Application and Validation of Activity Monitors' Epoch Lengths and Placement Sites for Physical Activity Assessment in Exergaming

Effectiveness of a pain neuroscience education programme on the physical activity of patients with chronic low back pain compared with a standard back school programme: protocol for a randomised controlled study (END-LC)

INTRODUCTION

Education is recognised as an effective and necessary approach in chronic low back pain. Nevertheless, data regarding the effectiveness of education in promoting physical activity in the medium term or long term are still limited, as are the factors that could lead to successful outcomes. Our study aims to assess the effectiveness of a pain neuroscience education programme compared with traditional back school on physical activity 3 months and 1 year after educational sessions coupled with a multidisciplinary rehabilitation programme. Additionally, we seek to evaluate the effects of these educational interventions on various factors, including pain intensity and psychobehavioural factors. Finally, our goal is to identify the determinants of success in educational sessions combined with the rehabilitation programme.

METHODS AND ANALYSIS

The study will involve 82 adults with chronic low back pain. It will be a monocentric, open, controlled, randomised, superiority trial with two parallel arms: an experimental group, 'pain neuroscience education', and a control group, 'back school'. The primary outcome is the average number of steps taken at home over a week, measured by an actigraph. Secondary outcomes include behavioural assessments. Descriptive and inferential analysis will be conducted. Multivariate modelling will be performed using actimetric data and data from the primary and secondary outcomes.

ETHICS AND DISSEMINATION

The Committee for Personal Protection of Ile de France VII (CPP) gave a favourable opinion on 22 June 2023 (National number: 2023-A00346-39). The study was previously registered with the National Agency for the Safety of Medicines and Health Products (IDRCB: 2023-A00346-39). Participants signed an informed consent during the inclusion visit. This protocol is the version submitted to the CPP entitled 'Protocol Version N°1 of 03/29/2023'. The results of the study will be presented nationally and internationally through conferences and publications.

TRIAL REGISTRATION NUMBER

NCT05840302.

Adaptation and study protocol for harvest for health together Arizona: A mentored community garden intervention for survivors of cancer

Background

Current health behavior recommendations for skin cancer prevention, treatment, and survivorship are the same for survivors of other cancers; they include eating a healthy diet, being physically active, maintaining a healthy weight, and minimizing ultraviolet (U.V.) exposure. Few interventions exist to support health behaviors beyond U.V. exposure. We adapted Harvest for Health, a home-based mentored gardening intervention for cancer survivors, for implementation in Arizona as a community-based intervention.

Methods

Stakeholder-informed adaptations for Harvest for Health Together Arizona (H4H2-AZ) included updating intervention materials to be relevant to the arid desert environment, emphasizing the importance of sun safety in cancer survivorship, and shifting from a home-based to a community-based delivery model. Participants will be enrolled in cohorts aligned with growing seasons (e.g., spring, monsoon, fall) and matched to an individual 30 ft2 community garden plot for two growing seasons (6 months). Original intervention components retained are: 1) Master Gardeners deliver the intervention providing one-to-one mentorship and 2) gardening materials and supplies provided. This pilot six-month single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer as primary outcomes. Secondary outcomes are to explore the effects on cancer preventive health behaviors and health-related quality of life.

Discussion

This pilot single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer. If successful, the intervention could be widely implemented throughout existing Master Gardener programs and community garden networks for survivors of other cancers.

Trial registration

ClinicalTrials.gov identifier: NCT05648604. Trial registered on December 13, 2022.

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial

BACKGROUND

Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas.

OBJECTIVE

This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah.

METHODS

We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign.

RESULTS

The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management.

CONCLUSIONS

Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50392.

Opal Actigraphy (Activity and Sleep) Measures Compared to ActiGraph: A Validation Study

Physical activity and sleep monitoring in daily life provide vital information to track health status and physical fitness. The aim of this study was to establish concurrent validity for the new Opal Actigraphy solution in relation to the widely used ActiGraph GT9X for measuring physical activity from accelerometry epic counts (sedentary to vigorous levels) and sleep periods in daily life. Twenty participants (age 56 + 22 years) wore two wearable devices on each wrist for 7 days and nights, recording 3-D accelerations at 30 Hz. Bland-Altman plots and intraclass correlation coefficients (ICCs) assessed validity (agreement) and test-retest reliability between ActiGraph and Opal Actigraphy sleep durations and activity levels, as well as between the two different versions of the ActiGraph. ICCs showed excellent reliability for physical activity measures and moderate-to-excellent reliability for sleep measures between Opal versus Actigraph GT9X and between GT3X versus GT9X. Bland-Altman plots and mean absolute percentage error (MAPE) also show a comparable performance (within 10%) between Opal and ActiGraph and between the two ActiGraph monitors across activity and sleep measures. In conclusion, physical activity and sleep measures using Opal Actigraphy demonstrate performance comparable to that of ActiGraph, supporting concurrent validation. Opal Actigraphy can be used to quantify activity and monitor sleep patterns in research and clinical studies.

The effect of narrative element incorporation on physical activity and game experience in active and sedentary virtual reality games

Narratives are pervasive in video games and have been found to increase physical activity in active video games. However, the effect of incorporating narrative elements has seldom been examined in fully immersive virtual reality games. We investigated the effect of narrative element incorporation (between-subject: narrative vs. no narrative) in active virtual reality and sedentary virtual reality games (within-subject) and examined between- and within-subject effects on physical activity behavior, game experience, and physical activity engagement. We randomized 36 sedentary college students to either the narrative or the non-narrative group. All participants played an active virtual reality and a sedentary virtual reality game in counter-balanced order. Before each game session, they either watched a 5-min narrative video (narrative) or directly played the original virtual reality games without narratives (non-narrative). We collected participants' physical activity data using wrist-worn accelerometers; we obtained their game experience and physical activity engagement via questionnaires. The narrative group spent a greater proportion of time in moderate-to-vigorous physical activity (%) and had less non-movement time during the active virtual reality gameplay than the non-narrative group (all p values < .05). The active virtual reality sessions induced a greater positive affect and greater physical activity engagement ratings than the sedentary virtual reality sessions. The incorporation of narrative elements in active virtual reality increased the relative time spent in moderate-to-vigorous physical activity and reduced non-movement time, compared to the non-narrative group. Active virtual reality encouraged more activity by participants and offered them a more enjoyable gaming experience in which they engaged more. Active virtual reality is a feasible physical activity promotion option among sedentary adults; the incorporation of narrative elements in active virtual reality helps increase relative moderate-to-vigorous physical activity and should be further explored for its efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00754-7.

Physical Activity and Physical and Mental Health in Middle-Aged Adults with Down Syndrome

Background

Adults with Down syndrome have an increased risk of aging-related physical and mental health conditions and experience them at an earlier age than the general population. There is a need to investigate modifiable lifestyle factors that may reduce risk for these conditions.

Method

The present study investigated the associations between physical activity (i.e., sedentary behavior and moderate-to-vigorous activity) assessed via accelerometer across 7 days and caregiver-reported physical and mental health of 66 non-demented middle-aged adults with Down Syndrome aged 25-55 years (52% female).

Results

Regression analyses indicated that more time spent in moderate intensity physical activity was associated with less risk of sleep apnea (b = -.031 p = .004) and endocrine/metabolic conditions (b = -.046 p = .009), and lower total number of physical health conditions (b = -.110 p =.016) and anxiety disorders (b = -.021 p =.049) after controlling for relevant sociodemographics. After also adjusting for BMI, the association between time spent in moderate intensity physical activity and sleep apnea (b=-.035, p = .002), endocrine/metabolic conditions (b=-.033, p = .045) and total physical health (b=-.091, p =.026) remained significant Unexpectedly, time spent in sedentary behavior was negatively associated with musculoskeletal conditions (b=-.017, p = .044).

Conclusion

Findings indicate important associations between physical activity in everyday life and the physical and mental health of adults with Down syndrome. Social policies and interventions aimed at reducing time spent sitting around (i.e., sedentary behavior) and encouraging moderate-to-vigorous activity may be a low-burden and low-cost mechanism for fostering healthy physical and mental aging in the Down syndrome population.

Sound reasons for unsound sleep: Comparative support for the sentinel hypothesis in industrial and nonindustrial groups

Background and objectives

Sleep is a vulnerable state in which individuals are more susceptible to threat, which may have led to evolved mechanisms for increasing safety. The sentinel hypothesis proposes that brief awakenings during sleep may be a strategy for detecting and responding to environmental threats. Observations of sleep segmentation and group sentinelization in hunter-gatherer and small-scale communities support this hypothesis, but to date it has not been tested in comparisons with industrial populations characterized by more secure sleep environments.

Methodology

Here, we compare wake after sleep onset (WASO), a quantitative measure of nighttime awakenings, between two nonindustrial and two industrial populations: Hadza hunter-gatherers (n = 33), Malagasy small-scale agriculturalists (n = 38), and Hispanic (n = 1,531) and non-Hispanic White (NHW) (n = 347) Americans. We compared nighttime awakenings between these groups using actigraphically-measured sleep data. We fit linear models to assess whether WASO varies across groups, controlling for sex and age.

Results

We found that WASO varies significantly by group membership and is highest in Hadza (2.44 h) and Malagasy (1.93 h) and lowest in non-Hispanic Whites (0.69 h). Hispanics demonstrate intermediate WASO (0.86 h), which is significantly more than NHW participants. After performing supplementary analysis within the Hispanic sample, we found that WASO is significantly and positively associated with increased perception of neighborhood violence.

Conclusions and implications

Consistent with principles central to evolutionary medicine, we propose that evolved mechanisms to increase vigilance during sleep may now be mismatched with relatively safer environments, and in part responsible for driving poor sleep health.

Technological infrastructure, sleep, and rest-activity patterns in a Kaqchikel Maya community

Sleep duration, quality, and rest-activity pattern-a measure for inferring circadian rhythm-are influenced by multiple factors including access to electricity. Recent findings suggest that the safety and comfort afforded by technology may improve sleep but negatively impact rest-activity stability. According to the circadian entrainment hypothesis, increased access to electric lighting should lead to weaker and less uniform circadian rhythms, measured by stability of rest-activity patterns. Here, we investigate sleep in a Maya community in Guatemala who are in a transitional stage of industrialization. We predicted that (i) sleep will be shorter and less efficient in this population than in industrial settings, and that (ii) rest-activity patterns will be weaker and less stable than in contexts with greater exposure to the natural environment and stronger and more stable than in settings more buffered by technologic infrastructure. Our results were mixed. Compared to more industrialized settings, in our study population sleep was 4.87% less efficient (78.39% vs 83.26%). We found no significant difference in sleep duration. Rest-activity patterns were more uniform and less variable than in industrial settings (interdaily stability = 0.58 vs 0.43; intradaily variability = 0.53 vs 0.60). Our results suggest that industrialization does not inherently reduce characteristics of sleep quality; instead, the safety and comfort afforded by technological development may improve sleep, and an intermediate degree of environmental exposure and technological buffering may support circadian rhythm strength and stability.

Active video games in fully immersive virtual reality elicit moderate-to-vigorous physical activity and improve cognitive performance in sedentary college students

BACKGROUND

Active video games are a new method for increasing physical activity (PA). Fully immersive virtual reality (VR) is a hardware device on which an active video game can run. Active (video games in) VR (AVR), might increase immersion, game engagement, and moderate-to-vigorous PA (MVPA), thereby yielding greater exercise-related benefits, e.g., cognitive performance.

METHODS

We examined the induction of MVPA via an AVR and a sedentary VR (SVR) as well as the effects of VR play on cognitive performance, which was monitored using 2 different methods. Each of 29 sedentary college students attended three 20-min laboratory sessions (AVR, SVR, or control) in a randomized order; during the control session, they sat quietly doing nothing. A fully immersive headset was used for the 2 video game sessions. We monitored and computed participants' PA using hip-worn accelerometers (wGT3x-bt; ActiGraph, Pensacola, FL, USA) and a heart rate band (Polar H7; Polar, Kempele, Finland). After each session, the participants completed a mnemonic similarity test (MST) to measure recognition memory. They also filled out a motion sickness questionnaire and an abbreviated game experience questionnaire.

RESULTS

The AVR session induced a significantly greater heart rate and more time spent in MVPA than did either of the other 2 sessions regardless of the PA monitoring method. AVR elicited greater game experience questionnaire-assessed sensory and imaginative immersion, challenge, and positive affect than did SVR. The mnemonic similarity test recognition score was marginally higher post-AVR session than it was post-SVR session.

CONCLUSION

AVR elicited MVPA without a significant increase in motion sickness and induced a better game experience and better borderline cognitive performance than did SVR.

Physical activity and cognitive and imaging biomarkers of Alzheimer's disease in down syndrome

Adults with Down syndrome (DS) are at risk for Alzheimer's disease. Despite sharing trisomy 21, however, there is variability in the age of disease onset. This variability may mean that other factors, such as lifestyle, influence cognitive aging and disease timing. The present study assessed the association between everyday life physical activity using an actigraph accelerometer and cognitive functioning and early Alzheimer's disease pathology via positron emission tomography amyloid-β and tau and diffusion tension imaging measures of white matter integrity in 61 non-demented adults with DS. Percent time in sedentary behavior and in moderate-to-vigorous activity were associated (negatively and positively, respectively) with cognitive functioning (r = -.472 to .572, p < 0.05). Neither sedentary behavior nor moderate-to-vigorous activity were associated with amyloid-β or tau, but both were associated with white matter integrity in the superior and inferior longitudinal fasciculus (Fractional Anisotropy: r = -.397 to -.419, p < 0.05; Mean Diffusivity: r = .400, p < 0.05). Longitudinal studies are needed to determine if physical activity promotes healthy aging in DS.

Applicability of Physiological Monitoring Systems within Occupational Groups: A Systematic Review

The emergence of physiological monitoring technologies has produced exceptional opportunities for real-time collection and analysis of workers' physiological information. To benefit from these safety and health prognostic opportunities, research efforts have explored the applicability of these devices to control workers' wellbeing levels during occupational activities. A systematic review is proposed to summarise up-to-date progress in applying physiological monitoring systems for occupational groups. Adhering with the PRISMA Statement, five databases were searched from 2014 to 2021, and 12 keywords were combined, concluding with the selection of 38 articles. Sources of risk of bias were assessed regarding randomisation procedures, selective outcome reporting and generalisability of results. Assessment procedures involving non-invasive methods applied with health and safety-related goals were filtered. Working-age participants from homogeneous occupational groups were selected, with these groups primarily including firefighters and construction workers. Research objectives were mainly directed to assess heat stress and physiological workload demands. Heart rate related variables, thermal responses and motion tracking through accelerometry were the most common approaches. Overall, wearable sensors proved to be valid tools for assessing physiological status in working environments. Future research should focus on conducting sensor fusion assessments, engaging wearables in real-time evaluation methods and giving continuous feedback to workers and practitioners.

Hill Runner's Physiology, Performance and Nutrition: A Descriptive Study

Objectives: The aim of this descriptive study was to characterise anthropometric variables, aerobic capacity, running performance and energy intake and expenditure of hill runners in free-living conditions, and to investigate the relationship between age, anthropometric variables, aerobic capacity and running performance.

Methods: Twenty-eight hill runners participated in this study (17 males and 11 females; aged 18–65 years). Body fat percentage estimate, sum of eight skinfolds (triceps, subscapular, biceps, iliac crest, supraspinale, abdominal, front thigh and medial calf) and maximal oxygen capacity (VO₂max) were assessed in a laboratory setting. Participants also completed a timed hill run (Dumyat Hill, Scotland, ascent: 420 m, distance: 8 km) while wearing a portable gas analyzer to assess oxygen consumption (VO₂). Energy intake and energy expenditure were assessed in free-living conditions over three consecutive days different from the testing days through self-reported food diaries and accelerometers.

Results: VO₂max assessed in the lab (51.2 ± 7.6 ml·min⁻¹·kg⁻¹) showed a weak negative relationship with age [rs(23) = −0.38, p = 0.08]. Neither body fat percentage (median 12.4; IQR 10.1–17.1) nor the sum of skinfolds (median 81.8; IQR 62.4–97.8 mm) correlated with age [rs(28) = 0.001, p = 0.10 and 26 rs(28) = −0.02, p = 0.94, respectively]. The observed intensity of the hill run was 89 ± 6% of the age predicted maximum heart rate and 87 ± 9% of the VO₂max observed in the lab. Hill running performance correlated with VO₂max [r(21) = 0.76, p < 0.001], age [rs(26) = −0.44, p = 0.02] and with estimated body fat percentage and sum of skinfolds [rs(26) = −0.66, p < 0.001 and rs(26) = −0.49, p = 0.01, respectively]. Energy intake negatively correlated with age [rs(26) = −0.43, p = 0.03], with the overall energy intake being significantly lower than the total energy expenditure (2273 ± 550 vs. 2879 ± 510 kcal·day⁻¹; p < 0.001; d = 1.05).

Conclusion: This study demonstrated that hill running performance is positively associated with greater aerobic capacity and negatively associated with increases in adiposity and age. Further, the study highlights that hill runners are at risk of negative energy balance.

Comparison of Inhibitory Control After Acute Bouts of Exergaming Between Children with Obesity and Their Normal-Weight Peers

Objective: The benefits of exergaming on executive function in children have been increasingly reported; however, weight-dependent effects of exergames on executive function, and inhibitory control in particular, remain poorly understood. We examined performance on an inhibitory control task at baseline and following acute bouts of exergaming in children who varied in weight status. Materials and Methods: Forty 8-12-year-old children with obesity (n = 20) and normal weight (n = 20) performed neutral, congruent, and incongruent conditions of a Victoria Stroop Test (VST) before and after exergames through an Xbox One in an elementary classroom. We measured time spent in moderate-to vigorous-intensity activity through ActiGraph accelerometers and recorded gameplay time. Results: At baseline, children with obesity relative to their normal-weight peers had significantly longer reaction times (P = 0.011), resulting in significantly longer completion time (P = 0.005) during incongruent trials requiring greater inhibitory control, and therefore had higher interference scores (P = 0.024). However, following acute bouts of exergames, children with obesity compared with their normal-weight counterparts significantly decreased completion time (P = 0.013), made fewer errors (P = 0.012) during incongruent trials, and subsequently had reduced interference effects (P = 0.037). Children with obesity and normal-weight children spent similar time (minutes) (7.8 vs. 8.6, P = 0.725) in moderate-to vigorous-intensity activity during similar gameplay time (8.7 vs. 10.5, P = 0.819). Conclusion: Our results suggest that greater, acute cognitive gains occur in children with obesity relative to normal-weight children following similar intensity and duration of exergames, which may be due to reduced inhibitory control capacity at baseline in childhood obesity.

Development and Evaluation of an Accelerometer-Based Protocol for Measuring Physical Activity Levels in Cancer Survivors: Development and Usability Study

Background

The collection of self-reported physical activity using validated questionnaires has known bias and measurement error.

Objective

Accelerometry, an objective measure of daily activity, increases the rigor and accuracy of physical activity measurements. Here, we describe the methodology and related protocols for accelerometry data collection and quality assurance using the Actigraph GT9X accelerometer data collection in a convenience sample of ovarian cancer survivors enrolled in GOG/NRG 0225, a 24-month randomized controlled trial of diet and physical activity intervention versus attention control.

Methods

From July 2015 to December 2019, accelerometers were mailed on 1337 separate occasions to 580 study participants to wear at 4 time points (baseline, 6, 12, and 24 months) for 7 consecutive days. Study staff contacted participants via telephone to confirm their availability to wear the accelerometers and reviewed instructions and procedures regarding the return of the accelerometers and assisted with any technology concerns.

Results

We evaluated factors associated with wear compliance, including activity tracking, use of a mobile app, and demographic characteristics with chi-square tests and logistic regression. Compliant data, defined as ≥4 consecutive days with ≥10 hours daily wear time, exceeded 90% at all study time points. Activity tracking, but no other characteristics, was significantly associated with compliant data at all time points (P<.001). This implementation of data collection through accelerometry provided highly compliant and usable activity data in women who recently completed treatment for ovarian cancer.

Conclusions

The high compliance and data quality associated with this protocol suggest that it could be disseminated to support researchers who seek to collect robust objective activity data in cancer survivors residing in a wide geographic area.

The impact of narratives and active video games on long-term moderate-to-vigorous physical activity: A randomized controlled trial protocol

BACKGROUND

Although physical activity (PA) has been shown in helping prevent and treat obesity, current PA interventions are still not effective in ameliorating the obesity epidemic. Additional forms of PA need to be investigated to improve PA engagement and outcomes. We hypothesize that pairing a narrative (i.e., story) with an active video game (AVG), a less traditional form of PA, will increase participant engagement in PA. This paper presents the rationale, implementation, and pilot results of a study assessing the effect of narrative's impact on PA and a series of other health outcomes.

OBJECTIVE

This paper presents the rationale, implementation, and pilot results of a study assessing the effect of narrative's impact on PA and a series of other health outcomes.

METHODS/DESIGN

The Active Video Game Study is a six-month randomized controlled single-blind trial projected to include 210 participants. The intervention strategy will pair a narrative to an active video game (AVG). Participants will be randomized into 3 groups: condition A [Narrative + AVG], condition B [AVG Only], and condition C [Control]. Participants will undergo three in-person data collection visits over the course of six months. Inclusion criteria are that children are between the ages of 8-12 and have a BMI ≥ 85%. The primary outcome is change in moderate to vigorous physical activity (MVPA). Secondary outcome measures include change in BMI percentile, fasting insulin and glucose, lipid panel, C-reactive protein, and cognitive function. A pilot trial of n = 6 was conducted to help develop procedures and address problems that could arise in the main trial.

DISCUSSION

Successful completion of this study will provide the empirical basis for novel intervention and design strategies to enhance the impact of AVGs on long-term MVPA.

Cross-generational comparability of hip- and wrist-worn ActiGraph GT3X+, wGT3X-BT, and GT9X accelerometers during free-living in adults

ActiGraph accelerometers are frequently used to characterize physical activity, but free-living cross-generational comparability of newer models has not been verified. Participants (N = 70) wore GT9X and wGT3X-BT accelerometers at the hip and a sub-sample (n = 54) wore GT9X and either wGT3X-BT or GT3X+ monitors at each wrist for 4 days. Vector magnitude (VM) counts, VM acceleration, Mean Amplitude Deviation (MAD), and Euclidean Norm Minus One (ENMO) were calculated (60-s epoch), and cut-points were used to determine percent of time spent in each intensity (sedentary/light, moderate, vigorous). Epoch-level correlation coefficients (r) were ≥0.73, and weighted kappa for intensity classifications ranged from 0.71 (ENMO, hip) to 0.98 (VM counts, non-dominant wrist). Monitors were equivalent for all outcomes, except ENMO (all locations/monitors), percent of time spent in sedentary/light (hip) and moderate (hip and non-dominant wrist) activity as classified by ENMO-based cut-points, and vigorous activity as classified by VM count cut-points (non-dominant wrist; p > 0.05). While epoch-level data were not identical, most outcomes were strongly related between models (e.g., MAD, VM) and equivalent once reduced to percent of time spent in each intensity. However, monitor output was not equivalent for the acceleration-based metric ENMO, suggesting that caution should be exercised when comparing this outcome among ActiGraph models.

The Effect of Narrative on Physical Activity via Immersion During Active Video Game Play in Children: Mediation Analysis

BACKGROUND

Active video games (AVGs) can increase physical activity (PA) and help produce higher physiological expenditure. Animated narrative videos (NVs) possess unique immersive and motivational properties. When added to AVGs, they have been found to increase moderate-to-vigorous physical activity (MVPA) as opposed to the original no video condition. However, there is no evidence of whether that was due to the NV or the addition of an animated video to an AVG.

OBJECTIVE

This study aimed to investigate the differential effect of adding an NV versus a nonnarrative video (NNV) to an AVG on PA parameters and physiological responses and to explore the mediating role of immersion.

METHODS

A total of 22 children aged 8 to 12 years were randomly assigned to the NV or NNV condition. They were instructed to play an AVG (on Xbox Kinect) for as long as they wanted. We used accelerometers to estimate the time spent (in minutes) in MVPA. Heart rate (HR) and rate of perceived exertion (RPE) were measured before, during, and after the AVG play session. The participants then reported their experience of narrative immersion via a questionnaire.

RESULTS

The NV group had significantly higher narrative immersion (mean 3.50, SD 0.55 vs mean 2.91, SD 0.59; P=.03) and MVPA (mean 19.46, SD 13.31 vs mean 7.85, SD 5.83; P=.02) than the NNV group. Narrative immersion was positively correlated with MVPA (r=0.52; P=.01) and average HR during AVG (r=0.43; P=.05). Mediation analysis indicated that narrative immersion mediated the effect of NV (NV vs NNV) on MVPA (direct effect: beta=7.51; P=.01). The indirect effect was that NV was positively correlated with the mediator variable narrative immersion (beta=.59; P=.03), which was itself marginally associated with MVPA (beta=6.95; P=.09); when narrative immersion was included in the model, the regression coefficient was attenuated.

CONCLUSIONS

AVG with added narratives elicits more narrative immersion, resulting in more minutes in MVPA. Narrative immersion served as a mediator between NV and MVPA via its elicitation of an elevated HR without increasing RPE. The inclusion of immersive narratives in AVG could be helpful for inducing MVPA, to enhance AVG engagement without additional exertion.

Using Narrative Game Design to Increase Children's Physical Activity: Exploratory Thematic Analysis

Background

Physical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children’s physical activity.

Objective

Little is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games.

Methods

In this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis.

Results

Findings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity.

Conclusions

This research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles.

Exploring Energy Expenditure and Body Movement of Exergaming in Children of Different Weight Status

PURPOSE

This study examined differences in energy expenditure and bodily movement among children of different weight status during exergames that varied in mode and intensity.

METHODS

Fifty-seven 8- to 12-year-old children including overweight/obesity (n = 28) and normal weight (n = 29) played three 10-minute interval Xbox One exergames (Fruit Ninja, Kung-Fu, and Shape Up) categorized based on predominantly upper-, whole-, or lower-limb movement, respectively. The authors measured bodily movement through accelerometry and obtained energy expenditure and metabolic equivalent (MET) via indirect calorimetry.

RESULTS

Energy expended during gameplay was the highest in Shape Up (P < .01) and higher in Kung-Fu than Fruit Ninja (P < .01). Absolute energy expenditure was significantly higher in overweight/obese children (P < .01), but not when controlling for body mass across 3 exergames (P > .05). Based on the MET cut-points, overweight/obese children spent more time at light intensity (<3 METs) for Fruit Ninja (P < .05) and Shape Up (P < .01), but less time at vigorous intensity (≥6 METs) for Kung-Fu (P < .01) and Shape Up (P < .01). Lower-limb movements during Shape Up were less in overweight/obese children (P = .03).

CONCLUSION

Although children in both groups expended similar energy relative to their body mass during gameplay, overweight/obese children spent more time at light intensity but less time at vigorous intensity with fewer movements especially while playing a lower limb-controlled exergame.

Validation of a widely used heart rate monitor to track steps in older adults

BACKGROUND

Activity tracking devices gain popularity in research, which is due to their multiple features (e.g. heart rate monitor, step count) and easy handling. Nevertheless, many devices used for research are lacking validation of specific features. This study aimed to assess the validity of the Polar M400© activity tracker to count steps in older adults and, therefore, compared it to a previously validated pedometer (Omron Walking Style©) and observed step count.

METHODS

Thirty-two older adults (mean age: 74.8±5.9 years) walked at a self-selected, normal gait speed on a tartan track for 200 meters while wearing the activity tracker and the pedometer. Additionally, steps were counted manually. Data was analysed using Kruskal-Wallis test and Lin's concordance coefficient. Furthermore, Bland Altman plots were employed to evaluate accuracy of the activity tracker.

RESULTS

Kruskal-Wallis test revealed significant differences between the step count of the activity tracker and the pedometer (P=0.011) but no further differences were observed. Lin's concordance showed a moderate correlation between activity tracker and pedometer (rc=0.561) and between pedometer and observed step count (rc=0.690). A high correlation was detected between activity tracker and observed step count (rc=0.802). Bland Altman plots revealed good accuracy of the activity tracker.

CONCLUSIONS

The Polar M400© activity tracker accurately assesses steps during walking in older adults. Nevertheless, a slight overestimation compared to the pedometer was observed, which should be considered when using the activity tracker for tracking steps over a longer period of time.