Active video games as a tool to prevent excessive weight gain in adolescents: rationale, design and methods of a randomized controlled trial

BMC Public Health

Emely de Vet²  Johannes Brug⁴  Jacob C Seidell⁵  Michiel R de Boer⁵  Maaike van de Bovenkamp⁵  Mai JM Chinapaw¹  Monique Simons³ 

[1] Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands;Chairgroup Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Wageningen University and Research Centre, Wageningen, The Netherlands;TNO, Expertise Centre Life Style, Leiden, The Netherlands;Department of Epidemiology & Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands;Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands

关键词: Randomized controlled trial;    Overweight;    Excessive body weight;    Prevention;    Adolescent;    Sedentary lifestyle;    Physical activity;    Exergames;    Active games;    Video games;   

Others  :  1131823
DOI  :  10.1186/1471-2458-14-275

 received in 2013-12-13, accepted in 2014-03-13,  发布年份 2014

【 摘 要 】

Background

Excessive body weight, low physical activity and excessive sedentary time in youth are major public health concerns. A new generation of video games, the ones that require physical activity to play the games –i.e. active games- may be a promising alternative to traditional non-active games to promote physical activity and reduce sedentary behaviors in youth. The aim of this manuscript is to describe the design of a study evaluating the effects of a family oriented active game intervention, incorporating several motivational elements, on anthropometrics and health behaviors in adolescents.

Methods/Design

The study is a randomized controlled trial (RCT), with non-active gaming adolescents aged 12 – 16 years old randomly allocated to a ten month intervention (receiving active games, as well as an encouragement to play) or a waiting-list control group (receiving active games after the intervention period). Primary outcomes are adolescents’ measured BMI-SDS (SDS = adjusted for mean standard deviation score), waist circumference-SDS, hip circumference and sum of skinfolds. Secondary outcomes are adolescents’ self-reported time spent playing active and non-active games, other sedentary activities and consumption of sugar-sweetened beverages. In addition, a process evaluation is conducted, assessing the sustainability of the active games, enjoyment, perceived competence, perceived barriers for active game play, game context, injuries from active game play, activity replacement and intention to continue playing the active games.

Discussion

This is the first adequately powered RCT including normal weight adolescents, evaluating a reasonably long period of provision of and exposure to active games. Next, strong elements are the incorporating motivational elements for active game play and a comprehensive process evaluation. This trial will provide evidence regarding the potential contribution of active games in prevention of excessive weight gain in adolescents.

Trial registration

Dutch Trial register NTR3228.

【 授权许可】

   
2014 Simons et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Livingstone MB: Childhood obesity in Europe: a growing concern. Public Health Nutr 2001, 4(1A):109-116.
• [2]Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM: Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006, 295(13):1549-1555.
• [3]Schönbeck Y, Talma H, van Dommelen P, Bakker B, Buitendijk SE, Hirasing RA, van Buuren S: Increase in prevalence of overweight in Dutch children and adolescents: a comparison of nationwide growth studies in 1980, 1997 and 2009. PLoS One 2011, 6(11):e27608.
• [4]Brug J, van Stralen MM, te Velde SJ, te Velde SJ, Chinapaw MJ, de Bourdeaudhuij I, Lien N, Bere E, Maskini V, Singh AS, Maes L, Moreno L, Jan N, Kovacs E, Lobstein T, Manios Y: Differences in weight status and energy-balance related behaviors among schoolchildren across Europe: the ENERGY-project. PLoS One 2012, 7(4):e34742.
• [5]Brug J, van Stralen MM, Chinapaw MJ, de Bourdeaudhuij I, Lien N, Bere E, Singh AS, Maes L, Moreno L, Jan N, Kovacs E, Lobstein T, Manios Y, te Velde SJ: Differences in weight status and energy-balance related behaviours according to ethnic background among adolescents in seven countries in Europe: the ENERGY-project. Pediatr Obes 2012, 7(5):399-411.
• [6]Bell LM, Curran JA, Byrne S, Roby H, Suriano K, Jones TW, Davis EA: High incidence of obesity co-morbidities in young children: a cross-sectional study. J Paediatr Child Health 2011, 47(12):911-917. doi:10.1111/j.1440-1754.2011.02102.x. Epub 2011 Sep 9
• [7]Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M: Health and economic burden of the projected obesity trends in the USA and the UK. Lancet 2011, 378(9793):815-825.
• [8]Withrow D, Alter DA: The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2011, 12:131-141.
• [9]Alberga AS, Sigal RJ, Goldfield G, Prud’homme D, Kenny GP: Overweight and obese teenagers: why is adolescence a critical period? Pediatric Obesity 2012, 7(4):261-273.
• [10]Kvaavik E, Tell GS, Klepp KI: Predictors and tracking of body mass index from adolescence into adulthood: follow-up of 18 to 20 years in the Oslo Youth Study. Arch Pediatr Adolesc Med 2003, 157(12):1212-1218.
• [11]Hill JO: Understanding and addressing the epidemic of obesity: an energy balance perspective. Endocr Rev 2006, 27(7):750-761.
• [12]Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, Goldfield G, Connor Gorber S: Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 2011, 8:98. BioMed Central Full Text
• [13]Boone JE, Gordon-Larsen P, Adair LS, Popkin BM: Screen time and physical activity during adolescence: longitudinal effects on obesity in young adulthood. Int J Behav Nutr Phys Act 2007, 4:26. BioMed Central Full Text
• [14]te Velde SJ, de Bourdeaudhuij I, Thorsdottir I, Rasmussen M, Hagströmer M, Klepp KI, Brug J: Patterns in sedentary and exercise behaviors and associations with overweight in 9–14 year old boys and girls: a cross sectional study. BMC Public Health 2007, 7:16. BioMed Central Full Text
• [15]Stettler N, Signer TM, Suter PM: Electronic games and environmental factors associated with childhood obesity in Switzerland. Obes Res 2004, 12(6):896-903.
• [16]Utter J, Neumark-Sztainer D, Jeffery R, Story M: Couch potatoes or french fries: are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents? J Am Diet Assoc 2003, 103(10):1298-1305.
• [17]Lambiase M: Treating pediatric overweight through reductions in sedentary behavior: a review of the literature. J Pediatr Health Care 2009, 23(1):29-36. doi:10.1016/j.pedhc.2008.04.005. Epub 2008 Aug 9. Review
• [18]Rideout VJ, Foehr UG, Roberts DF: Generation M2: media in the lives of 8- to 18-year olds. Menlo Park, CA: Henry J. Kaiser Family Foundation; 2010.
• [19]Simons M, de Vet E, Brug J, Seidell J, Chinapaw M: Active and non-active video gaming among Dutch adolescents: who plays and how much? J Sports Sci Med 2013. doi:10.1016/j.jsams.2013.10.250
• [20]Nikken P: Computerspellen in het gezin [Computergames in the family]. Hilversum: NICAM; 2003.
• [21]The Netherlands National Gamers Survey 2009Available at: http://www.tns-nipo.com/kenniscentrum/nieuws/nederland-telt-9 webcite,3-miljoen-gamers/. Accessed December 348 6, 2010
• [22]Simons M, de Vet E, Hoornstra S, Brug J, Seidell J, Chinapaw M: Adolescents’views on active and non-active videogames: a focus group study. Games Health J 2012, 1(3):211-218.
• [23]Barnett A, Cerin E, Baranowski T: Active video games for youth: a systematic review. J Phys Act Health 2011, 8(5):724-737.
• [24]Biddiss E, Irwin J: Active video games to promote physical activity in children and youth: a systematic review. Arch Pediatr Adolesc Med 2010, 164(7):664-672.
• [25]Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000, 55(1):68-78.
• [26]Ryan RM, Deci EL: Self-regulation and the problem of human autonomy: does psychology need choice, self-determination, and will? J Pers 2006, 74(6):1557-1585.
• [27]Chaput JP, Visby T, Nyby S, Klingenberg L, Gregersen NT, Tremblay A, Astrup A, Sjodin A: Video game playing increases food intake in adolescents: a randomized crossover study. Am J Clin Nutr 2011, 93(6):1196-1203.
• [28]Oldham-Cooper RE, Hardman CA, Nicoll CE, Rogers PJ, Brunstrom JM: Playing a computer game during lunch affects fullness, memory for lunch, and later snack intake. Am J Clin Nutr 2011, 93(2):308-313.
• [29]Kremers SP, van der Horst K, Brug J: Adolescent screen-viewing behaviour is associated with consumption of sugar-sweetened beverages: the role of habit strength and perceived parental norms. Appetite 2007, 48(3):345-350.
• [30]Epstein LH, Roemmich JN, Paluch RA, Raynor HA: Influence of changes in sedentary behavior on energy and macronutrient intake in youth. Am J Clin Nutr 2005, 81(2):361-366.
• [31]Epstein LH, Saad FG, Giacomelli AM, Roemmich JN: Effects of allocation of attention on habituation to olfactory and visual food stimuli in children. Physiol Behav 2005, 84(2):313-319.
• [32]Lyons EJ, Tate DF, Ward DS, Wang X: Energy intake and expenditure during sedentary screen time and motion-controlled video gaming. Am J Clin Nutr 2012, 96(2):234-239.
• [33]Hopkins M, King NA, Blundell JE: Acute and long term effects of exercise on appetite control: is there any benefit for weight control? Curr Opin Clin Nutr Metab Care 2010, 13:635-640.
• [34]Mellecker RR, Lanningham-Foster L, Levine JA, McManus AM: Energy intake during activity enhanced video game play. Appetite 2010, 55(2):343-347.
• [35]Maddison R, Foley L, Ni Mhurchu C, Jiang Y, Jull A, Prapavessis H, Hohepa M, Rodgers A: Effects of active video games on body composition: a randomized controlled trial. Am J Clin Nutr 2011, 94(1):156-163.
• [36]Straker LM, Abbott RA, Smith AJ: To remove or to replace traditional electronic games? A crossover randomised controlled trial on the impact of removing or replacing home access to electronic games on physical activity and sedentary behaviour in children aged 10–12 years. BMJ Open 2013., 3(6) doi:10.1136/bmjopen-2013-002629. Print 2013
• [37]Maloney AE, Bethea TC, Kelsey KS, Marks JT, Paez S, Rosenberg AM, Catellier DJ, Hamer RM, Sikich L: A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time. Obesity (Silver Spring) 2008, 16(9):2074-2080. doi:10.1038/oby.2008.295
• [38]Ni Mhurchu C, Maddison R, Jiang Y, Jull A, Prapavessis H, Rodgers A: Couch potatoes to jumping beans: a pilot study of the effect of active video games on physical activity in children. Games for Health Journal 2012, 1(2):96-103. doi:10.1089/g4h.2011.0009
• [39]Maloney AE, Threlkeld KA, Cook WL: Comparative effectiveness of a 12-week physical activity intervention for overweight and obese youth: exergaming with dance dance revolution. Games Health J 2012, 1(2):96-103. doi:10.1089/g4h.2011.0009
• [40]Madsen KA, Yen S, Wlasiuk L, Newman TB, Lustig R: Feasibility of a dance videogame to promote weight loss among overweight children and adolescents. Arch Pediatr Adolesc Med 2007, 161(1):105-107.
• [41]Chinapaw MJM, Jacobs WM, Vaessen EPG, Titze S, van Mechelen W: The motivation of children to play an active video game. J Sci Med Sport 2008, 11(2):163-166.
• [42]LeBlanc AG, Chaput JP, McFarlane A, Colley RC, Thivel D, Biddle SJ, Maddison R, Leatherdale ST, Tremblay MS: Active video games and health indicators in children and youth: a systematic review. PLoS One 2013, 8(6):e65351. doi:10.1371/journal.pone.0065351. Print 2013
• [43]NHS-NRG 2007. [Preventie van gewichtsstijging en richtlijnen voor gewichtsbeheersing in Nederland] http://www.fontysmediatheek.nl/w/images/9/95/NHS-NRGRichtlijnenGewichtsbeheersing.pdf webcite
• [44]Paez S, Maloney A, Kelsey K, Wiesen C, Rosenberg A: Parental and environmental factors associated with physical activity among children participating in an active video game. Pediatr Phys Ther 2009, 21(3):245-253.
• [45]Simons M, Bernaards C, Slinger J: Active gaming in Dutch adolescents: a descriptive study. Int J Behav Nutr Phys Act 2012, 9:118. doi:10.1186/1479-5868-9-118 BioMed Central Full Text
• [46]Baranowski T, Abdelsamad D, Baranowski J, O’Connor TM, Thompson D, Barnett A, Cerin E, Chen TA: Impact of an active video game on healthy children’s physical activity. Pediatrics 2011, 129(3):e636-e642.
• [47]Daley AJ: Can exergaming contribute to improving physical activity levels and health outcomes in children? Pediatrics 2009, 124:763-771. originally published online Jul 13, 2009
• [48]Peng W, Crouse JC, Lin J-H: Using active video games for physical activity promotion: a systematic review of the current state of research. Health Educ Behav 2013, 40:171. originally published online 6 July 2012
• [49]Durnin JV, Rahaman MM: The assessment of the amount of fat in the human body from measurements of skinfold thickness. Br J Nutr 1967, 21(3):681-689.
• [50]de Jong E, Visscher TL, Hirasing RA, Heymans MW, Seidell JC, Renders CM: Association between TV viewing, computer use and overweight, determinants and competing activities of screen time in 4- to 13- year-old children. Int J Obes 2013, 37:47-53. doi:10.1038/ijo.2011.244; published online 13 December 2011
• [51]Philippaerts RM, Matton L, Wijndaele K, Balduck AL, de Bourdeaudhuij I, Lefevre J: Validity of a physical activity computer questionnaire in 12- to 18-year-old boys and girls. Int J Sports Med 2006, 27(2):131-136.
• [52]van der Horst K, Oenema A, van de Looij-Jansen P, Brug J: The ENDORSE study: research into environmental determinants of obesity related behaviors in Rotterdam schoolchildren. BMC Public Health 2008, 8:142. doi:10.1186/1471-2458-8-142 BioMed Central Full Text
• [53]van Assema P, Brug J, Ronda G, Steenhuis I: The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake. J Hum Nutr Diet 2001, 14(5):377-390.
• [54]McAuley E, Duncan T, Tammen VV: Psychometric properties of the intrinsic motivation inventory in a competitive sport setting: a confirmatory factor analysis. Res Q Exerc Sport 1987, 60(1):48-58.
• [55]Davis FD: Perceived usefulness, perceived ease of Use, and user acceptance of information technology. MIS Quarterly 1989, 13(3):319-340.
• [56]Hsu C-L, Lu H-P: Why do people play on-line games? An extended TAM with social influences and flow experience. Inf Manage 2004, 41(7):853-868.
• [57]Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw J, Foy R, Kaner EFS, Smith L, Bonetti D: Constructing questionnaires based on the theory of planned behavior: a manual for health services researchers. United Kingdom: Centre for Health Services Research: Newcastle Upon Tyne; 2004.
• [58]Singh AS, Chin A, Paw MJ, Kremers SP, Visscher TL, Brug J, van Mechelen W: Design of the Dutch obesity intervention in teenagers (nrg-doit): systematic development, implementation and evaluation of a school based intervention aimed at the prevention of excessive weight gain in adolescents. BMC Public Health 2006, 6:304. BioMed Central Full Text
• [59]Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS: Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000, 32(9 Suppl):S498-S504.
• [60]Staiano AE, Abraham AA, Calvert SL: Adolescent exergame play for weight loss and psychosocial improvement: a controlled physical activity intervention. Obesity (Silver Spring) 2013, 21(3):598-601. doi:10.1002/oby.20282
• [61]Hall KD, Butte NF, Swinburn BA, Chow CC: Dynamics of childhood growth and obesity: development and validation of a quantitative mathematical model. Lancet Diab Endocrinol 2013, 1:97-105.