Squire's Quest! Dietary outcome evaluation of a multimedia game. Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: The electronic games to aid motivation to exercise (eGAME) study The effect of active video gaming on children's physical activity, behavior preferences and body composition. The effect of active video games by ethnicity, sex and fitness: subgroup analysis from a randomised controlled trial Effects of interactive video game cycling on overweight and obese adolescent health. Design and Evaluation of a Computer Game to Promote a Healthy Diet for Young Adults Effects of active video games on body composition: a randomized controlled trial. The Fun Families Study: intervention to reduce children's TV viewing. Active video games to promote physical activity in children with cancer: a randomized clinical trial with follow-up
BACKGROUND Fruit , juice , and vegetable  ( FJV ) consumption among children is low . Innovative programs are needed to enable children to increase FJV intake . Psychoeducational multimedia permits the delivery of interventions as design ed and capitalizes on known behavior change principles . DESIGN Elementary school was the unit of recruitment , assignment , and analysis . Twenty-six elementary schools were pair matched on size and percentage of free or reduced-price lunch , and r and omly assigned to treatment or control groups . Data were collected just before and just after the program . SETTING / PARTICIPANTS All fourth- grade students in participating elementary schools were invited to participate . Data were collected on 1578 students . MAIN OUTCOME Servings of fruit , 100 % juice , and vegetables consumed . INTERVENTION Squire 's Quest ! is a ten-session , psychoeducational , multimedia game delivered over 5 weeks , with each session lasting about 25 minutes . Based on social cognitive theory , educational activities attempted to increase preferences for FJV through multiple exposures and associating fun with their consumption , increase asking behaviors for FJV at home and while eating out , and increase skills in FJV preparation through making virtual recipes . MEASURES Four days of dietary intake were assessed before and after the intervention . Assessment was made by the Food Intake Recording Software System ( FIRSSt ) , which conducts a multiple pass , 24-hour dietary intake interview directly with the children . RESULTS Children participating in Squire 's Quest ! increased their FJV consumption by 1.0 servings more than the children not receiving the program . CONCLUSIONS Psychoeducational multimedia games have the potential to substantially change dietary behavior . More research is warranted Background Childhood obesity has reached epidemic proportions in developed countries . Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity . Active video games , where players physically interact with images onscreen , may have utility as a novel intervention to increase physical activity and improve body composition in children . The aim of the Electronic Games to Aid Motivation to Exercise ( eGAME ) study is to determine the effects of an active video game intervention over 6 months on : body mass index ( BMI ) , percent body fat , waist circumference , cardio-respiratory fitness , and physical activity levels in overweight children . Methods / Design Three hundred and thirty participants aged 10–14 years will be r and omized to receive either an  active video game up grade package  or to a control group ( no intervention ) .  Discussion An overview of the eGAME study is presented , providing an example of a large , pragmatic r and omized controlled trial in a community setting . Reflection is offered on key issues encountered during the course of the study . In particular , investigation into the feasibility of the proposed intervention , as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial . Trial registration Australian New Zeal and Clinical Trials Registry Active video game interventions typically provide children a single game that may become unappealing . A peripheral device ( jOG ) encourages step-powered gaming on multiple games . This trial evaluated the effect of jOG on children 's objective ly measured PA , body fat and self-reported behaviors . 42 of 58 eligible children ( 8 - 10 y ) r and omly assigned to an intervention ( jOG ) or control ( CON ) completed the trial . Intervention children received two jOG devices for home use . Analyses of covariance compared the intervention effect at 6 and 12 weeks from baseline . No differences were found between groups for counts per minute ( CPM ; primary outcome ) at 6 and 12 weeks ( p > .05 ) . Active video gaming increased ( adjusted change 0.95 ( 95 % CI 0.25 , 1.65 ) h·d⁻¹ , p < .01 ) and sedentary video gaming decreased ( -0.34 ( -1.24 , 0.56 ) h·d⁻¹ , p > .05 ) at 6 weeks relative to CON . No body fat changes were observed between groups . Targeted changes in video game use did not positively affect PA . Larger trials are needed to verify the impact of active video games on children 's PA and health Background The prevention and treatment of childhood obesity is a key public health challenge . However , certain groups within population s have markedly different risk profiles for obesity and related health behaviours . Well- design ed subgroup analysis can identify potential differential effects of obesity interventions , which may be important for reducing health inequalities . The study aim was to evaluate the consistency of the effects of active video games across important subgroups in a r and omised controlled trial ( RCT ) . Findings A two-arm , parallel RCT was conducted in overweight or obese children ( n = 322 ; aged 10–14 years ) to determine the effect of active video games on body composition . Statistically significant overall treatment effects favouring the intervention group were found for body mass index , body mass index z-score and percentage body fat at 24 weeks . For these outcomes , pre-specified subgroup analyses were conducted among important baseline demographic ( ethnicity , sex ) and prognostic ( cardiovascular fitness ) groups . No statistically significant interaction effects were found between the treatment and subgroup terms in the main regression model ( p = 0.36 to 0.93 ) , indicating a consistent treatment effect across these groups . Conclusions Preliminary evidence suggests an active video games intervention had a consistent positive effect on body composition among important subgroups . This may support the use of these games as a pragmatic public health intervention to displace sedentary behaviour with physical activity in young people The purpose of this study was to examine the efficacy of interactive video game stationary cycling ( GameBike ) in comparison with stationary cycling to music on adherence , energy expenditure measures , submaximal aerobic fitness , body composition , and cardiovascular disease risk markers in overweight and obese adolescents , using a r and omized controlled trial design . Thirty overweight ( with at least 1 metabolic complication ) or obese adolescents aged 12 - 17 years were stratified by gender and r and omized to video game or music condition , with 4 participants ( 2 per group ) failing to complete the twice weekly 60 min sessions of the 10-week trial . The music group had a higher rate of attendance compared with the video game group ( 92 % vs. 86 % , p < 0.05 ) . Time spent in minutes per session at vigorous intensity ( 80%-100 % of predicted peak heart rate ) ( 24.9 ± 20 min vs. 13.7 ± 12.8 min , p < 0.05 ) and average distance ( km ) pedaled per session ( 12.5 ± 2.8 km vs. 10.2 ± 2.2 km , p < 0.05 ) also favoured the music group . However , both interventions produced significant improvements in submaximal indicators of aerobic fitness as measured by a grade d cycle ergometer protocol . Also , when collapsed , the exercise modalities reduced body fat percentage and total cholesterol . The present study indicates that cycling to music was just as effective  as stationary cycling while playing video games at improving fitness , body composition , and cholesterol profiles in overweight and obese teens , and result ed in increased attendance , vigorous intensity of physical activity , and distance pedaled . Therefore , our data support the superiority of cycling to music and indicate investing in the more expensive GameBike may not be worth the cost This article reports the development and evaluation of a computer game ( RightWay Café ) as a special medium to promote a healthy diet for young adults . Structural features of computer games , such as interactive tailoring , role playing , the element of fun , and narrative , were operationalized in the RightWay Café game to afford behavior rehearsal in a safe and entertaining way . Theories such as the health belief model , social cognitive theory , and theory of reasoned action guided the content design of the game to influence mediators of behavior change , including self-efficacy , perceived benefits , perceived barriers , and behavior change intention . A r and omized controlled evaluation study with pretest , posttest , and follow-up design demonstrated that this game was effective in teaching nutrition and weight management knowledge and increasing people 's self-efficacy and perceived benefits of healthy eating , as well as their intention to be on a healthy diet . Limited long-term effects were also found : participants in the game-playing group had greater self-efficacy than participants in the control group after 1 month . This study vali date s the computer game – based approach to health promotion for young adults . Limitations and implication s are also discussed BACKGROUND Sedentary activities such as video gaming are independently associated with obesity .  Active video games , in which players physically interact with images on screen , may help increase physical activity and improve body composition . OBJECTIVE The aim of this study was to evaluate the effect of active video games over a 6-mo period on weight , body composition , physical activity , and physical fitness . DESIGN We conducted a 2-arm , parallel , r and omized controlled trial in Auckl and , New Zeal and . A total of 322 overweight and obese children aged 10 - 14 y , who were current users of sedentary video games , were r and omly assigned at a 1:1 ratio to receive either an active video game up grade package ( intervention , n = 160 ) or to have no change ( control group , n = 162 ) . The primary outcome was the change from baseline in body mass index ( BMI ; in kg/m(2 ) ) . Secondary outcomes were changes in percentage body fat , physical activity , cardiorespiratory fitness , video game play , and food snacking . RESULTS At 24 wk , the treatment effect on BMI ( -0.24 ; 95 % CI : -0.44 , -0.05 ; P = 0.02 ) favored the intervention group . The change ( ±SE ) in BMI from baseline increased in the control group ( 0.34 ± 0.08 ) but remained the same in the intervention group ( 0.09 ± 0.08 ) . There was also evidence of a reduction in body fat in the intervention group ( -0.83 % ; 95 % CI : -1.54 % , -0.12 % ; P = 0.02 ) . The change in daily time spent playing active video games at 24 wk increased ( 10.03 min ; 95 % CI : 6.26 , 13.81 min ; P < 0.0001 ) with the intervention accompanied by a reduction in the change in daily time spent playing nonactive video games ( -9.39 min ; 95 % CI : -19.38 , 0.59 min ; P = 0.06 ) . CONCLUSION An active video game intervention has a small but definite effect on BMI and body composition in overweight and obese children . This trial was registered in the Australian New Zeal and Clinical Trials Registry at http://www.anzctr.org.au/ as ACTRN12607000632493 Media consumption may contribute to  childhood obesity . This study developed and evaluated a theory-based , parent-focused intervention to reduce television and other media consumption to prevent and reduce childhood obesity .  Families ( n = 202 ) with children ages 6 - 9 were recruited from a large , urban multiethnic population into a r and omized controlled trial ( 101 families into the intervention group and 101 into the  control group ) , and were followed for 6 months . The intervention consisted of a 2-hour workshop and six bimonthly newsletters . Behavioral objectives included : ( i ) reduce TV watching ; ( ii ) turn off TV when nobody is watching ; ( iii ) no TV with meals ;  ( iv ) no TV in the child 's bedroom ; and ( v ) engage in fun non-media related activities .  Parents were 89 % female , 44 % white , 28 % African American , 17 % Latino , and 11 % Asian , mean age 40 years ( s.d . = 7.5 ) ; 72 % were married . Children were 49 % female , mean age 8 years ( s.d . = 0.95 ) . Sixty-five percent of households had three or more TVs and video game players ; 37 % had at least one h and held video game , and 53 % had three or more computers . Average children 's weekday media exposure was 6.1 hours . At 6 months follow-up , the intervention group was less likely to report the TV being on when nobody was watching ( adjusted odds ratio ( AOR ) = 0.23 , P < 0.05 ) , less likely to report eating snacks while watching TV ( AOR = 0.47 , P < 0.05 ) , and less likely to have a TV in the child 's bedroom ( AOR = 0.23 , P < 0.01 ) . There was a trend toward reducing actual media consumption but these outcomes did not reach statistical significance . Effective strategies to reduce children 's TV viewing were identified Background Low levels of physical activity , musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer . Intensive medical treatment and a decline in physical activity may also result in reduced motor performance . Therefore , simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children ’s cancer treatment . Methods The aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer . The research is conducted as a parallel r and omized clinical trial with follow-up . Patients between 3 and 16 years old , diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate . Based on statistical estimates , the target enrollment is 40 patients . The intervention includes playing elective active video games and , in addition , education and consultations for the family . The control group will receive a general recommendation for physical activity for 30 minutes per day . The main outcomes are the amount of physical activity and sedentary behavior . Other outcomes include motor performance , fatigue and metabolic risk factors . The outcomes are examined with question naires , diaries , physical examinations and blood tests at baseline and at 2 , 6 , 12 and 30 months after the baseline . Additionally , the children ’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months . Discussion This trial will help to answer the question of whether playing active video games is beneficial for children with cancer . It will also provide further reasoning for physical activity promotion and training of motor skills during treatment . Trial registration Clinical Trials.gov identifier : NCT01748058 ( October 15 , 2012 )
Reflecting public health interest in the potential of exergames to encourage PA , many review s of this literature have appeared.18 - 20 Some review s have been sympathetic,21,22 whereas others have been critical.23,24 A reasonably balanced assessment revealed that , in research laboratories , exergames could provide an intense workout that included moderate-to-vigorous PA  , but under less-supervised circumstances , children tended not to get much activity18 and their interest in the activity waned over 1 week or less .
Video games , the most commonly enjoyed medium by this generation of children , generates more money than Hollywood productions .
Forty percent of these studies influenced obesity or obesogenic behavior in the desired directions.12 A roundtable discussion of investigators of G4H and obesity indicated substantial potential for video games to reduce child obesity , but emphasized the need for games to be fun , not just health promoting.13 Some of the obesity-related studies used games specially design ed to target diet and /or PA change outside the games.14 - 17 " Squire 's Quest ! , "