Health and well-being needs of Indigenous adolescents: a protocol for a scoping review of qualitative studies.

INTRODUCTION: Improving the health of Indigenous adolescents is central to addressing the health inequities faced by Indigenous peoples. To achieve this, it is critical to understand what is needed from the perspectives of Indigenous adolescents themselves. There have been many qualitative studies that capture the perspectives of Indigenous young people, but synthesis of these has been limited to date. METHODS AND ANALYSIS: This scoping review seeks to understand the specific health needs and priorities of Indigenous adolescents aged 10-24 years captured via qualitative studies conducted across Australia, Aotearoa New Zealand, Canada, the USA, Greenland and Sami populations (Norway and Sweden). A team of Indigenous and non-Indigenous researchers from these nations will systematically search PubMed (including the MEDLINE, PubMed Central and Bookshelf databases), CINAHL, Embase, Scopus, the Informit Indigenous and Health Collections, Google Scholar, Arctic Health, the Circumpolar Health Bibliographic Database, Native Health Database, iPortal and NZresearch.org, as well as specific websites and clearinghouses within each nation for qualitative studies. We will limit our search to articles published in any language during the preceding 5 years given that needs may have changed significantly over time. Two independent reviewers will identify relevant articles using a two-step process, with disagreements resolved by a third reviewer and the wider research group. Data will then be extracted from included articles using a standardised form, with descriptive synthesis focussing on key needs and priorities. This scoping review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. ETHICS AND DISSEMINATION: Ethics approval was not required for this review. Findings will be disseminated via a peer-reviewed journal article and will inform a broader international collaboration for Indigenous adolescent health to develop evidence-based actions and solutions.

Plasma Neuronal Growth Regulator 1 May Link Physical Activity to Reduced Risk of Type 2 Diabetes: A Proteome-Wide Study of ARIC Participants.

Habitual physical activity (PA) impacts the plasma proteome and reduces the risk of developing type 2 diabetes (T2D). Using a large-scale proteome-wide approach in Atherosclerosis Risk in Communities study participants, we aimed to identify plasma proteins associated with PA and determine which of these may be causally related to lower T2D risk. PA was associated with 92 plasma proteins in discovery (P < 1.01 × 10-5), and 40 remained significant in replication (P < 5.43 × 10-4). Eighteen of these proteins were independently associated with incident T2D (P < 1.25 × 10-3), including neuronal growth regulator 1 (NeGR1; hazard ratio per SD 0.85; P = 7.5 × 10-11). Two-sample Mendelian randomization (MR) inverse variance weighted analysis indicated that higher NeGR1 reduces T2D risk (odds ratio [OR] per SD 0.92; P = 0.03) and was consistent with MR-Egger, weighted median, and weighted mode sensitivity analyses. A stronger association was observed for the single cis-acting NeGR1 genetic variant (OR per SD 0.80; P = 6.3 × 10-5). Coupled with previous evidence that low circulating NeGR1 levels promote adiposity, its association with PA and potential causal role in T2D shown here suggest that NeGR1 may link PA exposure with metabolic outcomes. Further research is warranted to confirm our findings and examine the interplay of PA, NeGR1, adiposity, and metabolic health.

Young Adult Physical Activity Trajectories and Midlife Nonalcoholic Fatty Liver Disease.

Importance: Physical activity (PA) is recommended for preventing and treating nonalcoholic fatty liver disease (NAFLD). Yet, how long-term patterns of intensity-based physical activity, including moderate-intensity PA (MPA) and vigorous-intensity PA (VPA), might affect the prevalence of NAFLD in middle age remains unclear. Objective: To identify distinct intensity-based PA trajectories from young to middle adulthood and examine the associations between PA trajectories and NAFLD prevalence in midlife. Design, Setting, and Participants: This population-based cohort of 2833 participants used the Coronary Artery Risk Development in Young Adults study data. The setting included field clinics in Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. Data analysis was completed in March 2023. Exposures: PA was self-reported at 8 examinations over 25 years (1985-1986 to 2010-2011) and separately scored for MPA and VPA. Main Outcomes and Measures: NAFLD was defined as liver attenuation values less than 51 Hounsfield units after exclusion of other causes of liver fat, measured using computed tomography in year 25 (2010-2011). Results: Among a total of 2833 participants included in the sample, 1379 (48.7%) self-identified as Black, 1454 (51.3%) as White, 1206 (42.6%) as male, and 1627 (57.4%) as female from baseline (1985-1986) (mean [SD] age, 25.0 [3.6] years) to year 25 (2010-2011) (mean [SD] age, 50.1 [3.6] years). Three MPA trajectories were identified: very low stable (1514 participants [53.4%]), low increasing (1096 [38.7%]), and moderate increasing (223 [7.9%]); and 3 VPA trajectories: low stable (1649 [58.2%]), moderate decreasing (1015 [35.8%]), and high decreasing (169 [6.0%]). After adjustment for covariates (sex, age, race, study center, education, smoking status, and alcohol consumption), participants in the moderate decreasing (risk ratio [RR], 0.74; 95% CI, 0.54-0.85) and the high decreasing (RR, 0.59; 95% CI, 0.44-0.80) VPA trajectories had a lower risk of NAFLD in middle age, relative to participants in the low stable VPA trajectory. Adjustments for baseline body mass index and waist circumference attenuated these estimates, but the results remained statistically significant. The adjusted RRs across the MPA trajectories were close to null and not statistically significant. Conclusions and Relevance: This cohort study of Black and White participants found a reduced risk of NAFLD in middle age for individuals with higher levels of VPA throughout young to middle adulthood compared with those with lower VPA levels. These results suggest the need for promoting sustainable and equitable prevention programs focused on VPA over the life course to aid in lowering NAFLD risk.

Aerobic and Muscle-Strengthening Physical Activity, Television Viewing, and Nonalcoholic Fatty Liver Disease: The CARDIA Study.

BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) in U.S. adults is over 30%, yet the role of lifestyle factors in the etiology of NAFLD remains understudied. We examined the associations of physical activity, by intensity and type, and television viewing with prevalent NAFLD. METHODS: Cross-sectional analysis of a population-based sample of 2726 Black (49%) and White (51%) adults (Mean (SD) age, 50 (3.6) years; 57.3% female) from the CARDIA study. Exposures were aerobic activity by intensity (moderate, vigorous; hours/week); activity type (aerobic, muscle-strengthening; hours/week); and television viewing (hours/week), examined concurrently in all models and assessed by validated questionnaires. Our outcome was NAFLD (liver attenuation < 51 Hounsfield Units), measured by non-contrast computed tomography, after exclusions for other causes of liver fat. Covariates were sex, age, race, study center, education, diet quality, smoking status, alcohol consumption, and body mass index or waist circumference. RESULTS: 648 participants had NAFLD. In the fully adjusted modified Poisson regression model, the risk ratios per interquartile range of each exposure were moderate-intensity aerobic activity, 1.10 (95% CI, 0.97-1.26); vigorous-intensity aerobic activity, 0.72 (0.63-0.82); muscle-strengthening activity, 0.89 (0.80-1.01); and television viewing, 1.20 (1.10-1.32). Relative to less active participants with higher levels of television viewing, those who participated in ≥2 h/week of both vigorous-intensity aerobic and muscle-strengthening activity and <7 h/week of television viewing had 65% lower risk of NAFLD (risk ratio = 0.35, 95% CI = 0.23-0.51). CONCLUSION: Adults who follow public health recommendations for vigorous-aerobic and muscle-strengthening activity, as well as minimize television viewing, are considerably less likely to have NAFLD than those who do not follow the recommendations and who have relatively high levels of television viewing.

Development and Intertester Reliability of a Novel Device to Measure Nonweightbearing Ankle Joint Dorsiflexion Range of Motion.

BACKGROUND: Ankle joint dorsiflexion range of motion is essential to normal gait. Ankle equinus has been implicated in a number of foot and ankle pathologies included Achilles tendonitis, plantar fasciitis, ankle injury, forefoot pain, and foot ulceration. Reliable measurement of ankle joint dorsiflexion range of motion, both clinically and in a research setting, is important. METHODS: The primary aim of this study was to investigate the intertester reliability of an innovative device for measuring ankle joint dorsiflexion range of motion. A total of 31 (n = 31) participants volunteered to take part in this study. A paired t-test was performed to assess for systematic differences between the mean measures of each rater. Intertester reliability was evaluated using the intraclass correlation coefficient (ICC) and their 95% confidence intervals. RESULTS: A paired t-test demonstrated that the mean ankle joint dorsiflexion range of motion did not significantly differ between raters. The ankle joint ROM mean for rater 1 was 4.65 SD (3.71) and rater 2 was 4.67 SD (3.91). Intertester reliability for the use of the Dorsi-Meter was excellent and demonstrated a very narrow range of error. The ICC (95%CI) was 0.991 (0.980 to 0.995) the SEM (in degrees) was 0.07, the MDC95, in degrees was 0.19 and 95% LOA, degrees was -1.49 to 1.46. CONCLUSIONS: We found the intertester reliability of the Dorsi-Meter to demonstrate higher levels of intertester reliability compared to previous studies investigating other devices. We reported the MDC values to provide an estimate of the smallest amount of change in the ankle joint dorsiflexion range of motion that must be achieved to reflect a true change, outside the error of the test. The Dorsi-Meter has been established as an appropriate reliable device to measure ankle joint dorsiflexion for clinicians and researchers with very small minimal detectable change and limits of agreement.

Comparative Effectiveness of Physical Activity Intervention Programs on Motor Skills in Children and Adolescents: A Systematic Review and Network Meta-Analysis.

Objective: To evaluate how different physical activity (PA) interventions (traditional, exergaming, and teacher/parent education) impacted children's motor skills (object control, locomotor, and gross motor). Design: Systematic review and network meta-analysis. Data sources: PubMed, Medline, Scopus, Web of Science, EMBASE, and PsycINFO. Eligibility criteria: (1) Participants comprised 1708 children 3-12 years; (2) PA or exercise-based interventions were investigated; (3) only studies using a Test of Gross Motor Skills assessment were included; (4) RCT were chosen as the study design to assess the impact of PA interventions on children's motor skills; and (5) culture-based PA studies with English language only were included. Data were analyzed using a Bayesian network meta-analysis. Results: The results were reported as standardized mean differences (SMDs) with associated 95% credible intervals (CrIs). For object control, aerobic intervention (SMD 6.90, 95% Crl 1.39 to 13.50); for locomotor, exergaming intervention (SMD 12.50, 95% Crl 0.28 to 24.50); and for gross motor, aerobic intervention (SMD 7.49, 95% Crl 0.11 to 15.70) were the most effective treatments. Conclusion: Children's FMSs have been improved through different PA interventions. Among them, aerobic interventions seem to be the most effective intervention in enhancing object control skills and overall gross motor skills.

Dose-response association of aerobic and muscle-strengthening physical activity with mortality: a national cohort study of 416 420 US adults.

OBJECTIVES: To investigate the dose-response association of aerobic physical activity (PA) and muscle-strengthening exercise (MSE) with all-cause mortality. METHODS: National Health Interview Survey data (1997-2014) were linked to the National Death Index through 2015, which produced a cohort of 416 420 US adults. Cox proportional-hazard models were used to estimate HRs and 95% CIs for the associations of moderate aerobic PA (MPA), vigorous aerobic PA (VPA) and MSE with mortality risk. Models controlled for age, sex, race-ethnicity, income, education, marital status, survey year, smoking status, body mass index and chronic conditions. RESULTS: Relative to those who engaged in no aerobic PA, substantial mortality risk reduction was associated with 1 hour/week of aerobic PA (HR: 0.85, 95% CI: 0.83 to 0.86) and levelled off at 3 hours/week of aerobic PA (0.73, 0.71 to 0.75). Similar results were observed for men and women and for individuals younger and older than 60 years. MSE conferred additional mortality risk reduction at 1 time/week (0.89, 0.81 to 0.97) and appeared no longer beneficial at 7 times/week (0.99, 0.94 to 1.04). CONCLUSION: The minimum effective dose of aerobic PA for significant mortality risk reduction was 1 hour/week of MPA or VPA, with additional mortality risk reduction observed up to 3 hours/week. For older adults, only small decreases in mortality risk were observed beyond this duration. Completing MSE in combination with aerobic PA conferred additional mortality risk reduction, with a minimum effective dose of 1-2 times/week.

Effects of Exergaming on College Students' Situational Interest, Self-Efficacy, and Motion Sickness.

Objective: Given the low levels of physical activity (PA) among U.S. college students, the use of exergaming as a supplement to traditional exercise may promote higher levels of motivation and PA. Therefore, this study's purpose was to examine the effect of two different exergames on college students' situational interest (SI), self-efficacy (SE), and equilibrium change (EQC) compared to traditional treadmill walking. Methods: Sixty college students (30 female; Mage = 23.6 ± 4.1 years; MBMI = 23.9 ± 4.0 kg/m2) participated in three separate 20 min exercise sessions: (1) Xbox 360 Kinect Just Dance; (2) Xbox 360 Kinect Reflex Ridge; and (3) traditional treadmill walking at 4.0 mph. Participants' SI, SE, and EQC were measured after each session using a series of validated surveys. Results: A mixed model analysis of covariance (ANCOVA) with repeated measures evaluated mean differences between exercise sessions for all outcomes. Significant main effects were observed between the three exercise sessions (all p < 0.01). Specifically, Just Dance and Reflex Ridge sessions yielded significantly higher SI scores than treadmill exercise, F (10, 49) = 54.61, p < 0.01, η2 = 0.92. In addition, participants experienced significantly lower EQC in Reflex Ridge than in treadmill exercise, F (2, 58) = 4.26, p = 0.02, η2 = 0.13. No differences were identified for SE. Conclusion: The integration of exergaming into traditional exercise routines may help to promote higher levels of SI but not SE amongst college students. RR exergaming also demonstrated low EQC as compared to traditional exercise. Experimental study designs are warranted to provide additional evidence on the efficacy of exergaming.

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/m2) 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 (ηp2). 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, ηp2 = 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, muscle-strengthening PA frequency, sleep efficiency, PA-related intrinsic motivation, and perceived PA barriers.

Acute Effects of Virtual Reality Exercise Biking on College Students' Physical Responses.

Purpose: Current evidence regarding the use of commercially available immersive virtual reality (VR) headsets and compatible VR exercise apparatus in the promotion of individuals' physical activity (PA) is lacking. This exploratory study investigated the acute effects of a VirZoom VR exercise bike (vBike) on college students' physical responses compared to an exergaming bike (eBike) and a traditional stationary exercise bike (tBike). Method: Forty-eight college students (34 females, Xage = 23.58 ± 3.39; XBMI = 23.81 ± 3.57) completed three separate 20-minute cycling sessions on the vBike, eBike, and tBike in a counterbalanced order. Outcomes included rating of perceived exertion (RPE), assessed at 4-minute intervals throughout each cycling session, and overall PA, operationalized as pedal revolution counts (PRC) during each session. Results: Linear models indicated significant group differences between exercise modalities for RPE (F (2,138) = 14.76-27.30, all p < .001, η2 = 0.17-0.27) and PRC (F (2,138) = 74.862, p < .001, η2 = 0.48). Pairwise comparisons revealed that RPE was reported significantly higher at each time point (i.e., 4th minute, 8th minute, 12th minute, 16th minute, and 20th minute) during the tBike session vs. the vBike and eBike sessions (p < .001) and that participants had higher PRC during the vBike session vs. the eBike and tBike sessions (p < .001). Conclusion: A commercially available VR exercise bike would trigger greater overall PA as compared to exergaming and traditional cycling while being perceived less intense. Future intervention studies conducted in real-world settings to determine cause and effect relationship are warranted.

Investigating Relationships between Preschool Children's Perceived Competence, Motor Skills, and Physical Activity: A Cross-Lagged Panel Model.

BACKGROUND: Motor skill competence (MSC) and perceived competence (PC) are primary correlates that are linked with physical activity (PA) participation, yet there is limited evidence of the mutual longitudinal or temporal associations between these variables in preschoolers. Therefore, this study's purpose was to examine the bidirectional relationships between MSC and PA, MSC and PC, and PC and PA in preschoolers over time. METHODS: The final sample were 61 preschoolers (Mage = 4.45 years, ranging from 4 to 5) from two underserved schools. MSC was assessed using the Test of Gross Motor Development, Second Edition (TGMD-2). PC was assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children. PA was assessed using ActiGraph GT9X Link accelerometers during three consecutive school days. All assessments of MSC, PC, and PA were measured in identical conditions at schools at the baseline (T1) and the end of the eighth week (T2). We employed a cross-lagged model approach to understand the bidirectional relationships between MSC, PC, and PA. RESULTS: The results showed that T1 MSC significantly predicted T2 MSC (p < 0.01) and T1 MSC significantly predicted T2 PA only in girls (p = 0.03). Additionally, a cross-lagged effect of T1 MSC and T2 PC was only observed in boys (p = 0.03). Lastly, a significant association for T1 moderate-to-vigorous physical activity (MVPA) and T2 PC was only observed in girls (p = 0.04). CONCLUSIONS: Bidirectional relationships between the variables were not observed in preschoolers. However, significant gender differences were observed in each cross-lagged model.

The Dilemma of Analyzing Physical Activity and Sedentary Behavior with Wrist Accelerometer Data: Challenges and Opportunities.

Physical behaviors (e.g., physical activity and sedentary behavior) have been the focus among many researchers in the biomedical and behavioral science fields. The recent shift from hip- to wrist-worn accelerometers in these fields has signaled the need to develop novel approaches to process raw acceleration data of physical activity and sedentary behavior. However, there is currently no consensus regarding the best practices for analyzing wrist-worn accelerometer data to accurately predict individuals' energy expenditure and the times spent in different intensities of free-living physical activity and sedentary behavior. To this end, accurately analyzing and interpreting wrist-worn accelerometer data has become a major challenge facing many clinicians and researchers. In response, this paper attempts to review different methodologies for analyzing wrist-worn accelerometer data and offer cutting edge, yet appropriate analysis plans for wrist-worn accelerometer data in the assessment of physical behavior. In this paper, we first discuss the fundamentals of wrist-worn accelerometer data, followed by various methods of processing these data (e.g., cut points, steps per minute, machine learning), and then we discuss the opportunities, challenges, and directions for future studies in this area of inquiry. This is the most comprehensive review paper to date regarding the analysis and interpretation of free-living physical activity data derived from wrist-worn accelerometers, aiming to help establish a blueprint for processing wrist-derived accelerometer data.

Application of an Online Combination Exercise Intervention to Improve Physical and Mental Health in Obese Children: A Single Arm Longitudinal Study.

Introduction: Childhood obesity has become a global public health concern in the past decade. The purpose of this study was to explore the effectiveness of an online combination exercise intervention in improving the physical and mental health of obese children. Methods: This study adopted a one-group pre-test and post-test research design. A total of 28 obese children from 6 elementary schools in Heze City, Shandong Province, China, were recruited. All participants received an 8-week online combination exercise intervention and were tested at a three-month follow-up. Participants were tested and surveyed regarding their demographic, feasibility, and obesity indicators using mental health and quality of life questionnaires. The data were statistically analyzed using a one-way analysis of variance with repeated measures. Results: A total of 26 obese children (Meanage = 10.15 years) completed the study. The retention rate was 92.9% for the entire trial (two obese children withdrew due to their inability to exercise) and no adverse events were reported. In addition, the obese children completed 25/32 (78.1%) of the online courses. After 8 weeks of the intervention, the changes in the body fat percentage of the obese children [mean difference (MD) = -3.126, p < 0.001, Cohen's d = -1.777], thinking dimension score (MD = 1.654, p < 0.001, Cohen's d = 0.603), total quality of life score (MD = 6.385, p < 0.05, Cohen's d = 0.610), and work attitude dimension score (MD = 1.346, p < 0.001, Cohen's d = 0.744) showed significant differences compared to the baseline. However, no significant differences were identified between the post-intervention and three-month follow-up measurements (p > 0.05), and we assumed that the intervention effect was maintained three months after the intervention. Conclusion: An online combination exercise intervention is a safe and feasible option to improve the mental health and quality of life of obese children and may have long-term health benefits.

Bidirectional Relationships among Children's Perceived Competence, Motor Skill Competence, Physical Activity, and Cardiorespiratory Fitness across One School Year.

PURPOSE: The bidirectional associations among children's motor skill competence (MSC), perceived competence (PC), physical activity (PA), and cardiorespiratory fitness (CRF) over time remain unanswered. This study is aimed at discerning the bidirectional relationships among elementary school children's MSC, PC, PA and, CRF over the course of one school year. METHODS: A total of 261 second and third grade children (127 boys, 134 girls; meanage = 8.27 years; BMI = 18.22 ± 3.71) were recruited from two Texas elementary schools. Approximately 73.56% of participants were White American. Children's baseline data were assessed in September/October in 2012 (Time1), and identical assessments were conducted in April/May in 2013 (Time2). MSC was assessed using product-oriented skill tests (e.g., throw, kick, and jump). PC was assessed via the Pictorial Scale of Perceived Competence for Children. Minutes spent in moderate-to-vigorous PA (MVPA) was assessed using ActiGraph GT3X+ accelerometers for five days, and CRF was assessed by the PACER test. Six age- and body mass index-adjusted cross-lagged panel models were used to test the relationships between the variables. RESULTS: We observed that T1 MSC significantly predicted T2 MSC (ß = 0.59; p < 0.01), T2 CRF (ß = 0.28; p < 0.01), and T2 MVPA (ß = 0.18; p < 0.01). Children's CRF was a positive predictor for T2 CRF (ß = 0.56; p < 0.01) and T2 MSC (ß = 0.13; p < 0.05) Additionally, T1 MVPA significantly predicted T2 MVPA (ß = 0.30; p < 0.01) and T2 PC (ß = -0.14; p < 0.05). CONCLUSION: Findings suggested a fully bidirectional relationship between elementary children's MSC and CRF. Other bidirectional relationships among the variables were only partially supported. Educators and health professionals need to emphasize the importance of developing both MSC and CRF to maintain physical health over time.

Effectiveness of Smartphone-Based Physical Activity Interventions on Individuals' Health Outcomes: A Systematic Review.

DESIGN: A systematic review. Data Sources. 114 studies were gathered using the following search descriptors: ("mobile phone" OR "smartphone" OR "cell phone" OR "mobile device" OR "mobile apps" OR "mHealth") AND ("exercise" OR "physical activity" OR "physical fitness" OR "motor activity") AND ("physiological outcomes" OR "weight outcomes" OR "psychological outcomes" OR "health" OR "health behavior"). Seven databases were used including databases such as Academic Search Premier and PubMed. PRISMA guidelines were followed in this review. Eligibility Criteria for Selecting Studies. The 20 articles included in this review met the following inclusion criteria: (1) randomized and controlled trials, (2) involving an outcome variable measured by accelerometer, and (3) intervention enforced by a smartphone application. RESULTS: Overall, 56% of the studies reviewed in this paper resulted in successful interventions. Of the 19 articles that examined the first individual health outcome of physical and physiological outcomes, 11 interventions resulted in a positive effect on one of the following parameters: MVPA/step count, sedentary behavior, cardiorespiratory fitness, and blood pressure. Six interventions examined the effects on the second individual health outcome, weight-related outcomes. Five of these interventions observed significant positive effects from mobile application interventions on weight and waist circumference. Six articles evaluated the effectiveness of smartphone-based physical activity interventions on the third and final individual health outcome, psychological outcomes, with four resulting in significant positive outcomes in self-efficacy, life enjoyment/satisfaction, and intrinsic PA motivation. CONCLUSION: The findings in this review suggest that mobile application physical activity interventions, compared to unguided exercise activities, can effectively improve certain health outcomes for individuals such as physical/physiological and weight-related outcomes. It was found that research in the area of effectiveness of mobile application interventions on specific psychosocial health outcomes such as self-efficacy, life enjoyment, and intrinsic PA motivation is limited. Thus, the effect of mobile health applications remains unclear for psychosocial outcomes. Due to this limitation, more research is warranted to confirm the findings of this review.

Changes in Chinese Adults' Physical Activity Behavior and Determinants before and during the COVID-19 Pandemic.

PURPOSE: To investigate the changes in Chinese adults' physical activity (PA) behavior and determinants before and during the COVID-19 pandemic. METHOD: A total of 1028 adults (aged 19-59 years) were recruited from 127 urban and rural neighborhoods in China using stratified three-stage probability sampling. Data collection was conducted in December 2019 and July 2020. RESULTS: Compared with the data before the pandemic, individuals' weekly moderate-to-vigorous-intensity PA (MVPA) decreased significantly from 139 min to 120 min, seven months after the outbreak (p = 0.01), with female and rural populations displaying a more significant decrease (p = 0.02). Overall, 13.7% of participants met the PA guidelines (World Health Organization) both before and during the pandemic, while 21.8% met the guidelines only before the pandemic and 18.1% increased their PA and met the PA guidelines during the pandemic. A total of 46.4% did not meet the PA guidelines before or during the pandemic. Determinants of PA behavior change before and during the pandemic included sports skills, self-determined motivation and support from sports organizations. CONCLUSIONS: The Chinese adults' PA levels decreased significantly from before to during the COVID-19 pandemic, particularly among the female population. It is suggested that the enhancement of self-determined motivation, improvement of sport skills, and support from sports organizations might be effective in facilitating individuals' engagement in PA during the pandemic.

Effect of Wearable Technology-Based Physical Activity Interventions on Breast Cancer Survivors' Physiological, Cognitive, and Emotional Outcomes: A Systematic Review.

This systematic review synthesized all randomized controlled trials (RCTs) and controlled trials examining the effects of wearable health technology-based physical activity interventions on physiological, cognitive, and emotional outcomes in breast cancer survivors (BCS). We searched NCBI, Academic Search Premier, EMBASE, Web of Science, PubMed, and Medline from inception to March 2021. We included studies which: (1) were RCTs or controlled trials ≥8 weeks in duration; (2) were peer-reviewed and published in English; (3) sampled BCS in full remission and had not received treatment for at least six months; (4) utilized wearable health technology (e.g., Fitbit, Garmin xGC30); and (5) examined physiological, emotional, and/or cognitive outcomes. Sixty-six studies were identified and 14 were included in the review. Most of the observed effects were statistically significant and those which employed multi-component interventions generally yielded greater effects. Overall, the use of wearable health technology reduced sedentary behavior and increased moderate-to-vigorous intensity physical activity. Further, increased moderate-to-vigorous intensity physical activity was observed to be associated with increased perceived cognition and higher cognitive performance. Multiple studies also observed significant improvements in attitude, worry, and anxiety. Overall, findings suggested wearable health technology-based physical activity interventions to be effective for improving physical activity, attitude, and cognitive functions and for reducing sedentary behavior, anxiety, and worry in BCS.

Relationships between College Students' Sedentary Behavior, Sleep Quality, and Body Mass Index.

PURPOSE: Sedentary behavior (SB), sleep efficiency (SE), sleep duration (SD), and body mass index (BMI) are crucial determinants of an individual's health. However, empirical evidence regarding associations between these factors in young adults living in China remains unknown. Therefore, the purpose of this study was to examine the relationships between accelerometer-measured SB, SE, SD, and BMI in Chinese college students. METHODS: Two-hundred and twenty college students (115 females, Meanage = 20.29 years, SD = 2.37) were recruited from a south-central Chinese university. Participants' SB (daily % time spent in SB), SE (number of minutes of sleep duration/number of minutes in bed), and SD were assessed via wrist-worn ActiGraph GT9X Link accelerometers for one week. Body weight was measured using a digital weight scale, height was measured using a stadiometer, and BMI was calculated as weight (kg)/height (m2). RESULTS: Participants' average time spent in SB was 76.52% (SD = 10.03), SE was 84.12% (SD = 4.79), and BMI was 20.67 kg/m2 (SD = 3.12), respectively. Regression analyses indicated that SB (ß = -0.17, p = 0.01) and BMI (ß = -0.20, p < 0.01) negatively predicted SE. In addition, BMI negatively predicted SD (ß = -0.22, p < 0.01). CONCLUSION: Prolonged SB (e.g., screen viewing, smartphone use, and computer playing) and higher BMI may link to shorter sleep duration and lower sleep efficiency in Chinese young adults. Future randomized controlled trials are needed to further confirm these findings. Given that increased BMI status and SB may relate to adverse health outcomes, more population-based intervention strategies seeking to lower BMI and reduce SB (e.g., nutrition education and physical activity promotion) are needed in this population.

Health wearable devices for weight and BMI reduction in individuals with overweight/obesity and chronic comorbidities: systematic review and network meta-analysis.

OBJECTIVE: To analyse the comparative effectiveness of different health wearable-based physical activity (PA) promotion intervention strategies against each other and control for reducing body weight and body mass index (BMI) in individuals with overweight/obesity and chronic comorbidities. DESIGN: Systematic review and network meta-analysis (PROSPERO identifier: CRD42020158191). DATA SOURCES: We performed two independent searches from December 2019 to September 2020 in PubMed, MEDLINE, Scopus, Web of Science, Central Register of Controlled Trials, EMBASE and PsycINFO databases for articles published in English between 2007 and 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria were based on the PICOS framework. We included randomised controlled trials of health wearable-based interventions using two or more PA intervention arms/strategies and compared their effects on participants' body weight (kg) and BMI (kg/m2) with a control group. Data were analysed using a Bayesian network meta-analysis to directly and indirectly compare the effects of the six different intervention strategies (comparators). The six comparators were: (1) control group (ie, usual care, waitlist); (2) comparison group (ie, traditional, non-health wearable PA interventions); (3) commercial health wearable-only intervention (eg, Fitbit, Polar M400); (4) research grade health wearable-only intervention (ie, accelerometers or pedometers); (5) multicomponent commercial health wearable intervention (eg, Fitbit + nutrition counselling); and (6) multicomponent research grade health wearable intervention. The results were reported as standardised mean differences (SMDs) with associated 95% credible intervals (CrIs). RESULTS: From 641 screened records, 31 studies were included. For body weight reduction in individuals with overweight/obesity and chronic comorbidities, accelerometer/pedometer-only (SMD -4.44, 95% CrI -8.94 to 0.07) and commercial health wearable-only (SMD -2.76, 95% CrI -4.80 to -0.81) intervention strategies were the most effective compared with the three other treatments and control. For BMI reduction, multicomponent accelerometer/pedometer (SMD -3.43, 95% CrI -4.94 to -2.09) and commercial health wearable-only (SMD -1.99, 95% CrI -4.95 to 0.96) intervention strategies were the most effective compared with the other four conditions. CONCLUSION: Health wearable devices are effective intervention tools/strategies for reducing body weight and BMI in individuals with overweight/obesity and chronic comorbidities.

Small-Groups Versus Full-Class Exergaming on Urban Minority Adolescents' Physical Activity, Enjoyment, and Self-Efficacy.

BACKGROUND: The effects of school-based exergaming interventions on adolescents' physical activity (PA) and psychosocial outcomes have been mixed. Researchers speculate this may be attributed to design issues. Therefore, this study examined differences in urban minority adolescents' PA, enjoyment, and self-efficacy during small-groups and full-class exergaming. METHODS: Forty-seven urban minority adolescents (83% black; X¯age=11.8+1.3 y) completed two 15-minute exergaming sessions on the Xbox One Kinect Just Dance: (1) small groups (n = 3-4) and (2) full class (n = 23-24). Participants' time in sedentary behavior, light PA, and moderate to vigorous PA and steps were retrieved from ActiGraph GT3X+ accelerometers with enjoyment and self-efficacy assessed using validated surveys. RESULTS: Participants spent significantly more time in sedentary behavior (5.9 [5.2] min vs 3.5 [2.7] min, respectively: P < .001, d = 0.57) and less time in moderate-to-vigorous PA (2.1 [2.8] min vs 5.5 [2.2] min, respectively: P < .001, d = 0.85) during the full-class versus the small-groups session. Moreover, small-groups exergaming resulted in significantly higher steps than the full-class exergaming (504.2 [132.1] vs 387.8 [122.1], respectively: P = .01, d = 0.50) and significantly greater enjoyment (3.5 [1.1] vs 3.2 [1.0], respectively: P = .02, d = 0.37). There were no significant differences between sessions for time in light PA and self-efficacy. CONCLUSIONS: Small-groups exergaming appears ideal for promoting enjoyable PA at higher intensities and lower sedentary time in underserved minority adolescents.