Active video games and health indicators in children and youth: a systematic review

BACKGROUND: Active video games (AVGs) have gained interest as a way to increase physical activity in children and youth. The effect of AVGs on acute energy expenditure (EE) has previously been reported; however, the influence of AVGs on other health-related lifestyle indicators remains unclear.

OBJECTIVE: This systematic review aimed to explain the relationship between AVGs and nine health and behavioural indicators in the pediatric population (aged 0-17 years). DATA SOURCES: Online databases (MEDLINE, EMBASE, psycINFO, SPORTDiscus and Cochrane Central Database) and personal libraries were searched and content experts were consulted for additional material.

DATA SELECTION: Included articles were required to have a measure of AVG and at least one relevant health or behaviour indicator: EE (both habitual and acute), adherence and appeal (i.e., participation and enjoyment), opportunity cost (both time and financial considerations, and adverse events), adiposity, cardiometabolic health, energy intake, adaptation (effects of continued play), learning and rehabilitation, and video game evolution (i.e., sustainability of AVG technology).

RESULTS: 51 unique studies, represented in 52 articles were included in the review. Data were available from 1992 participants, aged 3-17 years, from 8 countries, and published from 2006-2012. Overall, AVGs are associated with acute increases in EE, but effects on habitual physical activity are not clear. Further, AVGs show promise when used for learning and rehabilitation within special populations. Evidence related to other indicators was limited and inconclusive.

CONCLUSIONS: Controlled studies show that AVGs acutely increase light- to moderate-intensity physical activity; however, the findings about if or how AVG lead to increases in habitual physical activity or decreases in sedentary behaviour are less clear. Although AVGs may elicit some health benefits in special populations, there is not sufficient evidence to recommend AVGs as a means of increasing daily physical activity.

Measuring physical activity in a cardiac rehabilitation population using a smartphone-based questionnaire

BACKGROUND: Questionnaires are commonly used to assess physical activity in large population-based studies because of their low cost and convenience. Many self-report physical activity questionnaires have been shown to be valid and reliable measures, but they are subject to measurement errors and misreporting, often due to lengthy recall periods. Mobile phones offer a novel approach to measure self-reported physical activity on a daily basis and offer real-time data collection with the potential to enhance recall.

OBJECTIVE: The aims of this study were to determine the convergent validity of a mobile phone physical activity (MobilePAL) questionnaire against accelerometry in people with cardiovascular disease (CVD), and to compare how the MobilePAL questionnaire performed compared with the commonly used self-recall International Physical Activity Questionnaire (IPAQ).

METHODS: Thirty adults aged 49 to 85 years with CVD were recruited from a local exercise-based cardiac rehabilitation clinic in Auckland, New Zealand. All participants completed a demographics questionnaire and underwent a 6-minute walk test at the first visit. Subsequently, participants were temporarily provided a smartphone (with the MobilePAL questionnaire preloaded that asked 2 questions daily) and an accelerometer, which was to be worn for 7 days. After 1 week, a follow-up visit was completed during which the smartphone and accelerometer were returned, and participants completed the IPAQ.

RESULTS: Average daily physical activity level measured using the MobilePAL questionnaire showed moderate correlation (r=.45; P=.01) with daily activity counts per minute (Acc_CPM) and estimated metabolic equivalents (MET) (r=.45; P=.01) measured using the accelerometer. Both MobilePAL (beta=.42; P=.008) and age (beta=-.48, P=.002) were significantly associated with Acc_CPM (adjusted R(2)=.40). When IPAQ-derived energy expenditure, measured in MET-minutes per week (IPAQ_met), was considered in the predicted model, both IPAQ_met (beta=.51; P=.001) and age (beta=-.36; P=.016) made unique contributions (adjusted R(2)=.47, F2,27=13.58; P<.001).There was also a significant association between the MobilePAL and IPAQ measures (r=.49, beta=.51; P=.007).

CONCLUSIONS: A mobile phone-delivered questionnaire is a relatively reliable and valid measure of physical activity in a CVD cohort. Reliability and validity measures in the present study are comparable to existing self-report measures. Given their ubiquitous use, mobile phones may be an effective method for physical activity surveillance data collection.

Self-report use-of-time tools for the assessment of physical activity and sedentary behaviour in young people: systematic review

UNLABELLED: Regular physical activity and limiting extended periods of sitting are two behaviours critical for the prevention of obesity in young people. The purpose of the systematic review was to synthesize the psychometric evidence for self-report use-of-time tools that assess these behaviours. Articles were retrieved that reported reliability and/or validity for use-of-time tools in participants aged 18 years or under. Outcome variables were physical activity, sedentary behaviour and energy expenditure. Study quality was appraised, and the results summarized narratively. Sixteen studies and six different tools were identified. The tools were the Previous Day Physical Activity Recall, the Three-Day Physical Activity Recall, the Physical Activity Interview, the Computerized Activity Recall, the Activitygram, and the Multimedia Activity Recall for Children and Adolescents. Overall, tools indicated moderate validity compared with objective and criterion comparison methods. Generally, validity correlation coefficients were in the range of 0.30-0.40. Correlation coefficients for test-retest reliability ranged widely from 0.24 to 0.98. CONCLUSION: Use-of-time tools have indicated moderate reliability and validity for the assessment of physical activity and energy expenditure. Future research should focus on using criterion methods and on validating specifically for sedentary behaviour outcomes. Implementation of these tools for population surveillance should be considered.

Parents' and children's perceptions of active video games: a focus group study

Energy expenditure studies have shown that playing Active Video Games (AVGs) is positively associated with increases in heart rate and oxygen consumption. It is proposed that playing AVGs may be a useful means of addressing inactivity and obesity in children. This study explored children's and parents' perceptions of AVGs and the likely facilitators and barriers to sustained use of AVGs. Data were gathered using focus group interviews: seven with children, four with adults. Both children and parents reported that AVGs offered a way to increase activity and improve fitness. Barriers to sustained engagement, according to parents, were the cost of AVGs and lack of space in the home to play the games. According to children, the likelihood of long-term engagement with AVGs depended on game content and child age, with AVGs being seen as more appropriate for younger children than teenagers. It would appear that there is potential for AVGs to reduce inactivity in young people. However, barriers to widespread, sustainable adoption would need to be addressed if this potential is to be realized.

Use of active video games to increase physical activity in children: a (virtual) reality?

There has been increased research interest in the use of active video games (in which players physically interact with images onscreen) as a means to promote physical activity in children. The aim of this review was to assess active video games as a means of increasing energy expenditure and physical activity behavior in children. Studies were obtained from computerized searches of multiple electronic bibliographic databases. The last search was conducted in December 2008. Eleven studies focused on the quantification of the energy cost associated with playing active video games, and eight studies focused on the utility of active video games as an intervention to increase physical activity in children. Compared with traditional nonactive video games, active video games elicited greater energy expenditure, which was similar in intensity to mild to moderate intensity physical activity. The intervention studies indicate that active video games may have the potential to increase free-living physical activity and improve body composition in children; however, methodological limitations prevent definitive conclusions. Future research should focus on larger, methodologically sound intervention trials to provide definitive answers as to whether this technology is effective in promoting long-term physical activity in children.

Predicting physical activity intention and behavior in school-age children

Two studies were conducted to predict physical activity in school-aged children. Study 1 tested the utility of an integrated model in predicting physical activity (PA) intention and behavior-the theory of planned behavior (TPB) and self-efficacy theory. Six hundred and forty-five New Zealand children (aged 11-13 years) completed measures corresponding to the integrated model and a self-reported measure of PA one week later. Perceived behavioral control (PBC) and subjective norm were the two strongest predictors of intentions. Task efficacy and barrier efficacy were the two strongest predictors of PA. A second study (Study 2) was conducted to determine whether the self-efficacy measures could discriminate objectively measured PA levels. Sixty-seven Canadian children (aged 11-13 years) completed task and barrier self-efficacy measures. The following week, children classified as 'high' (n = 11) and 'lower' (n = 7) for both task and barrier efficacy wore an Actical® monitor for seven consecutive days to provide activity-related energy expenditure (AEE) data. Results showed that children with high efficacy expended significantly greater AEE than their lower efficacious counterparts. Findings from these two studies provide support for the use of self-efficacy interventions as a potentially useful means of increasing PA levels among school-aged children.

The Short Questionnaire to Assess Health-Enhancing (SQUASH) physical activity in adolescents: a validation using doubly labeled water

Accurate assessment of physical activity energy expenditure (PAEE) among adolescents is important for surveillance, evaluating interventions, and understanding the relation between energy balance and normal physiological and behavioral growth and development. The purpose of this study was to examine the validity of the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH)13 for measuring PAEE among adolescents. Methods: The participants were seventeen adolescents (9 females; Mean age = 17.53; SD = 0.62). Energy expenditure was measured during a 9-day period with doubly labeled water (DLW). The SQUASH was self-administered on the morning of the 10th day and assessed commuting activities, leisure time activities, household activities, and activities at work and school over the previous 9 days. Results: A Bland-Altman plot indicated that the SQUASH underestimated PAEE compared with DLW by a mean difference of 126 kcal·d-1 (95% limits of agreement:-1,207 to 1,459 kcal·d-1), representative of a 10% underestimation. The Spearman rank order correlation coefficient showed there was a significant association between the SQUASH and DLW (r =.50, P =.04), for estimating PAEE. Conclusion: When using a sample of highly active adolescents, the SQUASH is a valid self-report tool for measuring PAEE at the group and individual rank order level.

Descriptive epidemiology of physical activity levels and patterns in New Zealanders in advanced age

BACKGROUND: Little is known about the physical activity levels and behaviors of advanced age New Zealanders. METHODS: A cross-sectional analysis of data from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), Te Puāwaitanga O Nga Tapuwae Kia ora Tonu, measures of physical activity (PASE) (n = 664, aged 80-90 [n = 254, Māori, aged 82.5(2), n = 410 non-Māori, aged 85(.5)]) was conducted to determine physical activity level (PAL). A substudy (n = 45) was conducted to attain detailed information about PAL and behaviors via the Multimedia Activity Recall for Children and Adults (MARCA) and accelerometry. The main study was analyzed by sex for Māori and non-Māori. RESULTS: Men consistently had higher levels of physical activity than women for all physical activity measures. Sex was significant for different domains of activity.

Validation of the SenseWear Mini activity monitor in 5-12-year-old children

OBJECTIVES: This study aimed to validate SenseWear Mini software algorithm versions 2.2 (SW2.2) and 5.2 (SW5.2) for estimating energy expenditure (EE) in children. DESIGN: Laboratory-based validation study. METHODS: 57 children aged 5-12 y completed a protocol involving 15 semi-structured sedentary (SED), light-intensity (LPA), and moderate- to vigorous-intensity (MVPA) physical activities. EE was estimated using portable indirect calorimetry (IC). The accuracy of EE estimates (kcal·min(-1)) from SW2.2 and SW5.2 were examined at the group level and individual level using the mean absolute percentage error (MAPE), Bland-Altman plots and equivalence testing. RESULTS: MAPE values were lower for SW5.2 (30.1±10.7%) than for SW2.2 (44.0±6.2%). Although mean differences for SW5.2 were smaller than for SW2.2 during SED (-0.23±0.22 vs. -0.61±0.20kcal·min(-1)), LPA (-0.69±0.76 vs. -1.07±0.46kcal·min(-1)) and MVPA (-2.22±1.15 vs. -2.57±1.15kcal·min(-1)), limits of agreement did not decrease for the updated algorithms. For all activities, SW2.2 and SW5.2 were not equivalent to IC (p>0.05). Errors increased with increasing intensity. CONCLUSION: The current SenseWear Mini algorithms SW5.2 underestimated EE. The overall improved accuracy for SW5.2 was not accompanied with improved accuracy at the individual level and EE estimates were not equivalent to IC.

Energetic consequences of time-activity budgets for a breeding seabird

How animals allocate their time to different behaviours has important consequences for their overall energy budget and reflects how they function in their environment. This potentially affects their ability to successfully reproduce, thereby impacting their fitness. We used accelerometers to record time-activity budgets of 21 incubating and chick-rearing kittiwakes (Rissa tridactyla) on Puffin Island, UK. These budgets were examined on a per day and per foraging trip basis. We applied activity-specific estimates of energy expenditure to the kittiwakes' time-activity budgets in order to identify the costs of variation in their allocation of time to different behaviours. Estimates of daily energy expenditure for incubating kittiwakes averaged 494 ± 20 kJ d-1 while chick-rearing birds averaged 559 ± 11 kJ d-1. Time-activity budgets highlighted that kittiwakes did not spend a large proportion of their time flying during longer foraging trips, or during any given 24-h period. With time spent flying highlighted as the driving factor behind elevated energy budgets, this suggests behavioural compensation resulting in a possible energetic ceiling to their activities. We also identified that kittiwakes were highly variable in the proportion of time they spent either flying or on the water during foraging trips. Such variation meant that using forage trip duration alone to predict energy expenditure gave a mean error of 19% when compared to estimates incorporating the proportion of a foraging trip spent flying. We have therefore highlighted that trip duration alone is not an accurate indicator of energy expenditure.

Energetics of communal roosting in chestnut-crowned babblers: implications for group dynamics and breeding phenology

For many endotherms, communal roosting saves energy in cold conditions, but how this might affect social dynamics or breeding phenology is not well understood. Using chestnut-crowned babblers (Pomatostomus ruficeps), we studied the effects of nest use and group size on roosting energy costs. These 50 g cooperatively breeding passerine birds of outback Australia breed from late winter to early summer and roost in huddles of up to 20 in single-chambered nests. We measured babbler metabolism at three ecologically relevant temperatures: 5°C (similar to minimum nighttime temperatures during early breeding), 15°C (similar to nighttime temperatures during late breeding) and 28°C (thermal neutrality). Nest use alone had modest effects: even for solitary babblers at 5°C, it reduced nighttime energy expenditures by <15%. However, group-size effects were substantial, with savings of up to 60% in large groups at low temperatures. Babblers roosting in groups of seven or more at 5°C, and five or more at 15°C, did not need to elevate metabolic rates above basal levels. Furthermore, even at 28°C (thermoneutral for solitary babblers), individuals in groups of four or more had 15% lower basal metabolic rate than single birds, hinting that roosting in small groups is stressful. We suggest that the substantial energy savings of communal roosting at low temperatures help explain why early breeding is initiated in large groups and why breeding females, which roost alone and consequently expend 120% more energy overnight than other group members, suffer relatively higher mortality than communally roosting group mates.

Impact of an 8-month trial using height-adjustable desks on children's classroom sitting patterns and markers of cardio-metabolic and musculoskeletal health

During school hours, children can sit for prolonged and unbroken periods of time. This study investigated the impact of an 8-month classroom-based intervention focusing on reducing and breaking-up sitting time on children's cardio-metabolic risk factors (i.e., body mass index, waist circumference, blood pressure) and perceptions of musculoskeletal discomfort. Two Year-6 classes (24 students per class) in one primary school were assigned to either an intervention or control classroom. The intervention classroom was equipped with height-adjustable desks and the teacher was instructed in the delivery of pedagogical strategies to reduce and break-up sitting in class. The control classroom followed standard practice using traditional furniture. At baseline, and after 8-months, time spent sitting, standing, stepping, and sitting-bouts (occasions of continuous sitting) as well as the frequency of sit-to-stand transitions were obtained from activPAL inclinometers and the time spent in light-intensity physical activity was obtained from ActiGraph accelerometers. Demographics and musculoskeletal characteristics were obtained from a self-report survey. Hierarchical linear mixed models found that during class-time, children's overall time spent sitting in long bouts (>10 min) were lower and the number of sit-to-stand transitions were higher in the intervention group compared to the control group, while no changes were observed for musculoskeletal pain/discomfort. No significant intervention effects were found for the anthropometrics measures and blood pressure. Height-adjustable desks and pedagogical strategies to reduce/break-up sitting can positively modify classroom sitting patterns in children. Longer interventions, larger and varied sample size may be needed to show health impacts; however, these desks did not increase musculoskeletal pain/discomfort.

Under-reporting of energy intake in the 1997 national nutrition survey

Aims To estimate the level of under-reporting of energy intake by gender, age, ethnicity and body size (normal, overweight, obese) in the 1997 National Nutrition Survey (NNS97) in New Zealand.
Methods Data were from 4,258 participants (1,808 men and 2,450 women aged 15 years and over) who completed the 24-hour diet recall; the primary methodology used in the NNS97. Under-reporting was assessed using the ratio of reported energy intake to estimated resting metabolic rate (EI: RMRest). Cut-off limits were used to identify percentages of under-reporters in the various subgroups.
Results Mean EI: RMRest was 1.40 for all participants (1.51 for men, 1.30 for women, p<0.001) with older age being associated with lower EI: RMRest (p<0.001). There were no significant differences in mean EI: RMRest between ethnic groups for men.
Mean EI: RMRest for women were: Maori 1.46, European 1.29, and Pacific 1.37 (p<0.01). A larger body size was associated with a significantly lower EI: RMRest especially for women.
Percentages of ‘definite’ under-reporters (individual EI: RMRest <0.9) were as follows: men 12%, women 21%; Europeans 16%, Maori 23% and Pacific 26%; normal weight (11%), overweight (19%) and obese (27%) participants; and from 10% in the youngest to 23% in the oldest age group (p<0.001 for all results).
Conclusion In this study, in agreement with the literature, women, older people and obese people under-reported more than men, younger people and non-obese people. Possible ethnic differences in under-reporting rates need further study. Care is needed in interpreting the energy intake data from the NNS97.

Physiological response to extreme fasting in subantarctic fur seal (Arctocephalus tropicalis) pups : metabolic rates, energy reserve utilization, and water fluxes

Physiological response to extreme fasting in subantarctic fur seal (Arctocephalus tropicalis) pups: metabolic rates, energy reserve utilization, and water fluxes. Am J Physiol Regul Integr Comp Physiol 297: R1582–R1592, 2009. First published September 23, 2009; doi:10.1152/ajpregu.90857.2008.— Surviving prolonged fasting requires various metabolic adaptations, such as energy and protein sparing, notably when animals are simultaneously engaged in energy-demanding processes such as growth. Due to the intermittent pattern of maternal attendance, subantarctic fur seal pups have to repeatedly endure exceptionally long fasting episodes throughout the 10-mo rearing period while preparing for nutritional independence. Their metabolic responses to natural prolonged fasting (33.4 ± 3.3 days) were investigated at 7 mo of age. Within 4–6 fasting days, pups shifted into a stage of metabolic economy characterized by a minimal rate of body mass loss (0.7%/day) and decreased resting metabolic rate  (5.9 ± 0.1 ml O₂ ·kg^-1·day^-1) that was only 10% above the level predicted for adult terrestrial mammals. Field metabolic rate (289 ± 10 kJ·kg^-1 ·day^-1) and water influx (7.9 ± 0.9 ml·kg^-1 ·day^-1) were also among the lowest reported for any young otariid, suggesting minimized energy allocation to behavioral activity and thermoregulation. Furthermore, lean tissue degradation was dramatically reduced. High initial adiposity (>48%) and predominant reliance on lipid catabolism likely contributed to the exceptional degree of protein sparing attained. Blood chemistry supported these findings and suggested utilization of alternative fuels, such as β-hydroxybutyrate and de novo synthesized glucose from fat-released glycerol. Regardless of sex and body condition, pups tended to adopt a convergent strategy of extreme energy and lean body mass conservation that appears highly adaptive for it allows some tissue growth during the repeated episodes of prolonged fasting they experience throughout their development.

Influence of maternal mass and condition on energy transfer in Weddell seals

* 1
Environmental variation influences food abundance and availability, which is reflected in the reproductive success of top predators. We examined maternal expenditure, offspring mass and condition for Weddell seals in 2 years when individuals exhibited marked differences in these traits.
* 2
For females weighing 355 kg there was a positive relationship between maternal post-partum mass (MPPM) and lactation length, but below this there was no relationship, suggesting that heavier females were able to increase lactation length but lighter females were restricted to a minimum lactation period of 33 days.
* 3
Overall, females were heavier in 2002, but in 2003 shorter females were lighter than similar-sized females in 2002 suggesting that the effects of environmental variability on foraging success and condition are more pronounced in smaller individuals.
* 4
There was no relationship between MPPM and pup birth mass, indicating pre-partum investment did not differ between years. However, there was a positive relationship between MPPM and pup mass gain. Mass and energy transfer efficiency were 10·2 and 5·4% higher in 2002 than 2003, which suggests costs associated with a putatively poor-resource year were delayed until lactation.
* 5
Heavier females lost a higher proportion of mass during lactation in both years, so smaller females may not have been able to provide more to their offspring to wean a pup of similar size to larger females.
* 6
MPPM had only a small influence on total body lipid; therefore, regardless of mass, females had the same relative body composition. Females with male pups lost a higher percentage of lipid than those with female pups, but by the end of lactation female pups had 4·5% higher lipid content than males.
* 7
It appears that for Weddell seals the consequences of environmentally induced variation in food availability are manifested in differences in maternal mass and expenditure during lactation. These differences translate to changes in pup mass and condition at weaning with potential consequences for future survival and recruitment.