Nan Zeng

A systematic review of active video games on rehabilitative outcomes among older patients

Background Although current research supports the use of active video games (AVGs) in rehabilitation, the evidence has yet to be systematically reviewed or synthesized. The current project systematically reviewed literature, summarized findings, and evaluated the effectiveness of AVGs as a therapeutic tool in improving physical, psychological, and cognitive rehabilitative outcomes among older adults with chronic diseases. Methods Seven databases (Academic Search Complete, Communication & Mass Media Complete, ERIC, PsycINFO, PubMed, SPORTDiscus, and Medline) were searched for studies that evaluated the effectiveness of AVG-based rehabilitation among older patients. The initial search yielded 946 articles; after evaluating against inclusion criteria and removing duplicates, 19 studies of AVG-based rehabilitation remained. Results Most studies were quasi-experimental in design, with physical functioning the primary outcome investigated with regard to the use of AVGs in rehabilitation. Overall, 9 studies found significant improvements for all study outcomes, whereas 9 studies were mixed, with significant improvements on several study outcomes but no effects observed on other outcomes after AVG-based treatments. One study failed to find any benefits of AVG-based rehabilitation. Conclusion Findings indicate AVGs have potential in rehabilitation for older patients, with several randomized clinical trials reporting positive effects on rehabilitative outcomes. However, existing evidence is insufficient to support the advantages of AVGs over standard therapy. Given the limited number of studies and concerns with study design quality, more research is warranted to make more definitive conclusions regarding the ability of AVGs to improve rehabilitative outcomes in older patients.

Exergaming and obesity in youth: current perspectives

Although exergaming has been used as a physical activity modality among various populations, the evidence regarding its effectiveness on health-related outcomes in overweight/obese individuals remains unclear. The current study systematically reviewed literature and summarized findings of exergame-based interventions in overweight/obese populations with the goal of clarifying the current perspectives on exergaming and obesity. The initial search yielded 202 articles from six databases; 12 studies were included after evaluating for inclusion criteria and removing duplicates. Among these studies, seven were randomized controlled trials, two were control trials, and three were comparison studies. Overall, exergaming has the potential to attenuate weight gain and shows promise when used for physical activity and physical fitness promotion. Further, exergame play is positively associated with psychological well-being, but its effects on physiological outcomes are inconclusive. Finally, effects of exergaming on energy intake are not clear. Existing evidence supports that exergaming may elicit some health benefits in people who are overweight or/and obese. The limited number of available randomized controlled trials, however, restrict the ability to draw a conclusion that exergaming can trigger a change in all health-related outcomes. More research is warranted to make definitive conclusions regarding the effects of exergaming on health-related outcomes in such populations.

Reliability of Using Motion Sensors to Measure Children’s Physical Activity Levels in Exergaming

Objectives: This study examined the reliability of two objective measurement tools in assessing children’s physical activity (PA) levels in an exergaming setting. Methods: A total of 377 children (190 girls, Mage = 8.39, SD = 1.55) attended the 30-min exergaming class every other day for 18 weeks. Children’s PA levels were concurrently measured by NL-1000 pedometer and ActiGraph GT3X accelerometer, while children’s steps per min and time engaged in sedentary, light, and moderate-to-vigorous PA were estimated, respectively. Results: The results of intraclass correlation coefficient (ICC) indicated a low degree of reliability (single measures ICC = 0.03) in accelerometers. ANOVA did detect a possible learning effect for 27 classes (p < 0.01), and the single measures ICC was 0.20 for pedometers. Moreover, there was no significant positive relationship between steps per min and time spent in moderate-to-vigorous physical activity (MVPA). Finally, only 1.3% variance was explained by pedometer as a predictor using Hierarchical Linear Modeling to further explore the relationship between pedometer and accelerometer data. Conclusions: The NL-1000 pedometers and ActiGraph GT3X accelerometers have low reliability in assessing elementary school children’s PA levels during exergaming. More research is warranted in determining the reliable and accurate measurement information regarding the use of modern devices in exergaming setting.

Accelerometer-Determined Physical Activity and Clinical Low Back Pain Measures in Adolescents With Chronic or Subacute Recurrent Low Back Pain

STUDY DESIGN: Cross‐sectional. BACKGROUND: Although low back pain (LBP) occurs commonly in adolescence, little is known about the relationship between objectively measured physical activity and chronic LBP. OBJECTIVES: To assess the relationship between an objective physical activity measure (accelerometer) and standard clinical measures (pain intensity, disability, and quality of life) in a sample of adolescents with recurrent or chronic LBP. METHODS: The study included a subsample of 143 adolescents, 12 to 18 years of age, from a randomized clinical trial. Pearson correlations (r) and bivariate linear regression were used to assess the relationship between baseline measures of sedentary, light, and moderate‐to‐vigorous physical activity using accelerometers and clinical measures of LBP (pain intensity, disability, and quality of life). RESULTS: Participants spent an average of 610.5 minutes in sedentary activity, 97.6 minutes in light physical activity, and 35.6 minutes in moderate‐to‐vigorous physical activity per day. Physical activity was very weakly associated with clinical measures of LBP (r<0.13). None of the assessed correlations were statistically significant, and bivariate regression models showed that physical activity measures explained very little of the variability for clinical measures of LBP (R2<0.02). CONCLUSION: We found no important relationship between objectively measured physical activity and self‐reported LBP intensity, disability, or quality of life in adolescents with recurrent or chronic LBP. The parent randomized clinical trial was registered at ClinicalTrials. gov (NCT01096628).

Feasibility of smartphone application and social media intervention on breast cancer survivors’ health outcomes

Breast cancer survivors are at risk for poor health, with physical activity a possible treatment. Little research has examined how technology might promote breast cancer survivor physical activity or health. The aim of this study is to investigate the feasibility of employing a commercially available mobile health application- and social media-based health education intervention to improve breast cancer survivor physical activity or health.Ten breast cancer survivors (X̅ age = 45.80 ± 10.23 years; X̅ weight = 79.51 ± 20.85 kg) participated in this 10-week single-group pilot study from 2015 to 2016. Participants downloaded the MapMyFitness application, documented all physical activity with MapMyFitness, and were enrolled in a Social Cognitive Theory-based, Facebook-delivered health education intervention. Objectively measured physical activity, weight or body composition, cardiovascular fitness, psychosocial constructs, and quality of life indices were measured at baseline and 10 weeks. Intervention use and acceptability was evaluated during and following the intervention. Descriptive statistics were calculated for all study outcomes, with qualitative analyses performed regarding use and acceptability.At postintervention, average daily moderate-to-vigorous physical activity and steps increased by 2.6 min and 1,657, respectively, with notable decreases in weight (2.4 kg) and body fat percentage (2.3%). Physical activity-related social support and ability to engage in social roles or activity demonstrated the greatest improvements among all psychosocial and quality of life indices, respectively. Participants enjoyed the feedback and tracking features of MapMyFitness, with most finding the Facebook component helpful. All participants recommended the intervention for future use.Physical activity interventions combining commercially available mobile health applications and theoretically based social media-delivered health interventions may promote certain physiological, psychosocial, and quality of life outcomes among breast cancer survivors. Larger samples and randomized studies are warranted.

Effectiveness of Combined Smartwatch and Social Media Intervention on Breast Cancer Survivor Health Outcomes: A 10-Week Pilot Randomized Trial

Physical activity (PA) among breast cancer survivors (BCS) can improve this population’s health and quality of life (QoL). This study evaluated the effectiveness of a combined smartwatch- and social media-based health education intervention on BCS’s health outcomes. Thirty BCS (X¯age = 52.6 ± 9.3 years; X¯Wt = 80.2 ± 19.6 kg) participated in this 10-week, 2-arm randomized trial, with BCS randomized into: (1) experimental group (n = 16): received Polar M400 smartwatches for daily PA tracking and joined a Facebook group wherein Social Cognitive Theory-related PA tips were provided twice weekly; and (2) comparison group (n = 14): only joined separate, but content-identical Facebook group. Outcomes included PA, physiological, psychosocial, and QoL variables. Specifically, PA and energy expenditure (EE) was assessed by ActiGraph GT3X+ accelerometers while physiological, psychosocial, and QoL were examined via validated instruments at baseline and post-intervention. No baseline group differences were observed for any variable. Ten BCS dropped out of the study (experimental: 4; comparison: 6). Compared to completers, dropouts differed significantly on several outcomes. Thus, a per-protocol analysis was performed, revealing significant group differences for changes in social support (t = −2.1, p = 0.05) and barriers (t = −2.2, p = 0.04). Interestingly, the comparison group demonstrated improvements for both variables while the intervention group demonstrated slightly decreased social support and no change in barriers. Notably, both groups demonstrated similarly increased daily light PA, moderate-to-vigorous PA, EE, and steps of 7.7 min, 5.1 min, 25.1 kcals, and 339 steps, respectively, over time. Despite extensive user training, several experimental BCS found the Polar M400 use difficult—possibly decreasing intervention adherence. Future interventions should utilize simpler smartwatches to promote PA among middle-aged clinical/non-clinical populations.

Virtual Reality Exercise for Anxiety and Depression: A Preliminary Review of Current Research in an Emerging Field

Objective: Although current evidence supports the use of virtual reality (VR) in the treatment of mental disorders, it is unknown whether VR exercise would be beneficial to mental health. This review synthesized literature concerning the effect of VR exercise on anxiety and depression among various populations. Methods: Ten electronic databases were searched for studies on this topic from January 2000 through October 2017. Studies were eligible if the article: (1) was peer-reviewed; (2) was published in English; and (3) used quantitative measures in assessing anxiety- and depression-related outcomes. Results: A total of five empirical studies met the eligibility criteria. These studies included two randomized clinical trials, one control trial, and two cross-sectional studies. Four studies reported significant improvements in anxiety- and depression-related measures following VR exercise, including reduced tiredness and tension, in addition to increased energy and enjoyment. Nonetheless, one study failed to support the effectiveness of VR exercise over traditional exercise alone on depressive symptoms. Conclusions: Findings favor VR exercise in alleviating anxiety and depression symptomology. However, existing evidence is insufficient to support the advantages of VR exercise as a standalone treatment over traditional therapy in the alleviation of anxiety and depression given the paucity of studies, small sample sizes, and lack of high-quality research designs. Future studies may build upon these limitations to discern the optimal manner by which to employ VR exercise in clinical settings.

Effects of physical activity on motor skills and cognitive development in early childhood: A systematic review

Objective This study synthesized literature concerning casual evidence of effects of various physical activity programs on motor skills and cognitive development in typically developed preschool children. Methods Electronic databases were searched through July 2017. Peer-reviewed randomized controlled trials (RCTs) examining the effectiveness of physical activity on motor skills and cognitive development in healthy young children (4–6 years) were screened. Results A total of 15 RCTs were included. Of the 10 studies assessing the effects of physical activity on motor skills, eight (80%) reported significant improvements in motor performance and one observed mixed findings, but one failed to promote any beneficial outcomes. Of the five studies investigating the influence of physical activity on cognitive development, four (80%) showed significant and positive changes in language learning, academic achievement, attention, and working memory. Notably, one indicated no significant improvements were observed after the intervention. Conclusions Findings support causal evidence of effects of physical activity on both motor skills and cognitive development in preschool children. Given the shortage of available studies, future research with large representative samples is warranted to explore the relationships between physical activity and cognitive domains as well as strengthen and confirm the dose-response evidence in early childhood.

The Effects Of Exergaming On Patients' Rehabilitative Outcomes: A Meta-analysis: 285 Board #122 June 1, 9: 30 AM - 11: 00 AM.

METHODS: Meta-analyses of randomized controlled exercise intervention trials were included by searching 9 electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality was assessed using AMSTAR while quality of the evidence was assessed using GRADE. Results were summarized and prediction intervals, number needed-to-treat (NNT), and percentile improvements calculated. A random-effects model was used to pool results from the individual studies included in each meta-analysis. RESULTS: Of 277 citations screened, 3 meta-analyses that included 2-9 studies and 63-599 men and women (total N = 950) were included. Moderate to vigorous exercise was performed for 5-52 weeks, 3-10 times per week, for 20-90 minutes per session. Methodological quality ranged from 36%-64% while quality of the evidence was very low to low. Statistically significant improvements (p < 0.05) were observed for the Apnea-Hypopnea Index (AHI), overall sleep quality, global score, subjective sleep and sleep latency. No statistically significant differences were observed for sleep duration, efficiency, disturbance or daytime function. The NNT and percentile improvements ranged from 4-7 and 18.1-21.9, respectively. With the exception of AHI, statistically significant heterogeneity and a large amount of inconsistency were observed for all statistically significant outcomes. When pooled, statistically significant standardized mean difference (SMD) improvements along with statistically significant heterogeneity and a large amount of inconsistency were found for overall sleep quality (SMD = -0.50, 95% CI, -0.72, -0.28, z = 4.6, p <0.001; Q = 30.7, p = 0.004; I-squared = 57.7%, 95% CI, 23.4%76.6%). The NNT was 7 while percentile improvement was 19. CONCLUSIONS: Exercise is associated with improvements in selected sleep outcomes in the sample of adults included. A need exists for a large, well-designed, and more inclusive meta-analysis. (PROSPERO Registration #CRD42015023449). Supported by NIH Grant U54GM104942.