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

Factors Associated with Sustained Exergaming: Longitudinal Investigation.

International audienceBACKGROUND: Exergaming is technology-driven physical activity (PA) which, unlike traditional video game play, requires that participants be physically active to play the game. Exergaming may have potential to increase PA and decrease sedentary behavior in youth, but little is known about sustained exergaming.OBJECTIVE: The objectives of this study were to describe the frequency, correlates, and predictors of sustained exergaming.METHODS: Data were available in AdoQuest (2005-11), a longitudinal investigation of 1843 grade 5 students in Montréal, Canada. This analysis used data from grade 9 (2008-09) and 11 (2010-11). Participants at Time 1 (T1; mean age 14 years, SD 0.8 ) who reported past-week exergaming (n=186, 19.1% of AdoQuest sample) completed mailed self-report questionnaires at Time 2 (T2; mean age 16 years, SD 0.8). Independent sociodemographic, psychological, and behavioral correlates (from T2)/predictors (from T1 or earlier) were identified using multivariable logistic regression.RESULTS: Of 186 exergamers at T1, 81 (44%) reported exergaming at T2. Being female and having higher introjected regulation (ie, a type of PA motivation indicative of internalizing PA as a behavior) were independent correlates. None of the predictors investigated were associated with sustained exergaming.CONCLUSIONS: Almost half of grade 9 exergamers sustained exergaming for 2 years. Exergaming may be a viable approach to help adolescents engage in and sustain PA during adolescence. Sex and PA motivation may be important in the sustainability of exergaming

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Investigating the relationships among depression and anxiety symptoms, self-esteem and physical activity in women treated for breast cancer: a pilot study comparing two physical activity interventions

Physical activity (PA) is a low-cost accessible intervention that may help breast cancer survivors (BCS) achieve optimal physical and mental health. However, few BCS meet current recommendations for PA. The objectives of this pilot study were four-fold. The first objective was to compare two 12-week community-based interventions on PA levels, self-esteem and depression and anxiety symptoms in BCS. In one intervention, BCS received a free membership to the Curves training program, and in the other, BCS participated in an independent lifestyle program (LET) that encouraged leisure activities using Canada's PA Guide to Healthy Active Living. The second objective was to compare compliance with the recommended PA levels between the two groups, and the third objective was to use the exercise and self-esteem model (EXSEM) to examine the relationships among changes in PA, self-esteem and depression and anxiety symptoms in BCS. A final objective was to compare participants who had increased their PA, independent of intervention group, with participants who maintained or decreased their PA, using the EXSEM variables. Participants included 30 BCS aged 33-74 years (Mage = 55.7, SD = 8.9). Most participants reported being Caucasian (n=26; 86.7%), married (n=16; 53.3%), having children (n=24; 86.7%), being English-speaking (n=20; 66.7%) and having at least a high school education (n=25; 86.7%). Participants were diagnosed with stage 0 through IV breast cancer and reported a range of treatments. Data were collected in mailed questionnaires at baseline, six weeks, and 12 weeks after baseline. Participants in the two intervention groups did not differ at baseline in socio-demographic, behavioural or clinical characteristics. The Curves group had higher PA levels initially than the LET group, and PA levels decreased over time. Physical activity in the LET group increased over 12 weeks, however the increases were not statistically significant. A higher percentage of women in the CurvesTM group complied with PA recommendations, compared to the LET group. The correlations among EXSEM variables and depression and anxiety symptoms suggested that the model was partially supported by these data, and that physical competence may be an important self-esteem variable among BCS. Overall these data suggest that feasible community-based interventions such as the LET and CurvesTM may help increase PA among BCS. More research is needed to identify types of interventions that are suitable, effective, and feasible for BCS.L'activité physique (AP) est une intervention accessible à faible coût qui peut aider les survivants du cancer du sein (SCS) à atteindre une santé physique et mentale optimale. Cependant, peu de SCS suivent les recommandations actuelles d'AP. Les objectifs de cette étude pilote était quadruple. Le premier objectif était de comparer deux interventions à base communautaire de 12 semaines sur les niveaux d'AP, l'estime de soi et la dépression, et les symptômes d'anxiété des SCS. Dans l'une des interventions, le SCS a reçu une adhésion gratuite au programme d'entrainement Curves, et dans l'autre, le SCS a participé à un programme de vie autonome (LET) qui encourage les activités de loisirs en utilisant le Guide d'Activité Physique Canadien pour un mode de vie sain. Le deuxième objectif était de comparer la conformité avec les niveaux d'AP recommandés entre les deux groupes, et le troisième et quatrième objectif était d'utiliser le modèle d'exercice et d'estime de soi (MEXES) pour examiner les relations entre l'AP, l'estime de soi et la dépression, et les symptômes d'anxiété des SCS ainsi que d'examiner les participants qui avaient augmenté leur AP sur les variables MEXES, comme la dépression et les symptômes d'anxiété, avec ceux des participants qui n'ont pas augmenté leur AP. Les participants comprenaient 30 SCS âgés de 33 à 74 ans (Mâge = 55.7, ET= 8.9). La plupart des participants ont déclaré être de race blanche (n = 26; 86.7%), mariés (n = 16; 53.3%), avoir des enfants (n = 24; 86.7%), être anglophones (n = 20; 66.7%) et posséder au moins une diplôme d'études secondaires (n = 25; 86.7%). Les participants étaient diagnostiqués du stade 0 à IV du cancer du sein et fait état de divers traitements. Les données ont été recueillies dans les questionnaires envoyés par la poste au départ, six semaines et 12 semaines après le début. Les caractéristiques sociodémographiques, comportementales ou cliniques des deux groupes d'intervention ne diffèrent pas au départ. Le groupe Curves a d'abord présenté des niveaux plus élevés d'AP que le groupe LET, puis les niveaux d'AP ont diminué avec le temps. L'activité physique dans le groupe LET a augmenté au cours des 12 semaines, cependant, ces augmentations n'ont pas été statistiquement significatives. Un pourcentage plus élevé de femmes dans le groupe Curves ont respecté les niveaux d'AP recommandés par rapport au groupe LET. Les corrélations entre les variables MEXES et la dépression et les symptômes d'anxiété ont suggéré que le modèle était partiellement confirmé par ces données, et que la compétence physique peut être une importante variable de l'estime de soi parmi les SCS. Globalement, ces données suggèrent que des interventions communautaires simples et à faible coût, comme LET et Curves peuvent aider à augmenter l'AP chez les SCS. Des recherches approfondies seraient nécessaires pour identifier les types d'interventions appropriées, efficaces et réalisables pour les SCS

Gender differences in reasons to quit smoking among adolescents

It is well established that many adolescents who smoke want to quit, but little is known about why adolescents want to quit and if reasons to quit differ across gender. The objective of this study was to determine if reasons to quit smoking differ in boys and girls. Data on the Adolescent Reasons for Quitting (ARFQ) scale were collected in mailed self-report questionnaires in 2010–2011 from 113 female and 83 male smokers aged 14–19 years participating in AdoQuest, a longitudinal cohort study of the natural course of the co-occurrence of health-compromising behaviors in children. Overall, the findings indicate that reasons to quit in boys and girls appear to be generally similar, although this finding may relate to a lack of gender-oriented items in the ARFQ scale. There is a need for continued research to develop and test reasons to quit scales for adolescents that include gender-oriented items

Link between Physical Activity Type in Adolescence and Body Composition in Adulthood

International audiencePURPOSE: We investigated whether type of physical activity (PA) (sports, running, and fitness/dance) engaged in during adolescence is associated with body composition in late adolescence or early adulthood.METHODS: Data were drawn from 631 participants in the Nicotine Dependence in Teens study, a prospective investigation of students ages 12-13 yr at inception. Self-report PA data were collected at baseline, in grade 7, and every 3-4 months thereafter during the 5 yr of high school (1999-2005). Anthropometric indicators (height, weight, waist circumference, triceps, and subscapular skinfold thickness) were measured at ages 12, 16, and 24 yr. On the basis of prior exploratory factor analysis, PA was categorized into one of three types (sports, running, and fitness/dance). Regression models estimated the association between number of years participating in each PA type (0-5 yr) during high school and body composition measures in later adolescence or early adulthood.RESULTS: In multivariable models accounting for age, sex, and parent education, more number of years participating in running during adolescence was associated with lower body mass index, waist circumference, and skinfold thickness in later adolescence and early adulthood (all P < 0.01). This association was no longer apparent in models that accounted for body composition at age 12 yr. The number of years participating in sports was positively associated with body mass index in early adulthood (P = 0.02), but fitness/dance was not statistically significantly associated with any outcome.CONCLUSION: Sustaining participation in running, but not in other PA types, during adolescence was related to lower body composition in later adolescence and adulthood. However, more research is needed to determine whether this association is attributable to a relationship between PA and body composition in early adolescence

Body image emotions, perceptions, and cognitions distinguish physically active and inactive smokers

Objectives: To determine if body image emotions (body-related shame and guilt, weight-related stress), perceptions (self-perceived overweight), or cognitions (trying to change weight) differ between adolescents characterized by smoking and physical activity (PA) behavior. Methods: Data for this cross-sectional analysis were collected in 2010–11 and were available for 1017 participants (mean (SD) age = 16.8 (0.5) years). Participants were categorized according to smoking and PA status into four groups: inactive smokers, inactive non-smokers, active smokers and active non-smokers. Associations between body image emotions, perceptions and cognitions, and group membership were estimated in multinomial logistic regression. Results: Participants who reported body-related shame were less likely (OR (95% CI) = 0.52 (0.29–0.94)) to be in the active smoker group than the inactive smoker group; those who reported body-related guilt and those trying to gain weight were more likely (2.14 (1.32–3.48) and 2.49 (1.22–5.08), respectively) to be in the active smoker group than the inactive smoker group; those who were stressed about weight and those perceiving themselves as overweight were less likely to be in the active non-smoker group than the inactive smoker group (0.79 (0.64–0.97) and 0.41 (0.19–0.89), respectively). Conclusion: Body image emotions and cognitions differentiated the active smoker group from the other three groups

Development and Validation of the Reasons to Exergame (RTEX) Scale in Young Adults: Exploratory Factors Analysis

International audienceBackground Exergaming is associated with positive health benefits; however, little is known about what motivates young people to exergame. Objective This study aimed to develop a new Reasons to Exergame (RTEX) scale and describe its psychometric properties (Study 1) including test-retest reliability (Study 2). We also examined the test-retest reliability of self-report exergaming behavior measures (Study 2). Methods We identified scale items in consultation with experts. In Study 1, we conducted an Exploratory Factor Analysis of RTEX and examined how the factors identified relate to exergaming frequency and intensity in a population-based sample of 272 young adults. In Study 2, we examined the test-retest reliability of RTEX factors and self-report measures of past-week exergaming frequency and intensity among 147 college students. Results We identified four factors in RTEX: exergaming for fitness, exergaming for enjoyment, preferring exergaming over other gaming options, and choosing exergaming over competing interests (eg, sports). Test-retest reliability of RTEX factors (ICC 0.7-0.8) and self-report exergaming frequency (ICC 0.4-0.9) was adequate. Exergaming for fitness and enjoyment were positively associated with the frequency of exergaming with friends and family, and with exergaming intensity. Preferring exergaming over other gaming options and choosing exergaming over competing interests (eg, sports) were not related to exergaming behavior. Conclusions RTEX is a psychometrically sound scale with four factors that measure reasons to exergame. Replication of these findings is needed in larger, more diverse samples

Reasons to quit smoking by social status in adolescents

Background: Recent studies report social disparities in reasons to quit smoking among adults, but it is unclear if this observation also pertains to adolescents who smoke. The objective of this study was to describe social disparities in reasons to quit smoking in adolescents. Method: Data on indicators of social status, cigarette smoking and the Adolescent Reasons For Quitting (ARFQ) scale were collected in mailed self-report questionnaires completed by 1,242 grade u students in 2010-11. The associations between each of ten social status indicators and two of the ARFQ subscales were investigated among current adolescents who smoke (n=190; 45% male; mean (sd) age =16.8(0.5)) in logistic regression analyses controlling for age, sex and number of years since first puff. Results: Sixty-three percent of adolescents who smoke rated health as an extremely or very important reason to quit smoking; only 28% endorsed social disapproval. None of the indicators of social status were associated with health as a reason to quit. Participants whose mothers were employed were less likely to endorse social disapproval as a reason to quit smoking (OR (95% CI) = 0.38 (0.15-0.96)). Conclusions: Adolescents who smoke, regardless of social status, endorse health as an important reason to quit smoking, but fewer thought that social disapproval was important. There are few social disparities in reasons to quit in adolescents