Louise Foley

Effects of active video games on body composition: a randomized controlled trial

BACKGROUNDnSedentary 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.nnnOBJECTIVEnThe 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.nnnDESIGNnWe conducted a 2-arm, parallel, randomized controlled trial in Auckland, New Zealand. A total of 322 overweight and obese children aged 10-14 y, who were current users of sedentary video games, were randomly assigned at a 1:1 ratio to receive either an active video game upgrade 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.nnnRESULTSnAt 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).nnnCONCLUSIONnAn 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 Zealand Clinical Trials Registry at http://www.anzctr.org.au/ as ACTRN12607000632493.

Changes in active commuting and changes in physical activity in adults: a cohort study

BackgroundActive travel is associated with greater physical activity, but there is a dearth of research examining this relationship over time. We examined the longitudinal associations between change in time spent in active commuting and changes in recreational and total physical activity.MethodsAdult commuters working in Cambridge, United Kingdom completed questionnaires in 2009 and 2012, and a sub-set completed objective physical activity monitoring in 2010 and 2012. Commuting was assessed using a validated seven-day travel to work record. Moderate-to-vigorous physical activity was assessed using the Recent Physical Activity Questionnaire and combined heart rate and movement sensing. We used multivariable multinomial logistic regression models to examine associations between change in time spent in active commuting and tertiles of changes in time spent in recreational and total physical activity.ResultsFour hundred sixty-nine participants (67xa0% female, mean age 44xa0years) provided valid travel and self-reported physical activity data. Seventy-one participants (54xa0% female, mean age 45xa0years) provided valid travel and objectively measured physical activity data. A decrease in active commuting was associated with a greater likelihood of a decrease in self-reported total physical activity (relative risk ratio [RRR] 2.1, 95xa0% CI 1.1, 4.1). Correspondingly, an increase in active commuting was associated with a borderline significantly greater likelihood of an increase in self-reported total physical activity (RRR 1.8, 95xa0% CI 1.0, 3.4). No associations were seen between change in time spent in active commuting and change in time spent in either self-reported recreational physical activity or objectively measured physical activity.ConclusionsChanges in active commuting were associated with commensurate changes in total self-reported physical activity and we found no compensatory changes in self-reported recreational physical activity. Promoting active commuting has potential as a public health strategy to increase physical activity. Future longitudinal research would be useful to verify these findings.

Screen-Time Weight-loss Intervention Targeting Children at Home (SWITCH): a randomized controlled trial

BackgroundScreen-based activities, such as watching television (TV), playing video games, and using computers, are common sedentary behaviors among young people and have been linked with increased energy intake and overweight. Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child, small sample sizes, and short follow-up periods. The SWITCH (Screen-Time Weight-loss Intervention Targeting Children at Home) study aimed to determine the effect of a home-based, family-delivered intervention to reduce screen-based sedentary behaviour on body composition, sedentary behaviour, physical activity, and diet over 24 weeks in overweight and obese children.MethodsA two-arm, parallel, randomized controlled trial was conducted. Children and their primary caregiver living in Auckland, New Zealand were recruited via schools, community centres, and word of mouth. The intervention, delivered over 20 weeks, consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content, which focused on training and educating them to use a wide range of strategies designed to reduce their child’s screen time. Families were given Time Machine TV monitoring devices to assist with allocating screen time, activity packages to promote alternative activities, online support via a website, and monthly newsletters. Control participants were given the intervention material on completion of follow-up. The primary outcome was change in children’s BMI z-score from baseline to 24 weeks.ResultsChildren (n = 251) aged 9-12 years and their primary caregiver were randomized to receive the SWITCH intervention (n = 127) or no intervention (controls; n = 124). There was no significant difference in change of zBMI between the intervention and control groups, although a favorable trend was observed (-0.016; 95% CI: -0.084, 0.051; p = 0.64). There were also no significant differences on secondary outcomes, except for a trend towards increased children’s moderate intensity physical activity in the intervention group (24.3 min/d; 95% CI: -0.94, 49.51; p = 0.06).ConclusionsA home-based, family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9-12 years.Trial registrationAustralian New Zealand Clinical Trials RegistryWebsite: http://www.anzctr.org.auTrial registration number: ACTRN12611000164998

Effects of living near an urban motorway on the wellbeing of local residents in deprived areas: Natural experimental study

Background Health and wellbeing are partly shaped by the neighbourhood environment. In 2011, an eight kilometre (five mile) extension to the M74 motorway was opened in Glasgow, Scotland, constructed through a predominantly urban, deprived area. We evaluated the effects of the new motorway on wellbeing in local residents. Methods This natural experimental study involved a longitudinal cohort (n = 365) and two cross-sectional samples (baseline n = 980; follow-up n = 978) recruited in 2005 and 2013. Adults from one of three study areas—surrounding the new motorway, another existing motorway, or no motorway—completed a postal survey. Within areas, individual measures of motorway proximity were calculated. Wellbeing was assessed with the mental (MCS-8) and physical (PCS-8) components of the SF-8 scale at both time points, and the short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) at follow-up only. Results In multivariable linear regression analyses, cohort participants living nearer to the new M74 motorway experienced significantly reduced mental wellbeing over time (MCS-8: -3.6, 95% CI -6.6 to -0.7) compared to those living further away. In cross-sectional and repeat cross-sectional analyses, an interaction was found whereby participants with a chronic condition living nearer to the established M8 motorway experienced reduced (MCS-8: -3.7, 95% CI -8.3 to 0.9) or poorer (SWEMWBS: -1.1, 95% CI -2.0 to -0.3) mental wellbeing compared to those living further away. Conclusions We found some evidence that living near to a new motorway worsened local residents’ wellbeing. In an area with an existing motorway, negative impacts appeared to be concentrated in those with chronic conditions, which may exacerbate existing health inequalities and contribute to poorer health outcomes. Health impacts of this type of urban regeneration intervention should be more fully taken into account in future policy and planning.

Effects of living near a new urban motorway on the travel behaviour of local residents in deprived areas: Evidence from a natural experimental study

ABSTRACT We evaluated the effects of a new motorway built through deprived neighbourhoods on travel behaviour in residents. This natural experiment comprised a longitudinal cohort (n=365) and two cross‐sectional samples (baseline n=980; follow‐up n=978) recruited in 2005 and 2013. Adults from one of three study areas ‐ surrounding the new motorway (South), an existing motorway (East), or no motorway (North) ‐ completed a previous day travel record. Adjusted two‐part regression models examined associations between exposure and outcome. Compared to the North, cohort participants in the South were more likely to undertake travel by any mode (OR 2.1, 95% CI 1.0–4.2) at follow‐up. Within the South study area, cohort participants living closer to a motorway junction were more likely to travel by any mode at follow‐up (OR 4.7, 95% CI 1.1–19.7), and cross‐sectional participants living closer were more likely to use a car at follow‐up (OR 3.4, 95% CI 1.1–10.7), compared to those living further away. Overall, the new motorway appeared to promote travel and car use in those living nearby, but did not influence active travel. This may propagate socioeconomic inequalities in non‐car owners.

Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH): process evaluation of a randomised controlled trial intervention

BackgroundThe Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH) trial tested a family intervention to reduce screen-based sedentary behaviour in overweight children. The trial found no significant effect of the intervention on children’s screen-based sedentary behaviour. To explore these null findings, we conducted a pre-planned process evaluation, focussing on intervention delivery and uptake.MethodsSWITCH was a randomised controlled trial of a 6-month family intervention to reduce screen time in overweight children aged 9–12 years (nu2009=u2009251). Community workers met with each child’s primary caregiver to deliver the intervention content. Community workers underwent standard training and were monitored once by a member of the research team to assess intervention delivery. The primary caregiver implemented the intervention with their child, and self-reported intervention use at 3 and 6xa0months. An exploratory analysis determined whether child outcomes at 6xa0months varied by primary caregiver use of the intervention.ResultsMonitoring indicated that community workers delivered all core intervention components to primary caregivers. However, two thirds of primary caregivers reported using any intervention component “sometimes” or less frequently at both time points, suggesting that intervention uptake was poor. Additionally, analyses indicated no effect of primary caregiver intervention use on child outcomes at 6xa0months, suggesting the intervention itself lacked efficacy.ConclusionsPoor uptake, and the efficacy of the intervention itself, may have played a role in the null findings of the SWITCH trial on health behaviour and body composition.Trial registrationThe trial was registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12611000164998); registration date: 10/02/2011.

Experiences of connectivity and severance in the wake of a new motorway: Implications for health and well-being

The construction of new urban roads may cause severance, or the separation of residents from local amenities or social networks. Using qualitative data from a natural experimental study, we examined severance related to a new section of urban motorway constructed through largely deprived residential neighbourhoods in Glasgow, Scotland. Semi-structured and photo-elicitation interviews were used to better understand severance and connectivity related to the new motorway, and specifically implications for individual and community-level health and well-being through active travel and social connections. Rather than a clear severance impact attributable to the motorway, a complex system of connection and severance was spoken about by participants, with the motorway being described by turns as a force for both connection and severance. We conclude that new transport infrastructure is complex, embedded, and plausibly causally related to connectedness and health. Our findings suggest the potential for a novel mechanism through which severance is enacted: the disruptive impacts that a new road may have on third places of social connection locally, even when it does not physically sever them. This supports social theories that urge a move away from conceptualising social connectedness in terms of the local neighbourhood only, towards an understanding of how we live and engage dynamically with services and people in a much wider geographical area, and may have implications for local active travel and health through changes in social connectedness.

Patterns of health behaviour associated with active travel: a compositional data analysis

BackgroundActive travel (walking or cycling for transport) is associated with favourable health outcomes in adults. However, little is known about the concurrent patterns of health behaviour associated with active travel. We used compositional data analysis to explore differences in how people doing some active travel used their time compared to those doing no active travel, incorporating physical activity, sedentary behaviour and sleep.MethodsWe analysed cross-sectional data from the 2014/15 United Kingdom Harmonised European Time Use Survey. Participants recorded two diary days of activity, and we randomly selected one day from participants aged 16xa0years or over. Activities were categorised into six mutually exclusive sets, accounting for the entire 24xa0h: (1) sleep; (2) leisure moderate to vigorous physical activity (MVPA); (3) leisure sedentary screen time; (4) non-discretionary time (work, study, chores and caring duties); (5) travel and (6) other. This mixture of activities was defined as a time-use composition. A binary variable was created indicating whether participants reported any active travel on their selected diary day. We used compositional multivariate analysis of variance (MANOVA) to test whether mean time-use composition differed between individuals reporting some active travel and those reporting no active travel, adjusted for covariates. We then used adjusted linear regression models and bootstrap confidence intervals to identify which of the six activity sets differed between groups.Results6143 participants (mean age 48xa0years; 53% female) provided a valid diary day. There was a statistically significant difference in time-use composition between those reporting some active travel and those reporting no active travel. Those undertaking active travel reported a relatively greater amount of time in leisure MVPA and travel, and a relatively lower amount of time in leisure sedentary screen time and sleep.ConclusionsCompared to those not undertaking active travel, those who did active travel reported 11xa0min more in leisure MVPA and 18xa0min less in screen time per day, and reported lower sleep. From a health perspective, higher MVPA and lower screen time is favourable, but the pattern of sleep is more complex. Overall, active travel was associated with a broadly health-promoting composition of time across multiple behavioural domains, which supports the public health case for active travel.

Effects of urban motorways on physical activity and sedentary behaviour in local residents: A natural experimental study

BackgroundThere is little evidence on how changing the physical environment changes health-related behaviours. We studied the effects of the new M74 motorway (freeway) — opened in 2011 — and the existing M8 motorway in Glasgow, Scotland, on physical activity and sedentary behaviour among local residents.MethodsThis natural experimental study used baseline (T1; 2005) and follow-up data (T2; 2013) from a longitudinal cohort (Nxa0=xa0365) and two cross-sectional samples (T1xa0Nxa0=xa0980; T2xa0Nxa0=xa0978). Adult participants were recruited from three study areas: one surrounding the new motorway, one surrounding the existing motorway, and a third, control, area without a motorway. The outcomes were self-reported time spent sitting, walking, and in moderate-to-vigorous physical activity (MVPA). Motorway exposure was defined in terms of (1) study area and (2) distance from home to the nearest motorway junction. Outcomes were regressed on exposures in two-part (walking and MVPA) or linear (sedentary behaviour) cohort and repeat cross-sectional models, adjusted for baseline behaviour and sociodemographic covariates.ResultsCohort participants living in the M8 area were less likely to participate in MVPA at follow-up than those living in the area without a motorway (OR 0.37; 95%CI 0.15, 0.91). Within the M8 area, those living closer to the motorway were also less likely to do so (OR 0.30; 95%CI 0.09, 0.97). No other statistically significant results were found.ConclusionsWe found some evidence of a negative association between exposure to an existing urban motorway and MVPA. However, the behavioural impacts of motorways are likely to be complex and evolve over time.

Health impacts of the M74 urban motorway extension: a natural experimental study

Abstract Background Increasing peoples mobility can improve access to diverse opportunities, but new roads are associated with noise and community severance, and their effects on physical activity, injuries, and health inequalities are poorly understood. This study investigated how an urban motorway, opened in Glasgow in 2011, affected travel and activity patterns, injuries, and wellbeing in local communities, and how these impacts were experienced and brought about. Methods This was a mixed-method, controlled, before and after natural experimental study. We conducted multivariable cohort, cross-sectional, and repeat cross-sectional analyses of survey responses from adults resident in the M74 corridor (intervention area) and two matched control areas, one surrounding the existing M8 motorway and one with no motorway (numbers by area: baseline [in 2005] 449, 431, 465, respectively; follow-up [in 2013] 430, 446, 467; cohort participants 126, 112, 127). We also conducted interrupted time-series analyses of police casualty data (STATS19 forms, 1997–2014; n=78u2008919), and thematic analysis of ethnographic data from 42 participants using constant comparison. Graded exposure measures based on the log distance of the motorway from each participants home served as a further basis for controlled comparisons. The study was approved by the University of Glasgow Faculty of Medicine (ref FM01304) and Social Sciences (refs 400120077, 400130156, and 400130157) ethics committees. Findings Living closer to the new motorway was associated with an estimated 3·6 unit (95% CI 0·7–6·6) reduction over time in mental wellbeing (mental component summary score [MCS-8] of SF-8) per unit of proximity in cohort analysis, and associated with a greater likelihood of car use at follow-up in repeat cross-sectional analysis (odds ratio 3·4, 95% CI 1·1–10·7). We found some evidence that participation in physical activity declined among cohort participants living closer to the existing M8 motorway (0·4, 0·2–0·9). We found no evidence of changes in active travel (survey data) or casualties (STATS19 data). Although the new motorway improved connectivity for individuals with more dispersed social networks and access to a motor vehicle, the impacts on those with neither of them were more complex and sometimes negative. Changes in community composition and cohesion, and perceptions of personal safety, were widely perceived as more important influences than was the opening of the motorway. Interpretation Although the study identified both benefits and harms, overall these findings highlight the potential for new major road infrastructure to add further burdens to already disadvantaged communities, exacerbating inequalities and contributing to poorer health outcomes. Funding National Institute for Health Research (NIHR) Public Health Research Programme. The funder had no role in the design of the study, the analysis or interpretation of the data, the writing of the abstract, or the decision to submit it for publication.