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Talens C, da Quinta N, Adebayo FA, Erkkola M, Heikkilä M, Bargiel-Matusiewicz K, Ziółkowska N, Rioja P, Łyś AE, Santa Cruz E, Meinilä J. Mobile- and Web-Based Interventions for Promoting Healthy Diets, Preventing Obesity, and Improving Health Behaviors in Children and Adolescents: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2025; 27:e60602. [PMID: 40392587 DOI: 10.2196/60602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 10/30/2024] [Accepted: 04/07/2025] [Indexed: 05/22/2025] Open
Abstract
BACKGROUND Childhood and adolescent obesity is a growing global health issue linked to noncommunicable diseases such as cardiovascular disease and type 2 diabetes. Digital health technologies, including mobile apps and web-based programs, offer scalable tools to improve health behaviors, but their effectiveness in young populations remains unclear. OBJECTIVE This systematic review aimed to evaluate the effectiveness of mobile and web-based digital interventions in promoting healthy diets, reducing obesity risk, increasing physical activity, and improving nutrition-related knowledge and attitudes among children and adolescents. METHODS A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar databases, along with hand-searching reference lists of key systematic reviews. The search encompassed records published up to September 30, 2024. Eligible studies were randomized controlled trials targeting dietary intake, anthropometric measurements, physical activity, or nutrition-related attitudes and knowledge among participants aged ≤18 years. Screening, full-text eligibility assessment, and data extraction were done partly in duplicate (20%; κ=0.86 for title or abstract screening, κ=0.71 for full-text eligibility assessment, and κ=0.78 data extraction). Risk of bias was evaluated using the Cochrane Risk-of-Bias tool (κ=0.71 for interrater reliability of 20% duplicate evaluation). Data were synthesized narratively. RESULTS From 300 records screened, a total of 37 articles (34 studies) were included. Interventions included games, (in 21/34 studies, 62%), mobile apps, web-based programs, and other digital tools. Among the 34 included studies, 23 (68%) studies reported positive outcomes for at least 1 measured variable. Fruit intake improved in 17 of 34 studies (50%) assessing fruit intake, while 7 of 34 studies (21%) targeting sugar-sweetened beverage consumption showed reductions. Improvements in nutrition knowledge were reported in 23 of 34 (68%) studies, but changes in anthropometric measures and physical activity outcomes showed no effect. Risk of bias was low for random sequence generation but high or unclear in other domains for many studies. CONCLUSIONS Mobile- and web-based interventions, particularly game-based tools, show promise for promoting healthy dietary behaviors and increasing nutrition knowledge in children and adolescents. However, the evidence for long-term sustainability and impact on anthropometric and physical activity outcomes remains limited. Future research should focus on understanding which digital features drive effectiveness, extending follow-up periods, and exploring the role of family involvement in interventions. TRIAL REGISTRATION PROSPERO CRD42023423512; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=423512.
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Affiliation(s)
- Clara Talens
- AZTI, Food Research, Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Noelia da Quinta
- AZTI, Food Research, Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Folasade A Adebayo
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | - Maria Heikkilä
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
| | | | | | - Patricia Rioja
- AZTI, Food Research, Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Agnieszka E Łyś
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University in Poznań, Poznań, Poland
| | - Elena Santa Cruz
- AZTI, Food Research, Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Jelena Meinilä
- Department of Food and Nutrition, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki, Finland
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Kracht CL, Tovar A, Gans KM, Lee RE, Tandon PS, von Ash T, Francis L. How to integrate and leverage digital health modalities for health promotion in early childhood education: Opportunities to improve intervention access and engagement. Transl Behav Med 2025; 15:ibaf006. [PMID: 40052536 PMCID: PMC11967918 DOI: 10.1093/tbm/ibaf006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2025] Open
Abstract
Early childhood education (ECE) settings are important for the development of children's healthy eating and physical activity behaviors. Efforts to disseminate and implement health behavior promotion strategies in ECE settings have seldom optimized digital health, a missed opportunity highlighted by the COVID-19 pandemic. In this commentary, we discuss previous efforts to shift ECE-based health behavior programs to digital health modalities, notable opportunities for digital health in these settings, and a multilevel perspective to support future efforts. We propose future directions in digital health literacy, reaching various ECE settings, implementation science, and community partnerships to expand the use of digital interventions.
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Affiliation(s)
- Chelsea L. Kracht
- Clinical Sciences Division, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 S. Main Street, Providence, RI 02903, USA
| | - Kim M. Gans
- Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Room 330, Storrs, CT 06269, USA
| | - Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004, USA
| | - Pooja S. Tandon
- Department of Pediatrics, University of Washington & Seattle Children’s Research Institute, M/S CURE-3, PO Box 5371, Seattle, WA 98145, USA
| | - Tayla von Ash
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 S. Main Street, Providence, RI 02903, USA
| | - Lucine Francis
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, USA
- Johns Hopkins Center for School Health, 525 North Wolfe Street, Baltimore, MD 21205, USA
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Starnberg J, Renström L. Scoping review showed that obesity prevention in Nordic countries had limited effects on children from birth to 7 years of age. Acta Paediatr 2024; 113:912-922. [PMID: 37988200 DOI: 10.1111/apa.17043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
AIM The aim of this scoping review was to map and summarise clinical trials that attempted to prevent obesity in children from birth to 7 years of age in any of the Nordic countries. METHODS PubMed, CINAHL Plus and clinicaltrials.gov were searched for peer-reviewed papers and registered trials published in English or Swedish. The overall search period was from 1 January 2002 to 13 December 2022. We included randomised and non-randomised trials initiated from birth to 7 years of age that aimed to prevent obesity in Denmark, Finland, Iceland, Norway and Sweden. RESULTS The search resulted in 414 papers and 14 were included. Despite having diverse settings and designs, none of them reported consistently favourable results for anthropometric outcomes, apart from beneficial trends in subgroups with a high body mass index at baseline. Most studies reported temporarily improved dietary patterns. CONCLUSION There is a gap in the current research about how to best prevent obesity in children. We suggest that researchers should focus on risk groups and that interventions that last a number of years are needed.
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Affiliation(s)
- Josefine Starnberg
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Centre for Clinical Research, Region Gävleborg and Uppsala University, Gävle, Sweden
| | - Lina Renström
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Centre for Clinical Research, Region Gävleborg and Uppsala University, Gävle, Sweden
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Tigerstrand Grevnerts H, Delisle Nyström C, Migueles JH, Löf M. Longitudinal associations of meeting the WHO physical activity guidelines and physical fitness, from preschool to childhood. Scand J Med Sci Sports 2024; 34:e14624. [PMID: 38572847 DOI: 10.1111/sms.14624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/16/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
There is a well-established relationship between physical activity (PA) and physical fitness in children, being the latter an important marker for present and future health; however, there is still insufficient knowledge for the transition from the preschool age to early childhood. Therefore, this study in Swedish children aimed to investigate the estimated effect of meeting the aerobic component of the PA guidelines at 4 and/or 9 years of age on physical fitness measured at 9 years of age. PA was assessed using a wrist-worn ActiGraph accelerometer and identical data processing in 217 healthy children in Sweden (114 boys and 103 girls). Physical fitness test included cardiorespiratory (20 m shuttle run test), motor (4 × 10 m shuttle run), and muscular fitness (hand grip strength and long jump). A linear mixed model was run, investigating the interaction between meeting the PA guidelines and time (either 4 or 9 years of age) and each fitness component (at 4 and 9). Interactions by sex were also checked. Meeting the PA guidelines consistently (at 4 and 9 years) was significantly associated to better performance in physical fitness parameters for motor fitness (-0.76 s, p < 0.001) and lower body muscular fitness (+4.6 cm; p < 0.001) at 9 years. There was an interaction between meeting the PA guidelines and time point, for cardiorespiratory fitness (+4.58 laps; p < 0.001). This study shows that meeting the PA guidelines at 4 and 9 years of age is associated to higher physical fitness at 9 years of age.
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Affiliation(s)
| | | | | | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
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Johnson LG, Cho H, Lawrence SM, Keenan GM. Early childhood (1-5 years) obesity prevention: A systematic review of family-based multicomponent behavioral interventions. Prev Med 2024; 181:107918. [PMID: 38417469 DOI: 10.1016/j.ypmed.2024.107918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/06/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Globally 38.9 million children under age 5 have overweight or obesity, leading to type 2 diabetes, cardiovascular complications, depression, and poor educational outcomes. Obesity is difficult to reverse and lifestyle behaviors (healthy or unhealthy) can persist from 1.5 years of age. Targeting caregivers to help address modifiable behaviors may offer a viable solution. OBJECTIVE Evaluate the impact of multicomponent family interventions on weight-based outcomes in early childhood and explore related secondary behavior outcomes. METHODS Four databases were searched (1/2017-6/2022) for randomized controlled trials (RCTs) of obesity-prevention interventions for children (1-5 years). Eligible studies included an objectively measured weight-based outcome, family interventions targeting the caregiver or family, and interventions including at least two behavioral components of nutrition, physical activity, or sleep. RESULTS Eleven interventions were identified consisting of four delivery modes: self-guided (n = 3), face-to-face group instruction (n = 3), face-to-face home visits (n = 2), and multiple levels of influence (n = 3). The reviewed studies reported almost no significant effects on child weight-based outcomes. Only two studies (one was an underpowered pilot study) resulted in significant positive child weight-management outcomes. Seven of the interventions significantly improved children's dietary intake. CONCLUSION Except for one, the reviewed studies reported that family based interventions had no significant effects on child weight-based outcomes. Future studies of this type should include measurements of age and sex-based body mass index (BMI) and trajectories, and also examine other important benefits to the children and families.
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Affiliation(s)
- Lisa G Johnson
- College of Nursing, University of Florida College of Nursing, 1225 Center Dr, Gainesville, FL 32610, United States.
| | - Hwayoung Cho
- College of Nursing, University of Florida College of Nursing, 1225 Center Dr, Gainesville, FL 32610, United States
| | - Samantha M Lawrence
- College of Nursing, University of Florida College of Nursing, 1225 Center Dr, Gainesville, FL 32610, United States
| | - Gail M Keenan
- College of Nursing, University of Florida College of Nursing, 1225 Center Dr, Gainesville, FL 32610, United States
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Jiang S, Ng JYY, Chong KH, Peng B, Ha AS. Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e52905. [PMID: 38381514 PMCID: PMC10918543 DOI: 10.2196/52905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/04/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers. OBJECTIVE This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness. METHODS We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. RESULTS Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes. CONCLUSIONS eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions. TRIAL REGISTRATION PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.
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Affiliation(s)
- Shan Jiang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Johan Y Y Ng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Kar Hau Chong
- School of Health and Society and Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Bo Peng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Amy S Ha
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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Zhou P, Li Y, Lau PWC, Yan L, Song H, Shi TL. Effectiveness of parent-based electronic health ( eHealth) intervention on physical activity, dietary behaviors, and sleep in preschoolers: A systematic review. J Exerc Sci Fit 2024; 22:1-13. [PMID: 38021206 PMCID: PMC10663681 DOI: 10.1016/j.jesf.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background The lifestyles of preschoolers have become physically inactive and sedentary, their eating habits unhealthy, and their sleep routines increasingly disturbed. Parental involvement appears crucial to combat the unhealthy lifestyle of preschoolers. Because of the recognized barriers to traditional face-to-face interventions, easy access and lower costs make electronic health (eHealth) interventions appealing. However, whether parent-based eHealth intervention may be harnessed to improve the aforementioned lifestyle behaviors of preschoolers is currently unclear, a gap that this systematic review intends to address. This study aims to systematically review the current literature concerning the effectiveness of parent-based eHealth intervention on the physical activity, dietary behaviors, and sleep of preschoolers. Method This systematic review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Six databases (EMBASE, PubMed, MEDLINE, Web of Science, SPORTDiscus, and PsycINFO) were retrieved for the period from January 2000 to December 2022. Studies were eligible if 1 they were quantitative study design; 2 eHealth interventions in which parents were the change agents targeted children aged 3-6 years; 3 interventions examined the effectiveness of eHealth or incorporated eHealth as one of the intervention modalities; 4 at least one variable included in either primary or secondary outcome had to concentrate on the physical activity, diet, and sleep of preschoolers; 5 publication type was limited to the English language and peer-reviewed journal articles; 6 study settings were confined to family- or parent-based ones. The risk of bias was assessed, based upon Version 2 of the Cochrane risk-of-tool for randomized trials (RoB2). Results Twelve studies were screened. No significant group-by-time improvement in physical activity was found in studies related to physical activity outcomes. Two studies reported a significant difference between groups concerning motor ability, with one study indicating improved object control with the other reporting improvement in both object control and locomotor skills. Of the studies related to dietary behavior outcomes, six studies reported a significant difference at the posttest compared to the control group, in terms of vegetable and fruit intake, sugar-sweetened drinks, reduced candy consumption, and improved non-core food. Three studies reported a significant difference between groups in sleep duration at the end of the posttest, with the result of one study limited to preference-only participants. None of the reviewed studies found a significant difference between groups for sleep problems. Conclusion Parent-based eHealth interventions were not significantly effective in improving physical activity and reducing sleep problems in preschoolers, but the majority of studies have found that this type of intervention significantly improves the dietary behaviors and sleep duration of preschoolers. High-quality, robustly designed studies to balance the intervention dosage and sequence are needed to investigate the effectiveness of parent-based eHealth intervention on physical activity, dietary behaviors, and sleep in preschoolers, particularly those raised in other cultural background, which may significantly impact their lifestyle. Trial registration International Prospective Register of Systematic Review (PROSPERO): CRD42023418861.
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Affiliation(s)
- Peng Zhou
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Yin Li
- Department of Physical Education, Sun Yat-sen University, China
| | - Patrick WC. Lau
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Liang Yan
- Department of Physical Education, China Women's University, Beijing, China
| | - Huiqi Song
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Tony Lei Shi
- Beijing Normal University-Hong Kong Baptist University United International College, China
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Lundgren O, Henriksson P, Delisle Nyström C, Henström M, Löf M. Hyperactivity in preschool age is associated with higher fat-free mass and healthy lifestyle behaviours five years later: A longitudinal study of Swedish children. Pediatr Obes 2024; 19:e13084. [PMID: 37972645 DOI: 10.1111/ijpo.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND There is evidence for a link between hyperactivity and obesity, especially among older children. Both conditions seem to be multifactorial in origin and hypotheses of common underlying issues, such as emotional dysregulation, have been suggested. However, studies of the co-occurrence of the two conditions in younger age groups have been inconclusive. OBJECTIVES We aimed to study the longitudinal associations of psychological strengths and difficulties at 4 years of age with health behaviours, body composition, physical fitness, and cardiovascular disease (CVD) risk factors 5 years later. METHODS Parents of 226 4-year-old children filled out the Strengths and Difficulties Questionnaire (SDQ). At 9 years of age, we assessed health behaviours, physical fitness, body composition, and CVD risk factors. Associations were examined with linear regression models that were adjusted for sex, age of the child at 9, and maternal education. RESULTS In the adjusted models, hyperactivity at 4 was associated with higher fat-free mass (β = 0.18, p = 0.007) and lower levels of sedentary behaviour (β -0.14, p = 0.043) at 9 years. Furthermore, greater emotional problems at 4 were associated with lower intake of fruit and vegetables (β -0.14, p = 0.038) at 9 years. However, there were no statistically significant associations between psychological difficulties and fat-mass index. CONCLUSIONS Our novel data provide no evidence of an association between hyperactivity in preschool age and obesity or obesity-related behaviours in school age. Future studies examining how psychological factors relate to obesity development should consider a developmental perspective.
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Affiliation(s)
- Oskar Lundgren
- Crown Princess Victoria Children's Hospital, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Maria Henström
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
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Cranney L, Nguyen B, Clare P, Maitland N, Wrigley J, Moorhouse L. Reach, acceptability and impact of an online parent healthy lifestyle intervention during the COVID-19 lockdown: A pilot study. Health Promot J Austr 2024; 35:188-195. [PMID: 37039498 DOI: 10.1002/hpja.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023] Open
Abstract
ISSUE ADDRESSED There is growing evidence that online parent-focused child healthy lifestyle interventions can improve healthy eating practices and food environments in the home. Greater understanding of whether and how parents engage with these online interventions is needed. This study evaluated the reach, acceptability and impacts of an online parent healthy lifestyle intervention. METHODS A pilot study was conducted in New South Wales during the COVID-19 pandemic when stay-at-home public health orders were in place (July-August 2021). A concurrent mixed methods design was adopted. Data collection measures were: an online participant survey at baseline, post-intervention and 3-month follow-up; two online post-intervention focus groups; and web metrics at post-intervention and 3-month follow-up. RESULTS There were 181 intervention participants, primarily mothers with high education levels and living in advantaged areas: 43 (24%) completed surveys post-intervention; and of these, 35 (81%; 19% of participants) completed surveys at follow-up. Sixteen mothers participated in focus groups. Parents' knowledge, self efficacy, role modelling and behaviours improved, but there were no significant differences detected over time. Metrics and survey data indicated webinar recordings, particularly the topics of 'Fussy Eating' and 'Screen time and sleep', had the greatest engagement and most perceived them as useful (93% and 96%, respectively). CONCLUSIONS An online healthy lifestyle intervention to support parents in providing opportunities for their children to engage in healthier lifestyle behaviours was appealing and acceptable to mothers and has the potential to improve families' healthy lifestyle behaviours. Enhancing intervention reach amongst fathers and priority populations, as well as incorporating design elements to enhance engagement will be important. SO WHAT?: An online healthy lifestyle intervention reached and engaged parents, despite being faced with additional parenting challenges arising from COVID-19 stay-at-home orders.
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Affiliation(s)
- Leonie Cranney
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Binh Nguyen
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip Clare
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicola Maitland
- Health Promotion Service, South Eastern Sydney Local Health District (SESLHD), Kogarah, New South Wales, Australia
| | - Jessica Wrigley
- Health Promotion Service, South Eastern Sydney Local Health District (SESLHD), Kogarah, New South Wales, Australia
| | - Lisa Moorhouse
- Health Promotion Service, South Eastern Sydney Local Health District (SESLHD), Kogarah, New South Wales, Australia
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Delisle Nyström C, Migueles JH, Henriksson P, Löf M. Physical Activity and Cardiovascular Risk Factors in Children from 4 to 9 Years of Age. SPORTS MEDICINE - OPEN 2023; 9:99. [PMID: 37874410 PMCID: PMC10597983 DOI: 10.1186/s40798-023-00647-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Physical activity guidelines for children encourage moderate-to-vigorous intensity activities (MVPA); however, some studies have found that only vigorous intensity activities (VPA) might promote health benefits in young children. Thus, the aim of this study is to investigate cross-sectional and 5-year longitudinal associations of VPA and MVPA with cardiovascular disease (CVD) risk factors in childhood using compositional data analysis. RESULTS This study utilized data from the SPINACH study (n = 411). Physical activity was measured with accelerometers at 4- and 9-years of age. CVD risk factors were measured at 9-years of age, and included blood pressure (BP), lipid metabolism, and glucose metabolism biomarkers, as well as a continuous metabolic syndrome risk score (MetS). Cross-sectional and longitudinal linear regression models were built using compositional data analysis standards. Cross-sectionally, reallocating time to VPA from lower-intensity behaviours at 9-years was associated with lower waist circumference (B = - 3.219, P = 0.002), diastolic BP (B = - 1.836, P = 0.036), triglycerides (B = - 0.214, P < 0.001), glucose (B = - 0.189, P = 0.033), insulin (B = - 2.997, P < 0.001), and HOMA-IR (B = - 0.778, P < 0.001). Similarly, reallocating time to VPA at 4-years was associated with lower MetS (B = - 0.831, P = 0.049), waist circumference (B = - 4.211, P = 0.015), systolic BP (B = - 5.572, P = 0.015), diastolic BP (B = - 2.931, P = 0.044), triglycerides (B = - 0.229, P = 0.034), glucose (B = - 0.325, P = 0.032), insulin (B = - 5.114, P = 0.001), and HOMA-IR (B = - 0.673, P = 0.001) at 9-years. Reallocations of time to MVPA at 4- or 9-years were not associated with CVD risk factors at 9-years. CONCLUSIONS VPA was associated with CVD risk factors in children both cross-sectionally (9-years) and longitudinally (at 4- and 9-years). MVPA seemed not to be a stimulus of enough intensity to trigger these potential cardiometabolic benefits in healthy children. Thus, these findings suggest the importance of higher intensity activities, i.e., VPA already in early childhood for cardiometabolic health.
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Affiliation(s)
- Christine Delisle Nyström
- Group MLÖ, Department of Biosciences and Nutrition, NEO, Karolinska Institutet, 141 83 Huddinge, Sweden
| | - Jairo H. Migueles
- Group MLÖ, Department of Biosciences and Nutrition, NEO, Karolinska Institutet, 141 83 Huddinge, Sweden
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Marie Löf
- Group MLÖ, Department of Biosciences and Nutrition, NEO, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden
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11
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Ricci G, Gibelli F, Bailo P, Caraffa AM, Nittari G, Sirignano A. Informed Consent in Paediatric Telemedicine: Challenge or Opportunity? A Scoping Review. Healthcare (Basel) 2023; 11:1430. [PMID: 37239716 PMCID: PMC10218595 DOI: 10.3390/healthcare11101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
The fundamental importance of informed consent as a prerequisite for the lawfulness of the medical act is an indisputable cornerstone of clinical practice. However, the provision of effective information and the collection of informed consent presents important critical issues in the underage patient, even considering that in general terms he or she does not have the power to directly express consent, which must be provided by parents or legal guardians. These critical issues are amplified in the context of telemedicine. The present study aims, through a scoping review of the literature of the past 10 years, to outline the operational practices adopted in the collection of informed consent from children in the context of telemedicine and to identify solutions devised to address the critical issues related to the provision of adequate information to the child in this particular care setting. The results of the research show that the activity of delivering adequate information to the child, itself complex, is made even more complex by the particular setting of telemedicine, which, however, could be effectively exploited to facilitate communication with the child patient.
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Affiliation(s)
- Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Anna Maria Caraffa
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Giulio Nittari
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
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12
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Salas-Groves E, Galyean S, Alcorn M, Childress A. Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e41235. [PMID: 36637888 PMCID: PMC9883741 DOI: 10.2196/41235] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. OBJECTIVE The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. METHODS A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. RESULTS In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use. CONCLUSIONS The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps.
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Affiliation(s)
- Emily Salas-Groves
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Shannon Galyean
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Michelle Alcorn
- Department of Hospitality & Retail Management, Texas Tech University, Lubbock, TX, United States
| | - Allison Childress
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
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13
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Cohrssen C, Richards B, Wang R. Using smartphones to disseminate home learning support to primary caregivers: An exploratory proof‐of‐concept study. INFANT AND CHILD DEVELOPMENT 2023. [DOI: 10.1002/icd.2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | - Ben Richards
- The University of Hong Kong Pok Fu Lam Hong Kong
| | - Rhoda Wang
- The University of Hong Kong Pok Fu Lam Hong Kong
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14
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Karssen LT, Larsen JK, Burk WJ, Kremers SPJ, Hermans RCJ, Ruiter ELM, Vink JM, de Weerth C. Process and effect evaluation of the app-based parenting program Samen Happie! on infant zBMI: A randomized controlled trial. Front Public Health 2022; 10:1012431. [PMID: 36620259 PMCID: PMC9822729 DOI: 10.3389/fpubh.2022.1012431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although energy balance-related parenting practices are regarded critical components in the prevention of childhood obesity, most programs targeting parenting practices with respect to a wide range of energy balance-related behaviors were not aimed at high-risk families with a lower socioeconomic position (SEP). Objective The Samen Happie! app-based program aimed to stimulate healthy child weight development especially among families with a lower SEP, by encouraging healthy energy balance-related parenting practices. Methods A two-armed randomized controlled trial examined the process and effectiveness of the Samen Happie! program on child zBMI outcomes at 6- and 12-months follow-up. In total, 357 Dutch parents with infants aged 5-15 months old at baseline participated. Parents in the app condition (n = 179) received access to the Samen Happie! app and were compared to a waitlist-control condition (n = 178). Changes in zBMI were examined through linear mixed-effects models based on intention-to-treat and exploratory per-protocol principles. Results Process data showed low levels of sustained app use and moderate app acceptability. A general increase in child zBMI was observed in both conditions after 6 and 12 months. Intention-to-treat analyses using multiple imputations showed several statistically significant differences between conditions and high-risk subgroups. Specifically, at 6-months follow-up, zBMI increase was least pronounced in the app condition among children of parents with lower educational level. These findings were supported by exploratory per-protocol analyses including only frequent app users. In addition, per-protocol analyses showed benefits of app use at 6-months follow-up for children of parents with higher BMI. However, these effects were reversed at 12-months follow-up in both intention-to-treat and per-protocol analyses, where children of parents in the app condition in general increased the most in zBMI. Conclusions This study suggests that the Samen Happie! program might prevent zBMI increases after 6 months among children of parents with lower educational level, and children of parents with higher BMI who more frequently use the app. However, the app did not prevent increases in zBMI after 12 months. Future research should investigate strategies to increase sustained app use and engagement in mHealth parenting programs for childhood obesity as well as options to combine app-based programs with additional support strategies aimed at high-risk families. Trial registration Netherlands trial register (ID: NTR6938), https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6938.
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Affiliation(s)
- Levie T. Karssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands,*Correspondence: Levie T. Karssen ✉
| | - Junilla K. Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - William J. Burk
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Stef P. J. Kremers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Roel C. J. Hermans
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emilie L. M. Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jacqueline M. Vink
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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15
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Shao X, Tan LH, He L. Physical activity and exercise alter cognitive abilities, and brain structure and activity in obese children. Front Neurosci 2022; 16:1019129. [PMID: 36340766 PMCID: PMC9631829 DOI: 10.3389/fnins.2022.1019129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
The prevalence of childhood obesity is increasing to such an extent that it has become a major global public health problem in the 21st century. Obesity alters children’s brain structure and activity and impairs their cognitive abilities. On the basis of these findings, it is necessary for educational and healthcare institutions to combat childhood obesity through preventive and therapeutic strategies. In general, exercise and physical activity are considered common but effective methods for improving physical, psychological, and brain health across the life span. Therefore, this review article mainly focuses on existing neuroimaging studies that have used magnetic resonance imaging (MRI), and functional magnetic resonance imaging (fMRI)to assess children’s brain anatomy and neural activity. We intended to explore the roles of physical activity and exercise in modulating the associations among childhood obesity, cognitive abilities, and the structure and activity of the brain.
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Affiliation(s)
- Xueyun Shao
- School of Sports, Shenzhen University, Shenzhen, China
- Shenzhen Institute of Neuroscience, Shenzhen, China
- *Correspondence: Xueyun Shao,
| | - Li Hai Tan
- Shenzhen Institute of Neuroscience, Shenzhen, China
| | - Longfei He
- School of Sports, Shenzhen University, Shenzhen, China
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16
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Bonvicini L, Pingani I, Venturelli F, Patrignani N, Bassi MC, Broccoli S, Ferrari F, Gallelli T, Panza C, Vicentini M, Giorgi Rossi P. Effectiveness of mobile health interventions targeting parents to prevent and treat childhood Obesity: Systematic review. Prev Med Rep 2022; 29:101940. [PMID: 36161123 PMCID: PMC9501985 DOI: 10.1016/j.pmedr.2022.101940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 12/05/2022] Open
Abstract
Childhood obesity is a high prevalence condition that causes a high burden of disease in adulthood. Mobile phone app are increasingly used to prevent it. We summarized the evidence on the effectiveness of mobile apps for devices used by parents to prevent and treat childhood and adolescent obesity. An update of a systematic review of the literature (De Lepeleere et al., 2017) was carried out. PubMed, Embase, Cochrane, CINAHL, PsycINFO, Scopus, and ERIC were searched up to 2020. The included studies should target children 1-18 years, compare an app aimed at preventing or treating overweight and obesity, as stand-alone intervention or as part of a complex program, installed on parents' mobile devices, to no intervention or an intervention without the app. Outcomes related to weight status, diet, and physical activity (PA) behaviors were considered. Nineteen studies (14 RCTs and 5 non-randomized trials) were included. The app was mainly used to record food consumption and PA, to set goals, to view progress, and send health promotion messages. One study reported a significant decrease and one a suggestive decrease in anthropometric measures in obese and overweight children, while other studies observed no effect. One study reported a significant increase in PA. Six interventions proved to be effective in changing dietary behaviors. Interventions targeting overweight and/or obese children had the most positive results. All studies reported high acceptability and feasibility of interventions. The differences between interventions and the small sample size of the studies did not allow this review to reach conclusion on effectiveness.
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Affiliation(s)
- Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Pingani
- Graduated in Human Nutrition Sciences at the San Raffaele University of Rome, Rome, Italy
| | | | | | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesca Ferrari
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Massimo Vicentini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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17
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Mobile Health Interventions and RCTs: Structured Taxonomy and Research Framework. J Med Syst 2022; 46:66. [PMID: 36068371 DOI: 10.1007/s10916-022-01856-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
Mobile Health Interventions (MHIs) have addressed a range of healthcare challenges and have been evaluated using Randomized Controlled Trials (RCTs) to establish clinical effectiveness. Using PRISMA we conducted a systematic literature review of RCTs for MHIs and identified 70 studies which were analyzed and classified using Nickerson-Varshney-Muntermann (NVM) taxonomy. From the resultant iterations of the taxonomy, we extracted insights from the categorized studies. RCTs cover a wide range of health conditions including chronic diseases, general wellness, unhealthy practices, family planning, end-of-life, and post-transplant care. The MHIs that were utilized by the RCTs were varied as well, although most studies did not find significant differences between MHIs and usual care. The challenges for MHI-based RCTs include the use of technologies, delayed outcomes, patient recruitment, patient retention, and complex regulatory requirements. These variances can lead to a higher rate of Type I/Type II errors. Further considerations are the impact of infrastructure, contextual and cultural factors, and reductions in the technological relevancy of the intervention itself. Finally, due to the delayed effect of most outcomes, RCTs of insufficient duration are unable to measure significant, lasting improvements. Using the insights from seventy identified studies, we developed a classification of existing RCTs along with guidelines for MHI-based RCTs and a research framework for future RCTs. The framework offers opportunities for (a) personalization of MHIs, (b) use of richer technologies, and (c) emerging areas for RCTs.
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18
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Yang L, Liang C, Yu Y, Xiao Q, Xi M, Tang L. Family sports interventions for the treatment of obesity in childhood: a meta-analysis. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:40. [PMID: 36056414 PMCID: PMC9440531 DOI: 10.1186/s41043-022-00317-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Obesity in children has become one of the key concerns of the World Health Organization, and the incidence of related non-communicable diseases is also rising. This study evaluates the effect of family sports participation on the treatment and prevention of obesity in children aged 0–14 years by systematic analysis. Method A literature review from 2000 to 2020 was conducted. According to PRISMA-IPD (Preferred Reporting Items for MetaAnalyses of individual participant data) guidelines. The two researchers independently assessed the risk and bias of the articles, obtained a comprehensive, high-quality result, and extracted the data based on the Cochrane intervention system review manual. Randomized controlled trials (RCTs) were selected from the searches that used family sports interventions or family sports combined with dietary adjustments and behavioral habits change. Only studies targeting overweight or obese children aged 0–14 years were included. Results The search resulted in a total of 16 studies. Across all 16 studies, there were a total of 1680 participants in the experimental groups and 1701 participants in the control groups. The results are as follows: body mass index (BMI) (SMD-RE = − 4.10, 95% CI (− 0.84 to 0.02), Z = 1.88, p = 0.06); Body weight (SMD-RE = − 0.77, 95% CI (− 1.53 to − 0.01), Z = 2.00, p = 0.05); Waist circumference (SMD-RE = − 0.45, 95% CI (− 1.36 to 0.47), Z = 0.96, p = 0.34); and Body fat rate (SMD-FE = − 0.06, 95% CI (− 0.22 to 0.11), Z = 0.69, p = 0.49). Hence, through family sports intervention among obese children, juvenile and obese body composition—BMI, body weight, waist circumference, and body fat rate—are all reduced. But only body weight was statistically significant. Conclusions Compared with the samples without family sports, the weight of obese children participating in family sports decreased, but there were no significant differences in other relevant physical indicators. Follow-up research should examine large-scale clinical trials with family sports as a single factor intervention, which are needed to provide stronger evidence of the intervention effect. However, family activities can help obese children grow and develop by improving their exercise capacity, enhancing their lifestyles, and facilitating communication and relationships with their parents. In the future, long-term sports training plans for children with obesity should be implemented.
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19
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Rodríguez-González P, Hassan MA, Gao Z. Effects of Family-Based Interventions Using Mobile Apps on Youth’s Physical Activity: A Systematic Review. J Clin Med 2022; 11:jcm11164798. [PMID: 36013037 PMCID: PMC9410395 DOI: 10.3390/jcm11164798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objective. This review synthesized the currently available literature on the effects of family-based interventions using smartphone apps on youth physical activity. Design. Systematic review. Data Sources. 1037 studies from eight databases were retrieved. Eligibility Criteria for Selecting Studies. The seven articles included in this review met the following inclusion criteria: (1) experimental studies, (2) using smartphone apps, and (3) involving families with healthy children/adolescents. Results. Studies were stratified according to whether they used smartphone apps only or the combination of sports wearables and their associated companion app. The smartphone app interventions showed significant improvements in youth’s PA levels. All but one of the studies reported no significant improvement in PA levels after the intervention. However, positive PA-related outcomes were found, and the combination of sports wearables and their associated companion app showed inconclusive results due to the small number of studies. A trend of the relevance of families in improving the PA levels of youths was found. Conclusions. The findings of this review indicate that more research is needed on the effects of family-based interventions using mobile apps on youth’s physical activity. Mixed results were found for variables related to the PA of the youth involved in these programs. Although strong evidence was found that youth’s physical activity levels do not always improve with the implementation of these programs, promising results were found for a positive impact on different variables related to physical activity. Therefore, more experimental studies using only a mobile app to promote PA as the main outcome are needed to understand the real effect of mobile apps on youth’s PA levels. Future studies need to further explore this topic by developing programs based on designs of high methodological quality.
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Affiliation(s)
- Pablo Rodríguez-González
- School of Kinesiology, The University of Minnesota, Cooke Hall 208, 1900 University Ave. SE, Minneapolis, MN 55455, USA
- Faculty of Teacher Training and Education, University of Oviedo, 33006 Asturias, Spain
| | - Mohamed A. Hassan
- School of Kinesiology, The University of Minnesota, Cooke Hall 208, 1900 University Ave. SE, Minneapolis, MN 55455, USA
- Department of Methods and Curriculum, Physical Education College for Men, Helwan University, Cairo 12552, Egypt
| | - Zan Gao
- School of Kinesiology, The University of Minnesota, Cooke Hall 208, 1900 University Ave. SE, Minneapolis, MN 55455, USA
- Correspondence:
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20
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Migueles JH, Delisle Nyström C, Leppänen MH, Henriksson P, Löf M. Revisiting the cross-sectional and prospective association of physical activity with body composition and physical fitness in preschoolers: A compositional data approach. Pediatr Obes 2022; 17:e12909. [PMID: 35212168 PMCID: PMC9539596 DOI: 10.1111/ijpo.12909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Information is limited for the benefits of physical activity (PA) in preschoolers. Previous research using accelerometer-assessed PA may be affected for multicollinearity issues. OBJECTIVES This study investigated the cross-sectional and prospective associations of sedentary behaviour (SB) and PA with body composition and physical fitness using compositional data analysis. METHODS Baseline PA and SB were collected in 4-year-old (n = 315) using wrist-worn GT3X+ during seven 24 h-periods. Body composition (air-displacement plethysmography) and physical fitness (PREFIT test battery) were assessed at baseline and at the 12-month follow-up. RESULTS Increasing vigorous PA at expenses of lower-intensity behaviours for 4-year-old was associated with body composition and physical fitness at cross-sectional and longitudinal levels. For example, reallocating 15 min/day from lower intensities to vigorous PA at baseline was associated with higher fat-free mass index (+0.45 kg/m2 , 95% confidence intervals [CI]: 0.18-0.72 kg/m2 ), higher upper-body strength (+0.6 kg, 95% CI: 0.1-1.19 kg), higher lower-body strength (+8 cm, 95% CI: 3-13 cm), and shorter time in completing the motor fitness test (-0.4 s, 95% CI: -0.82 to [-0.01] s) at the 12-month follow-up. Pairwise reallocations of time indicated that the behaviour replaced was not relevant, as long as vigorous PA was increased. CONCLUSIONS More time in vigorous PA may imply short- and long-term benefits on body composition and physical fitness in preschoolers. These findings using compositional data analysis corroborate our previously published results using isotemporal substitution models.
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Affiliation(s)
- Jairo H. Migueles
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sport SciencesUniversity of GranadaGranadaSpain
- Department of Biosciences and NutritionKarolinska InstitutetHuddingeSweden
| | | | - Marja H. Leppänen
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
- Folkhälsan Research CenterHelsinkiFinland
| | - Pontus Henriksson
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Marie Löf
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Biosciences and NutritionKarolinska InstitutetHuddingeSweden
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21
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De-Jongh González O, Tugault-Lafleur CN, Buckler EJ, Hamilton J, Ho J, Buchholz A, Morrison KM, Ball GD, Mâsse LC. The Aim2Be mHealth Intervention for Children With Overweight or Obesity and Their Parents: Person-Centered Analyses to Uncover Digital Phenotypes. J Med Internet Res 2022; 24:e35285. [PMID: 35 PMCID: PMC9221987 DOI: 10.2196/35285] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/07/2022] [Accepted: 04/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Despite the growing number of mobile health (mHealth) interventions targeting childhood obesity, few studies have characterized user typologies derived from individuals’ patterns of interactions with specific app features (digital phenotypes). Objective This study aims to identify digital phenotypes among 214 parent-child dyads who used the Aim2Be mHealth app as part of a randomized controlled trial conducted between 2019 and 2020, and explores whether participants’ characteristics and health outcomes differed across phenotypes. Methods Latent class analysis was used to identify distinct parent and child phenotypes based on their use of the app’s behavioral, gamified, and social features over 3 months. Multinomial logistic regression models were used to assess whether the phenotypes differed by demographic characteristics. Covariate-adjusted mixed-effect models evaluated changes in BMI z scores (zBMI), diet, physical activity, and screen time across phenotypes. Results Among parents, 5 digital phenotypes were identified: socially engaged (35/214, 16.3%), independently engaged (18/214, 8.4%) (socially and independently engaged parents are those who used mainly the social or the behavioral features of the app, respectively), fully engaged (26/214, 12.1%), partially engaged (32/214, 15%), and unengaged (103/214, 48.1%) users. Married parents were more likely to be fully engaged than independently engaged (P=.02) or unengaged (P=.01) users. Socially engaged parents were older than fully engaged (P=.02) and unengaged (P=.01) parents. The latent class analysis revealed 4 phenotypes among children: fully engaged (32/214, 15%), partially engaged (61/214, 28.5%), dabblers (42/214, 19.6%), and unengaged (79/214, 36.9%) users. Fully engaged children were younger than dabblers (P=.04) and unengaged (P=.003) children. Dabblers lived in higher-income households than fully and partially engaged children (P=.03 and P=.047, respectively). Fully engaged children were more likely to have fully engaged (P<.001) and partially engaged (P<.001) parents than unengaged children. Compared with unengaged children, fully and partially engaged children had decreased total sugar (P=.006 and P=.004, respectively) and energy intake (P=.03 and P=.04, respectively) after 3 months of app use. Partially engaged children also had decreased sugary beverage intake compared with unengaged children (P=.03). Similarly, children with fully engaged parents had decreased zBMI, whereas children with unengaged parents had increased zBMI over time (P=.005). Finally, children with independently engaged parents had decreased caloric intake, whereas children with unengaged parents had increased caloric intake over time (P=.02). Conclusions Full parent-child engagement is critical for the success of mHealth interventions. Further research is needed to understand program design elements that can affect participants’ engagement in supporting behavior change. Trial Registration ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/NCT03651284 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-4080-2
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Affiliation(s)
- Olivia De-Jongh González
- School of Population and Public Health, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Claire N Tugault-Lafleur
- School of Nutrition Sciences, Faculty of Health Sciences, The University of Ottawa., Ottawa, ON, Canada
| | - E Jean Buckler
- School of Exercise Science, Physical and Health Education, University of Victoria., Victoria, BC, Canada
| | - Jill Hamilton
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Josephine Ho
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Geoff Dc Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, BC, Canada
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22
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Park J, Park MJ, Seo YG. Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e29003. [PMID: 34787572 PMCID: PMC8726568 DOI: 10.2196/29003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/02/2021] [Accepted: 10/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. OBJECTIVE The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. METHODS Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. RESULTS In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=-1.26 kg/m2, 95% CI -2.24 to -0.28), lifestyle modification comparator (WMD=-1.75, 95% CI -2.76 to -0.74), intervention involving both boys and girls (WMD=-1.30, 95% CI -2.14 to -0.46), and intervention involving obesity only (WMD=-1.92, 95% CI -3.75 to -0.09). CONCLUSIONS The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity.
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Affiliation(s)
- Jihyun Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Mi-Jeong Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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23
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Brown V, Tran H, Downing KL, Hesketh KD, Moodie M. A systematic review of economic evaluations of web-based or telephone-delivered interventions for preventing overweight and obesity and/or improving obesity-related behaviors. Obes Rev 2021; 22:e13227. [PMID: 33763956 DOI: 10.1111/obr.13227] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 12/16/2022]
Abstract
Obesity prevention interventions with behavioral or lifestyle-related components delivered via web-based or telephone technologies have been reported as comparatively low cost as compared with other intervention delivery modes, yet to date, no synthesized evidence of cost-effectiveness has been published. This study aimed to conduct a systematic review of economic evaluations of obesity prevention interventions with a telehealth or eHealth intervention component. A systematic search of six academic databases was conducted through October 2020. Studies were included if they reported full economic evaluations of interventions aimed at preventing overweight or obesity, or interventions aimed at improving obesity-related behaviors, with at least one intervention component delivered by telephone (telehealth) or web-based technology (eHealth). Findings were reported narratively, based on the Consolidated Health Economic Evaluation Reporting Standards. Twenty-seven economic evaluations were included from 20 studies meeting the inclusion criteria. Sixteen of the included interventions had a telehealth component, whereas 11 had an eHealth component. Seventeen interventions were evaluated using cost-utility analysis, five with cost-effectiveness analysis, and five undertook both cost-effectiveness and cost-utility analyses. Only eight cost-utility analyses reported that the intervention was cost-effective. Comparison of results from cost-effectiveness analyses was limited by heterogeneity in methods and outcome units reported. The evidence supporting the cost-effectiveness of interventions with a telehealth or eHealth delivery component is currently inconclusive. Although obesity prevention telehealth and eHealth interventions are gaining popularity, more evidence is required on their effectiveness and cost-effectiveness.
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Affiliation(s)
- Vicki Brown
- Deakin Health Economics, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, New South Wales, Australia
| | - Huong Tran
- Deakin Health Economics, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, New South Wales, Australia
| | - Katherine L Downing
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, New South Wales, Australia
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24
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Truong K, Park S, Tsiros MD, Milne N. Physiotherapy and related management for childhood obesity: A systematic scoping review. PLoS One 2021; 16:e0252572. [PMID: 34125850 PMCID: PMC8202913 DOI: 10.1371/journal.pone.0252572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity. METHOD A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy. RESULTS From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively. CONCLUSION When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.
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Affiliation(s)
- Kim Truong
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Sandra Park
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Margarita D. Tsiros
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
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Reddy P, Dukhi N, Sewpaul R, Ellahebokus MAA, Kambaran NS, Jobe W. Mobile Health Interventions Addressing Childhood and Adolescent Obesity in Sub-Saharan Africa and Europe: Current Landscape and Potential for Future Research. Front Public Health 2021; 9:604439. [PMID: 33777878 PMCID: PMC7991289 DOI: 10.3389/fpubh.2021.604439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
Child and adolescent overweight is a growing public health problem globally. Europe and low and middle-income (LMIC) countries in Sub-Saharan Africa provide sufficiently suitable populations to learn from with respect to the potential for mobile health (mHealth) interventions in this area of research. The aim of this paper is to identify mHealth interventions on prevention and treatment of childhood and adolescent obesity in Sub-Saharan Africa and Sweden and report on their effects, in order to inform future research in this area. A search of peer-reviewed publications was performed using PubMed, ScienceDirect, EBSCOhost, and Scopus. The search included all articles published up to August 2019. The search strings consisted of MeSH terms related to mHealth, overweight or obesity, children, adolescents or youth and individual countries in Europe and Sub-Saharan Africa. Second, a combination of free-text words; mobile phone, physical activity, exercise, diet, weight, BMI, and healthy eating was also used. Seven studies were reported from Europe and no eligible studies from Sub-Saharan Africa. The results of this narrative review indicate a lack of research in the development and testing of mHealth interventions for childhood and adolescent obesity. There is a need for an evidence base of mHealth interventions that are both relevant and appropriate in order to stem the epidemic of overweight and obesity among children and adolescents in these countries. Uptake of such interventions is likely to be high as there is high penetrance of mobile phone technology amongst adolescents, even within poor communities in Africa.
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Affiliation(s)
- Priscilla Reddy
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa.,Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | - Natisha Dukhi
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Ronel Sewpaul
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | | | - Nilen Sunder Kambaran
- Analytics, Retirement, Compensation and Health Actuarial Consulting, Westlake, Cape Town, South Africa
| | - William Jobe
- Department of Informatics, University West, Trollhättan, Sweden
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26
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Røed M, Medin AC, Vik FN, Hillesund ER, Van Lippevelde W, Campbell K, Øverby NC. Effect of a Parent-Focused eHealth Intervention on Children's Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial. J Med Internet Res 2021; 23:e18311. [PMID: 33591279 PMCID: PMC7925157 DOI: 10.2196/18311] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/08/2020] [Accepted: 01/17/2021] [Indexed: 01/16/2023] Open
Abstract
Background In Western countries, children’s diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet. Objective In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diets by shaping their food and eating environment. Methods The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. Results At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. Conclusions A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420
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Affiliation(s)
- Margrethe Røed
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Anine C Medin
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Frøydis N Vik
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Elisabet R Hillesund
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Wendy Van Lippevelde
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway.,Department of Marketing, Innovation and Organisation, Ghent University, Ghent, Belgium
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Nina C Øverby
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
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27
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Fowler LA, Grammer AC, Staiano AE, Fitzsimmons-Craft EE, Chen L, Yaeger LH, Wilfley DE. Harnessing technological solutions for childhood obesity prevention and treatment: a systematic review and meta-analysis of current applications. Int J Obes (Lond) 2021; 45:957-981. [PMID: 33627775 PMCID: PMC7904036 DOI: 10.1038/s41366-021-00765-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/24/2020] [Accepted: 01/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Technology holds promise for delivery of accessible, individualized, and destigmatized obesity prevention and treatment to youth. OBJECTIVES This review examined the efficacy of recent technology-based interventions on weight outcomes. METHODS Seven databases were searched in April 2020 following PRISMA guidelines. Inclusion criteria were: participants aged 1-18 y, use of technology in a prevention/treatment intervention for overweight/obesity; weight outcome; randomized controlled trial (RCT); and published after January 2014. Random effects models with inverse variance weighting estimated pooled mean effect sizes separately for treatment and prevention interventions. Meta-regressions examined the effect of technology type (telemedicine or technology-based), technology purpose (stand-alone or adjunct), comparator (active or no-contact control), delivery (to parent, child, or both), study type (pilot or not), child age, and intervention duration. FINDINGS In total, 3406 records were screened for inclusion; 55 studies representing 54 unique RCTs met inclusion criteria. Most (89%) included articles were of high or moderate quality. Thirty studies relied mostly or solely on technology for intervention delivery. Meta-analyses of the 20 prevention RCTs did not show a significant effect of prevention interventions on weight outcomes (d = 0.05, p = 0.52). The pooled mean effect size of n = 32 treatment RCTs showed a small, significant effect on weight outcomes (d = ‒0.13, p = 0.001), although 27 of 33 treatment studies (79%) did not find significant differences between treatment and comparators. There were significantly greater treatment effects on outcomes for pilot interventions, interventions delivered to the child compared to parent-delivered interventions, and as child age increased and intervention duration decreased. No other subgroup analyses were significant. CONCLUSIONS Recent technology-based interventions for the treatment of pediatric obesity show small effects on weight; however, evidence is inconclusive on the efficacy of technology based prevention interventions. Research is needed to determine the comparative effectiveness of technology-based interventions to gold-standard interventions and elucidate the potential for mHealth/eHealth to increase scalability and reduce costs while maximizing impact.
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Affiliation(s)
- Lauren A. Fowler
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Anne Claire Grammer
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Amanda E. Staiano
- grid.250514.70000 0001 2159 6024LSU’s Pennington Biomedical Research Center, Baton Rouge, LA USA
| | - Ellen E. Fitzsimmons-Craft
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Ling Chen
- grid.4367.60000 0001 2355 7002Division of Biostatistics, Washington University School of Medicine, St. Louis, MO USA
| | - Lauren H. Yaeger
- grid.4367.60000 0001 2355 7002Washington University School of Medicine, St. Louis, MO USA
| | - Denise E. Wilfley
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
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Giorgi Rossi P, Ferrari F, Amarri S, Bassi A, Bonvicini L, Dall'Aglio L, Della Giustina C, Fabbri A, Ferrari AM, Ferrari E, Fontana M, Foracchia M, Gallelli T, Ganugi G, Ilari B, Lo Scocco S, Maestri G, Moretti V, Panza C, Pinotti M, Prandini R, Storani S, Street ME, Tamelli M, Trowbridge H, Venturelli F, Volta A, Davoli AM. Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study. JMIR Mhealth Uhealth 2020; 8:e16165. [PMID: 32357123 PMCID: PMC7308901 DOI: 10.2196/16165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies. Objective The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity. Methods After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app. Results Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet. Conclusions The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project.
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Affiliation(s)
- Paolo Giorgi Rossi
- Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Ferrari
- Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sergio Amarri
- Pediatria Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Bassi
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Laura Bonvicini
- Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Dall'Aglio
- Servizio Tecnologie Informatiche e Telematiche Interaziendale, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudia Della Giustina
- Servizio Igiene degli Alimenti e Nutrizione, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Fabbri
- Servizio Igiene degli Alimenti e Nutrizione, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Maria Ferrari
- Dipartimento di Salute Pubblica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Ferrari
- Pediatra di libera scelta, Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marta Fontana
- Pediatria Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Foracchia
- Servizio Tecnologie Informatiche e Telematiche Interaziendale, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giulia Ganugi
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Barbara Ilari
- Medicina dello Sport e Prevenzione Cardiovascolare, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Lo Scocco
- Pediatria Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Maestri
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Veronica Moretti
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Costantino Panza
- Pediatra di libera scelta, Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mirco Pinotti
- Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Riccardo Prandini
- Dipartimento di scienze politiche e sociali, Università di Bologna, Bologna, Italy
| | - Simone Storani
- Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Elisabeth Street
- Pediatria Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Tamelli
- Servizio di igiene pubblica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesco Venturelli
- Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Volta
- Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Maria Davoli
- Pediatra di libera scelta, Dipartimento di cure primarie, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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- Cocreation of Service Innovation in Europe Project, Reggio Emilia, Italy
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29
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State of the art in clinical decision support applications in pediatric perioperative medicine. Curr Opin Anaesthesiol 2020; 33:388-394. [DOI: 10.1097/aco.0000000000000850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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30
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Zarnowiecki D, Mauch CE, Middleton G, Matwiejczyk L, Watson WL, Dibbs J, Dessaix A, Golley RK. A systematic evaluation of digital nutrition promotion websites and apps for supporting parents to influence children's nutrition. Int J Behav Nutr Phys Act 2020; 17:17. [PMID: 32041640 PMCID: PMC7011240 DOI: 10.1186/s12966-020-0915-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Globally children’s diet quality is poor. Parents are primary gatekeepers to children’s food intake; however, reaching and engaging parents in nutrition promotion can be challenging. With growth in internet and smartphone use, digital platforms provide potential to disseminate information rapidly to many people. The objectives of this review were to conduct a comprehensive and systematic evaluation of nutrition promotion via websites and apps supporting parents to influence children’s nutrition, from three different perspectives: 1) current evidence base, 2) end user (parent) experience and 3) current commercial offerings. Methods Three systematic reviews were undertaken of (1) studies evaluating the effectiveness for digital platforms for improving nutrition in children and parents, (2) studies conducting user-testing of digital tools with parents, (3) websites and apps providing lunch-provision information to parents. Searches were conducted in five databases for reviews one and two, and systematic search of Google and App Store for review three. Randomised controlled trials, cohort and cross-sectional and qualitative studies (study two only) were included if published in English, from 2013, with the intervention targeted at parents and at least 50% of intervention content focused on nutrition. Search results were double screened, with data extracted into standardised spreadsheets and quality appraisal of included search results. Results Studies evaluating digital nutrition interventions targeting parents (n = 11) demonstrated effectiveness for improving nutrition outcomes, self-efficacy and knowledge. Six of the included randomised controlled trials reported digital interventions to be equal to, or better than comparison groups. User-testing studies (n = 9) identified that digital platforms should include both informative content and interactive features. Parents wanted evidence-based information from credible sources, practical tools, engaging content and connection with other users and health professionals. Websites targeting lunch provision (n = 15) were developed primarily by credible sources and included information-based content consistent with dietary guidelines and limited interactive features. Lunchbox apps (n = 6), developed mostly by commercial organisations, were more interactive but provided less credible information. Conclusions Digital nutrition promotion interventions targeting parents can be effective for improving nutrition-related outcomes in children and parents. As demonstrated from the lunchbox context and user-testing with parents, they need to go beyond just providing information about positive dietary changes, to include the user-desired features supporting interactivity and personalisation.
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Affiliation(s)
- Dorota Zarnowiecki
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia.
| | - Chelsea E Mauch
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Georgia Middleton
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Louisa Matwiejczyk
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Wendy L Watson
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Jane Dibbs
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Anita Dessaix
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Rebecca K Golley
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
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St. George SM, Agosto Y, Rojas LM, Soares M, Bahamon M, Prado G, Smith JD. A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence. Obes Rev 2020; 21:e12939. [PMID: 31808277 PMCID: PMC6980892 DOI: 10.1111/obr.12939] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023]
Abstract
The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.
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Affiliation(s)
- Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yaray Agosto
- Department of Health Promotion and Disease Prevention, Florida International University Robert Stempel College of Public Health & Social Work, Miami, Florida, USA
| | - Lourdes M. Rojas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mary Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Monica Bahamon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Home-Based Exergaming on Preschoolers' Energy Expenditure, Cardiovascular Fitness, Body Mass Index and Cognitive Flexibility: A Randomized Controlled Trial. J Clin Med 2019; 8:jcm8101745. [PMID: 31640158 PMCID: PMC6832462 DOI: 10.3390/jcm8101745] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/12/2019] [Accepted: 10/18/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The effects of exergaming-based physical activity (PA) interventions on preschoolers' health outcomes and cognition remain largely unexplored. Therefore, we conducted a randomized controlled trial to discern the effectiveness of a home-based educational exergaming intervention on preschoolers' energy expenditure, fitness, body mass index, and cognition. METHODS Participants were 32 preschoolers (16 girls; 59.4% Asian; Mage = 4.72, SD = ±0.73) recruited from the Twin Cities area in Minnesota. During baseline testing, we measured preschooler's daily energy expenditure (EE), cardiovascular fitness, body mass index, and cognitive flexibility using validated instruments. Participants were then randomly assigned to one of two conditions: (1) the exergaming intervention condition; or (2) control condition. The intervention program requested children participate in home-based educational exergaming using the LeapTV gaming console for at least 30 min/session 5 times/week. The control condition asked children to maintain regular PA patterns without any exergaming gameplay. Each condition lasted 12 weeks. We conducted identical outcome assessments for all children at baseline and post-intervention. RESULTS Analysis of covariance with repeated measures yielded significant time x group interaction effects for cognitive flexibility, Wilks' Lambda = 0.81, F(1, 29) = 6.98, p = 0.01, η2 = 0.19, suggesting children in the exergaming group demonstrated significantly greater increases in cognitive flexibility as compared to those in the control group over time. There were no significant differences for time x group changes between the two groups for EE, Wilks' Lambda = 0.92, F(1, 29) = 2.29, p = 0.14, η2 = 0.08; cardiovascular fitness, Wilks' Lambda = 0.96, F(1, 29) = 1.07, p = 0.31, η2 = 0.04; and BMI, Wilks' Lambda = 0.99, F(1, 29) = 0.05, p = 0.82, η2 = 0.01. However, our data did suggest a marginal effect of time for EE, Wilks' Lambda = 0.89, F(1, 29) = 3.26, p = 0.08, η2 = 0.08, indicating that children's daily EE increased from baseline to post-intervention. CONCLUSIONS Home-based educational exergaming may positively impact cognitive flexibility in preschoolers. Studies with larger sample sizes in multiple geographic locations are needed, with our study suggesting a longer intervention period might also be warranted.
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Rodriguez Rocha NP, Kim H. eHealth Interventions for Fruit and Vegetable Intake: A Meta-Analysis of Effectiveness. HEALTH EDUCATION & BEHAVIOR 2019; 46:947-959. [PMID: 31347403 DOI: 10.1177/1090198119859396] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. An adequate intake of fruits and vegetables (FVI) has shown benefits for reduced risk of manifesting chronic diseases. Thus, development of effective interventions to promote FVI is paramount. Aim. To assess the effectiveness of eHealth interventions for FVI targeted to healthy population, in comparison with control groups, and identify the moderators contributing to their effectiveness. Method. A database search was conducted in April 2016 and July 2018 using MEDLINE, PsycINFO, ERIC, Google Scholar, SciELO, and RISS, yielding 19 eligible studies. Risk of bias was assessed using Cochrane's Risk of Bias Tool. Random-effects model was used to calculate effect sizes (ES) by weighted standardized mean differences. Results. This meta-analysis includes 19 studies and 6,894 participants. The most common eHealth tool used was Internet-based interventions (n = 10). Most of studies were conducted in adults (n = 11), followed by children (n = 4), and adolescents (n = 4). The minimum number of behavior change techniques (BCTs) used was one, and the maximum seven. The overall ES was small (0.26, p < .001), favoring eHealth interventions. The between-studies heterogeneity was large (I2 = 62.77%, p < .001). Subgroup analyses showed that the components with larger ES were tailored interventions (0.27, p < .001), computer-based interventions (0.44, p < .001), and use of ≥7 BCTs (0.42, p < .001). Discussion. All studies showed a positive ES favoring interventions. Large heterogeneity could be explained in part by the number of BCTs and type of eHealth tool used. Nonetheless, more concrete evidence regarding other intervention components effectiveness was limited by small sample size. Conclusion. The use of eHealth tools for the improvement of FVI showed to be more effective compared with nonintervention and interventions not using these technologies. Nonetheless, more research is needed to determine the specific combination of intervention components that could translate into larger effectiveness.
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