A Digital Health Program Targeting Physical Activity Among Adolescents With Overweight or Obesity: Open Trial

A scoping review of the types and features of technology used to deliver exercise prescription and improve exercise adherence

OBJECTIVE

Exercise adherence and motivation can benefit from technology, but the specific factors influencing these improvements remain unclear. This scoping review aimed to outline the types and features of technology used in exercise prescription within healthcare, focusing on enhancing users' adherence to exercise.

METHODS

A comprehensive systematic literature search was conducted from January 2000 to February 2023 across Web of Science, Google Scholar, and MEDLINE via PubMed. The review sought studies on technology-based exercise prescriptions for adults ≥ 18 years, evaluating features that enhance motivation or adherence.

RESULTS

Out of 1724 articles reviewed, 45 met the criteria, demonstrating that mobile applications, exercise gaming, wearable trackers, and websites are commonly used technologies for prescribing exercise in healthcare setting. Common features, special features, and motivating features were found to be important in all technology-based exercise tools to enhance users' adherence and motivation.

CONCLUSION

This review provides a comprehensive overview of the technological types and approaches that can support and improve exercise adherence among health service users. The findings also emphasize on specific features that can address current gaps in technology-driven fitness interventions.

PRACTICE IMPLICATIONS

Healthcare professionals should make informed decisions when recommending these tools to health service users, since technology does play a significant role in promoting long-term adherence to exercise programs.

Associations between number of steps and health outcomes in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Today's public health discourse prioritizes the health and well-being of children and adolescents. As step counts include both light and moderate-to-vigorous physical activities, and monitoring steps has become a popular method for assessing daily physical activity, it is critical to gain a better understanding of how measuring daily steps may contribute to overall health in children and adolescents. The aim of this study was to thoroughly review the studies that investigated the associations between daily number of steps (DNoS) and health outcomes (HO) in children and adolescents.

METHODS

Electronic searches were conducted in PubMed, Google Scholar, Cochrane, MEDLINE, Web of Science, SPORTDiscus (2000 -January 2024.). Key terms such as number of steps, daily steps, average steps, physical activity, health outcomes were used. The primary outcomes were (1) body composition/obesity risk factors; (2) cardiorespiratory fitness (CRF); and (3) cardiovascular risk factors. Secondary outcomes were psychological/psychosocial parameters (sleep habits, i.e. quality of life). We assessed the methodological quality of each trial using AXIS quality assessment tool. In instances where continuous data emanated from two or more trials, a meta-analysis was undertaken.

RESULTS

The main findings of this systematic review and meta-analysis are that an increased number of DNoS is associated with better HO in children and adolescents, as evidenced by improvements in body mass index (BMI), body weight, waist circumference, body fat percentage, and cardiorespiratory fitness (i.e., VO2max). However, due to a dearth of studies and conflicting results from current studies, no inferences can be drawn about the correlations between DNoS and sleep quality, quality of life, or cardiovascular risk factors (i.e., blood pressure). Across most of the studies, the average correlation between the DNoS and HO reflected a small, but significant, association with a small effect size.

CONCLUSIONS

Our findings highlight the importance of daily physical activity, as evidenced by the association between the number of steps and health outcomes in children and adolescents.

TRIAL REGISTRATION

PROSPERO # CRD42024523729.

Behavior Change Techniques in Physical Activity Interventions Targeting Overweight and Obese Children and Adolescents: A Systematic Review

Substantial evidence globally confirms the benefits of physical activity (PA) interventions for the physical and mental health of overweight and obese children and adolescents. However, current research has yet to determine which behavior change techniques (BCTs) are most effective in PA interventions for this population. This systematic review aims to evaluate the application of BCTs in PA interventions for overweight and obese children and adolescents and to identify the most effective BCTs using the promise ratio. Five electronic databases (PubMed, Embase, Cochrane Central, Web of Science, and PsycINFO) were searched up to 31 May 2024, to identify intervention studies meeting the eligibility criteria for promoting PA in the target population. Thirteen studies were included (nine randomized controlled trials and four quasi-experimental studies). The quality of the included studies was assessed using a revised version of the Cochrane Risk of Bias tool and the Risk of Bias in Non-randomized Studies tool. Among the 24 BCTs implemented, the most frequently applied were goal setting (behavior), instruction on how to perform the behavior, feedback on behavior, and self-monitoring of behavior. Action planning, social support, and material incentives showed the most significant potential to promote PA. These findings provide valuable insights for designing future PA interventions for this group, with the potential to improve health outcomes and enhance PA participation among obese children and adolescents.

Intervention Satisfaction and Feasibility of the Active Children Through In-Home, Web-Based Physical Activity (ACTIWEB-PA) Pilot Randomized Controlled Trial in Children

PURPOSE

We assessed feasibility and satisfaction of the Active Children Through In-Home Web-Based Physical Activity pilot trial, delivering a web-based movement integration intervention to children.

METHOD

Eighty-two children (8-11 y), insufficiently active, were randomly assigned to either exercise intervention (n = 41) or wait-list control (n = 41). The intervention involved 20-minute exercise videos, 5 times weekly for 12 weeks, using the UNICEF Kid Power website at home. Feasibility metrics included recruitment (target: 70%), retention (target: 80%), adherence rates, and satisfaction assessed through surveys and interviews. Retention rate-1 was percentage completing posttest surveys, and retention rate-2 was percentage completing posttest accelerometry. Parent logs assessed adherence.

RESULTS

Recruitment, retention-1, and retention-2 rates were 73.6%, 93.9%, and 80.5%, respectively. The intervention group had 5 dropouts; wait-list control had none. Sixty-nine percent showed high intervention adherence. Parents consistently expressed satisfaction, finding the intervention enjoyable and beneficial. Although children initially provided positive reviews, their interest declined over time, with increasing expressions of monotony. Suggestions to increase novelty and incorporate a social component were made by participants. The intervention was also found to be particularly useful during inclement weather.

CONCLUSION

Active Children Through In-Home Web-Based Physical Activity trial exceeded feasibility targets of recruitment and retention and achieved moderate overall adherence. Future trials should emphasize novelty and peer participation for improved adherence and satisfaction.

Use of Extrinsic Motivators to Improve the Body Mass Index of Obese or Overweight Adolescents: A Systematic Review

BACKGROUND

The prevalence of overweight and obesity is increasing at an alarming rate in children and adolescents worldwide. Given the dimension of the problem, treatments of childhood obesity are recognized as of extreme importance. Current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity.

OBJECTIVE

The purpose of this systematic review is to evaluate the use of extrinsic motivators in improving the BMI of obese or overweight adolescents.

METHODS

The inclusion criteria were as follows: 1) overweight or obese adolescents, 2) intervention using extrinsic motivators, 3) outcome variables related to weight status. The exclusion criteria were associated chronic disease. The search process was conducted in PubMed and Web of Science (last searched on 23/04/2023). The risk of bias was evaluated independently by two authors with the Cochrane's tools: RoB2 (RCT), ROBINS-I and ROBINS-E.

RESULTS

From 3,163 studies identified, 20 articles (corresponding to 18 studies) were included in the analysis. The studies differ in study design, sample size, follow-up duration, outcomes reported, and extrinsic motivators used. Most of the studies had videogames or apps as intervention. Nine studies (50%) showed a statistically significant decrease of BMI. The most used extrinsic motivators were "Motivation" (n=13), "Feedback" (n=10) and "Rewards" (n=9), and the ones that seem to have a higher impact on decreasing BMI are "Reminders" (100%) and "Peer-support" (80%).

CONCLUSIONS

The heterogeneity of studies makes analysis difficult. No study has evaluated the extrinsic motivators in isolation. Most of the studies have a moderate or high risk of bias. The extrinsic motivators that seem to be more useful are "Reminders" and "Peer-support", but more studies are needed, namely well designed RCTs, homogeneity in BMI measure and extrinsic motivators definitions, and longer duration to better understand long-term impact of extrinsic motivators on weight management success.

CLINICALTRIAL

Adolescents with Type 2 Diabetes: Overcoming Barriers to Effective Weight Management

The prevalence of type 2 diabetes (T2DM) among children and adolescents has remarkably increased in the last two decades, particularly among ethnic minorities. Management of T2DM is challenging in the adolescent population due to a constellation of factors, including biological, socioeconomic, cultural, and psychological barriers. Weight reduction is an essential component in management of T2DM as weight loss is associated with improvement in insulin sensitivity and glycemic status. A family centered and culturally appropriate approach offered by a multidisciplinary team is crucial to address the biological, psychosocial, cultural, and financial barriers to weight management in youth with T2DM. Lifestyle interventions and pharmacotherapy have shown modest efficacy in achieving weight reduction in adolescents with T2DM. Bariatric surgery is associated with excellent weight reduction and remission of T2DM in youth. Emerging therapies for weight reduction in youth include digital technologies, newer GLP-1 agonists and endoscopic procedures.