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BackgroundThe prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences. ObjectiveThis pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs. MethodsParticipants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA. ResultsOf the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (−58.8 min; P=.04) but not for the intervention group (−5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames. ConclusionsAGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing. Trial RegistrationClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415.

BackgroundFamily-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the “mHealth DRIVE” program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. ObjectiveThe objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. MethodsStudy 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. ResultsParental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children’s (N=10) BMI z-scores significantly decreased (mean –0.14, SD 0.17; P=.025). Over 90% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80% of providers reported that they and the families would benefit from digital tools to support child weight management. ConclusionsPediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers. Trial RegistrationClinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541.

BackgroundPreschool age is an important time to master fundamental motor skills (FMS) through structured physical activity, yet many young children lag behind in motor skill development. ObjectiveThe Promoting Lifelong Activity in Youth (PLAY) study is a pilot comparative effectiveness trial to test the acceptability, feasibility, and preliminary effectiveness of a mobile app delivered to parents to promote FMS development in their preschool children (aged 3-5 years). MethodsWe conducted a 2-arm, parallel-design, randomized comparative effectiveness trial in 72 parent-child dyads from the southeastern United States. Experts in motor development and developmental psychology developed an app designed to deliver a 12-week program to parents of preschoolers using 1 of 2 curricula: an FMS program (intervention) that involved peer modeling, parent engagement, and structured skills-based activities and an unstructured physical activity (comparator) curriculum that provided suggestions for child-led physical activity (ie, free play). Primary outcomes are feasibility and acceptability of the app and child’s FMS measured at end of intervention (week 12). Exploratory outcomes are child’s objective physical activity, perceived movement competence, and parent report of self-regulation at the end of treatment (week 12) and sustained outcomes at follow-up (week 24). ResultsThis project was funded in September 2018, with institutional review board approval in August 2018. Data collection took place from May 2019 through February 2020. To date, the project team has completed data collection on 69 preschool-age children, and results are expected to be published by 2021. ConclusionsThe PLAY study examines the feasibility and preliminary effectiveness of a mobile app, parent-led curricula to promote FMS proficiency for preschool children. If found to be effective, the app has the potential for wide-scale dissemination to parents of preschoolers and to provide a model for the utilization of mobile apps to promote young children’s motor skill development. Trial RegistrationClinicalTrials.gov NCT03901300; https://clinicaltrials.gov/ct2/show/NCT03901300 International Registered Report Identifier (IRRID)DERR1-10.2196/19943

Background: Toddler physical activity is critical for child health, but little is known about its applications in early childhood education (ECE) centers. The aims of this study were 1) to determine if pragmatic and nature-based modifications to an ECE center's outdoor setting were feasible and acceptable, and 2) to identify barriers and facilitators of toddler physical activity at ECE centers. Methods: A multiphase mixed-methods study (QUANT+QUAL) was conducted. In the QUANT study, a stepped, sequential modification of the outdoor setting, using pragmatic and cost-effective nature-based elements, was conducted with a delayed control group over 10-weeks, with follow-up assessments 3-months later (week-20). Five elements (tree cookies, garden, teacher training, playground stencils, and nature table) were introduced individually. Feasibility was assessed using teacher surveys. Acceptability and engagement were assessed by direct observation of toddler use of outdoor elements. Accelerometers were used to assess toddlers' physical activity during outdoor sessions. The QUAL study included semi-structured interviews from ECE center directors (n = 27, 55.6% African American, 92.5% female) that were analyzed using content analysis for themes related to 1) toddler physical activity, 2) barriers and facilitators to toddler outdoor environment changes, 3) perspectives on nature-based elements, and 4) provider training. Member check focus groups (n = 2, 7-10/group) were conducted for additional interpretation. All three sources were reviewed for integration. Results: Toddlers engaged in physical activity for most of the outdoor sessions (>85%). This limited the effect of the intervention, but aligned with directors' and members' sentiments that toddlers were already quite active. Across directors, reported barriers to toddler outdoor environment changes were teacher turnover and finances. All nature-based elements, except the stencils, were feasible and acceptable, even at week-20. Directors and members identified additional age-appropriate elements, and desired pragmatic training with technical assistance and funding to implement these changes. Directors and members also desired a curriculum that could be used outdoors. Conclusions: Nature-based elements were feasible and acceptable to toddlers. Directors were enthusiastic about nature-based elements, but barriers exist in linking directors with these elements. Opportunities to combine toddler-age curricula and pragmatic options for outdoor play may improve ECE centers' outdoor settings and ultimately toddler health. [ABSTRACT FROM AUTHOR]

Purpose: Summer day camp offers children opportunities to grow knowledge and skills, be physically active, and have fun. Compared to healthy children, at-risk children (i.e., overweight, or with obesity and chronic health conditions) typically display less optimal health behaviors and psychosocial well-being, especially during summer months. This study examined the preliminary effectiveness of an American-Diabetes-Association-sponsored summer day camp at improving children's health behaviors (i.e., physical activity, screen time, diet, sleep) and psychosocial well-being outcomes (i.e., quality of life [QoL], enjoyment, weight-related self-efficacy). Method: The sample consisted of 39 participants, including 19 boys and 20 girls, with majority being overweight (n = 4 or 10%) or with obesity (n = 26 or 67%), who attended the day camp for one week. Results: Significant improvements were observed in screen time, quality of life, and physical function. The results further showed significant time by gender interaction effect for overall QoL (p < 0.05, η p 2 = 0.15), physical health (a dimension of QoL; p < 0.05, η p 2 = 0.18), and significant time by household income for the psychosocial health (another dimension of QoL), favoring boys and those from higher income families. Discussion: The findings indicate a positive preliminary effectiveness of the summer camp at reducing children's screen time and improving their QoL, especially in boys and those from higher-income families. Future research should focus on health disparities and expansion of this camp for the potential of longer-term and more robust effects related to wellness, nutrition literacy, physical activity promotion, and obesity prevention. [ABSTRACT FROM AUTHOR]

BackgroundYouth in the United States have low levels of cardiorespiratory fitness, a risk factor for childhood obesity. Lower levels of physical fitness for black and Hispanic youth contribute to health disparities. In this feasibility study, we examined active video games (AVGs) as a tool to improve fitness and attitudes toward physical activity during early adolescence.MethodA 6-week AVG program took place in a youth development program in a high-poverty neighborhood in New York City. Youth aged 10 to 15 years (50% overweight or obese) participated in 2 fitness tests and completed surveys that captured barriers to physical activity pre- and postintervention. Each week, participants played Wii Fit games for 30 minutes.ResultsParticipants improved the number of sit-ups and step-ups they completed from pre- to postintervention (p

This pilot study tested the efficacy of auditory and visual stimuli to increase children's exercise intensity while exercising in a classroom. Nineteen children aged 6 to 12 years participated in four exercise conditions (treadmill with and without music; cycling with and without video) with heart rate monitored continuously. This study used "t" tests to compare % HR above rest between conditions. Children met levels of vigorous intensity in all conditions. There was a small but nonsignificant effect in % HR for treadmill (94 ± 18 with music vs. 87 ± 18 without music, Cohen's d = 0.39) and cycling (49 ± 25 with video vs. 59 ± 30 without video, Cohen's d = 0.37). Children reached vigorous-intensity levels regardless of auditory or visual stimulus. Future research should test positive and negative effects of auditory and visual stimuli on children's exercise intensity within a school setting.

Obesogenic environments promote excessive caloric and fat intake. A total of 23 low-income, African American adolescents digitally photographed their lunchtime food environment at a school buffet during summer camp. Depicted food was coded for nutritional content on the platescape (own plate or others' plates) and the tablescape (open buffet). Students digitally depicted high-caloric and high-fat content, particularly students who had higher baseline waist-to-hip ratio. Students who included higher caloric and fat content in their digital diaries gained more weight over the 4-week program than those who did not. Digital photography connects adolescents' perceived food environment with weight gain, revealing the environmental cues that promote excessive caloric and fat intake. Digital photography can also identify adolescents with problematic eating behaviors that increase risk for obesity. (Contains 3 figures and 3 tables.)