Monique Simons

Games for Health for Children - Current Status and Needed Research

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a populations diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.

The association between commuter cycling and sickness absence

OBJECTIVE To study the association between commuter cycling and all-cause sickness absence, and the possible dose-response relationship between absenteeism and the distance, frequency and speed of commuter cycling. METHOD Cross-sectional data about cycling in 1236 Dutch employees were collected using a self-report questionnaire. Company absenteeism records were checked over a one-year period (May 2007-April 2008). Propensity scores were used to make groups comparable and to adjust for confounders. Zero-inflated Poisson models were used to assess differences in absenteeism between cyclists and non-cyclists. RESULTS The mean total duration of absenteeism over the study year was more than 1 day shorter in cyclists than in non-cyclists. This can be explained by the higher proportion of people with no absenteeism in the cycling group. A dose-response relationship was observed between the speed and distance of cycling and absenteeism. Compared to people who cycle a short distance (<or=5 km) three times a week, people who cycle more often and longer distances are absent for fewer days on average. CONCLUSION Cycling to work is associated with less sickness absence. The more often people cycle to work and the longer the distance travelled, the less they report sick.

Active and non-active video gaming among Dutch adolescents: Who plays and how much?

OBJECTIVES The aim of study was to determine prevalence and identify demographic correlates of active and non-active gaming among adolescents. DESIGN Cross-sectional. METHODS A survey, assessing game behavior and correlates, was conducted among adolescents (12-16 years, n = 373), recruited via schools. Multivariable logistic regression analyses were conducted to examine demographic correlates of active gaming (≥ 1 h per week) and non-active gaming (>7h per week). RESULTS Of all participants (n=373), 3% reported to play exclusively active games, 40% active games and non-active games, 40% exclusively non-active games, and 17% not playing video games at all. Active gaming adolescents played active games on average on 1.5 (sd = 1.2) days per school week for 36 (sd = 32.9)min and 1 (sd = 0.54) day per weekend for 42 (sd = 36.5)min. Non-active gaming adolescents played on average on 3.3 (sd = 1.6) days per school week for 65 (sd = 46.0)min and 1.4 (sd = 0.65) days per weekend for 80 (sd = 50.8)min. Adolescents attending lower levels of education were more likely to play active games ≥ 1 h per week than adolescents attending higher educational levels. Boys and older adolescents were more likely to play non-active games >7h per week, than girls or younger adolescents. CONCLUSIONS Many adolescents play active games, especially those following a lower educational level, but time spent in this activity is relatively low compared to non-active gaming. To be feasible as a public health strategy, active gaming interventions should achieve more time is spent on active gaming at the expense of non-active gaming.

Dutch children and parents' views on active and non-active video gaming

Active video games that require whole body movement to play the game may be an innovative health promotion tool to substitute sedentary pastime with more active time and may therefore contribute to childrens health. To inform strategies aimed at reducing sedentary behavior by replacing non-active by active gaming, opinions about active and non-active video games are explored among 8- to 12-year-old children and their parents. Six qualitative, semi-structured focus groups were held with 8- to 12-year-old children (n = 46) and four with their parents (n = 19) at three different primary schools in The Netherlands. The focus groups with children discussed game preferences, gaming context and perceived game-related parenting. The focus groups with parents addressed considerations in purchasing video games, perceived positive and negative consequences of gaming, and game-related parenting. Both children and their parents were very positive about active video games and preferred active games over non-active games. Active video games were considered more social than non-active video games, and active games were played more often together with friends and family than non-active video games. Parenting practices did not differ for active and non-active video games, although some parents were less strict regarding active games. Two conditions for practical implementation were met: children enjoyed active video games, and parents were willing to buy active video games. Active video games were preferred to non-active video games, illustrating that using active video games is a promising health promotion tool to reduce sedentary pastime in youth.

Efficient and Effective Change Principles in Active Videogames

Active videogames have the potential to enhance population levels of physical activity but have not been successful in achieving this aim to date. This article considers a range of principles that may be important to the design of effective and efficient active videogames from diverse discipline areas, including behavioral sciences (health behavior change, motor learning, and serious games), business production (marketing and sales), and technology engineering and design (human-computer interaction/ergonomics and flow). Both direct and indirect pathways to impact on population levels of habitual physical activity are proposed, along with the concept of a game use lifecycle. Examples of current active and sedentary electronic games are used to understand how such principles may be applied. Furthermore, limitations of the current usage of theoretical principles are discussed. A suggested list of principles for best practice in active videogame design is proposed along with suggested research ideas to inform practice to enhance physical activity.

Replacing Non-Active Video Gaming by Active Video Gaming to Prevent Excessive Weight Gain in Adolescents

Objective The aim of the current study was to evaluate the effects of and adherence to an active video game promotion intervention on anthropometrics, sedentary screen time and consumption of sugar-sweetened beverages and snacks among non-active video gaming adolescents who primarily were of healthy weight. Methods We assigned 270 gaming (i.e. ≥2 hours/week non-active video game time) adolescents randomly to an intervention group (n = 140) (receiving active video games and encouragement to play) or a waiting-list control group (n = 130). BMI-SDS (SDS = adjusted for mean standard deviation score), waist circumference-SDS, hip circumference and sum of skinfolds were measured at baseline, at four and ten months follow-up (primary outcomes). Sedentary screen time, physical activity, consumption of sugar-sweetened beverages and snacks, and process measures (not at baseline) were assessed with self-reports at baseline, one, four and ten months follow-up. Multi-level-intention to treat-regression analyses were conducted. Results The control group decreased significantly more than the intervention group on BMI-SDS (β = 0.074, 95%CI: 0.008;0.14), and sum of skinfolds (β = 3.22, 95%CI: 0.27;6.17) (overall effects). The intervention group had a significantly higher decrease in self-reported non-active video game time (β = -1.76, 95%CI: -3.20;-0.32) and total sedentary screen time (Exp (β = 0.81, 95%CI: 0.74;0.88) than the control group (overall effects). The process evaluation showed that 14% of the adolescents played the Move video games every week ≥1 hour/week during the whole intervention period. Conclusions The active video game intervention did not result in lower values on anthropometrics in a group of ‘excessive’ non-active video gamers (mean ~ 14 hours/week) who primarily were of healthy weight compared to a control group throughout a ten-month-period. Even some effects in the unexpected direction were found, with the control group showing lower BMI-SDS and skin folds than the intervention group. The intervention did result in less self-reported sedentary screen time, although these results are likely biased by social desirability. Trial Registration Dutch Trial Register NTR3228

Feasibility of an Active Game Program in a Dutch Pre-Vocational High School Setting

OBJECTIVE This study examined the use of an active gaming program in a pre-vocational school over a 1-year period. SUBJECTS AND METHODS Three hundred students (mean age, 13.3 years; range, 12-18 years) were invited to participate and exposed to the active game program called E-sportszone, in which they could participate during the school day and after school. Attendance to E-sportszone was assessed by objectively monitoring over a 1-year period and self-report. Questionnaires about E-sportszone attendance, physical activity (PA), and sedentary behavior and underlying psychosocial determinants were administered at baseline and after 1 year. RESULTS Forty-two percent of the students attended the E-sportszone at least once. Attendance over the year varied from 1 day through 114 days (median, 3 days) with a peak during the E-sportszone marathon that was organized. Multivariate analysis showed boys used the E-sportszone more than girls (odds ratio [OR] 2.8) and older students were less likely to be users than younger students (OR 0.4). Furthermore, students who had a more positive attitude toward PA (OR 1.5) or who had higher scores on intention to use the E-sportszone (OR 1.5) were more likely to engage in active gaming than those who had lower scores. CONCLUSIONS A substantial group of at-risk students (i.e., high body mass index, low PA, and high level of sedentary behavior) used the E-sportszone at least once. However, frequency of usage was low, resulting in limited contribution to PA behavior. Long-term use was challenging, and future studies should focus on strategies to encourage continued use of active games in this type of pre-vocational school setting.

Energy Expenditure of Three Public and Three Home-based Active Video Games in Children

The purpose of this study was to assess the energy expenditure (EE) experienced by children when playing six active video games, which can be used in a home environment and in a public setting (e.g. game center), and to evaluate whether the intensity of playing these games can meet the threshold for moderate-intensity physical activity, which is set at an EE equivalent to three times resting metabolic rate. Children are recommended to be physically active at a moderate intensity for at least one hour a day.

Personal, social, and game-related correlates of active and non-active gaming among dutch gaming adolescents : survey-based multivariable, multilevel logistic regression analyses

Background Playing video games contributes substantially to sedentary behavior in youth. A new generation of video games—active games—seems to be a promising alternative to sedentary games to promote physical activity and reduce sedentary behavior. At this time, little is known about correlates of active and non-active gaming among adolescents. Objective The objective of this study was to examine potential personal, social, and game-related correlates of both active and non-active gaming in adolescents. Methods A survey assessing game behavior and potential personal, social, and game-related correlates was conducted among adolescents (12-16 years, N=353) recruited via schools. Multivariable, multilevel logistic regression analyses, adjusted for demographics (age, sex and educational level of adolescents), were conducted to examine personal, social, and game-related correlates of active gaming ≥1 hour per week (h/wk) and non-active gaming >7 h/wk. Results Active gaming ≥1 h/wk was significantly associated with a more positive attitude toward active gaming (OR 5.3, CI 2.4-11.8; P<.001), a less positive attitude toward non-active games (OR 0.30, CI 0.1-0.6; P=.002), a higher score on habit strength regarding gaming (OR 1.9, CI 1.2-3.2; P=.008) and having brothers/sisters (OR 6.7, CI 2.6-17.1; P<.001) and friends (OR 3.4, CI 1.4-8.4; P=.009) who spend more time on active gaming and a little bit lower score on game engagement (OR 0.95, CI 0.91-0.997; P=.04). Non-active gaming >7 h/wk was significantly associated with a more positive attitude toward non-active gaming (OR 2.6, CI 1.1-6.3; P=.035), a stronger habit regarding gaming (OR 3.0, CI 1.7-5.3; P<.001), having friends who spend more time on non-active gaming (OR 3.3, CI 1.46-7.53; P=.004), and a more positive image of a non-active gamer (OR 2, CI 1.07–3.75; P=.03). Conclusions Various factors were significantly associated with active gaming ≥1 h/wk and non-active gaming >7 h/wk. Active gaming is most strongly (negatively) associated with attitude with respect to non-active games, followed by observed active game behavior of brothers and sisters and attitude with respect to active gaming (positive associations). On the other hand, non-active gaming is most strongly associated with observed non-active game behavior of friends, habit strength regarding gaming and attitude toward non-active gaming (positive associations). Habit strength was a correlate of both active and non-active gaming, indicating that both types of gaming are habitual behaviors. Although these results should be interpreted with caution because of the limitations of the study, they do provide preliminary insights into potential correlates of active and non-active gaming that can be used for further research as well as preliminary direction for the development of effective intervention strategies for replacing non-active gaming by active gaming among adolescents.

Gaming, Adiposity, and Obesogenic Behaviors among Children

Videogames in general have been maligned for causing obesity because of their inherent sedentariness, whereas exergames have been both maligned for requiring low levels of activity and extolled for requiring physical activity to move game play along. The intensity and duration of physical activity resulting from exergame play have shown varying results, and they have been explored for use in obesity treatment and prevention, primarily among children. Other videogames have been developed and tested to help children change their diet and physical activity practices with various outcomes. As a field of inquiry, we are in the earliest stages of understanding how, or under what circumstances, videogames can influence all these behavioral and health outcomes. To deal with these complexities, we have assembled a group of investigators who have made important, but diverse, contributions to this research agenda and asked them to address five key child obesity-related issues in a Roundtable format. Brief biosketches are presented at the end of this article.