Previously submitted to: JMIR Serious Games (no longer under consideration since Jun 20, 2023)
Date Submitted: Jan 27, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The effects of an exergame implemented in primary schools on physical activity, sedentary time and motivation in children
ABSTRACT
Background:
The majority of children are insufficiently physically active. The interest in video games amongst children provides new opportunities to increase physical activity (PA) via exergames. Tailoring exergames is costly and labor intensive and therefore the implementation of an exergame with minimal support could be promising. The exergame BOOSTH uses a wrist worn activity tracker to measure steps per day. As a reward for the performed PA, children can unlock levels in the online BOOSTH game. In addition, the BOOSTH battle enables competition between groups.
Objective:
The current study aims to investigate the effect of the exergame BOOSTH, implemented in the primary school setting, on PA, sedentary time (ST), screen time and motivation towards PA after three and six months.
Methods:
The study was a cluster randomized controlled trial. Stratified by community and school size, sixteen primary schools were randomized into standard physical education curriculum (control) or standard physical education curriculum + BOOSTH (intervention). Measurements were performed at baseline and after 3 and 6 months. PA (total PA, light PA and moderate to vigorous PA (MVPA)) and ST were measured with the GT3X Actigraph accelerometer and the BAECKE questionnaire. Motivation towards PA was measured with the BREQ-2 questionnaire. Data were analyzed using linear mixed models.
Results:
710 children (53% girls, 10 ± 1y of age) participated in this study. After correction for baseline levels/data, children in the intervention group had on average a lower MVPA (min/day) (effect estimate B= -10, p= <0.001) and higher ST (min/day) (B= 24, p= 0.002) at six months compared to the control group. After six months, children in the intervention group reported lower intrinsic motivation towards PA (B= 0.27, p = 0.011) and higher screen time on a weekday (B= 0.033, p = 0.045) compared to the intervention group. Sensitivity analyses showed similar results.
Conclusions:
Implementation of the exergame BOOSTH in the primary school setting had adverse effects on promoting PA and reducing ST in daily life of children in the first half year. A mixed method process evaluation is needed to gain a more complete understanding of the (un)successful implementation components, and to identify recommendations for future exergame interventions in the school setting. Clinical Trial: ClinicalTrials.gov, NCT03440580, https://clinicaltrials.gov/ct2/show/NCT03440580.
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