Using Virtual Agents and Activity Monitors to Autonomously Track and Assess Self-Determined Physical Activity Among Young Children: A 6-Week Feasibility Field Study

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

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

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.

Scaling the Virtual Fitness Buddy Ecosystem as a School-Based Physical Activity Intervention for Children

Childhood obesity is a growing concern as it can lead to lifelong health problems that carry over into adulthood. A substantial contributing factor to obesity is the physical activity (PA) habits that are formed in early childhood, as these habits tend to sustain throughout adulthood. To aid children in forming healthy PA habits, we designed a mixed reality system called the Virtual Fitness Buddy ecosystem, in which children can interact with a virtual pet agent. As a child exercises, their pet becomes slimmer, faster, and able to play more games with them. Our initial deployment of this project showed promise but was only designed for a short-term intervention lasting three days. More recently, we have scaled it from a pilot grade study to a 9-month intervention comprised of 422 children. Ultimately, our goal is to scale this project to be a nationwide primary prevention program to encourage moderate to vigorous PA in children. This article explores the challenges and lessons learned during the design and deployment of this system at scale in the field.

Protean Kinematics: A Blended Model of VR Physics

Avatar research largely focuses on the effects of the appearance and external characteristics of avatars, but may also warrant further consideration of the effects of avatar movement characteristics. With Protean kinematics, we offer an expansion the avatar-user appearances-based effects of the Proteus Effect to a systematic exploration into the role of movement in affecting social perceptions (about others) and idealized perceptions (about self). This work presents both a theoretical (typology) and methodological (physics-based measurement) approach to understanding the complex blend of physical inputs and virtual outputs that occur in the perceptual experience of VR, particularly in consideration of the collection of hippocampal (e.g., place cells, grid cells) and entorhinal neurons (e.g., speed cells) that fire topologically relative to physical movement in physical space. Offered is a novel method that distills the blend of physical and virtual kinematics to contribute to modern understandings of human-agent interaction and cognitive psychology.

Using virtual agents to increase physical activity in young children with the virtual fitness buddy ecosystem: Study protocol for a cluster randomized trial

BACKGROUND

Designing and implementing a truly self-determined physical activity (PA) intervention has required excessive amounts of labor and expenses that, until recently, have made it prohibitively costly to implement in the field at scale.

METHODS

Guided by self-determination theory, and harnessing the power of consumer-grade interactive technologies, we developed the Virtual Fitness Buddy (VFB) Ecosystem. Designed to foster intrinsic motivation toward adopting PA as a lifestyle change in 6-10-year-old children, the Ecosystem features a mixed-reality kiosk which houses a personalized virtual pet for each user. Each time a child visits the kiosk, the pet (a mid-sized dog) automatically detects its owner based on the data from a child's Fitbit, assists the child in setting daily PA goals and provides tailored feedback on the child's PA progress. The pet alerts parents in real-time by sending text messages and relaying the parents' response to the child, so that parents and children can remain connected about the child's PA progress even when they are physically apart. We aim to implement the kiosk in 12 after-school sites, plus use 12 additional sites as controls, where children can still set and view progress toward their PA goals without access to a virtual pet.

CONCLUSION

The VFB Ecosystem represents a new generation of technology-mediated health interventions for children to promote sustainable PA lifestyle changes. Because the VFB Ecosystem is a cost- and labor-effective solution that integrates consumer-grade technology with low barriers for continued use, it has the potential for rapid diffusion and widespread public health impact.