Interventions for Childhood Obesity: Evaluating Technological Applications Targeting Physical Activity Level and Diet

Overweight and obese children have increased risks for multiple preventable diseases and conditions which can impair their physiological health and significantly increases the overall cost of their healthcare. Free mobile applications and technology for weight loss, dietary tracking, and physical activity may be quite useful for monitoring nutritional intake and exercise to facilitate weight loss. If so, nurses are well positioned to recommend such tools as part of their efforts to prevent childhood obesity and help children and parents better manage childhood obesity when it is present. However, there are no guidelines that nurses can use to determine what applications or technologies are most beneficial to children and their parents. The purpose of this project is to develop such guidelines based on a review of the scientific literature published in the last 5 years. Articles regarding healthy-lifestyle promoting mobile applications and technological approaches to health and fitness interventions were identified by searching articles indexed by CINAHL, Psychinfo, Medline, ERIC, IEEE Xplore, and Academic Search Premier. Identified articles were assessed using Melnyk’s hierarchy of evidence and organized into tables so that implications for research and suggestions for practice could be made

Game Changer: Investing in Digital Play to Advance Children's Learning and Health

Based on a literature review and interviews with digital learning experts, explores how digital games can foster skills and knowledge for better academic performance and health. Makes recommendations for government research, partnerships, and media

Contribution of Exergaming Behaviour to Physical Activity: Toward Better Understanding the Role of Motivation

Physical activity (PA) is associated with numerous health benefits. Because PA patterns established early in life track into adulthood, it is important that children develop and sustain healthy PA habits. Current guidelines recommend that youth accumulate ≥ 60 minutes of moderate to vigorous intensity PA daily, but many youth do not attain this level. Evaluation of public health interventions that aim to promote PA provide little evidence of sustained positive effects over time. This could relate, at least in part, to interventions lacking a strong conceptual foundation and, in particular, to a lack of underpinnings that recognize the central role of motivation in PA. It is important that effective strategies to increase and sustain healthy PA levels in youth are identified. The Self-Determination Theory is used to explain why people adopt and maintain healthy PA behaviors and posits that sustained PA relates to natural or intrinsic tendencies or motivations to behave in healthy and effective ways. Positive PA experiences in school, at home and in community settings may foster an internal desire or motivation to sustain PA participation simply for its challenges or for enjoyment. Lack of sustained PA among youth could reflect a scarcity of enjoyable PA options that fit with the sophisticated technetronic expectations of youth today. PA interventions must “keep up with the times,” by acknowledging young peoples’ prevailing interests and by incorporating advancements in technology that heighten interest and motivation for PA. Exergaming, a type of non-sedentary videogame that requires players to be physically active in order to attain a series of incrementally challenging goals, is increasingly viewed as an enjoyable PA option among today’s technology-immersed youth. However, although critical to informing the design, implementation and sustainability of exergaming interventions, evidence on exergaming-related motivation, preferences, intentions and sustainability is lacking. Research in this domain is needed to ascertain whether exergaming interventions can help youth become and remain physically active, and which facets of exergaming hold the most promise in sustaining positive PA change. More specifically, using “gamified augmented reality” such as exergaming could help youth attain recommended PA levels and promote sustainable healthy behaviour, while at the same time contributing to enjoyment of PA. The three studies described in this thesis examine motivation and exergaming in-depth using SDT and its tenants as a theoretical guide and a common theme across studies. Thus, the role of motivation and intentions in exergaming behaviour and how they contribute to PA in the general population of youth is a key contribution of this dissertation. Study 1, a review of reviews on exergaming, provides background for the next two studies, each of which was conducted in population-based (as opposed to clinical or experimental) settings. Twenty-five reviews spanning 2009 to 2016 were retained, each of which incorporated between 5 and 100 articles. A positive relationship between exergaming and energy expenditure (EE) was well-documented, but whether exergaming increases PA or changes body composition was not established. There is however, evidence that exergaming (i.e., as a non-sedentary use of screens) is a healthy alternative to sedentary behaviour, that it improves cognitive function, that it is an interesting and enjoyable pastime in youth, that it shows promise as a PA option by adding variety and alternative PA forms in health and dietary interventions and finally that it is likely more health-promoting than traditional videogames because of higher EE and possibly improved physical fitness, body composition and cognitive health. However, more research and specifically, longitudinal studies are needed to assess whether exergaming can be sustained to obtain these benefits over time. Study 2 identified correlates of sustained exergaming. We reported that almost 50% of grade 9 students sustained exergaming for 2-3 years. Study results suggest that in non-clinical settings, exergaming may be a practical approach to help adolescents maintain PA during adolescence. Study 3 examined the psychometric properties of a new scale to assess reasons for exergaming (i.e., the Reasons to Exergame (RTEX) scale). This study also examined whether and how the scale relates to the timing, intensity and duration of past-month exergaming. RTEX items were developed in consultation with PA and exergaming experts and using key exergaming constructs, including PA, general interest in videogames and enjoyment of exergaming. RTEX was found to be a reliable and valid assessment of reasons to exergame. However, further studies should replicate these initial findings in larger, more diverse samples

Games for health for children - current status and needed research

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population's diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills

A Review of the Relationship between Screen Time and Low Levels of Physical Activity with Obesity and Sedentary Behaviors in Children and Adolescents

INTRODUCTION: The prevalence of childhood obesity currently lies at 17% in the United States alone and continues to increase each year. Obesity generally is a result of an imbalance between energy intake and energy expenditure. The increase of childhood obesity prevalence may have adverse morbidity and mortality implications in adulthood, including increased risk of developing Type 2 diabetes, heart disease, certain cancers, insulin resistance, and more. Multiple factors contribute to childhood obesity, including parental behaviors, socioeconomic factors, and media influence. Studies have shown that sedentary behaviors, such as watching television and playing video games, are a major contributor to obesity in children and adolescents. National guidelines recommend that children engage in a minimum of an hour of moderate physical activity every day, yet studies show they are not meeting these requirements. AIM: The aim of this Capstone project is to examine the relationship between screen time and low levels of physical activity with obesity and sedentary behaviors in children and adolescents. The aim is also to examine ways to leverage screen time as a strategy to increase physical activity levels, particularly through the use of active video games. METHODS: A review of relevant literature RESULTS: The findings of this Capstone project support the idea that high levels of sedentary activity and screen time are associated with weight gain and obesity in children and adolescents. Evidence was present that active video games can serve as a promising strategy to increasing physical activity levels among children and adolescents. Reducing sedentary behaviors must happen at the home, institution, and community level. DISCUSSION: The battle of childhood obesity has shown progress in recent years. Studies show that states are now showing progress in decreasing childhood obesity rates, particularly among low-income preschoolers aged 2 to 4 years. Evidence from the literature review shows that sedentary behaviors in adolescents are associated with negative health outcomes. The literature revealed that excessive television is linked to weight gain. Evidence suggests that targeting parents’ behavior is essential to reducing sedentary behaviors among adolescents. The literature review revealed that the use of active video games serves as a promising approach to reducing sedentary behaviors and increasing physical activity levels in children and adolescents

Her Life Depends on it III: Sport, Physical Activity and the Health and Well-being of American Girls and Women

Her Life Depends On It III is the Women's Sports Foundation's comprehensive report that reviews existing and emerging research on the links between participation in sport and physical activity and the health and wellbeing of American girls and women. As with the previous editions in 2004 and 2009, this study also confirms that physical activity and sport provides the critical foundation, in no small part, that allows girls and women to lead healthy, strong, and fulfilled lives. Ten years since its first publication, the updated Her Life Depends On It provides an even more comprehensive review of the ever-expanding body of research that demonstrates how important it is for girls and women to participate in sport and physical activity. The report's contents reflect the review of 1,500 studies, nearly 400 covered since the previous edition