Lessons Learned Through the Implementation of an eHealth Physical Activity Gaming Intervention with High School Youth

Physical Activity Interventions During the School Day: Reviewing Policies, Practices, and Benefits

BACKGROUND

There are many ways to increase physical activity (PA) during the school day as part of a Comprehensive School Physical Activity Plan. This article reviews policies and practices that can be used during the school day to increase PA for students.

METHODS

We searched systematic reviews for articles that met criteria (2010-2018, phase 1), followed by a search for individual articles addressing topics for which we did not identify a sufficiently relevant or recent review or to update an earlier review that concluded insufficient evidence (2010-2020, phase 2). We included 45 articles (45 studies, 54 interventions).

RESULTS

We grouped studies by intervention type: school-wide PA approaches to reach all students within the school setting (17), physical education (PE) interventions (13), and interventions related to recess (15). Few studies involved secondary schools or rural settings. Among 45 studies reporting PA behavior or fitness outcomes, 37 reported at least 1 improvement.

CONCLUSIONS

PA policies, PE, and recess can help improve school health by increasing the PA levels of students.

The Effects of mHealth-Based Gamification Interventions on Participation in Physical Activity: Systematic Review

BACKGROUND

It is well known that regular physical exercise has associated benefits; yet, participation remains suboptimal. Mobile health (mHealth) has become an indispensable medium to deliver behavior change interventions, and there is a growing interest in the gamification apps in mHealth to promote physical activity (PA) participation. Gamification could use game design elements (such as points, leaderboards, and progress bars), and it has the potential to increase motivation for PA and engagement. However, mHealth-based gamification interventions are still emerging, and little is known about the application status and efficacy of such interventions.

OBJECTIVE

This systematic review aims to investigate gamification apps in mHealth for improving PA levels and simultaneously summarize the impact of gamification interventions on PA participation.

METHODS

We searched PubMed, Scopus, Web of Science, Embase, CINAHL (EBSCO host), and IEEE Xplore from inception to December 20, 2020. Original empirical research exploring the effects of gamification interventions on PA participation was included. The papers described at least one outcome regarding exercise or PA participation, which could be subjective self-report or objective indicator measurement. Of note, we excluded studies about serious games or full-fledged games.

RESULTS

Of 2944 studies identified from the database search, 50 (1.69%) were included, and the information was synthesized. The review revealed that gamification of PA had been applied to various population groups and broadly distributed among young people but less distributed among older adults and patients with a disease. Most of the studies (30/50, 60%) combined gamification with wearable devices to improve PA behavior change, and 50% (25/50) of the studies used theories or principles for designing gamified PA interventions. The most frequently used game elements were goal-setting, followed by progress bars, rewards, points, and feedback. This review demonstrated that gamification interventions could increase PA participation; however, the results were mixed, and modest changes were attained, which could be attributed to the heterogeneity across studies.

CONCLUSIONS

Overall, this study provides an overview of the existing empirical research in PA gamification interventions and provides evidence for the efficacy of gamification in enhancing PA participation. High-quality empirical studies are needed in the future to assess the efficacy of a combination of gamification and wearable activity devices to promote PA, and further exploration is needed to investigate the optimal implementation of these features of game elements and theories to enhance PA participation.

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

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

Use of Fitbit Devices in Physical Activity Intervention Studies Across the Life Course: Narrative Review

BACKGROUND

Commercial off-the-shelf activity trackers (eg, Fitbit) allow users to self-monitor their daily physical activity (PA), including the number of steps, type of PA, amount of sleep, and other features. Fitbits have been used as both measurement and intervention tools. However, it is not clear how they are being incorporated into PA intervention studies, and their use in specific age groups across the life course is not well understood.

OBJECTIVE

This narrative review aims to characterize how PA intervention studies across the life course use Fitbit devices by synthesizing and summarizing information on device selection, intended use (intervention vs measurement tool), participant wear instructions, rates of adherence to device wear, strategies used to boost adherence, and the complementary use of other PA measures. This review provides intervention scientists with a synthesis of information that may inform future trials involving Fitbit devices.

METHODS

We conducted a search of the Fitabase Fitbit Research Library, a database of studies published between 2012 and 2018. Of the 682 studies available on the Fitabase research library, 60 interventions met the eligibility criteria and were included in this review. A supplemental search in PubMed resulted in the inclusion of 15 additional articles published between 2019 and 2020. A total of 75 articles were reviewed, which represented interventions conducted in childhood; adolescence; and early, middle, and older adulthood.

RESULTS

There was considerable heterogeneity in the use of Fitbit within and between developmental stages. Interventions for adults typically required longer wear periods, whereas studies on children and adolescents tended to have more limited device wear periods. Most studies used developmentally appropriate behavior change techniques and device wear instructions. Regardless of the developmental stage and intended Fitbit use (ie, measurement vs intervention tool), the most common strategies used to enhance wear time included sending participants reminders through texts or emails and asking participants to log their steps or synchronize their Fitbit data daily. The rates of adherence to the wear time criteria were reported using varying metrics. Most studies supplemented the use of Fitbit with additional objective or self-reported measures for PA.

CONCLUSIONS

Overall, the heterogeneity in Fitbit use across PA intervention studies reflects its relative novelty in the field of research. As the use of monitoring devices continues to expand in PA research, the lack of uniformity in study protocols and metrics of reported measures represents a major issue for comparability purposes. There is a need for increased transparency in the prospective registration of PA intervention studies. Researchers need to provide a clear rationale for the use of several PA measures and specify the source of their main PA outcome and how additional measures will be used in the context of Fitbit-based interventions.

Agent-Oriented Goal Models in Developing Information Systems Supporting Physical Activity Among Adolescents: Literature Review and Expert Interviews

Background

Information and communication technologies (ICTs) are becoming increasingly popular in supporting the fight against low physical activity (PA) levels among adolescents. However, several ICT solutions lack evidence-based content. Therefore, there is a need to identify important features that have the potential to efficiently and consistently support the PA of adolescents using ICT solutions.

Objective

This study aims to create evidence-based models of requirements for ICT solutions supporting PA by combining scientific evidence from literature and health experts. In addition, we test the suitability of agent-oriented goal models in this type of modeling process.

Methods

A literature search of PubMed, Web of Science, and Scopus databases was conducted to identify evidence-based functional, quality, and emotional goals that have previously been proven to be relevant in supporting PAs among youth using ICT solutions. The identified goals were presented in the form of goal models. These models were used to collaborate with health experts to receive their input on the topic and suggestions for improvement. The initial goal models were improved based on the feedback from the experts.

Results

The results indicated that agent-oriented goal modeling is a suitable method for merging information from the literature and experts. One strength of agent-oriented goal models is that they present emotional requirements together with quality and functional requirements. Another strength is the possibility of presenting results from a literature review in a systematic manner and using them thereafter in the communication process with stakeholders. Agent-oriented goal models that were created were easy to understand for health experts without previous experience in requirements engineering, which facilitates and supports collaboration with nontechnical stakeholders.

Conclusions

The proposed agent-oriented goal models effectively merged information from scientific literature and experts in the field and presented early functional, quality, and emotional requirements in a holistic and coherent manner. We believe that the created models have high potential to help requirements engineers and developers to provide more efficient ICT solutions that support PA among adolescents in the future.

Exploring the Feasibility of Relapse Prevention Strategies in Interdisciplinary Multimodal Pain Therapy Programs: Qualitative Study

BACKGROUND

Although interdisciplinary multimodal pain treatment (IMPT) programs are widely regarded as treatment of choice for patients with chronic pain, there are signs that many patients are unable to maintain their treatment gains in the long term. To facilitate the maintenance of positive treatment outcomes over time, we developed two relapse prevention strategies.

OBJECTIVE

The main objective of this study was to explore the feasibility of these strategies within the context of IMPT programs.

METHODS

We performed a feasibility study using 3 workbook prototypes containing either one or both strategies. For a period of 6 months, the workbooks were made available in two IMPT facilities. Qualitative data were collected through a focus group and semistructured interviews. We performed a thematic analysis using a deductive approach with (1) applicability to the treatment program, (2) acceptability of the workbook content, and (3) form, as predefined themes.

RESULTS

The final dataset consisted of transcripts from a focus group with health care providers and 11 telephone interviews and 2 additional in-depth interviews with patients. In general, the intervention was perceived as useful, easy to use, and in line with the treatment program. The data also include suggestions to further improve the use of both strategies, including more specific implementation guidelines, revised goal-setting procedure, and development of a mobile health version. However, several factors, including a high dropout rate and small sample size, impact the external validity of our findings.

CONCLUSIONS

This study should be regarded as a first step in the process of transforming the prototype workbook into an effective intervention for clinical practice. Although these initial results indicate a favorable evaluation of both behavior regulation strategies within the workbook, this study encountered multiple barriers regarding implementation and data collection that limit the generalizability of these results. Future research efforts should specifically address the fidelity of HCPs and patients and should include clear procedures regarding recruitment and use of both relapse prevention strategies during treatment.

Can Active Video Games Improve Physical Activity in Adolescents? A Review of RCT

Children and adolescents are not meeting the required federal physical activity (PA) guidelines established by the United States Department of Health and Human Services. It is critical that a regular pattern of PA is established in their youth to ensure ongoing PA into adulthood. However, many programs implemented during adolescence have shown limited effects, stressing the need for more innovative approaches to generate more interest and maintenance of PA behavior in this age group. Active video games (AVGs) or exergaming may prove to be an innovate process to improve PA in children and adolescents. A literature review was conducted to explore if active video games or exergaming could be an effective intervention to improve physical activity in adolescents. Active video games, also called “exergames”, are a category of video games that require movement or physical exertion to play the game. The methodology consisted of searching Academic Search Premier, CINAHL, The Cochrane Library, ERIC, PubMed, and Web of Science databases. Inclusion criteria involved only youth aged 12 to 19 years, randomized controlled trials (RCTs), and studies within the last 12 years. The following search terms were used: exergaming or active video games; physical activity or exercise; adolescents or youth; RCT or randomized clinical trial. The outcome indicates that exergaming or active video games can be an effective tool to improve PA in adolescents that will be more acceptable and sustainable than many conventional approaches.

The feasibility of a theory-based self-regulation intervention in schools to increase older adolescents' leisure time physical activity behavior

The purpose of this study was to test the feasibility of a theory-based self-regulation intervention to increase older adolescents' leisure time physical activity (LTPA) behavior. Forty-nine adolescents (M = 15.78 years; SD = 0.52; 31% female) from two schools agreed to participate. Participants were randomly assigned to the experimental or control arm at the school level. The experimental group (n = 24) underwent a brief self-regulation intervention for six weeks. The control group (n = 25) continued with standard classes. Intervention fidelity data was collected to assess feasibility. Outcome measures included self-reported LTPA behavior and self-regulation technique use. Intervention sessions were delivered as intended, participant attendance was high and compliance with intervention content was acceptable. The experimental group reported higher levels of LTPA behavior eight weeks post-intervention and increased use of self-regulation techniques. A brief theory-based self-regulation intervention delivered in a school-setting appears feasible and may increase LTPA behavior and self-regulation in adolescents.