ARTICLE IN PRESS JSHS344_proof ■ 6 December 2016 ■ 1/8 HOSTED BY Available online at www.sciencedirect.com Available online at www.sciencedirect.com ScienceDirect ScienceDirect Journal of Sport and Health Science xx (2016) 1–8 Production and hosting by Elsevier www.jshs.org.cn 1bs_bs_query Q2 Original article 2bs_bs_query 3bs_bs_query Twelve weeks of dance exergaming in overweight and obese adolescent 4bs_bs_query 5bs_bs_query girls: Transfer effects on physical activity, screen time, and self-efficacy 6bs_bs_query Q1 7bs_bs_query Amanda E. Staiano *, Robbie A. Beyl, Daniel S. Hsia, Peter T. Katzmarzyk, Robert L. Newton Jr 8bs_bs_query Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA 9bs_bs_query Received 29 June 2016; revised 3 August 2016; accepted 5 September 2016 10bs_bs_query Available online 11 bs_bs_query 12bs_bs_query Background: Given the low levels of physical activity (PA) among adolescent girls in the US, there is a need to identify tools to motivate increased 13bs_bs_query PA. Although there is limited evidence that adolescents transfer PA from one context to another, exergames (i.e., video games that require gross 14bs_bs_query motor activity) may act as a gateway to promote overall PA outside game play. The purpose of this study was to examine potential transfer effects 15bs_bs_query (i.e., influences on external behaviors and psychological constructs) of a 12-week exergaming intervention on adolescent girls’ PA, screen time, 16bs_bs_query and self-efficacy toward PA, as well as the intrinsic motivation of exergaming. ≥ 17bs_bs_query Methods: Participants were 37 girls aged 14–18 years (65% African American, 35% white) who were overweight or obese (body mass index 85th 18bs_bs_query percentile) and were recruited from the community via school, physicians, news media, and social media sites. Adolescents were randomly 19bs_bs_query assigned to a 12-week group exergaming intervention (36 60-min sessions of group-based dance exergaming in a research laboratory using Kinect 20bs_bs_query for Xbox 360; Microsoft Corporation, Redmond, WA, USA) or to a no-treatment control group. Outcome variables included objectively measured 21bs_bs_query PA (total) and self-reported leisure-time PA (discretionary time only) 1 week before vs. 1 week after the intervention; selected type and intensity 22bs_bs_query of PA when placed in a gym setting for 30 min (“cardio free choice”); screen time; self-efficacy toward PA; and intrinsic motivation toward 23bs_bs_query exergaming. 24bs_bs_query Results: Attendance at the exergaming sessions was high (80%). Compared with the control group, the intervention group self-reported an = = 25bs_bs_query increase in PA (p 0.035) and fewer hours watching television or videos (p 0.01) after the intervention, but there were no significant differences 26bs_bs_query in sedentary, light, moderate, or vigorous PA measured by accelerometry. The intervention group significantly improved self-efficacy toward PA = 27bs_bs_query (p 0.028). The intervention group highly rated intrinsic motivation toward exergaming. 28bs_bs_query Conclusion: Exergaming for 12 weeks was associated with positive impacts on adolescent girls’ self-reported PA, television viewing, self-efficacy, 29bs_bs_query and intrinsic motivation. Future research is warranted to leverage exergames as an enjoyable, motivating, and effective PA tool. 30bs_bs_query © 2016 Production and hosting by Elsevier B.V.on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND 31bs_bs_query license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 32bs_bs_query 33bs_bs_query Keywords: Active video games; Leisure activity; Motivation; Screen time; Self-efficacy; Television 34bs_bs_query 35bs_bs_query 1. Introduction Leveraging adolescents’ interest in video games is an inno- 50bs_bs_query 36bs_bs_query vative approach to combating pediatric obesity and physical 51bs_bs_query 37bs_bs_query The average American adolescent spends 62 h each week in inactivity, but motivation to be physically active remains a 52bs_bs_query Q3 1 38bs_bs_query front of a screen. In contrast, only 8% of 12-to15-year-olds 5 major barrier. New-generation video games (i.e., exergames) 53bs_bs_query 39bs_bs_query meet national physical activity (PA) guidelines of 1 h of daily 2 require whole body movement, thereby yielding light to mod- 54bs_bs_query 40bs_bs_query moderate-to-vigorous PA, with adolescent girls having particu- erate levels of energy expenditure and elevated heart rate, which 55bs_bs_query Q4 3 41bs_bs_query larly low levels of PA. Insufficient PA is a major contributor to 3 could potentially contribute to weight loss and cardiovascular 56bs_bs_query 42bs_bs_query obesity, which affects 18% of adolescent girls in the USA and 6 health benefits. Exergames, or active video games, are popular 57bs_bs_query 43bs_bs_query 61% of obese adolescents with at least 1 risk factor for cardio- 4 among youth: in a study of 1241 adolescents (mean age 58bs_bs_query 44bs_bs_query vascular disease. ± 16.80 0.05 years), 24% reported playing exergames with an 59bs_bs_query 7 45bs_bs_query average play time of 50 min per session 2 days per week. It is 60bs_bs_query important that systematic reviews and meta-analyses indicate 61bs_bs_query 46bs_bs_query that exergaming can reach criteria of moderate- to vigorous- 62bs_bs_query 47bs_bs_query Peer review under responsibility of Shanghai University of Sport. 8–10 intensity activity. Whole body movement while exergaming, 63bs_bs_query 48bs_bs_query * Corresponding author. 49bs_bs_query E-mail address: [email protected] (A.E. Staiano) such as during dance exergames, can reach levels of moderate 64bs_bs_query http://dx.doi.org/10.1016/j.jshs.2016.11.005 2095-2546/© 2016 Production and hosting by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Amanda E. Staiano, Robbie A. Beyl, Daniel S. Hsia, Peter T. Katzmarzyk, Robert L. Newton Jr, Twelve weeks of dance exergaming in overweight and obese adolescent girls: Transfer effects on physical activity, screen time, and self-efficacy, Journal of Sport and Health Science (2016), doi: 10.1016/j.jshs.2016.11.005 ARTICLE IN PRESS JSHS344_proof ■ 6 December 2016 ■ 2/8 2 A.E. Staiano et al. 9,10 1 65bs_bs_query intensity, and exergaming that involves lower body move- complete data for the accelerometry and were included in the 123bs_bs_query 66bs_bs_query ment produces higher energy expenditure than exergaming that present analysis. 124bs_bs_query 8 125bs_bs_query 67bs_bs_query uses just the arms. 2.2. Procedures 126bs_bs_query 68bs_bs_query Despite the extensive evidence that exergaming can reach 127bs_bs_query 69bs_bs_query levels of moderate-intensity PA, it is not known whether being These data were collected as secondary outcomes in a trial 128bs_bs_query 70bs_bs_query physically activity by means of an exergame may influence an designed to examine the effects of exergaming on body com- 129bs_bs_query 71bs_bs_query adolescent to become more physically activity outside game position and cardiovascular risk factors; a complete description 130bs_bs_query 20 72bs_bs_query play (i.e., “transfer effects”). There is limited evidence that of the intervention and study methods is published elsewhere. 131bs_bs_query 73bs_bs_query adolescents transfer PA from one context to another. Prior Study procedures were approved by the Pennington Biomedical 132bs_bs_query 74bs_bs_query data indicate that obese children aged 10–17 years experienced Research Center Institutional Review Board. Parents and ado- 133bs_bs_query 75bs_bs_query significantly increased self-reported PA and decreased screen lescents provided written consent and assent, respectively. Par- 134bs_bs_query 76bs_bs_query time after a 12-week exercise trial involving 2 supervised ticipants completed a baseline clinic visit. At the end of the 135bs_bs_query 11 77bs_bs_query and 1 home-based 45-to60-min exercise sessions per week. clinic visit, participants were randomly assigned to the inter- 136bs_bs_query 78bs_bs_query However, these exercises involved traditional gym equipment, vention or a no-treatment control group. 137bs_bs_query 79bs_bs_query including aerobic and resistance exercises. One randomized In the intervention condition, participants attended 60-min 138bs_bs_query 80bs_bs_query within-subjects trial in 26 male adolescents found higher levels group exergaming sessions 3 times per week for 12 weeks, 139bs_bs_query 81bs_bs_query of energy expenditure measured by indirect calorimetry during whereas the control group was instructed to maintain current 140bs_bs_query 82bs_bs_query a1-h exergaming session on the Kinect for Xbox 360 vs. a1-h level of activity for 12 weeks. The intervention occurred outside 141bs_bs_query 83bs_bs_query seated video game, yet there were no significant condition dif- school time in a dance studio at Pennington Biomedical, where 142bs_bs_query 84bs_bs_query ferences measured by accelerometry on boys’ PA levels over 3 3 to 4 exergaming stations were available, each equipped with 143bs_bs_query 12 85bs_bs_query subsequent days. The potential influence of a longer duration the Kinect for Xbox 360 gaming console, a television, and the 144bs_bs_query 86bs_bs_query of exergaming on adolescents’ activity choices, screen behav- following exergames: Just Dance(Just Dance 3, Just Dance 4, 145bs_bs_query 87bs_bs_query iors,