University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Nutrition Publications and Other Works Nutrition 2012 Active Video Gaming Compared to Unstructured, Outdoor Play in Children: Measurements of Estimated Energy Expenditure and Measured Percent Time in Moderate-to-Vigorous Physical Activity Susan Brittin Macarthur [email protected] Follow this and additional works at: https://trace.tennessee.edu/utk_nutrpubs Part of the Dietetics and Clinical Nutrition Commons, and the Environmental Public Health Commons Recommended Citation Macarthur, Susan Brittin, "Active Video Gaming Compared to Unstructured, Outdoor Play in Children: Measurements of Estimated Energy Expenditure and Measured Percent Time in Moderate-to-Vigorous Physical Activity" (2012). Nutrition Publications and Other Works. https://trace.tennessee.edu/utk_nutrpubs/20 This Article is brought to you for free and open access by the Nutrition at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Nutrition Publications and Other Works by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. Active Video Gaming Compared to Unstructured, Outdoor Play in Children: Measurements of Estimated Energy Expenditure and Measured Percent Time in Moderate-to- Vigorous Physical Activity A Thesis Presented for the Master of Science Degree The University of Tennessee, Knoxville Susan Brittin MacArthur May 2012 i Abstract It is recommended that children and adolescents participate in > 60 minutes of moderate- to-vigorous physical activity (MVPA) per day. Despite the current recommendations and positive health benefits, many children and adolescents still do not engage in regular physical activity (PA). One challenge for assisting children in becoming more active is sedentary screen-based activities (SBAs), such as watching television (TV), using computers, and playing sedentary video games (VGs), as SBAs may compete with time for being physically active in children. One modification to sedentary VGs that may increase PA in children is to alter them so that the VGs actually provide an option to engage in PA. These types of VGs are called active video games (AVG) or “Exer-gaming.” Studies have found that playing AVGs can produce the estimated energy expenditure (EE) comparable to moderate-intensity structured PAs, such as moderate- intensity treadmill walking and self-paced walking, but significantly less EE as compared to vigorous-intensity PAs, such as running. To determine if AVGs can provide a good source of PA in young children, it is important to note that young children acquire much of their PA through play rather than structured PA. Children’s play consists of short intermittent bouts of activity with frequent rest periods. Children are more active in unstructured, outdoor play areas where they can freely engage in activities requiring running, jumping and chasing. Thus to determine if AVGs are a good source of PA for young children, AVGs should be compared to unstructured play, rather than structured PA. Only one study has compared AVGs to unstructured PA in children and has used pedometry to assess PA. Thus, the purpose of this investigation was to compare AVG to unstructured outdoor play, as assessed by accelerometery and direct observation (DO), using a within-subjects design. ii TABLE OF CONTENTS CHAPTER 1: LITERATURE REVIEW. 1 Pediatric Obesity and Physical Activity ................................................................. 2 Are Children Meeting the Recommendations for Physical Activity? .................... 3 Measuring Physical Activity in Children ................................................................ 5 Self-Report Assessment of Physical Activity ................................................... 5 Accelerometery ................................................................................................. 7 Direct Observation .......................................................................................... 12 Community-based Strategies to Increase Physical Activity ................................. 13 Physical Inactivity and Sedentary Behaviors ........................................................ 17 Understanding the Relationship Between Physical Activity and Sedentary Screen- based Activities ..................................................................................................... 21 Active Video Game Play ...................................................................................... 22 Activity Patterns of Young Children .................................................................... 27 Summary ............................................................................................................... 29 CHAPTER 2: MANUSCRIPT. 32 Abstract ................................................................................................................. 33 Introduction ........................................................................................................... 35 Methods................................................................................................................. 38 iii Study Design ................................................................................................... 38 Participants ...................................................................................................... 38 Procedure ........................................................................................................ 40 Description of Activities ................................................................................. 42 Measures ......................................................................................................... 45 Data Analysis ................................................................................................. 53 Results ................................................................................................................... 54 Participant Characteristics .............................................................................. 54 Physical Activity and TV Questionnaire ........................................................ 54 Experience with Active Video Games ............................................................ 55 Pediatric Quality of Life Inventory 4.0 (Peds QL™ 4.0) ............................... 56 Dietary Intake.................................................................................................. 56 Liking of Games: Physical Activity Enjoyment Scale (PACES) ................... 56 Weather Conditions ........................................................................................ 56 Actical Accelerometer .................................................................................... 57 ActiGraph GT3X+ Accelerometer .................................................................. 58 Direct Observation .......................................................................................... 58 iv Discussion ............................................................................................................. 58 Application ............................................................................................................ 66 References ............................................................................................................. 67 Appendices ............................................................................................................ 74 Appendix A: Tables & Figures ....................................................................... 75 Appendix B: Forms ......................................................................................... 90 Vita ...................................................................................................................... 121 v LIST OF TABLES Table 1: Overall Study Design .............................................................................. 76 Table 2: Participant Characteristics ...................................................................... 77 Table 3:Physical Activity and TV Questionnaire ............................................... 78 Table 4: Experience with Active Video Games .................................................... 80 Table 5: Pediatric Quality of Life Inventory 4.0 (Peds QL™ 4.0) ....................... 81 Table 6: Dietary Intake for All Participants the Morning of Each Session .......... 82 Table 7: Physical Activity Enjoyment Scale (PACES) ........................................ 83 Table 8: Weather Conditions during Each Session............................................... 84 vi LIST OF FIGURES Figure 1: Actical Accelerometer Activity Counts per Minute .............................. 85 Figure 2: Actical Accelerometer Percent Time Engaged in Moderate-to-Vigorous Physical Activity (MVPA) .................................................................................... 86 Figure 3: Actical Accelerometer Estimated Energy Expenditure ......................... 87 Figure 4: ActiGraph GT3X + Accelerometer Activity Counts per Minute .......... 88 Figure 5: Direct Observation, Children’s Activity Rating Scale (CARS): Percent Time Engaged in Moderate-to-Vigorous Physical Activity ........................................... 89 vii CHAPTER I: LITERATURE REVIEW 1 Pediatric Obesity and Physical Activity The increasing prevalence of childhood obesity is a serious public health issue [1]. The 2007-2008 National Health