The effectiveness of physical activity interventions on blood pressure in children and adolescents:A systematic review and network meta-analysis

Background:High blood pressure(BP)is a major contributor to mortality and cardiovascular diseases.Despite the known benefits of exercise for reducing BP,it is crucial to identify the most effective physical activity(PA)intervention.This systematic review and network meta-analysis(NMA)aimed to evaluate the available evidence on the effectiveness of various PA interventions for reducing BP and to determine their hierarchy based on their impact on BP.Methods:A search of PubMed,SPORTDiscus,PsycINFO,Web of Science,CINAHL,Cochrane,and Eric databases was conducted up to December 2022 for this systematic review and NMA.Randomized controlled trials and quasi-experimental studies targeting healthy children and adolescents aged 6-12 years old were included in this study.Only studies that compared controlled and intervention groups using PA or exercise as the major influence were included.We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Three independent investigators performed the literature screening,data extraction,and risk of bias assessment.We used Bayesian arm-based NMA to synthesize the data.The primary outcomes were systolic BP and diastolic BP.We calculated the mean differences(MDs)in systolic BP and diastolic BP before and after treatment.Mean treatment differences were estimated using NMA and random-effect models.Results:We synthesized 27 studies involving 15,220 children and adolescents.PA combined with nutrition and behavior change was the most effective intervention for reducing both systolic BP and diastolic BP(MD=-8.64,95%credible interval(95%CI):-11.44 to-5.84;MD=-6.75,95%CI:-10.44 to-3.11),followed by interventions with multiple components(MD=-1.39,95%CI:-1.94 to-0.84;MD=-2.54,95%CI:-4.89 to-0.29).Conclusion:Our findings suggest that PA interventions incorporating nutrition and behavior change,followed by interventions with multiple components,are most effective for reducing both systolic BP and diastolic BP in children and adolescents.

Effects of personalized exercise prescriptions and social media delivered through mobile health on cancer survivors’physical activity and quality of life

Purpose This study aimed to examine the effects of a multi-component mobile health intervention(wearable,apps,and social media)on cancer survivors’(CS')physical activity(PA),quality of life,and PA determinants compared to exercise prescription only,social media only,and attention control conditions.Methods A total of 126 CS(age=60.37±7.41 years,mean±SD)were recruited from the United States.The study duration was 6 months and participants were randomly placed into 4 groups.All participants received a Fitbit tracker and were instructed to install its companion app to monitor their daily PA.They(1)received previously established weekly personalized exercise prescriptions via email,(2)received weekly Facebook health education and interacted with one another,(3)received both Conditions 1 and 2,or(4)were part of the control condition,meaning they adopted usual care.CS PA daily steps,quality of life(i.e.,physical health and mental health),and PA determinants(e.g.,self-efficacy,social support)were measured at baseline,3 months,and 6 months.Results The final sample size included 123 CS.The results revealed only the multi-component condition had greater improvements in PA daily steps than the control condition post-intervention(95%confidence interval(95%CI):368–2951;p<0.05).Similarly,those in the multi-component condition had significantly greater increased physical health than the control condition(95%CI:–0.41 to–0.01;p<0.05)over time.In addition,the social media condition had significantly greater increased perceived social support than the control condition(95%CI:0.01–0.93;p<0.05).No other significant differences on outcomes were identified.Conclusion The study findings suggest that the implementation of a multi-component mobile health intervention had positive effects on CS PA steps and physical health.Also,offering social media intervention has the potential to improve CS perceived social support.

Exercise and oncology:The role of physical activity in disease prevention and health promotion

The field of exercise-oncology has evolved significantly over the past 30 years.Numerous studies have examined the role of structured exercise interventions—often incorporating aerobic or resistance training at moderate-to-vigorous intensities,sometimes in conjunction with multi-modal strategies—for individuals living with and beyond cancer.

Acute Effects of Virtual Reality Exercise on Young Adults’ Blood Pressure and Feelings

Virtual reality(VR)seems to have the potential to provide opportunities to promote physical activity(PA)in a fun way.This paper aimed to examine the acute effects of three different virtual reality-based exercise bikes on young adults’blood pressure(BP)and feelings compared to a traditional exercise cycling session.Four exercise sessions(immersive VR cycling,two non-immersive VR cycling,and traditional cycling)were completed by 36 young adults(22 females;Mage=23.6 years).BP was measured immediately before and after each session using a BP cuff and exercise-induced feelings were assessed via an established survey immediately after each session.Parti-cipants’previous experience with VR was used as the covariate in the ANCOVA with repeated measures.Signif-icant main effects were observed across cycling sessions for systolic blood pressure[F(2,29)=3.04,p=0.02,(η^(2)=0.38)]and feelings[F(3,32)=7.74,p<0.01,η^(2)=.42].In particular,immersive VR and traditional cycling signif-icantly increased systolic blood pressure compared to the two non-immersive VR sessions.Moreover,immersive VR significantly increased feelings compared to the two non-immersive VR sessions,whereas these two non-immersive VR exercises had significantly greater increased feelings compared to traditional cycling,respectively.Findings suggest immersive VR-based exercise cycling may lead to higher exercise intensities compared to non-immersive VR cycling.Further,immersive VR cycling yielded higher feelings compared to non-immersive VR and traditional cycling.Thus,immersive VR-based exercise can be a fun and physically active health promotion tool among young adults.

Effects of exergaming on motor skill competence,perceived competence,and physical activity in preschool children

Background: Few school settings offer opportunities for preschool children to engage in structured physical activity, and only a few studies have been conducted examining exergaming's effectiveness on health outcomes in this age group. This study's purpose, therefore, was to examine a school-based exergaming intervention's effect on preschool children's perceived competence(PC), motor skill competence(MSC), and physical activity versus usual care(recess), as well as to examine gender differences for these outcomes.Methods: A total of 65 preschool children from 2 underserved urban schools were assigned to 1 of 2 conditions, with the school as the experimental unit:(1) usual care recess group(8 weeks of 100 min of recess/week(5 days ￡ 20 min)) and(2) exergaming intervention group(8 weeks of100 min of exergaming/week(5 days ￡ 20 min) at school). All children underwent identical assessments of PC, MSC, and moderate-to-vigorous physical activity(MVPA) at baseline and at the end of the 8 th week.Results: A significant Group ￡ Time effect was observed for MVPA, F(1, 52) = 4.37, p = 0.04, h2 p= 0.04, but not for PC, F(1, 52) = 0.83, p = 0.37,h2 p= 0.02, or MSC, F(1, 52) = 0.02, p = 0.88, h2 p= 0.00. Specifically, the intervention children displayed significantly greater increased MVPA after8 weeks than the comparison children. Additionally, there was a significant time effect for MSC, F(1, 52) = 15.61, p < 0.01, h2 p= 0.23, and gender effect for MVPA, F(1, 52) = 5.06, p = 0.02, h2 p= 0.09. Although all preschoolers' MSC improved across time, boys demonstrated greater MVPA than girls at both time points.Conclusion: Exergaming showed a positive effect in promoting preschool children's MVPA at school and has the potential to enhance PC and MSC. More research with larger sample sizes and longer study durations are warranted.

Associations between individual and environmental factors and habitual physical activity among older Chinese adults:A social–ecological perspective

Purpose: To examine, within a social–ecological framework, associations between multifaceted individual and environmental factors and habitual physical activity(HPA) among older Chinese adults.Methods: Through a mix of qualitative and quantitative methods, a survey instrument assessing various factors underlying 3 social–ecological dimensions of intrapersonal, interpersonal, and community and environmental resources was developed. Using a cross-sectional design, older adults(n = 1580, aged 67 ± 7 years) recruited from 10 communities in Shandong province completed the social–ecological survey of HPA. Data were analyzed using Partial Least Squares Path Modeling.Results: Factors related to intrapersonal(medical knowledge, motivation, physical function, sport skills, socioeconomic status, and education),interpersonal(social support, social activity, and social norms), and community and physical environmental resources(safety, capacity, availability of and access to physical activity facilities) were found to be significantly associated with older adults' participation in HPA.Conclusion: The findings provide an initial validation of a social–ecological approach to the study of HPA in China, suggesting that strategies aimed at promoting physical activity in older adults should address multiple levels of factors that may contribute to the likelihood of older Chinese adults being physically active.

The effects of a bike active video game on players' physical activity and motivation

Background: Players may not acquire adequate levels of moderate-to-vigorous physical activity(MVPA) when playing commercial video games.This study's goal was to evaluate the effects of an exercise bike video game played by using a mobile application-based exergame that was designed exclusively to promote participants' MVPA, with additional attention paid to this game's ability to promote greater situational interest.Methods: An experimental design was used with 163 students(aged 20.31 ± 1.30, 18–26 years, 61.3% male), all of whom were randomly allocated into an experimental group and a control group. Physical activity(PA) levels were assessed with Acti Graph GT3X+(Acti Graph Inc., Fort Walton Beach, FL, USA) accelerometers. The situational interest scale was used to evaluate students' situational interest in both groups.Multivariate analysis of variance was conducted to examine the differences between sedentary behavior, PA levels, and situational interest between groups. Regression analyses were also used, with the purpose being to evaluate the strength of the relationship between PA and situational interest.Results: Results revealed that the experimental group had higher degrees of sedentary behavior, light PA, total interest, instant enjoyment,exploration intention, attention demand, novelty, and challenge, whereas the control group received higher scores for MVPA(control 95.01% vs.experimental group 89.94%). Regression analysis indicated that instant enjoyment(β = 0.49, p < 0.01), exploration intention(β = 0.18, p < 0.05),and attention demand(β = 0.17, p < 0.05) were positive predictors for total interest, explaining 43% of its variance.Conclusion: A newly designed mobile application-based exergame played via an exercise bike may enhance situational interest and provide a decent level of PA for players.

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, Psyc INFO, Pub Med, 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.

Motor competence and health-related fitness in children:A cross-cultural comparison between Portugal and the United States

Background: Motor competence and health-related fitness are important components for the development and maintenance of a healthy lifestyle in children. This study examined cross-cultural performances on motor competence and health-related fitness between Portuguese and U.S.children.Methods: Portuguese(n = 508; 10.14 § 2.13 years, mean § SD) and U.S.(n = 710; 9.48 § 1.62 years) children performed tests of cardiorespiratory fitness(Progressive Aerobic Cardiovascular Endurance Run), upper body strength(handgrip), locomotor skill performance(standing long jump), and object projection skill performance(throwing and kicking). Portuguese and U.S. children were divided into 2 age groups(6à9 and 10à13 years) for data analysis purposes. A twoàfactor oneàway analysis of covariance(ANOVA) was conducted with the Progressive Aerobic Cardiovascular Endurance Run, handgrip, standing long jump scores, kicking, and throwing speed(km/h) as dependent variables.Results: Results indicated that Portuguese children, irrespective of sex, presented better performances in locomotor and cardiorespiratory performance(standing long jump and Progressive Aerobic Cardiovascular Endurance Run) than U.S. children in both age bands. U.S. children outperformed Portuguese children during throwing and handgrip tests. Kicking tests presented gender differences: Portuguese boys and U.S. girls outperformed their internationally matched counterparts.Conclusion: Cultural differences in physical education curricula and sports participation may impact differences in motor competence and fitness development in these countries.

儿童参与动感舞蹈视频游戏的情景动机、体育活动参与度与愉悦性之间的联系

目的:调查"劲舞革命"游戏(Dance Dance Revolution,DDR)中儿童的情景动机、体力活动水平和他们感受到的体育活动愉悦性之间的关系。方法:在为期一周的实验中,215名小学生每天玩30 min DDR游戏。研究者测量了受试者对DDR的情境动机(内在动机、认同调控、外部调控和无动机),然后测量了他们玩DDR时由加速度确定的中到重度体育活动水平(MVPA),最后让受试者报告其参与体育活动的愉悦性。结果:只有内在动机与儿童玩DDR时的MVPA和愉悦性成正相关。而其他情境动机与MVPA和愉悦性之间无显著相关。回归分析进一步表明,内在动机是MVPA和愉悦性的重要预测因素。结论:在玩DDR中感到快乐并学到新事物的儿童有效提高了体育运动水平,同时也普遍感受到心理愉悦。

Fight fire with fire?Promoting physical activity and health through active video games

Physical inactivity has been identified as one of the leading causes of many chronic diseases such as cardiovascular disease,type 2 diabetes,and obesity.Technology such as video games plays a complicated role in physical inactivity—much like a double-edged sword.Traditionally,video games have contributed to the epidemic of physical inactivity and have

Impact of exergaming on young children's school day energy expenditure and moderate-to-vigorous physical activity levels

Background: Although emerging research is demonstrating the potential health impact of exergaming,investigations have primarily been conducted in laboratory settings among small samples with short-term interventions.Information on the effectiveness of exergaming in underserved children's objective physical activity(PA) in population-based settings is also scarce.Moreover,most empirical studies have only included 1 type of exergame in the intervention.Therefore,this study's purpose was to investigate the long-term impact of a multigame exergaming intervention among underserved children integrated within school curricula.Specifically,this study examined the effect of exergaming on children's accelerometer-determined sedentary behavior(SB),light PA,moderate-to-vigorous PA(MVPA),and energy expenditure(EE) over 2 years as compared with regular physical education(PE) classes.Methods: A total of 261 second-and third-grade children(134 girls,127 boys; mean age 8.27 years) were recruited from 2 Texas elementary schools.Children's pre-test 3-day SB,light PA,MVPA,and EE at school were assessed in the fall of 2012.Participants were assigned to 1 of 2groups:(1) exergaming/PE group(125 min weekly of exergaming-based PA program) and (2) comparison group(125 min weekly of PE).PA(SB,light PA,and MVPA) and EE outcome variables were assessed again in 2013(post-test) and 2014(follow-up).Results: Significant time effects were observed for SB(F(1,162)=25.0,p<0.01,η~2= 0.14),light PA(F(1,162)=9.6,p<0.01,η~2= 0.06),and MVPA(F(1,162)=6.2,p=0.01,η~2= 0.04) but not for EE(F(1,162)=0.63,p>0.05,η~2= 0.004).Subsequent pairwise comparisons revealed significant increases from pre-to post-test for light PA(p<0.01),MVPA(p<0.01),and EE(p=0.02) with no changes in SB(p>0.05).Conversely,significant decreases occurred in light PA(p<0.01) from post-test to follow-up with no differences seen in MVPA(p=0.08) and EE(p=0.06) over the same time period.A significant increase was seen,however,for SB from post-test to follow-up.Conclusion: Exergaming PE can have the same positive effect on children's light PA,MVPA,and EE as regular PE.More research is necessary to discern how to promote long-term PA participation after conclusion of the intervention.

Children's motor skill competence,physical activity, fitness,and health promotion

The high prevalence of childhood obesity, evident globally in the past decade, is partly due to low physical activity (PA).1 Obesity and low cardiovascular fitness in children may increase the risk of hypertension and hypercholesterolemia during childhood and may contribute to the development of chronic diseases in adulthood, such as hypertension and diabetes. 2 Participating in regular PA plays a significant role in the prevention of and decrease in childhood obesity and chronic diseases, thereby contributing to the prevention of chronic diseases later in adulthood.

Effects of a remote,YouTube-delivered exercise intervention on young adults’physical activity,sedentary behavior,and sleep during the COVID-19 pandemic:Randomized controlled trial

Background:Public health guidelines have called for innovative and flexible physical activity(PA)intervention strategies to promote PA and health amid the coronavirus disease 2019(COVID-19)pandemic.Therefore,this study’s purpose was to examine the effects of a home-based,YouTube-delivered PA intervention grounded in self-determination theory on young adults’free-living PA,sedentary behavior,and sleep quality(NCT04499547).Methods:Sixty-four young adults(48 females;age=22.8±3.4 years,mean±SD;body mass index=23.1±2.6 kg/m^(2))were randomized(1:1)into the intervention group,which received weekly aerobic and muscle-strengthening PA videos,or control group,which received weekly general health education videos,for 12 weeks.Our primary outcome was free-living moderate-to-vigorous PA(MVPA)and our secondary outcomes were sedentary behavior,light PA,and sleep quality(measured using ActiGraph accelerometers)along with muscle-strengthening PA frequency,self-determination theory-related motivation(non-regulation,external regulation,introjected regulation,identified regulation,integrated regulation,and intrinsic regulation),and perceived PA barriers(assessed using validated questionnaires).Repeated measures analysis of variances(ANOVAs)examined between-group differences at an adjusted significance level of 0.004 and effect sizes as partial eta-squared(η;).Results:We observed statistically significant interaction effects for MVPA,sleep efficiency,muscle-strengthening PA frequency,non-regulation,integrated regulation,intrinsic regulation,and perceived PA barriers(F(1,62)=10.75-77.67,p<0.001-0.002,η_(p)^(2)=0.15-0.56)with all outcomes favoring the intervention group.We observed no statistically significant differences in either group for sedentary behavior,light PA,sleep duration,or external,introjected,and identified regulations after 12 weeks(F(1,62)=1.11-3.64,p=0.06-0.61).Conclusion:With national COVID-19 restrictions still in place and uncertainty regarding post-pandemic PA environments and behaviors,a remote,YouTube-delivered PA intervention may help foster clinically meaningful improvements in young adults’free-living MVPA,musclestrengthening PA frequency,sleep efficiency,PA-related intrinsic motivation,and perceived PA barriers.

Application of network meta-analysis in the field of physical activity and health promotion

Continued advancement in the field of physical activity and health promotion relies heavily on the synthesis of rigorous scientific evidence.As such,systematic reviews and meta-analyses of randomized controlled trials have led to a better understanding of which intervention strategies are superior(i.e.,produce the greatest effects)in physical activity-based health behavior change interventions.Indeed,standard meta-analytic approaches have allowed researchers in the field to synthesize relevant experimental evidence using pairwise procedures that produce reliable estimates of the homogeneity,magnitude,and potential biases in the observed effects.However,pairwise meta-analytic procedures are only capable to discerning differences in effects between a select intervention strategy and a select comparison or control condition.In order to maximize the impact of physical activity interventions on health-related outcomes,it is necessary to establish evidence concerning the comparative efficacy of all relevant physical activity intervention strategies.The development of network meta-analysis(NMA)-most commonly used in medical-based clinical trials-has allowed for the quantification of indirect comparisons,even in the absence of direct,head-to-head trials.Thus,it stands to reason that NMA can be applied in physical activity and health promotion research to identify the best intervention strategies.Given that this analysis technique is novel and largely unexplored in the field of physical activity and health promotion,care must be taken in its application to ensure reliable estimates and discernment of the effect sizes among interventions.Therefore,the purpose of this review is to comment on the potential application and importance of NMA in the field of physical activity and health promotion,describe how to properly and effectively apply this technique,and suggest important considerations for its appropriate application in this field.In this paper,overviews of the foundations of NMA and commonly used approaches for conducting NMA are provided,followed by assumptions related to NMA,opportunities and challenges in NMA,and a step-by-step example of developing and conducting an NMA.

Application of e-health programs in physical activity and health promotion

Sedentary behavior has been identified as one of the major causes of many chronic diseases,such as cardiovascular diseases,stroke,cancer,osteoporosis,and type 2 diabetes.1 Modern technology plays a complex role in sedentary behavior—much like a double-edged sword.Specifically,some modern technologies,such as sedentary video games and computer games,have contributed to the epidemic of sedentary behavior and physical inactivity,whereas other novel technologies such as e-health have been increasingly used to promote physical activity(PA)and health.2,3 Indeed,e-health encompasses more than just Internet and medicine.It can include many sophisticated applications that deal with disease prevention and wellness,mobile decision making,emergency interventions,monitoring health,and remote care via mobile devices.

Effects of interrupting prolonged sitting on postprandial glycemia and insulin responses:A network meta-analysis

Purpose:This study aimed to evaluate the effectiveness of physical activity(PA)interrupting prolonged sitting(PS)on postprandial glycemia and insulin responses among adults.Methods:PubMed,EMBASE,Cochrane Library,Web of Science,CINAHL,PsycINFO,and the China National Knowledge Infrastructure databases were searched through September 30,2020.Randomized controlled trials(RCTs)that examined the effect of all forms of PA interrupting PS on postprandial glycemia and/or insulin responses among adults without chronic diseases were included in this study.The risk of bias of included studies was evaluated based on the Cochrane tool.A network meta-analysis was performed to estimate the summary standardized mean differences(SMDs)with 95%confidence intervals(95%CIs)with random effects.Results:Thirty crossover RCTs were included in our review.These RCTs included 9 types of interventions that interrupted PS.When compared to PS by itself,light-intensity PA intermittent interrupting(LPA-INT)PS and moderate-intensity PA intermittent interrupting(MPA-INT)PS significantly lowered postprandial glycemia(SMD=-0.46,95%CI:-0.70 to-0.21;SMD=-0.69,95%CI:-1.00 to-0.37,respectively)and significantly reduced postprandial insulin response(SMD=-0.46,95%CI:-0.66 to-0.26;SMD=-0.47,95%CI:-0.77 to-0.17,respectively).Results of the clustered ranking plot indicated that MPA-INT was the most effective intervention in lowering postprandial glycemia and insulin responses.Conclusion:Replacing PS with MPA-INT or LPA-INT has a positive effect in reducing postprandial glycemia and insulin responses,with MPA-INT being the optimal intervention strategy.