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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: There is limited evidence from globally diverse samples on the prevalence and correlates of meeting the global guideline of 180 minutes per day of total physical activity (TPA) among 3- to 4-year-olds. Methods: Cross-sectional study involving 797 (49.2% girls) 3- to 4-year-olds from 17 middle- and high-income countries who participated in the pilot phases 1 and 2 of the SUNRISE International Study of Movement Behaviours in the Early Years. Daily step count was measured using thigh-worn activPAL accelerometers. Children wore the accelerometers for at least one 24-hour period. Children were categorized as meeting the TPA guideline based on achieving ≥11,500 steps per day. Descriptive analyses were conducted to describe the proportion of meeting the TPA guideline for the overall sample and each of the sociodemographic variables, and 95% CIs were calculated. Multivariable logistic regression was used to determine the sociodemographic correlates of meeting the TPA guideline. Results: Mean daily step count was 10,295 steps per day (SD = 4084). Approximately one-third of the sample (30.9%, 95% CI, 27.6–34.2) met the TPA guideline. The proportion meeting the guideline was significantly lower among girls (adjusted OR [aOR] = 0.70, 95% CI, 0.51–0.96) and 4-year-olds (aOR = 0.50, 95% CI, 0.34–0.75) and higher among rural residents (aOR = 1.78, 95% CI, 1.27–2.49) and those from lower middle-income countries (aOR = 1.35, 95% CI, 0.89–2.04). Conclusions: The findings suggest that a minority of children might meet the TPA guideline globally, and the risk of not meeting the guideline differed by sociodemographic indicators. These findings suggest the need for more surveillance of TPA in young children globally and, possibly, interventions to improve childhood health and development. [ABSTRACT FROM AUTHOR]

Fundamental motor skills (FMSs) are building blocks for future movements and may vary according to cultural context. Moreover, network analysis can identify which skills contribute most to an overall set of skills. This study identified the most influential FMS in samples of U.S. and Brazil preschoolers that may contribute to a pattern of adequate motor skills. Participants were 101 Brazilian (55 boys; 47.52 ± 5.57 months of age) and 236 U.S. preschoolers (108 boys; 49.56 ± 8.27 months of age), who provided completed FMS assessments (Test of Gross Motor Development--third edition). Confirmatory factorial analysis was used to test alternative models. To quantify the importance of each variable in the network, the expected influence was calculated, using the network analysis Mplus, Rstudio, and JASP (version 0.14.1). Reduced models with nine and 11 FMS for Brazilian and U.S. preschoolers, respectively, showed adequate adjustment indexes. Jump (1.412) and one-hand strike (0.982) in the Brazilian sample, and hop (1.927) and dribble (0.858) in the U.S. sample, showed the highest expected influence values. This study presents a new perspective to report which are the most important FMS in preschoolers of different sociocultural contexts, which act as building blocks for the acquisition of more complex motor skills.

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

Background: More moderate to vigorous physical activity (MVPA) and less time in sedentary behavior (SB) may protect against poor mental health in adolescence. Depressive symptomatology may also influence adolescents' own MVPA and SB. The aim of this study was to examine the bidirectional relationship between adolescent MVPA, SB, and depressive symptomatology using a longitudinal approach. Methods: Adolescents (10–16 y) were recruited for a prospective observational cohort. Depressive symptomatology was measured using the Short Mood and Feelings Questionnaire. Accelerometry was used to measure MVPA and SB. Adolescents were classified by meeting the MVPA guideline (≥60 min/d) and quartiles of SB time, with the lowest amount of time in SB compared to others. Bidirectional associations between MVPA, SB, and depressive symptomatology were assessed using mixed-effects regression models. Results: At baseline, adolescents (n = 205) were 12.5 (2.0) years, 54.6% women, 59.1% White, and 34.6% African American. In unadjusted models, adolescents with less baseline time in SB had lower follow-up Short Mood and Feelings Questionnaire scores, and fewer were classified as depressed at follow-up compared to others. After adjustment, adolescents with less baseline time in SB had lower depressive symptomatology at follow-up. Conclusions: Limiting time spent in SB in adolescence may improve future mental health. [ABSTRACT FROM AUTHOR]

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.

Background: Youth 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. Method: A 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. Results: Participants improved the number of sit-ups and step-ups they completed from pre- to postintervention (p < 0.05). Participants also increased their self-efficacy, intention to exercise and perceived social support to exercise (p < 0.05). Youth reported a high level of enjoyment and perceived Wii Fit as ways to increase physical fitness and increase their physical activity. Conclusion: AVGs may be a viable alternative exercise program to increase physical activity for black and Hispanic youth living in poverty-impacted neighborhoods.

There is some, albeit inconsistent, evidence supporting sex differences in preschoolers' motor competence (MC), with these observations not uniform when analyzed by age, and cultural groups. Thus, this study examined sex differences across ages in 3‐ to 5‐year‐old children's MC. A cross‐country pooled sample of 6241 children aged 3–5 years (49.6% girls) was assessed for MC using the Test of Gross Motor Development—2nd/3rd edition, and children were categorized into groups of age in months. Multiple linear regression models and predictive margins were calculated to explore how sex and age in months affect scores of MC (i.e., locomotor and ball skills), with adjustments for country and BMI. The Chow's Test was used to test for the presence of a structural break in the data. Significant differences in favor of girls were seen at 57–59 and 66–68 months of age for locomotor skills; boys performed better in ball skills in all age periods, except for 42–44 and 45–47 months of age. The higher marginal effects were observed for the period between 45–47 and 48–50 months for locomotor skills (F = 30.21; and F = 25.90 for girls and boys, respectively), and ball skills (F = 19.01; and F = 42.11 for girls and boys, respectively). A significantly positive break point was seen at 45–47 months, highlighting the age interval where children's MC drastically improved. The identification of this breakpoint provides an evidence‐based metric for when we might expect MC to rapidly increase, and an indicator of early delay when change does not occur at that age. [ABSTRACT FROM AUTHOR]

Objective: The aim of this substudy within the Treatment Efforts Addressing Child Weight Management by Unifying Patients, Parents, and Providers (TEAM UP) pragmatic clinical trial was to compare the validity of anthropometric measurements collected remotely versus in person (≤7 days apart) among youth with obesity who were 6 to 15 years of age. Methods: Child (n = 37) weight and height were measured in person by a trained data assessor. These were compared with measurements taken remotely by the child's parent with live videoconferencing observation by a study data assessor. In‐person and remote measurements were compared using Bland–Altman plots, Pearson correlations, and two one‐sided paired t tests. A priori bounds of acceptability were set at ±0.68 kg to allow for typical weight fluctuations within the 7‐day comparison period. Results: Measurements were highly correlated (height: r = 0.991, p < 0.0001; weight: r = 0.999; p = 0.03). For height, two one‐sided t tests for upper, t(36) = 3.95, and lower, t(36) = −2.63, bounds (−1, 1) revealed an overall p = 0.006; absolute error was 3.5 cm. For weight, two one‐sided t tests for upper, t(36) = 1.93, and lower, t(36) = −7.91, bounds (−0.68, 0.68) revealed an overall p = 0.03; absolute error was 1.7 kg. Conclusions: The present findings support the utility and interpretation of remotely assessed weight management outcomes for both research and clinical purposes. These procedures may offer greater accessibility to evidence‐based measurement. [ABSTRACT FROM AUTHOR]

Obesity and weight management in children and youth continue to be challenging to address, affecting one-third of children and adolescents in the United States. Fewer than half of children (ages 6-11 years) and 8% of adolescents meet recommendations for daily physical activity. However, exergaming (a physical form of controlling video games) has become a popular activity among children and teens and could be leveraged to promote physical activity. The purpose of this study was to examine the role of competition to elicit vigorous intensity physical activity, measured by heart rate, while exergaming in 19 youth ages 6-13 years. Competition was manipulated through both performance-based praise and two-player competitive play. Intensity was significantly higher following the performance-based praise versus prepraise, and the post-praise session reached vigorous intensity (67% HR[subscript max] vs. 59% HR[subscript max]). Heart rate was marginally higher in two-player competitive play versus solitary play, and both sessions met vigorous intensity criteria (70% HR[subscript max] vs. 65% HR[subscript max]). By increasing opportunities for competition during exergaming, children may respond by participating more vigorously, which is important for good physical health.

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 [+ or -] 18 with music vs. 87 [+ or -] 18 without music, Cohen's d - 0.39) and cycling (49 [+ or -] 25 with video vs. 59 [+ or -] 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., Childhood obesity in the United States affects 18.5% of children and adolescents between the ages of 2 and 19 years, far surpassing the Healthy People 2020 goal of having the [...]