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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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Lu N, Lau PWC, Song H, Zhang Y, Ghani RBA, Wang C. The effect of electronic health (eHealth) interventions for promoting physical activity self-efficacy in children: A systematic review and meta-analysis. J Exerc Sci Fit 2024; 22:417-428. [PMID: 39315337 PMCID: PMC11417549 DOI: 10.1016/j.jesf.2024.09.002] [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: 06/18/2024] [Revised: 09/10/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024] Open
Abstract
Background/objective Physical activity (PA) self-efficacy plays a crucial role in maintaining and enhancing PA behaviors in children. However, the effectiveness of eHealth interventions in boosting PA self-efficacy among children remains uncertain. Furthermore, which behavior change techniques (BCTs) used in eHealth interventions can positively influence children's PA self-efficacy needs further exploration for designing tailored eHealth interventions. Therefore, this systematic review and meta-analysis aimed to identify the effectiveness of eHealth interventions and BCTs in promoting children's PA self-efficacy. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across six databases (PubMed, Web of Science, EBSCOhost, Ovid, SPORTDiscus, PsycINFO) up to January 8, 2024. Inclusion criteria included randomized controlled trials (RCT), quasi-experimental, and two-group experiments that examined the effect of eHealth interventions on PA self-efficacy among healthy children aged 0-18 years. The Physiotherapy Evidence Database (PEDro) scale was utilized to assess the risk of bias. Random effects meta-analysis was performed to determine the effectiveness of eHealth interventions and BCTs in selected studies. Results Sixteen studies were screened, including 6020 participants with an average age of 11.58 years (SD = 2.87). The result showed small but significant intervention effects with high heterogeneity (I2 = 92.34 %) for postintervention PA self-efficacy (Hedges' g = 0.315; 95 % CI = 0.069, 0.562, p = .012). Two BCTs were significantly associated with enhanced PA self-efficacy: instruction on performing the behavior (p = .003) and behavior demonstration (p = .036). Additionally, studies that adopted social support (unspecified) a nd prompt/cues were significantly less effective than studies that did not use these BCTs (p = .001). Conclusions The findings showed that eHealth interventions positively affect children's PA self-efficacy. This review is the pioneer in focusing on BCTs in eHealth interventions for children. The insights gained provide valuable knowledge about tailored BCTs incorporated into eHealth interventions that promote children's PA self-efficacy. Trial registration International Prospective Register of Systematic Review (PROSPERO): CRD42024512058.
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Affiliation(s)
- Nike Lu
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, China
| | - Patrick W C Lau
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, China
| | - Huiqi Song
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, China
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Ruhina Binta A Ghani
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, China
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Zhu X, Gu S, Li J. How do gamified digital therapeutics work on obesity self-management? Metabol Open 2024; 23:100314. [PMID: 39290343 PMCID: PMC11406243 DOI: 10.1016/j.metop.2024.100314] [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: 08/04/2024] [Revised: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
Obesity management can effectively reduce the risks and complications associated with obesity and improve the quality of life of patients. After assessing the advantages and limitations of various obesity management approaches, self-management has been strongly recommended due to the advantages of minimal side effects and lower costs compared to treatment via drugs and surgery. However, successfully implementing lifestyle intervention strategies requires scientific guidance and strong determination. With the development of electronic and information technology, lifestyle intervention has transformed considerably. A new concept, called Gamified Digital Therapeutics (GDTx), represents a gaming format with Digital Therapeutics (DTx). It can effectively enhance patient compliance and accessibility to chronic disease management. Here, we review recent studies on the application of GDTx for the self-management of obesity and discuss three aspects surrounding its completion rates, satisfaction levels, and effectiveness. In contrast to traditional approaches to obesity self-management, implementing GDTx effectively corrects unhealthy dietary and lifestyle habits, markedly enhancing the dissemination of nutritional and exercise-related health knowledge. Of particular significance is the evident improvement in the adherence of obese patients to weight loss programs. Despite numerous studies indicating that GDTx may offer an effective solution for obesity self-management, there are still several limitations in the medicalization of GDTx for self-management of obesity. This review aimed to provide a reference for subsequent studies and promote the widespread application of GDTx in obesity self-management to help reduce the obesity rate and alleviate the burden on obese patients.
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Affiliation(s)
- Xuejuan Zhu
- Department of Endocrinology, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai 200092, China
| | - Shuneng Gu
- BOKE Digital Health Research Institute, BOKE Medical Technology (Shanghai) Co., Ltd., Shanghai 200333, China
- BOKE Technology Group Co.,Ltd., Shanghai 200333, China
| | - Jian Li
- Department of Endocrinology, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai 200092, China
- BOKE Digital Health Research Institute, BOKE Medical Technology (Shanghai) Co., Ltd., Shanghai 200333, China
- BOKE Technology Group Co.,Ltd., Shanghai 200333, China
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Liu M, Guan X, Guo X, He Y, Liu Z, Ni S, Wu Y. Impact of Serious Games on Body Composition, Physical Activity, and Dietary Change in Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2024; 16:1290. [PMID: 38732536 PMCID: PMC11085665 DOI: 10.3390/nu16091290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Over the past four decades, obesity in children of all ages has increased worldwide, which has intensified the search for innovative intervention strategies. Serious games, a youth-friendly form of intervention designed with educational or behavioral goals, are emerging as a potential solution to this health challenge. To analyze the effectiveness of serious games in improving body composition, physical activity, and dietary change, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, EMBASE, and Scopus databases. Pooled standardized mean differences (SMD) were calculated for 20 studies (n = 2238 the intervention group; n = 1983 in the control group) using random-effect models. The intervention group demonstrated a slightly better, although non-significant, body composition score, with a pooled SMD of -0.26 (95% CI: -0.61 to 0.09). The pooled effect tends to be stronger with longer duration of intervention (-0.40 [95% CI: -0.96, 0.16] for >3 months vs. -0.02 [95% CI: -0.33, 0.30] for ≤3 months), although the difference was not statistically significant (p-difference = 0.24). As for the specific pathways leading to better weight control, improvements in dietary habits due to serious game interventions were not significant, while a direct positive effect of serious games on increasing physical activity was observed (pooled SMD = 0.61 [95% CI: 0.04 to 1.19]). While the impact of serious game interventions on body composition and dietary changes is limited, their effectiveness in increasing physical activity is notable. Serious games show potential as tools for overweight/obesity control among children and adolescents but may require longer intervention to sustain its effect.
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Affiliation(s)
- Mingchang Liu
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China; (M.L.); (X.G.); (Z.L.)
| | - Xinyue Guan
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China; (M.L.); (X.G.); (Z.L.)
| | - Xueqing Guo
- Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA 02215, USA;
| | - Yixuan He
- Department of Bioengineering, East China University of Science and Technology, Shanghai 200237, China;
| | - Zeqi Liu
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China; (M.L.); (X.G.); (Z.L.)
| | - Shiguang Ni
- Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China;
| | - You Wu
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China; (M.L.); (X.G.); (Z.L.)
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Prapkree L, Deringer R, Coccia C, Huffman F, Palacios C. Effect of using the snackability app on snack quality among US college students with overweight and obesity: A randomized controlled trial. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-10. [PMID: 38652645 DOI: 10.1080/07448481.2024.2337008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To determine if using the Snackability app improves snack intake among college students. PARTICIPANTS US college students with overweight/obesity were recruited in June 2020-April 2021. METHODS A randomized controlled trial was conducted to test the Snackability app use for 12 wk on snack scores (calculated from the app) compared to controls. We also explored the effect on diet quality (Healthy Eating Index-2015) and weight. Outcomes were compared between the intervention and the control groups at 4, 8, and 12 wk using repeated measures ANOVA. RESULTS Participants in the app group significantly increased snack score at week 4 (p < 0.001) and week 8 (p = 0.015) and increased HEI-2020 score (p < 0.001) at week 4 compared to controls. The first 4 wk had the highest app usage. No significant differences were seen in body weight. CONCLUSIONS The Snackability app can be used as a tool to help improve snack and diet quality in this group.
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Affiliation(s)
- Lukkamol Prapkree
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Rianna Deringer
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Catherine Coccia
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Fatma Huffman
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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Schaafsma HN, Jantzi HA, Seabrook JA, McEachern LW, Burke SM, Irwin JD, Gilliland JA. The impact of smartphone app-based interventions on adolescents' dietary intake: a systematic review and evaluation of equity factor reporting in intervention studies. Nutr Rev 2024; 82:467-486. [PMID: 37330675 PMCID: PMC10925905 DOI: 10.1093/nutrit/nuad058] [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: 06/19/2023] Open
Abstract
CONTEXT Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research. OBJECTIVES This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies. DATA SOURCES Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included. DATA EXTRACTION AND ANALYSIS Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis. CONCLUSION In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups.
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Affiliation(s)
- Holly N Schaafsma
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Children’s Health Research Institute, London, Ontario, Canada
| | - Heather A Jantzi
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- Children’s Health Research Institute, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Louise W McEachern
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Shauna M Burke
- Children’s Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jennifer D Irwin
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jason A Gilliland
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
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Bel-Serrat S, Greene E, Mullee A, Murrin CM. Theoretical and practical approaches for dietary behavior change in urban socioeconomically disadvantaged adolescents: a systematic review. Nutr Rev 2022; 80:1531-1557. [PMID: 35041005 PMCID: PMC9086747 DOI: 10.1093/nutrit/nuab120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT There is limited evidence on strategies used to promote dietary behavior changes in socioeconomically disadvantaged urban adolescents and on their effectiveness. OBJECTIVE A synthesis of nutrition interventions used in this group of adolescents is provided in this systematic review. DATA SOURCES Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, and ERIC) were searched until November 2020 to identify relevant studies. DATA EXTRACTION Forty-six manuscripts (n = 38 intervention studies) met the inclusion criteria. Quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool. A qualitative synthesis summarizing data on study characteristics was conducted. DATA ANALYSIS Studies were classified by intervention type as those focusing on hedonic determinants of dietary intake (n = 1), environmental changes to promote a specific dietary intake (n = 3), cognitive determinants (n = 29), and multicomponent strategies (n = 13). The social cognitive theory was the most applied theoretical framework, either alone or combined with other frameworks. Most of the intervention studies targeted multiple dietary outcomes, and success was not always reported for each. CONCLUSIONS Despite the heterogeneity of the studies and lack of combination of dietary outcomes into dietary scores or patterns to evaluate changes on the individuals' whole diets, long-term, theory-driven interventions targeting a single dietary factor seem promising in obtaining sustainable dietary behavior changes. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020188219.
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Affiliation(s)
- Silvia Bel-Serrat
- S. Bel-Serrat, E. Greene, and C.M. Murrin are with the National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. A. Mullee is with the Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Ellen Greene
- S. Bel-Serrat, E. Greene, and C.M. Murrin are with the National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. A. Mullee is with the Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Amy Mullee
- S. Bel-Serrat, E. Greene, and C.M. Murrin are with the National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. A. Mullee is with the Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Celine M Murrin
- S. Bel-Serrat, E. Greene, and C.M. Murrin are with the National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. A. Mullee is with the Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
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Warsinsky S, Schmidt-Kraepelin M, Rank S, Thiebes S, Sunyaev A. Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING). J Med Internet Res 2021; 23:e30390. [PMID: 34505840 PMCID: PMC8463952 DOI: 10.2196/30390] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so. OBJECTIVE This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions. METHODS We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field. RESULTS Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions. CONCLUSIONS Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.
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Affiliation(s)
- Simon Warsinsky
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Sascha Rank
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Scott Thiebes
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ali Sunyaev
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Gamification for the Improvement of Diet, Nutritional Habits, and Body Composition in Children and Adolescents: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13072478. [PMID: 34371989 PMCID: PMC8308535 DOI: 10.3390/nu13072478] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/29/2021] [Accepted: 07/18/2021] [Indexed: 12/21/2022] Open
Abstract
Currently, one of the main public health problems among children and adolescents is poor adherence to healthy habits, leading to increasingly high rates of obesity and the comorbidities that accompany obesity. Early interventions are necessary, and among them, the use of gamification can be an effective method. The objective was to analyse the effect of game-based interventions (gamification) for improving nutritional habits, knowledge, and changes in body composition. A systematic review and meta-analysis were performed in CINAHL, EMBASE, LILACS, MEDLINE, SciELO, and Scopus databases, following the PRISMA recommendations. There was no restriction by year of publication or language. Only randomized controlled trials were included. Twenty-three articles were found. After the intervention, the consumption of fruit and vegetables increased, as well as the knowledge on healthy food groups. The means difference showed a higher nutritional knowledge score in the intervention group 95% CI 0.88 (0.05–1.75). No significant effect of gamification was found for body mass index z-score. Gamification could be an effective method to improve nutritional knowledge about healthier nutritional habits. Promoting the development of effective educational tools to support learning related to nutrition is necessary in order to avoid and prevent chronic diseases.
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Schwarz A, Cardon G, Chastin S, Stragier J, De Marez L, Consortium SmartLife, DeSmet A. Does Dynamic Tailoring of A Narrative-Driven Exergame Result in Higher User Engagement among Adolescents? Results from A Cluster-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147444. [PMID: 34299895 PMCID: PMC8305797 DOI: 10.3390/ijerph18147444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
Physical activity interventions for youth are direly needed given low adherence to physical activity guidelines, but many interventions suffer from low user engagement. Exergames that require bodily movement while played may provide an engaging form of physical activity intervention but are not perceived as engaging to all. This study aimed to evaluate whether dynamic tailoring in a narrative-driven mobile exergame for adolescents played in leisure settings, can create higher user engagement compared to a non-tailored exergame. A cluster-randomized controlled trial assessed differences in user engagement between a dynamically tailored (based on an accelerometer sensor integrated in a T-shirt) and non-tailored condition. In total, 94 participants (M age = 14.61 ± 1.93; 35% female) participated and were assigned to one of the two conditions. User engagement was measured via a survey and game metric data. User engagement was low in both conditions. Narrative sensation was higher in the dynamically tailored condition, but the non-tailored condition showed longer play-time. User suggestions to create a more appealing game included simple and more colorful graphics, avoiding technical problems, more variety and shorter missions and multiplayer options. Less cumbersome or more attractive sensing options than the smart T-shirt may offer a more engaging solution, to be tested in future research.
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Affiliation(s)
- Ayla Schwarz
- Consumption and Healthy Lifestyles, Faculty of Social Sciences, Wageningen University & Research, 6708 PB Wageningen, The Netherlands;
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Sebastien Chastin
- School of Health and Life Science, Caledonian University, Glasgow G4 0BA, UK;
| | - Jeroen Stragier
- IMEC-MICT, Department of Communication Sciences, Ghent University, 9000 Ghent, Belgium; (J.S.); (L.D.M.)
| | - Lieven De Marez
- IMEC-MICT, Department of Communication Sciences, Ghent University, 9000 Ghent, Belgium; (J.S.); (L.D.M.)
| | - Consortium SmartLife
- KnowledgeBizConsulting, and Faculdade de Ciências e Tecnologia, Universidade NOVA, 1099-085 Lisbon, Portugal;
| | - Ann DeSmet
- Research Center for the Promotion of Health, Prosocial Behavior and Wellbeing PACE, Faculty of Psychological and Educational Sciences, Université Libre de Bruxelles, 1050 Brussels, Belgium
- Department of Communication Studies, University of Antwerp, 2000 Antwerp, Belgium
- Correspondence: ; Tel.: +32-(26)-503282
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Shagiwal SS, Groenestein E, Schop‐Etman A, Jongerling J, van der Waal J, Noordzij G, Denktas S. Effectiveness of behavioral interventions and behavior change techniques for reducing soft drink intake in disadvantaged adolescents: A systematic review and meta-analysis. Obes Sci Pract 2020; 6:708-734. [PMID: 33354348 PMCID: PMC7746974 DOI: 10.1002/osp4.452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/06/2023] Open
Abstract
Reducing sugar-sweetened beverage (SSB) intake is an important dietary target, especially among socioeconomically disadvantaged ethnic minority adolescents. This review and meta-analysis evaluated the effectiveness of behavioural interventions aiming to reduce SSB intake in socioeconomically disadvantaged ethnic minority adolescents and examined which behaviour change techniques (BCTs) were most effective. A systematic search was conducted using the PRISMA criteria. Quality assessments were done using the Cochrane criteria. In a narrative synthesis, studies were divided into effective and non-effective, and relative effectiveness ratios of individual BCTs were calculated. Pooled standardized mean differences (SMDs) and their 95% confidence intervals were estimated with random-effects models using cluster robust methods. Twenty-two studies were included in the qualitative synthesis. A meta-analysis (n = 19) revealed no significant between-group differences in reduction of SSB intake. Five self-regulatory BCTs had an effectiveness ratio >50%: feedback, goal-setting, action planning, self-monitoring and problem-solving/barrier identification. The risk of bias assessments were judged to be moderate to high risk for randomized controlled trials (RCTs) studies and low to moderate for pre-post studies. There was no indication of publication bias. In conclusion, self-regulatory BCTs may be effective components to change SSB behaviour. However, high-quality research is needed to evaluate the effectiveness of behavioural interventions and identify BCTs effective for reducing SSB intake among disadvantaged adolescents with ethnic minority backgrounds.
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Affiliation(s)
- S. S. Shagiwal
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral SciencesErasmus UniversityRotterdamThe Netherlands
| | - E. Groenestein
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral SciencesErasmus UniversityRotterdamThe Netherlands
| | - A. Schop‐Etman
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral SciencesErasmus UniversityRotterdamThe Netherlands
| | - J. Jongerling
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral SciencesErasmus UniversityRotterdamThe Netherlands
| | - J. van der Waal
- Department of Public Administration and Sociology, Erasmus School of Social and Behavioral SciencesErasmus UniversityRotterdamThe Netherlands
| | - G. Noordzij
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral SciencesErasmus UniversityRotterdamThe Netherlands
- Erasmus University CollegeErasmus UniversityRotterdamThe Netherlands
| | - S. Denktas
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral SciencesErasmus UniversityRotterdamThe Netherlands
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12
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Kato-Lin YC, Kumar UB, Sri Prakash B, Prakash B, Varadan V, Agnihotri S, Subramanyam N, Krishnatray P, Padman R. Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e15717. [PMID: 33206054 PMCID: PMC7710449 DOI: 10.2196/15717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 06/24/2020] [Accepted: 10/03/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Video and mobile games have been shown to have a positive impact on behavior change in children. However, the potential impact of game play patterns on outcomes of interest are yet to be understood, especially for games with implicit learning components. OBJECTIVE This study investigates the immediate impact of fooya!, a pediatric dietary mobile game with implicit learning components, on food choices. It also quantifies children's heterogeneous game play patterns using game telemetry and determines the effects of these patterns on players' food choices. METHODS We analyzed data from a randomized controlled trial (RCT) involving 104 children, aged 10 to 11 years, randomly assigned to the treatment group (played fooya!, a dietary mobile game developed by one of the authors) or the control group (played Uno, a board game without dietary education). Children played the game for 20 minutes each in two sessions. After playing the game in each session, the children were asked to choose 2 out of 6 food items (3 healthy and 3 unhealthy choices). The number of healthy choices in both sessions was used as the major outcome. We first compared the choice and identification of healthy foods between treatment and control groups using statistical tests. Next, using game telemetry, we determined the variability in game play patterns by quantifying game play measures and modeled the process of game playing at any level across all students as a Markov chain. Finally, correlation tests and regression models were used to establish the relationship between game play measures and actual food choices. RESULTS We saw a significant main effect of the mobile game on number of healthy foods actually chosen (treatment 2.48, control 1.10; P<.001; Cohen d=1.25) and identified (treatment 7.3, control 6.94; P=.048; Cohen d=.25). A large variation was observed in children's game play patterns. Children played an average of 15 game levels in 2 sessions, with a range of 2 to 23 levels. The greatest variation was noted in the proportion of scoring activities that were highly rewarded, with an average of 0.17, ranging from 0.003 to 0.98. Healthy food choice was negatively associated with the number of unhealthy food facts that children read in the game (Kendall τ=-.32, P=.04), even after controlling for baseline food preference. CONCLUSIONS A mobile video game embedded with implicit learning components showed a strong positive impact on children's food choices immediately following the game. Game telemetry captured children's different play patterns and was associated with behavioral outcomes. These results have implications for the design and use of mobile games as an intervention to improve health behaviors, such as the display of unhealthy food facts during game play. Longitudinal RCTs are needed to assess long-term impact. TRIAL REGISTRATION ClinicalTrials.gov NCT04082195; https://clinicaltrials.gov/ct2/show/NCT04082195, registered retrospectively.
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Affiliation(s)
| | - Uttara Bharath Kumar
- Center for Communication Programs, Johns Hopkins University, Baltimore, MD, United States
| | | | | | | | | | | | | | - Rema Padman
- The Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
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13
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Aliyari H, Sahraei H, Erfani M, Mohammadi M, Kazemi M, Daliri MR, Minaei-Bidgoli B, Agaei H, Sahraei M, Seyed Hosseini SMA, Tekieh E, Salehi M, Farajdokht F. Changes in Cognitive Functions Following Violent and Football Video Games in Young Male Volunteers by Studying Brain Waves. Basic Clin Neurosci 2020; 11:279-288. [PMID: 32963721 PMCID: PMC7502184 DOI: 10.32598/bcn.9.10.335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/10/2018] [Accepted: 12/02/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction: This research investigated the effects of violent and football video games on cognitive functions, cortisol levels, and brain waves. Methods: A total of 64 participants competed in a single-elimination tournament. Saliva samples of all players were obtained before and after the games for the assessment of cortisol levels. The cognitive performances of the players were also assessed by paced auditory serial addition test. Moreover, the electroencephalogram recording was conducted during the games. Results: The results showed that salivary cortisol levels significantly decreased after playing both games. Also, playing the football game increased reaction time, whereas decreased sustained attention and mental fatigue. Conclusion: Conversely, following playing a violent game, the reaction time decreased, and sustained attention and mental fatigue increased. Furthermore, the results of the EEG recording revealed that playing a violent game engaged more brain regions than the football game. In conclusion, playing violent game more effectively improved cognitive performances in the players than the football game.
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Affiliation(s)
- Hamed Aliyari
- Faculty of Electrical, Biomedical and Mechatronics Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Hedayat Sahraei
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Marjan Erfani
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Mohammadi
- Human Motion Control and Computational Neuroscience Laboratory, School of ECE, College of Engineering, University of Tehran, Tehran, Iran
| | - Masoomeh Kazemi
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Daliri
- Department of Electrical Engineering, University of Science and Technology, Tehran, Iran
| | | | - Hassan Agaei
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahraei
- Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Elaheh Tekieh
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Salehi
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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14
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Pot M, Paulussen TG, Ruiter RA, Mollema L, Hofstra M, Van Keulen HM. Dose-Response Relationship of a Web-Based Tailored Intervention Promoting Human Papillomavirus Vaccination: Process Evaluation of a Randomized Controlled Trial. J Med Internet Res 2020; 22:e14822. [PMID: 32520718 PMCID: PMC7395256 DOI: 10.2196/14822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 11/04/2019] [Accepted: 05/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background In the Netherlands, human papillomavirus (HPV) vaccination uptake remains low. To improve informed decision making (IDM) and HPV vaccination acceptability, we systematically developed an interactive, web-based tailored intervention to which mothers of Dutch girls were invited to participate. Objective The aim of this study was to provide insight into the intervention’s working mechanisms by evaluating (1) program use, (2) program acceptability, and (3) the relationship of program use with program acceptability and intervention effects (ie, dose-response relationship). Methods Only mothers from the intervention arm of a randomized controlled trial that assessed the effectiveness of the web-based, tailored intervention were included in this study. They were invited to visit the website of the web-based intervention between baseline (January 2015, just before access to the intervention) and follow up (March 2015, prior to the first HPV vaccination). Indicators for program use were time of website use (ie, duration of intervention exposure) and completeness (ie, proportion of all available web pages visited). HPV vaccination uptake registered by Praeventis was used as the primary outcome. Secondary outcomes were IDM, decisional conflict, and social-psychological determinants of HPV vaccination uptake. Results Among the 3995 invited mothers, 2509 (62.80%) logged on to the website, 2239 of whom (89.24%) visited at least one page of the intervention components. On average, mothers spent 21.39 minutes (SD 12.41) on the website and completed 50.04% (SD 26.18%) of the website components. Participants rated the website 7.64 (SD 1.39) on a 10-point scale. Program acceptability was significantly associated with completeness (β=4.36, P<.001), but not with time of website use (β=–.07, P=.77). Intention-to-treat analysis (N=3995) showed a significant positive effect of completeness on all outcome measures (all P<.003; Bonferroni-corrected α=.05/15 factors), including on HPV vaccination uptake. Time of website use had a significant positive effect on all outcomes (all P<.003), except for uptake (P=.20), risk perception when not vaccinated (P=.14), subjective norms (P=.03), and habit (P=.01). Conclusions Program use and acceptability of the intervention were adequate. Completeness was positively associated with acceptability. Furthermore, positive effects (ie, dose-response effects) were found for completeness and time of website use on the mothers’ IDM, decisional conflict, and almost all of the social-psychological determinants of HPV vaccination acceptability. In addition, the extent to which mothers completed the intervention had a positive impact on their daughters’ vaccination uptake. This indicates that the web-based, tailored intervention fits well with the mothers’ needs, and that completeness of use is essential for improving HPV vaccination uptake, acceptability, and IDM. Program use should therefore be promoted. Trial Registration Netherlands Trial Register NTR4795; https://www.trialregister.nl/trial/4795
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Affiliation(s)
- Mirjam Pot
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Theo Gwm Paulussen
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Robert Ac Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Liesbeth Mollema
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands
| | - Miranda Hofstra
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Hilde M Van Keulen
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
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15
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Grüne E, Popp J, Carl J, Pfeifer K. What do we know about physical activity interventions in vocational education and training? A systematic review. BMC Public Health 2020; 20:978. [PMID: 32571295 PMCID: PMC7309979 DOI: 10.1186/s12889-020-09093-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/12/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although the health benefits of physical activity (PA) are well known, young people's level of PA is often insufficient and tends to decline in adolescence. Numerous studies have investigated the effectiveness of PA-promoting interventions among young people, but none have reviewed the effectiveness of PA interventions in the vocational education and training (VET) setting. This systematic review aims to (1) synthesize and review the available literature on PA-promoting interventions in VET and (2) examine the effects of these interventions on PA-related outcomes such as PA level, physical fitness, physiological parameters, or psychological factors. METHODS Five electronic databases were searched for studies involving adolescents aged 15 to 20 years that took place in VET settings and evaluated the effects of interventions with a PA component on PA-related outcomes such as PA level, physical fitness, physiological parameters, or psychological factors. The screening process and the quality assessment were conducted by two independent reviewers; data extraction was conducted by one reviewer and verified by another. RESULTS The literature search identified 18,959 articles and 11,282 unique records. After the screening process, nine studies, all coming from European or Asian countries, met the pre-defined eligibility criteria and were included in qualitative analyses. All but two studies reported significant improvements for at least one PA-related outcome. The interventions substantially differed in their development approaches (top-down vs. bottom-up approaches), complexity (multi- vs. single-component), and addressed behavior (multi-behavioral vs. single-behavioral). The most conspicuous finding was that bottom-up approaches tend to improve outcomes at the psychological level and top-down approaches at the physical level. Regarding the interventions' complexity and addressed behavior, we did not reveal any conclusive results. CONCLUSION This systematic review highlights the varying effects of PA-promoting interventions in VET. Nevertheless, heterogeneous effects, overall weak study quality and availability of studies only from two continents limited our ability to draw clear conclusions about the potentially most effective intervention strategies. Therefore, future research should focus on high-quality studies with long-term follow-ups to make recommendations for practical use. TRIAL REGISTRATION PROSPERO CRD42018109845.
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Affiliation(s)
- Eva Grüne
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058, Erlangen, Germany.
| | - Johanna Popp
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058, Erlangen, Germany
| | - Johannes Carl
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058, Erlangen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058, Erlangen, Germany
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16
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Tabak M, de Vette F, van Dijk H, Vollenbroek-Hutten M. A Game-Based, Physical Activity Coaching Application for Older Adults: Design Approach and User Experience in Daily Life. Games Health J 2020; 9:215-226. [DOI: 10.1089/g4h.2018.0163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Monique Tabak
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
| | - Frederiek de Vette
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - Hylke van Dijk
- Serious Gaming Group, NHL University of Applied Sciences, Leeuwarden, The Netherlands
| | - Miriam Vollenbroek-Hutten
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
- Ziekenhuis Groep Twente, Almelo, The Netherlands
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17
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Puigdomenech Puig E, Robles N, Saigí-Rubió F, Zamora A, Moharra M, Paluzie G, Balfegó M, Cuatrecasas Cambra G, Garcia-Lorda P, Carrion C. Assessment of the Efficacy, Safety, and Effectiveness of Weight Control and Obesity Management Mobile Health Interventions: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e12612. [PMID: 31654566 PMCID: PMC6913727 DOI: 10.2196/12612] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/29/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. However, evidence of the efficacy, effectiveness, and safety of these apps is severely lacking. OBJECTIVE The aim of this study was to identify efficacy, safety, and effectiveness criteria used to assess weight control, overweight, and obesity management in mobile health (mHealth) interventions through a systematic review. METHODS PubMed, PsycINFO, Scopus, UK Trial Database, ClinicalTrials.gov, and the Cochrane Library were surveyed up to May 2018. All types of clinical studies were considered. A total of 2 independent reviewers assessed quality using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Ratings were used to provide an overall score for each study (low, moderate, or high). Data were synthesized in evidence tables. RESULTS From 233 potentially relevant publications, only 28 studies were included. Of these, 13 (46%) were randomized control trials, 11 were single-arm studies (39%), 3 were nonrandomized controlled trials (11%), and 1 study was a cluster randomized trial (4%). The studies were classified as low (15), high (7), and moderate (6) quality according to SIGN criteria. All studies focused on efficacy, with only 1 trial mentioning safety and another 1 effectiveness. In 11 studies, the apps were used as stand-alone interventions, the others were multicomponent studies that included other tools for support such as sensors or websites. The main management tool included in the apps was feedback messaging (24), followed by goal-setting mechanisms (20) and self-monitoring (19). The majority of studies took weight or body mass index loss as the main outcome (22) followed by changes in physical activity (14) and diet (12). Regarding outputs, usability, adherence, and engagement (17) were the most reported, followed by satisfaction (7) and acceptability (4). CONCLUSIONS There is a remarkable heterogeneity among these studies and the majority have methodological limitations that leave considerable room for improvement. Further research is required to identify all relevant criteria for assessing the efficacy of mHealth interventions in the management of overweight and obesity. TRIAL REGISTRATION PROSPERO CRD42017056761; https://tinyurl.com/y2zhxtjx.
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Affiliation(s)
- Elisa Puigdomenech Puig
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain
- eHealth Lab, Barcelona, Spain
| | - Noemí Robles
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain
- eHealth Lab, Barcelona, Spain
- eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
- Interdisciplinary Research Group on ICTs, Barcelona, Spain
| | - Alberto Zamora
- Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Blanes, Spain
- Grup de Medicina Traslacional i Ciències de la Decisió, Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Girona, Girona, Spain
| | - Montse Moharra
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Guillermo Paluzie
- Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Blanes, Spain
| | - Mariona Balfegó
- Clínica Sagrada Família, CPEN SL Servei d'Endocrinologia i Nutrició, Barcelona, Spain
| | | | - Pilar Garcia-Lorda
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Carme Carrion
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain
- eHealth Lab, Barcelona, Spain
- eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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18
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Kim J, Kim YM, Jang HB, Lee HJ, Park SI, Park KH, Lim H. Evidence-based Nutritional Intervention Protocol for Korean Moderate-Severe Obese Children and Adolescents. Clin Nutr Res 2019; 8:184-195. [PMID: 31384597 PMCID: PMC6675960 DOI: 10.7762/cnr.2019.8.3.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 12/30/2022] Open
Abstract
Diet-related behavioral modification for healthy eating and lifestyle is required to improve childhood obesity. The present study aimed to develop customized nutritional intervention protocol and education program to find barriers to adhere healthy diet and lifestyle for moderate to severe obese children and adolescents and their families. Theoretical framework approaches can be used to change behavior and achieve goals. Previous studies that described the relationship between behavioral modification and nutrition education theory were reviewed. The social cognitive theory and transtheoretical model were employed with behavioral changes to target a healthful diet and lifestyle. The nutrition care process (NCP) model was adopted to customize nutrition care for the participants. Customized nutritional intervention protocol was developed following as the four steps of the NCP. Firstly, nutrition status of the participants was assessed by the nutrition expert. Nutrition problems were described as "inadequate energy intake," "overweight/obesity," or "food and nutrition-related knowledge deficit." All nutrition sessions were designed for nutrition intervention to give nutritional knowledge and a practical mission in real life for individual goal setting and self-control. Meal planning, portion control, healthy snack selection and cooking with fruits and vegetables were consisted of five components of the nutrition education session. During each session, the participants and their families were interviewed by a nutrition expert for monitoring and evaluating diet-related goal setting and achievement. A theoretical and evidence-based nutritional intervention was developed for the secondary to tertiary prevention of childhood obesity. This nutrition intervention protocol and program might be helpful for the further research on childhood obesity. Trial Registration Clinical Research Information Service Identifier: KCT0002111.
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Affiliation(s)
- Jieun Kim
- Department of Medical Nutrition, Kyung Hee University, Yongin 17104, Korea.,Research Institute of Medical Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Yoon Myung Kim
- Department of Sports Industry Studies, Yonsei University International Campus, Incheon 21983, Korea
| | - Han Byul Jang
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju 28159, Korea
| | - Hye-Ja Lee
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju 28159, Korea
| | - Sang Ick Park
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju 28159, Korea
| | - Kyung-Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin 17104, Korea.,Research Institute of Medical Nutrition, Kyung Hee University, Seoul 02447, Korea
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19
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Baranowski T, Ryan C, Hoyos-Cespedes A, Lu AS. Nutrition Education and Dietary Behavior Change Games: A Scoping Review. Games Health J 2019; 8:153-176. [PMID: 30339086 PMCID: PMC6909754 DOI: 10.1089/g4h.2018.0070] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Games provide an attractive venue for engaging participants and increasing nutrition-related knowledge and dietary behavior change, but no review has appeared devoted to this literature. A scoping review of nutrition education and dietary behavior change videogames or interactive games was conducted. A systematic search was made of PubMed, Agricola, and Google Scholar. Information was abstracted from 22 publications. To be included, the publication had to include a videogame or interactive experience involving games (a videogame alone, minigames inserted into a larger multimedia experience, or game as part of a human-delivered intervention); game's design objective was to influence dietary behavior, a psychosocial determinant of a dietary behavior, or nutrition knowledge (hereinafter referred to as diet-related); must have been reported in English and must have appeared in a professional publication, including some report of outcomes or results (thereby passing some peer review). This review was restricted to the diet-related information in the selected games. Diversity in targeted dietary knowledge and intake behaviors, targeted populations/audiences, game mechanics, behavioral theories, research designs, and findings was revealed. The diversity and quality of the research in general was poor, precluding a meta-analysis or systematic review. All but one of the studies reported some positive outcome from playing the game(s). One reported that a web-based education program resulted in more change than the game-based intervention. Studies of games may have been missed; a number of dietary/nutrition games are known for which no evaluation is known; and the data presented on the games and research were limited and inconsistent. Conclusions and Implications: A firmer research base is needed to establish the efficacy and effectiveness of nutrition education and dietary behavior change games.
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Affiliation(s)
- Tom Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Courtney Ryan
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | | | - Amy Shirong Lu
- Health Technology Lab, Department of Communication Studies, College of Arts, Media & Design, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
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20
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Schwarz A, Mertens L, Simons M, Spook JE, Thompson D, Cardon G, De Bourdeaudhuij I, Chastin SF, DeSmet A. Which Game Narratives Do Adolescents of Different Gameplay and Sociodemographic Backgrounds Prefer? A Mixed-Methods Analysis. Games Health J 2019; 8:195-204. [DOI: 10.1089/g4h.2017.0178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ayla Schwarz
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Lieze Mertens
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Monique Simons
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Jorinde E. Spook
- Department of Communication, Philosophy and Technology, Centre for Integrative Development, Wageningen University, Wageningen, The Netherlands
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | - Sebastien F.M. Chastin
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Institute for Applied Health Research, School of Health and Life Science, Glasgow Caledonian University, Scotland, United Kingdom
| | - Ann DeSmet
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
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Wang C, Yu G. Investigating the Relationship Between Eye Movement and Brain Wave Activity Using Video Games: Pilot Study. JMIR Serious Games 2018; 6:e16. [PMID: 30213777 PMCID: PMC6231797 DOI: 10.2196/games.8908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/08/2018] [Accepted: 06/18/2018] [Indexed: 12/29/2022] Open
Abstract
Background All eye movements are related in one way or another to our mental processes with lateral eye movements being associated with the different hemispheres of the brain. Eye movement techniques form the basis of eye movement desensitization and reprocessing therapy, wherein forced eye movements activate neurological pathways to treat the subject. Objective The objective of our study was to examine the relationship between players' eye movements and their brain wave activities using a video game. Methods We used similar eye movement techniques in the form of a video game called Lifeguard that could potentially stimulate different eye movement mode and create a more engaging experience for the user. By designing an experiment, we further explored the differences in electroencephalogram spectral power activity for the alpha, beta, theta, delta, and gamma frequency bands in Lifeguard and Tetris. Results The game based on eye movement technologies resulted in decreased delta power and increased beta power, but significant difference between 2 games was not found. Conclusions The applied uses of this research could mean that eye movement desensitization and reprocessing can be conducted in a more fun and engaging way through the use of gaming technology.
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Affiliation(s)
- Chaoguang Wang
- Digital Entertainment Lab, School of Design, Hong Kong Polytechnic University, Kowloon, China (Hong Kong)
| | - Gino Yu
- Digital Entertainment Lab, School of Design, Hong Kong Polytechnic University, Kowloon, China (Hong Kong)
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De Cock N, Van Lippevelde W, Vangeel J, Notebaert M, Beullens K, Eggermont S, Deforche B, Maes L, Goossens L, Verbeken S, Moens E, Vervoort L, Braet C, Huybregts L, Kolsteren P, Van Camp J, Lachat C. Feasibility and impact study of a reward-based mobile application to improve adolescents' snacking habits. Public Health Nutr 2018; 21:2329-2344. [PMID: 29607800 PMCID: PMC11106033 DOI: 10.1017/s1368980018000678] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Adolescents' snacking habits are driven by both explicit reflective and implicit hedonic processes. Hedonic pathways and differences in sensitivity to food rewards in addition to reflective determinants should be considered. The present study evaluated the feasibility and impact of a mobile phone-delivered intervention, incorporating explicit reflective and implicit rewarding strategies, on adolescents' snack intake. DESIGN Adolescents (n 988; mean age 14·9 (sd 0·70) years, 59·4 % boys) completed a non-randomized clustered controlled trial. Adolescents (n 416) in the intervention schools (n 3) were provided with the intervention application for four weeks, while adolescents (n 572) in the control schools (n 3) followed the regular curriculum. Outcomes were differences in healthy snacking ratio and key determinants (awareness, intention, attitude, self-efficacy, habits and knowledge). Process evaluation data were collected via questionnaires and through log data of the app. RESULTS No significant positive intervention effects on the healthy snack ratio (b=-3·52 (se 1·82), P>0·05) or targeted determinants were observed. Only 268 adolescents started using the app, of whom only fifty-five (20·5 %) still logged in after four weeks. Within the group of users, higher exposure to the app was not significantly associated with positive intervention effects. App satisfaction ratings were low in both high and low user groups. Moderation analyses revealed small positive intervention effects on the healthy snack ratio in high compared with low reward-sensitive boys (b=1·38 (se 0·59), P<0·05). CONCLUSIONS The intervention was not able to improve adolescents' snack choices, due to low reach and exposure. Future interventions should consider multicomponent interventions, teacher engagement, exhaustive participatory app content development and tailoring.
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Affiliation(s)
- Nathalie De Cock
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, Ghent 9000, Belgium
| | | | - Jolien Vangeel
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Melissa Notebaert
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Kathleen Beullens
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Steven Eggermont
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Benedicte Deforche
- Department of Public Health, Ghent University, Ghent, Belgium
- Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lea Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Lien Goossens
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Sandra Verbeken
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Ellen Moens
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington DC, USA
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, Ghent 9000, Belgium
| | - John Van Camp
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, Ghent 9000, Belgium
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, Ghent 9000, Belgium
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Lagestad P, van den Tillaar R, Mamen A. Longitudinal Changes in Physical Activity Level, Body Mass Index, and Oxygen Uptake Among Norwegian Adolescents. Front Public Health 2018; 6:97. [PMID: 29651415 PMCID: PMC5884877 DOI: 10.3389/fpubh.2018.00097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Several studies have investigated activity levels among adolescents, but no study has examined longitudinal changes in physical activity (PA) level, body mass, and oxygen uptake among the same adolescents from the age of 14 to 19 years. The present study examined data from a research project that included a group of randomly selected students (N = 116) with objective measurements of PA (accelerometer data), self-reported PA level, and body mass and oxygen uptake during a 5-year period. The results show a significant decrease in the accelerometer-based PA level over time, from age 14 to 19. At 14 years of age, the minutes of moderate and/or vigorous PA was 66.7 min·day-1, but was less than half, at only 24.4 min·day-1, at 19 years of age. The self-reported activity data show a decrease in girls' general activity level over time, while boys' activity level during school breaks decreased strongly during the period: at age 14, 61% of the boys were classified as active, while at age 19, only 11% were physically active. Furthermore, body mass index increased during the period for both genders, while oxygen uptake decreased. Since both BMI and maximal oxygen uptake are important risk factors for future CVD, these findings point toward the importance of maintaining a high activity level during childhood and adolescence, in order to keep fit later in life.
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Affiliation(s)
| | | | - Asgeir Mamen
- Norwegian School of Health Sciences, Oslo, Norway
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Lagestad P, Floan O, Moa IF. Longitudinal Changes in AbsoluteVO 2peak, Physical Activity Level, Body Mass Index, and Overweightedness among Adolescents in Vocational and Non-Vocational Studies. Front Public Health 2017; 5:214. [PMID: 28871279 PMCID: PMC5566569 DOI: 10.3389/fpubh.2017.00214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/02/2017] [Indexed: 11/23/2022] Open
Abstract
The purpose of the study was to examine differences in physical activity level, physical fitness, body mass index, and overweight among adolescents in vocational and non-vocational studies, at the age of 14, 16, and 19, using a 5-year longitudinal design. Students in sport studies had the highest absoluteVO2peak and higher physical activity levels, than students in vocational subjects and students with a specialization in general studies. However, there were no significant differences between students in vocational subjects and students with a specialization in general studies according to absoluteVO2peak and physical activity levels. Students in vocational subjects were significantly more overweight/obese at 19 years of age, compared with the other students. Our findings support previous research pointing to overweightedness as being more widespread among adolescents in vocational programs than in non-vocational programs. However, differences in the physical activity level and physical fitness do not seem to explain these differences.
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