sense of belonging and internalization within PA contexts. Attributes, surrogate/related terms, antecedents and consequences of relatedness in PA were identified from extant literature.

CONCLUSION

This comprehensive analysis provides a clarification of the conceptual definition of relatedness in PA among adolescents. The concept can guide nurses in designing interventions to improve health behavior or promoting changes in health policy. Future research is needed to refine operational definitions of relatedness so that they represent the defining attributes of the concept.

Harnessing Phones to Target Pediatric Populations with Socially Complex Needs: Systematic Review

BACKGROUND

Mobile and smartphones are owned and accessed by many, making them a potentially optimal delivery mechanism to reach pediatric patients with socially complex needs (ie, pediatric populations who face overlapping adversities).

OBJECTIVE

To address the specialized needs of youth from such groups, this review synthesized the literature exploring the use of phone-based delivery to access pediatric populations with socially complex needs, targeting mental and behavioral health outcomes. The purpose of this synthesis was to provide recommendations for future research developing phone-based interventions for youth with socially complex needs.

METHODS

A trained medical librarian conducted the search strategy in the following databases: PubMed, Scopus, CINAHL, PsycINFO, Cochrane CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Studies targeting youth with socially complex needs were defined by recruiting samples that were primarily from traditionally underserved populations (ie, sex/gender minorities, racial/ethnic background, low socioeconomic status, rural/remote location, and sexual orientation). A systematic narrative framework was utilized and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed (registration number CRD42020141212).

RESULTS

A total of 14 studies met the inclusion criteria, with 3 depicting the use of phones to complete assessment and tracking goals and 11 to intervene on mental and behavioral health targets.

CONCLUSIONS

The literature indicates important directions for future research, including (1) involving diverse and representative teens (ie, the likely users of the interventions), stakeholders, and clinical/research staff; (2) integrating evidence-based therapies with minority-focused theories; (3) harnessing mobile device capabilities; and (4) considering and assessing for potential costs in phones as delivery mechanisms.

TRIAL REGISTRATION

PROSPERO CRD42020141212; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141212.

Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support

Background

The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual's changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual's state can change rapidly, unexpectedly, and in his/her natural environment.

Purpose

Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap.

Methods

Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration.

Conclusions

As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention.

"Just Say It Like It Is!" Use of a Community-Based Participatory Approach to Develop a Technology-Driven Food Literacy Program for Adolescents

FuelUp&Go! is a technology-driven food literacy program consisting of six in-person skill building sessions as well as fitness trackers, text messages, and a companion website. A community-based participatory research approach was used with adolescents who were recruited to participate in a Kid Council. Qualitative data were collected about the use of surveys, program activities, recipes, technology and text messages, and music and incentives. Changes suggested by Kid Councilmembers informed the design and development of a pilot program. Participants were recruited for the pilot program and completed pre- and postintervention surveys. The results indicated food-related knowledge remained low but increased from baseline to follow-up. Attitudes toward vegetables and physical activity increased slightly. Self-reported participation in physical activity and consumption of sugar-added beverages moved in positive directions. These findings suggest that community-based participatory research approach is an effective approach to engage adolescents in the development of a technology-driven food literacy program.

Text Messaging Based Obesity Prevention Program for Parents of Pre-Adolescent African American Girls

African American girls are at a greater risk of obesity than their nonminority peers. Parents have the primary control over the home environment and play an important role in the child obesity prevention. Obesity prevention programs to help parents develop an obesity-preventive home environment are needed. The purpose of this study was to collect formative research from parents of 8-10-year old African American girls about perceptions, expectations, and content for a text messaging based program. Mothers (n = 30) participated in surveys and interviews to inform message development and content. A professional expert panel (n = 10) reviewed draft text messages via a survey. All the mothers reported owning a cellphone with an unlimited texting plan, and they used their cellphones for texting (90.0%) and accessing the Internet (100.0%). The majority were interested in receiving text messages about healthy eating and physical activity (86.7%). Interviews confirmed survey findings. One hundred and seven text messages promoting an obesity-preventive home environment were developed. The expert panel and parents reported positive reactions to draft text messages. This research provides evidence that mobile health (mHealth) interventions appeal to parents of African American girls and they have ready access to the technology with which to support this approach.

Development of A Teen-Focused Exergame

INTRODUCTION

Exergames require body movement to play and may be an effective method for enhancing teen physical activity (PA). However, results have been mixed. Innovative methods are needed to develop Exergames that increase and maintain PA. Self-representational avatars, or avatars created from a digital image of an individual, may increase PA (e.g., intensity, duration) during Exergame play. This article addresses this novel idea by describing the development of an Exergame played with a self-representational avatar.

MATERIALS AND METHODS

Twelve- to 14-year-olds, stratified by gender, body mass index, and PA, were invited to participate in two rounds of data collection. Each round consisted of an online survey, followed by a telephone interview to ensure comprehension of survey responses. After the first round, an Exergame prototype and the system for creating the self-representational avatar were created. A second round of data was collected to obtain information with which to create a fully functional Exergame and the avatar creation system.

RESULTS

Forty-eight teens were recruited. The sample was multi-ethnic (41.7% White, 37.5% Black, 18.8% Hispanic, 2.1% Mixed/Other). Complete data were obtained on 48 teens in the first round of data collection and on 43 teens in the second round. Teens provided important information regarding preferences and expectations. Gender similarities and differences were observed.

CONCLUSION

This research contributes to the body of knowledge regarding how to design an appealing Exergame for teens navigated by a self-representational avatar.

Texting to Increase Adolescent Physical Activity: Feasibility Assessment

OBJECTIVE

Feasibility trials assess whether a behavior change program warrants a definite trial evaluation. This paper reports the feasibility of an intervention consisting of Self Determination Theory-informed text messages, pedometers, and goal prompts to increase adolescent physical activity.

METHODS

A 4-group randomized design with baseline and immediate post-study assessments was used. Groups (pedometer; pedometer + goal prompt; pedometer + goal prompt + theory-informed texts; no-treatment control) were systematically varied to assess the additive effect of intervention components on objectively measured physical activity (ie, ActiGraph). The primary outcome of the 12-week intervention was program feasibility. Changes in average daily step counts and minutes of moderate-to-vigorous physical activity also were examined. Post-intervention research with a subset of participants examined program reactions.

RESULTS

Participants (N = 160) were evenly split by sex, mostly 14-15 years old, and of diverse race/ethnicity. Feasibility criteria were met. The attrition rate was less than 2%. Modest increases in average daily step counts and moderate-to-vigorous physical activity were observed in all groups except the control group. Participants reported positive reactions to the intervention.

CONCLUSIONS

An intervention consisting of pedometers, theory-informed texts, and goal prompts, is a feasible and acceptable method for promoting physical activity to adolescents.

Stepwise Development a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown)

Background

Bullying is a significant public health issue among middle school-aged youth. Current prevention programs have only a moderate impact. Cell phone text messaging technology (mHealth) can potentially overcome existing challenges, particularly those that are structural (e.g., limited time that teachers can devote to non-educational topics). To date, the description of the development of empirically-based mHealth-delivered bullying prevention programs are lacking in the literature.

Objective

To describe the development of BullyDown, a text messaging-based bullying prevention program for middle school students, guided by the Social-Emotional Learning model.

Methods

We implemented five activities over a 12-month period: (1) national focus groups (n=37 youth) to gather acceptability of program components; (2) development of content; (3) a national Content Advisory Team (n=9 youth) to confirm content tone; and (4) an internal team test of software functionality followed by a beta test (n=22 youth) to confirm the enrollment protocol and the feasibility and acceptability of the program.

Results

Recruitment experiences suggested that Facebook advertising was less efficient than using a recruitment firm to recruit youth nationally, and recruiting within schools for the pilot test was feasible. Feedback from the Content Advisory Team suggests a preference for 2-4 brief text messages per day. Beta test findings suggest that BullyDown is both feasible and acceptable: 100% of youth completed the follow-up survey, 86% of whom liked the program.

Conclusions

Text messaging appears to be a feasible and acceptable delivery method for bullying prevention programming delivered to middle school students.

A Qualitative Study to Examine Feasibility and Design of an Online Social Networking Intervention to Increase Physical Activity in Teenage Girls

Background

Online social networks present wide-reaching and flexible platforms through which to deliver health interventions to targeted populations. This study used a social marketing approach to explore teenage girls’ perceptions of physical activity and the potential use of online social networks to receive a physical activity intervention.

Methods

Six focus groups were conducted with 19 Australian teenage girls (ages 13 to 18 years) with varying levels of physical activity and socioeconomic status. A semi-structured format was used, with groups discussion transcribed verbatim. Content analysis identified emergent themes, with triangulation and memos used to ensure accuracy.

Results

Physical activity was most appealing when it emphasised sport, exercise and fitness, along with opportunities for socialisation with friends and self-improvement. Participants were receptive to delivery of a physical activity intervention via online social networks, with Facebook the most widely reported site. Participants commonly accessed online social networks via mobile devices and particularly smartphones. Undesirable features included promotion of physical activity in terms of walking; use of cartoon imagery; use of humour; and promotion of the intervention via schools, each of which were considered “uncool”. Participants noted that their parents were likely to be supportive of them using an online social networking physical activity intervention, particularly if not promoted as a weight loss intervention.

Conclusion

This study identified key features likely to increase the feasibility and retention of an online social networking physical activity intervention for teenage girls. Guidelines for the design of interventions for teenage girls are provided for future applications.

The effect of need supportive text messages on motivation and physical activity behaviour

Few short messaging service (SMS) studies to support behaviour change have used a theoretical underpinning. Using a self-determination theory perspective, we explored the effects of need supportive (NS) SMS on physical activity in 65 (BMI = 24.06 kg/m(2), SD = 5.49; M = 25.76 years, SD = 10.23) insufficiently active individuals embarking on an existing exercise programme. For 10 weeks participants were randomised to an intervention group (NS) or control group (neutral). SMS were sent twice weekly, randomly, via an online SMS service. Mixed design ANCOVA and MANCOVA analyses of measures taken at baseline, mid and post intervention revealed increased levels of perceived autonomy support and psychological need satisfaction in the intervention group post intervention. Both groups reported increases in intrinsic motivation from pre to post intervention. Moderate intensity physical activity was greater in the intervention than the control group at 4-month post intervention with control group returning to baseline levels. Findings provide preliminary causal evidence to support the use of NS SMS to optimise physical activity behaviour change in individuals who are insufficiently active.

Preliminary efficacy and feasibility of embedding high intensity interval training into the school day: A pilot randomized controlled trial

Current physical activity and fitness levels among adolescents are low, increasing the risk of chronic disease. Although the efficacy of high intensity interval training (HIIT) for improving metabolic health is now well established, it is not known if this type of activity can be effective to improve adolescent health. The primary aim of this study is to assess the effectiveness and feasibility of embedding HIIT into the school day. A 3-arm pilot randomized controlled trial was conducted in one secondary school in Newcastle, Australia. Participants (n = 65; mean age = 15.8(0.6) years) were randomized into one of three conditions: aerobic exercise program (AEP) (n = 21), resistance and aerobic exercise program (RAP) (n = 22) and control (n = 22). The 8-week intervention consisted of three HIIT sessions per week (8–10 min/session), delivered during physical education (PE) lessons or at lunchtime. Assessments were conducted at baseline and post-intervention to detect changes in cardiorespiratory fitness (multi-stage shuttle-run), muscular fitness (push-up, standing long jump tests), body composition (Body Mass Index (BMI), BMI-z scores, waist circumference) and physical activity motivation (questionnaire), by researchers blinded to treatment allocation. Intervention effects for outcomes were examined using linear mixed models, and Cohen's d effect sizes were reported. Participants in the AEP and RAP groups had moderate intervention effects for waist circumference (p = 0.024), BMI-z (p = 0.037) and BMI (not significant) in comparison to the control group. A small intervention effect was also evident for cardiorespiratory fitness in the RAP group.

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Both HIIT intervention groups resulted in moderate improvements in body composition.

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The RAP group resulted in moderate improvements in cardiorespiratory fitness.

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The intervention dose was practical and achievable for participants and teachers.

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Teachers reported a willingness to embed HIIT within future PE lessons.

Physical Activity Design Guidelines for School Architecture

Increasing children's physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students' physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment's impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.

Smartphone apps to improve fitness and increase physical activity among young people: protocol of the Apps for IMproving FITness (AIMFIT) randomized controlled trial

Background

Physical activity is a modifiable behavior related to many preventable non-communicable diseases. There is an age-related decline in physical activity levels in young people, which tracks into adulthood. Common interactive technologies such as smartphones, particularly employing immersive features, may enhance the appeal and delivery of interventions to increase levels of physical activity in young people. The primary aim of the Apps for IMproving FITness (AIMFIT) trial is to evaluate the effectiveness of two popular “off-the-shelf” smartphone apps for improving cardiorespiratory fitness in young people.

Methods/Design

A three-arm, parallel, randomized controlled trial will be conducted in Auckland, New Zealand. Fifty-one eligible young people aged 14–17 years will be randomized to one of three conditions: 1) use of an immersive smartphone app, 2) use of a non-immersive app, or 3) usual behavior (control). Both smartphone apps consist of an eight-week training program designed to improve fitness and ability to run 5 km, however, the immersive app features a game-themed design and adds a narrative. Data are collected at baseline and 8 weeks. The primary outcome is cardiorespiratory fitness, assessed as time to complete the one mile run/walk test at 8 weeks. Secondary outcomes are physical activity levels, self-efficacy, enjoyment, psychological need satisfaction, and acceptability and usability of the apps. Analysis using intention to treat principles will be performed using regression models.

Discussion

Despite the proliferation of commercially available smartphone applications, there is a dearth of empirical evidence to support their effectiveness on the targeted health behavior. This pragmatic study will determine the effectiveness of two popular “off-the-shelf” apps as a stand-alone instrument for improving fitness and physical activity among young people. Adherence to app use will not be closely controlled; however, random allocation of participants, a heterogeneous group, and data analysis using intention to treat principles provide internal and external validity to the study. The primary outcome will be objectively assessed with a valid and reliable field-based test, as well as the secondary outcome of physical activity, via accelerometry. If effective, such applications could be used alongside existing interventions to promote fitness and physical activity in this population.

Trial Registration

Australian New Zealand Clinical Trials Registry: ACTRN12613001030763. Registered 16 September 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1968-y) contains supplementary material, which is available to authorized users.

What serious video games can offer child obesity prevention

Childhood obesity is a worldwide issue, and effective methods encouraging children to adopt healthy diet and physical activity behaviors are needed. This viewpoint addresses the promise of serious video games, and why they may offer one method for helping children eat healthier and become more physically active. Lessons learned are provided, as well as examples gleaned from personal experiences.

Using Pedometers for Measuring and Increasing Physical Activity in Children and Adolescents

The science and practice of step counting in children (typically aged 6-11 years) and adolescents (typically aged 12-19 years) has evolved rapidly over a relatively brief period with the commercial availability of research-grade pedometers and accelerometers. Recent reviews have summarized considerations for assessing physical activity using pedometers in young people (both children and adolescents), but 3 areas have received little attention: pedometer monitoring protocols, minimal (as opposed to optimal) step counts necessary for maintaining basal levels of health, and appropriate pedometer-based interventions for young people. Therefore, the objective of this review was to evaluate the current evidence and identify future research directions in these areas. The challenges of objective monitoring of physical activity in children and adolescents reinforce the importance of using protocols that minimize participant burden and the potential for tampering/reactivity. Evidence for a sedentary lifestyle cut point is limited; researchers are therefore encouraged to investigate several cut points (ie, <5000, <6000, <7000 steps/d) in children and adolescents to identify the health consequences of very low levels of ambulatory activity. Personalized messages may be necessary for health behavior change in pedometer-based interventions, but there is a need for more high-quality studies to develop the existing evidence base.