Physical activity is associated with broad physical and psychological benefits in children and adolescents. One construct which may universally characterize functioning across various pediatric populations is health-related quality of life (HRQOL). A number of studies have found positive associations between physical activity and HRQOL; however, to date no systematic review and meta-analysis of physical activity and HRQOL has successfully quantified effects in children and adolescents. A systematic search of PubMed, PsycINFO, and ProQuest Dissertation Abstracts identified 1081 relevant, non-duplicate articles. Out of these possible articles, 33 studies, including both descriptive and pre-post intervention designs, met inclusion criteria and were included in effect size analyses. In descriptive studies, there was a small, positive effect of physical activity on HRQOL based on child-reports (Hedge's g = .302, p < .001) and a negligible effect based on parent-proxy reports (Hedge's g =.115, p =.101). In intervention studies, there was a small, positive effect of physical activity intervention on HRQOL based on child-reports (Hedge's g = .279, p = .014) and a medium, positive effect based on parent-proxy reports (Hedge's g = .522, p = .012). However, effects are attenuated by removal of a single intervention study. Overall, these findings supported the primary hypothesis that increased levels of physical activity would be related to better HRQOL in youth, although the magnitude of these effects did not represent a minimal clinically important difference (MCID) in most studies. Hypothesized moderators, including chronic disease status, weight status, sex, and study rigor, did not significantly moderate the relationship between physical activity and HRQOL. Exploratory analyses did not find intervention contact hours or age to moderate the effect of exercise on HRQOL. Future studies are needed to assess HRQOL in youth before and after high-quality exercise interventions to quantify the type, frequency, iv duration, and intensity of physical activity needed to change HRQOL to a clinically meaningful level. Although effects were small and analyses were limited, this study represents the first meta-analysis of physical activity and HRQOL across pediatric populations and may serve as a guide for future studies.

Summary Background Structured exergaming with prescribed moderate intensity physical activity has reduced adiposity among adolescents. The extent to which adolescents reduce adiposity when allowed to self-select intensity level is not known. Objective The objective of the study was to examine the influence of exergaming on adolescent girls’ body composition and cardiovascular risk factors. Methods This randomized controlled trial assigned 41 overweight and obese girls aged 14 to 18 years to group-based dance exergaming (36 h over 3 months) or to a self-directed care control condition. Body size and composition were measured by anthropometry, dual-energy X-ray absorptiometry [%fat and bone mineral density {BMD}] and magnetic resonance imaging. Cardiovascular risk factors included blood pressure, cholesterol, triglycerides, glucose and insulin. Results Attrition was 5%. Using analysis of covariance controlling for baseline value, age and race, there were no significant condition differences. Per protocol (attended >75%), the intervention group significantly decreased abdominal subcutaneous adiposity and increased trunk and spine BMD (ps < 0.05). Per protocol (>2600 steps/session), the intervention group significantly decreased leg %fat and decreased abdominal subcutaneous and total adiposity (ps < 0.05). Conclusion Exergaming reduced body fat and increased BMD among those adolescent girls who adhered. Further research is required before exergaming is recommended in clinical settings.

Children and adolescents most often play active videogames, or exergames, in a social environment. Social play may enhance the potential benefits of an exergaming experience, much like group exercise and team sports are observed to improve physical activity-related outcomes above those of solitary exercise. Two ubiquitous elements of exergames are cooperation and competition. Previous literature suggests that cooperative and competitive aspects of exergames may affect physiological and psychosocial changes. Competitive play has been found to increase energy expenditure and aggression in short bouts of exergaming. Cooperative exergaming has been found to increase motivation, promote continued play, enhance self-efficacy, and increase pro-social behaviors. In one study, a cooperative exergaming condition also resulted in significant weight loss for overweight and obese adolescents. Individual player differences such as individual preferences, competitiveness, weight status, age, gender, and ethnicity may moderate effects. Although the current volume of literature on competition and cooperation in exergaming is small, social exergames hold promise as an engaging alternative to traditional physical activity interventions and may promote a broad range of positive outcomes for children and adolescents. Principles of cooperation and competition are applicable for developers of healthpromoting games. Future research is needed to further understand the mechanisms of how competition and cooperation in social exergaming impact physiological and psychosocial outcomes.

BackgroundLow levels of moderate-to-vigorous physical activity are associated with adverse health consequences.ObjectiveThe intent of the study was to determine the feasibility and efficacy of a 12-week physical activity promotion program targeting children, which was delivered to parents through mobile phones.MethodsPotential participants were recruited through advertisements placed in the newspaper, local hospitals and schools, and an email listserv. Sedentary children aged 6-10 years were randomly assigned to a minimal (MIG) or intensive (IIG) intervention group. Parents in the MIG were given a goal to increase (within 1 month) and maintain their child’s activity at 6000 pedometer steps/day above their baseline levels and to monitor their child’s steps daily. Parents in the IIG were given the same steps/day and monitoring goals, in addition to text messages and articles containing additional behavioral strategies (based on the Social Cognitive Theory) designed to promote their child’s physical activity. The intervention components were delivered via mobile phone. Anthropometrics, body composition, and questionnaires were administered in a clinic. Children wore a New Lifestyles pedometer (NL-1000) each day throughout the intervention and parents were to monitor their child’s step counts daily.ResultsOut of 59 children who screened for the study, a total of 27 children (mean age 8.7, SD 1.4 years; 56%, 15/27 female; 59%, 16/27 African American) were enrolled and completed the study. Overall, 97.90% (2220/2268; 98.20%, 1072/1092 for MIG; 97.60%, 1148/1176 for IIG) of expected step data were successfully entered by the parent or study coordinator. Parents in the MIG and IIG were sent approximately 7 and 13 text messages per week, respectively, averaged over the course of the study. IIG parents accessed an average of 6.1 (SD 4.4) articles over the course of the intervention and accessed a fewer number of articles in the last month compared to the first 2 months of the study (P=.002). Children in both the MIG and IIG significantly increased their physical activity, averaged over 12 weeks, by 1427.6 (SD 583.0; P=.02) and 2832.8 (SD 604.9; P<.001) steps/day above baseline, respectively. The between group difference was not statistically significant (P=.10; effect size=.40), nor was the group by time interaction (P=.57). Regardless of group assignment, children who significantly increased their physical activity reported greater increases in physical activity enjoyment (P=.003). The number of behavioral articles accessed by IIG parents was significantly correlated with change in children’s steps/day (r=.575, P=.04). Changes in children’s steps/day were unrelated to changes in their body composition, mood, and food intake.ConclusionsParent-targeted mobile phone interventions are feasible, yet more intense interventions may be needed to support parents’ efforts to increase their children’s physical activity to levels that approximate national recommendations.Trial RegistrationClinicaltrials.gov NCT01551108; http://clinic...