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Running App “Zombies, Run!” Users' Engagement with Physical Activity: A Qualitative Study
Abstract
Introduction: Sufficient physical activity (PA) is important for all aspects of health. Smartphone apps and the use of gamification, such as narrative-based augmented reality (AR), have a great potential to engage a variety of people in more PA. Zombies, Run! (ZR) is the world’s most popular running exergame app and therefore a suitable model to understand what users find engaging.
Objective: To understand people’s motivation and experience of using a narrative-based AR exergame app ZR for PA.
Materials and Methods: ZR users were randomly selected for interview from a quantitative ZR user’s survey. Interviews which were guided by a semi-structured topic guide were audio-recorded, transcribed, and analyzed using inductive and deductive thematic analysis.
Results: Participants were 15 males and 15 females aged 16–53 years (mean = 36, SD = 10), from 13 countries, with the largest proportions from the United States (30%) and United Kingdom (23%). The majority (73%) used ZR while running, followed by cycling and walking. Four overarching themes that emerged were: ‘‘Reasons for starting and staying with ZR,’’ ‘‘Preferred features,’’ ‘‘Perceived effects of ZR,’’ and ‘‘Pros and cons of the app.’’ Sixteen subthemes included the attraction of gamification and narrative appeal, desire to add something fun to PA, or to distract from the negative physiological effects of PA. Users’ favorite features were the feelings of immersion and presence through narrative, story line, and characters. The narrative motivated participants to engage in PA for longer sessions and encouraged long-term use.
Conclusions: This study identified a number of factors that users found attractive in an AR running exergame, particularly narrative. Our findings suggest that ZR may engage people in exercise by modifying their perception of PA through a story line or narrative, dissociating the players from the effort of exertion. AR narrative-based apps may be an effective way of engaging people with health-related behaviors or habit-forming activities.
... These suggestions make sense, as they would help make the app more engaging, motivating, and easy to use. According to a recent study conducted on the "Zombie Run" game, the gamification and narrative appeal of the game are particularly attractive to young individuals (Farič et al., 2021). The study revealed that many participants enjoyed incorporating an element of enjoyment into their physical activity routine or using the game to distract themselves from the physical effort of exercise. ...
... The immersive and engaging narrative, as well as the well-developed characters in the game, were also found to be highly appealing to users. However, features such as mood and sleep tracking, sharing workout results on social media, and digital avatars were not well-received by participants and were not found to be effective in motivating users (Farič et al., 2021). In the study conducted by Daryabeygi-Khotbehsara and co-workers (2021), the "Active2Gether" intervention was reported using three different arms. ...
... According to a recent focus group study with 8 adolescents aged 16-18, certain features such as mood and sleep tracking, sharing workout results on social media, having a digital avatar and coach, and receiving rewards were viewed negatively and deemed pointless and unhelpful (Domin et al., 2022). (Gomes et al., 2024;Paganini et al., 2021) Rewards (Farič et al., 2021;Gomes et al., 2024;Martin et al., 2020;Pope et al., 2017;Thornton et al., 2021)26/02/2025 11:51:00 Self-monitoring/ Tracking (Braun et al., 2024;Domin et al., 2022;Gomes et al., 2024;Paganini et al., 2021;Thornton et al., 2021) Social support (Braun et al., 2024;Ghosh et al., 2024;Gomes et al., 2024;Martin et al., 2020) Feature Reference Aesthetic features (Domin et al., 2022;Ghosh et al., 2024;Pope et al., 2017) Customization and personalization (Braun et al., 2024;Domin et al., 2022;Ghosh et al., 2024;Paganini et al., 2021) Relaxation (Paganini et al., 2021) Simplicity and accessibility (Domin et al., 2022;Paganini et al., 2021;Pope et al., 2017) Technical aspects/ training programs (Braun et al., 2024;Domin et al., 2022;Paganini et al., 2021) Results from reviews describe several features included in PA promotions apps (Table 3. BCTs and other features suggested by data from reviews). Some of them are more closely related to behaviour change theory, using of goal setting, action planning, self-monitoring, and feedback (Baumann et al., 2022). ...
Introduction: Previous research has not explored features and behavior change techniques (BCTs) in physical activity (PA) promotion interventions among adolescents, including mobile health (mHealth) applications. Purpose: This study aims to conduct a narrative literature review of adolescent PA promotion apps, examining their theoretical foundations, key BCTs, primary features, and their influence on PA adherence and maintenance. Methods: The review includes peer-reviewed studies published from 2012 to December 2024, employing qualitative and quantitative methodologies. Included studies examined healthy adolescents, focusing on PA app features and their relationship to PA promotion. Results: A total of twenty-one studies were analyzed: ten reviews, eight qualitative studies, and three app quality assessments. Findings indicate that mHealth tools and wearable trackers yield variable impacts on PA engagement. Conclusion: Future research must adopt higher methodological standards. Comparative studies on PA interventions require caution due to limitations such as insufficient research, inadequate compliance assessment tools, potential biases, and the absence of randomized controlled trials. The inconsistent outcomes from current intervention studies highlight the necessity for developing PA programs guided by intervention mapping or the Behavior Change Wheel, emphasizing high-quality methodologies tailored to specific target demographics.
... In practice, various examples demonstrate how well-crafted narratives in gamifed IS can contribute to their success. For instance, Zombies, Run!, an app regularly hailed as a prime example for good gamifcation design, uses audio plays to immerse users in a zombie apocalypse narrative to motivate users to engage in physical exercise [11]. Other examples of narratives in gamifed IS include the language education app Duolingo, which uses textual and audiobased mini-stories to challenge users' reading and listening comprehension, or the Microsoft Ofce add-on Ribbon Hero, which introduces users to new features based on the story of Clippy the paperclip [1]. ...
... As a research context, we chose a gamifed mobile application to support physical activity, since applications like Zombies, Run! or Fit for Battle have provided anecdotal evidence on the efectiveness of narratives in fostering physical activity behavior [11]. One reason is that physical activity tasks can easily be implemented into narratives by letting characters within the story perform similar actions to those that are desired to be performed by users [49]. ...
Gamification refers to the use of game design elements in non-game contexts to evoke both instrumental and experiential outcomes within users. Although narratives are an integral part of most video games, little academic attention has been paid toward narratives as part of gamification design. In this research, we investigate two distinct aspects of narratives in gamified information systems (IS): (1) the mental state of narrative transportation, and (2) the congruence between a narrative and an instrumental task. In an online experiment in the context of physical activity among 325 individuals, we find that high levels of narrative-task congruence make it easier for users to experience narrative transportation, which in turn positively influences the dual outcomes of gamified IS. We contribute to research by contextualizing narrative transportation theory and empirically investigating the affective and behavioral effects of congruence between instrumental task and game design elements.
... In one study, Farič et al. [29] investigated people's motivation and experience using a narrative-based AR exergame app called Zombies, Run! (ZR) for PA. The app immerses users in a post-apocalyptic world where running helps them collect supplies and build a base. ...
Mobile games have the potential to increase physical activity (PA). However, not all games can capture and sustain interest in PA, as it is challenging to maintain user engagement once the initial novelty diminishes. This research explores how augmented reality (AR) and idle game design, combined with persuasive strategies, can reduce sedentary behavior. We designed, developed and evaluated PetBuddy, a mobile health game aimed at promoting PA. Sixty-five young adults (between 18-35 years old) played the game for 10 days and completed a questionnaire about their experience. This is followed by an interview of 17 participants. Results revealed significant increases in PA with users meeting the World Health Organization's recommended activity levels and adopting healthier behavioral changes. Participants reported that the persuasive strategies implemented as game features (particularly competition) and the game experience motivated them to participate in PA. The findings from this research provide a deeper understanding of how mobile games can be designed to encourage PA.
... In terms of the objective evaluation, adolescents who used Pokémon Go showed greater entertainment and customization results as compared to the apps used as pedometers (Pacer and Strava, respectively). These results follow previous research, in which users of augmented reality apps showed a greater engagement in physical activity, as their perception was modified by a story line or narrative that dissociated them from exertion (Farič et al., 2021). Furthermore, previous research has shown that Pokémon Go has other strengths to consider, such as game enjoyment or player customization options (Hamari et al., 2019;Qin, 2021), which is supported by the results of the study. ...
The aims of the present research were to understand the reasons why adolescents stop using mobile applications and to discover the objective and subjective evaluation of mobile applications for physical activity by adolescents. A 10-week quasi-experimental design involving four experimental groups of adolescents who used mobile apps. A total of 240 adolescents aged 12–16 years participated in the research. The level of physical activity and the assessment of the apps used were recorded. The results showed an increase in physical activity after the intervention. The main reasons for not using the apps were that adolescents found the interface complex, or the apps did not work on their mobiles. Pokémon Go showed a greater entertainment and customization than the rest of the apps. It can be concluded that the abandonment of mobile app interventions is due to the fact that they are not designed for use in this population.
... Farič et al. [15] and Farič et al. [16] investigated the potential of virtual reality (VR) and narrative-based AR applications. The former found that VR shows promise in engaging adolescents in physical activity, although further development is needed. ...
Physical inactivity represents a significant public health challenge globally. Mobile applications, particularly those utilizing augmented reality (AR), have emerged as innovative tools for promoting physical activity. However, a systematic evaluation of their efficacy is essential. This systematic review aims to evaluate and synthesize the evidence regarding the effectiveness and benefits of mobile applications with augmented reality in enhancing physical activity and improving health outcomes. A comprehensive search was conducted in Scopus, PubMed, WOS, and the Cochrane Library databases following PRISMA guidelines. Observational and interventional studies evaluating AR mobile applications for physical exercise were included, without restrictions on publication date or language. The search terms included “Mobile Applications”, “Augmented Reality”, “Physical Fitness”, “Exercise Therapy”, and “Health Behavior”. The methodological quality was assessed using the ROBINS tool. The review identified twelve eligible studies encompassing 5,534,661 participants. The findings indicated significant increases in physical activity and improvements in mental health associated with the use of AR applications, such as Pokémon GO. However, potential risk behaviors were also noted. The evidence suggests that AR interventions can effectively promote physical activity and enhance health. Nonetheless, further research is needed to address limitations and optimize their efficacy. Future interventions should be tailored to diverse cultural contexts to maximize benefits and mitigate risks. AR mobile applications hold promise for promoting physical activity and improving health outcomes. Strategies to optimize their effectiveness and address identified risks should be explored to fully realize their potential.
... Narrative story-based pacing applications may help runners perform interval training or reach a target pace by following the instructions provided in the story. These methods of interaction allow runners to enjoy their run, motivate them, reduce their perceived rate of exertion, and at the same time help improve their pace [30,60]. However, a significant flaw of smartphone applications is their inability to track incorrect running forms that runners may adopt to match song speed or directions communicated through the phone, potentially leading to injuries and decrease in performance. ...
... There is evidence that 2020 was the most profitable year ever for the Pokémon Go enterprise [36], suggesting that many exergamers continued to play this outdoor game during COVID-19. Zombies, Run! also had an increase of 2 million users during COVID-19 [37]. Further, Ellis et al [38] reported that among 2004 young adult gamers (aged 30.5 years on average), Pokémon Go and Harry Potter: Wizards Unite were played frequently during the pandemic to maintain exercise levels and for social connection. ...
Background:
Exergaming may be an important option to support an active lifestyle during the COVID-19 pandemic.
Objective:
The objectives of this study were to: (i) explore whether change in exergaming status (stopped, started, stable and never exergamed) from before to during the pandemic related to change in walking or moderate-to-vigorous physical activity (MVPA); and (ii) among past-year exergamers only, describe change in minutes exergaming/ week from before to during the COVID-19 pandemic.
Methods:
The sample included 681 participants (M(SD)age=33.6 (0.5), 41% male) from the 22- year NDIT study who provided data on walking, MVPA, and exergaming in cycles 23 (2017-20) and 24 (2021). Physical activity (PA) change scores, including exergaming change scores, were computed by subtracting number of minutes/ week for each PA indicator in cycle 23 from minutes/ week in cycle 24, were described by exergaming status from before to during the pandemic.
Results:
Regardless of exergaming status, both minutes walking and engaging in MVPA declined by 30 minutes/ week from before to during the COVID-19 pandemic. Two-thirds participants (62.4%) were stable non-exergamers, 8.2% started exergaming during the pandemic, 19.7% stopped, and 9.7% were stable exergamers. Stable exergamers increased exergaming by a median 60 minutes/ week during the pandemic. Starters reported 85 minutes of exergaming/week during the pandemic.
Conclusions:
Exergaming may not have been enough to maintain pre-pandemic PA levels however exergaming can contribute to a substantial proportion of total PA among young adults and may therefore represent a valuable option to promote PA during periods of confinement.
... AR serious games (ARSG) are especially characterized by immersive storylines and high engagement that promotes learning and behavior change. Examples include Street Smart AR for women's safety [11], Zombie, Run! AR for health fitness [15], and ATHYNOS, an AR game prototype designed to provide cognitive and behavioral therapy for children with ADHD [6]. ...
Despite the efforts of existing Title IX training programs in the US, current intervention and prevention programs fail to address the problems caused by sexual violence on US college campuses. To address this issue, we designed a mobile augmented reality (AR) game-TitleIX: Step Up & Step In!-that encourages students to become more active and supportive of bystanders through innovative game play, while aiming to improve current sexual assault bystander intervention training. Utilizing AR technology and embodied conversational agents (ECAs), this game provides highly immersive scenario based training for sexual assault bystander intervention while connecting the users to realistic campus experiences. This inventive game design leverages innovative technology to increase awareness of real-world problems; specifically, sexual harassment targeting women and LGBTQ+ students on college campuses. The design implemented in this paper can inform the future construction of AR serious games for social justice.
... For example, 'Adventure Sync' in Pokémon Go rewards players by recording the number of daily walking steps and the exergame, Zombies, Run! Prompts the players to exercise due to the interactive missions and running scenarios. The narrative structure of these online games is used to modify the perceptions of individuals and distract them from the physical activity they may be exerting during the playing of the game (Fari c et al., 2021). Subsequently, these games may motivate the players to engage in outdoor activity (Zsila et al., 2018). ...
Background and aims:
Internet use has become an important part of daily living. However, for a minority it may become problematic. Moreover, problematic use of the Internet/smartphone (PUIS) has been associated with low physical activity. The present study investigated the temporal associations between three types of PUIS (i.e., problematic smartphone use [PSPU], problematic social media use [PSMU] and problematic gaming [PG]) and physical activity among Taiwanese university students.
Methods:
A six-month longitudinal survey study comprising three time points for assessments was conducted. From the original 974 participants, a total of 452 completed all three waves of an online survey comprising the International Physical Activity Questionnaire Short Form (IPAQ-SF) assessing physical activity level, Smartphone Application-Based Addiction Scale (SABAS) assessing PSPU, Bergen Social Media Addiction Scale (BSMAS) assessing PSMU, and Internet Gaming Disorder Short Form (IGDS9-SF) assessing PG.
Results:
The linear mixed effects model found positive temporal associations of PSMU and PG with physical activity level (PSMU: B = 85.88, SE = 26.24; P = 0.001; PG: B = 36.81, SE = 15.17; P = 0.02). PSPU was not associated with physical activity level (B = 40.54, SE = 22.99; P = 0.08). Additionally, the prevalence rates were 44.4% for at-risk/PSPU, 24.6% for at-risk/PSMU, and 12.3% for at-risk/PG.
Discussion and conclusions:
PSMU and PG unexpectedly demonstrated correlations with higher physical activity level. The nature of these relationships warrants additional investigation into the underlying mechanisms in order to promote healthy lifestyles among university students.
... For example, Zombies, Run! provides running scenarios and interactive missions to encourage the players to exercise. Pokémon GO as an exergame uses the number of daily walking steps as rewards to motivate players to engage in exercise and outdoor activities [45,46]. Individuals who have nomophobia may worry if they do not have their smartphone nearby and are unable to monitor or be rewarded for their physical activity. ...
Insufficient physical activity is a common problem for university students because they may engage in sedentary lifestyle owing to excessive time spent on their smartphones and social media use. This may result in problematic internet use (PIU) and nomophobia (fear of not having a mobile phone). Moreover, prior evidence shows that weight-related self-stigma is an important factor contributing to low physical activity. Therefore, the present study examined the associations between PIU, nomophobia, and physical activity among university students across mainland China, Taiwan, and Malaysia. Participants (3135 mainland Chinese, 600 Taiwanese, and 622 Malaysian) completed the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale
(SABAS), Nomophobia Questionnaire (NMPQ), Weight Self-Stigma Questionnaire (WSSQ), and International Physical Activity Questionnaire Short Form (IPAQ-SF). The measurement invariance of the assessed questionnaires was supported across the three regions. The present findings analyzed using partial least squares structural equation modeling showed that (i) greater nomophobia was associated with higher levels of physical activity, (ii) greater weight-related self-stigma was associated with higher levels of physical activity, and (iii) greater nomophobia was associated with greater weight-related self-stigma. Although the present findings suggest the possibility that experiencing some level of nomophobia or weight-related self-stigma appears to help improve physical activity, it
is not recommended that these be encouraged, but reducing PIU should be targeted as a means to improve physical activity.
The issue of insufficient physical activity among computer game players remains relevant. This study proposes a solution based on the comprehensive use of gaming-oriented mobile applications for the conditioning training of esports athletes. A sequential pedagogical experiment was conducted to determine the effectiveness of esports athletes applying an aerobic-focused conditioning training program (slow running). The program’s unique feature is its implementation in a remote format using mobile applications for planning, execution, control, and performance evaluation. It is based on an original concept of implementing running training in the form of a mobile running application (the so-called “exergame”) with a game-like nature (“Zombies, Run!”). The program was designed for a six-week implementation. Its effectiveness was determined by evaluating the dynamics of indicators: 1600 m run time; calculated maximal oxygen consumption (VO2 max); and heart rate (HR). Subjective attitudes towards the program’s physical loads were assessed using the Rating of Perceived Exertion (RPE) scale and the Physical Activity Satisfaction Needs scale. It was found that esports athletes significantly (p<0.05) improved their 1600 m run time, VO2 max, and HR indicators under the influence of the slow running program. Along with the volume and intensity increase of the running load, a decrease in RPE scale indicators was observed. The obtained data confirmed the advantages of the comprehensive use of mobile applications for normalizing the motor activity of esports athletes in the form of conditioning training. Both the remote format of planning and accounting and the game format of activities contributed to increasing the engagement of esports athletes in physical activity. The effectiveness of the slow running training program for esports athletes using mobile applications was established in terms of increasing physical activity (regular, organized physical activity), improving physical fitness (duration and volume of slow running), enhancing physical condition (VO2 max, HR), and interest in physical activity (adherence).
This paper explores the potential of drones in supporting running activities as pacesetters and video recorders. Using questionnaires and interviews, insights were gathered from 10 recreational runners regarding their experience running with a drone in the study and viewing drone-captured videos of their run. Results indicated that participants found the drone experience engaging and minimally disruptive, despite perceiving it somewhat unnatural and having polarized view on the spatial immersion. Analysis of responses unveiled factors affecting runners' experiences, while their reflections on drone-captured run videos revealed benefits of leveraging such footage for post-run self-reflections and opportunities for improvement. Additionally, participants' insights led to the identification of more roles and functions for drones in supporting various running activities, beyond pace-setting and video recorders. This study lays the groundwork for future research, positioning drone utilization in running as a promising avenue for exploration.
Background:
The COVID-19 Pandemic led to the implementation of worldwide restrictive measures to reduce social contact and viral spread. These measures have been reported to have a negative effect on physical activity (PA). Studies of PA during the pandemic have primarily used self -reported data. The single academic study that used tracked data did not report on demographics.
Objective:
The present study aimed to explore patterns of smartphone tracked activity before, during and immediately after lockdown in the UK, and examine differences by sociodemographic characteristics and prior levels of PA.
Methods:
Tracked longitudinal weekly minutes of physical activity were captured using the BetterPoints smartphone app between January and June 2020. Data was plotted by week, demographics and activity levels at baseline. Non-parametric tests of difference were used to assess mean and median weekly minutes of activity at significant points, before, during and as lockdown was eased. Changes over time by demographics (age, gender, Index of Multiple Deprivation, baseline activity levels) were examined using generalised estimating equations (GEEs).
Results:
There were 5395 users with mean age of 41 (SD 12), 61% were female. At baseline, 26% of users were inactive, 23% fairly active and 51% active. There was a relatively even spread across deprivation deciles (31% in the least deprived deciles and 23% in the most). We found significant changes in PA from the week before the first case of COVID-19 was announced (baseline), to the week that social distancing restrictions were relaxed (Friedman test: χ2(2) = 2331, p < 0.001.) By the first full week of lockdown, the median change in PA was 57 minutes less than baseline. This represents a 37% reduction in weekly minutes of PA. Overall, 63% of people decreased their level of activity between baseline and first week of COVID-19 restrictions. Younger people showed more PA before lockdown but the least PA after lockdown. In contrast, the over-65s appeared to remain more active throughout and increased their activity levels as soon as lockdown was eased. Levels of physical activity among those classed as active at baseline showed a larger drop compared with those considered to be fairly active or inactive. Socioeconomic group and gender did not appear to be associated with changes in PA.
Conclusions:
Our tracked physical activity data suggests a significant drop in PA during the UK's COVID-19 lockdown. Significant differences by age group and prior PA levels suggests that the Government's response to COVID-19 needs to be sensitive to these individual differences and react accordingly. Specifically, it should consider the impact on younger age groups, encourage everyone to increase their PA and not assume that people will recover prior levels of PA on their own.
Clinicaltrial:
Background
Early adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity.
Objective
The vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration.
Methods
The formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group.
Results
VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback.
Conclusions
This is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial.
Background:
Mother and baby units (MBUs) are an inpatient mental health service where women experiencing acute severe postpartum psychiatric difficulties can be admitted with their babies. They are currently viewed as best practice in the UK and elsewhere. However, as service provision is fragmented, some women residing in areas without MBUs are admitted to acute general psychiatric wards without their infants. This study aimed to compare qualitatively experiences of these two service types from the perspectives of women and clinicians.
Methods:
Semi-structured interviews were conducted with fifteen women who received treatment for perinatal mental health problems on a general psychiatric ward and/or MBU in England. Two focus groups were also conducted, one with MBU staff (n = 11) and one with acute ward staff (n = 6). Data were analysed thematically.
Results:
Women generally preferred being co-admitted with their baby to an MBU over lone admission to a general psychiatric ward. Women and clinicians felt that MBUs provided more perinatally-focused, family-centred care, and were better-equipped to meet women's needs. General wards were reported by women and staff to lack the necessary facilities and expertise to support perinatal women adequately, while separation of mothers and babies was often experienced by women as traumatic and detrimental to recovery. However, some areas for improvement were also identified across both service types, particularly relating to difficulties transitioning home post-discharge, inadequate support for family members, staffing issues and access problems (with MBUs).
Conclusions:
Findings suggest that specialist perinatal inpatient care is considered preferable to generic care in the perinatal period from both service user and staff perspectives. Increased collaboration between perinatal and non-perinatal services could help improve perinatal expertise on general psychiatric wards, while further expansion of perinatal services (e.g. to cater for women currently considered too high risk for MBUs and for those discharged from inpatient settings) could tackle other shortfalls in care.
The development of innovative technology, such as virtual reality (VR), has provided opportunities for promoting physical activity (PA) in a fun and engaging manner. The purpose of this study was to examine differences in young adults' situational motivation (SM) among immersive VR, non-immersive VR, and traditional stationary cycling sessions. In all, 49 healthy college students (35 females; M
age
= 23.6 years, SD = 3.4; M%BF = 24.0%, SD = 7.5) completed three separate 20 min cycling sessions: (1) immersive VR cycling; (2) non-immersive VR cycling; and (3) traditional cycling. Participants' SM was assessed via the situational motivation scale, which included four subconstructs: intrinsic motivation, identified regulation, external regulation, and amotivation. Repeated measures ANOVAs indicated significant differences for situational motivation between cycling sessions (F (2, 96) = 4.74-53.04, p < 0.01, ηp2 = 0.090-0.525). Specifically, participants elicited the highest level of intrinsic motivation in immersive VR cycling compared to the other two sessions. Moreover, participants in both immersive VR and traditional cycling showed greater identified regulation than the non-immersive VR session. Furthermore, participants showed greater external regulation compared to the immersive VR session. In addition, greater amotivation was observed in non-immersive VR compared to the immersive VR session. Findings suggested that immersive VR exercise has the potential to be an attractive exercise alternative, possibly promoting greater PA participation and adherence among young adults.
Background:
Although exercise has been shown to improve mood and well-being, the precise mechanism remains unknown. Neurosteroids are important neuroactive molecules with demonstrated involvement in several neurophysiological and disease processes. Previous research has noted neurosteroid changes in dehydroepiandrosterone (DHEA) levels following exercise.
Objectives:
To determine whether changes in DHEA levels are associated with mood improvement after exercise and whether there are any differences in the effects on younger and older individuals.
Methods:
Individuals ≤ 50 years of age or > 65 years of age were recruited for study participation. Before and after 30 minutes of a standardized cycling regimen, each patient provided a blood sample and completed a questionnaire on mood and well-being.
Results:
Findings confirmed a significant increase in DHEA levels post-exercise. A decrease in negative factors (fatigue, tension, depression, anger) and an increase in positive mood factors were noted. No difference in change of measures was noted between younger and older subjects. A positive correlation was noted between mood change and DHEA blood-level changes in older subjects. Among older males, DHEA appeared to be associated with mood change after exercise.
Conclusions:
While preliminary, findings indicate a possible association between mood improvement following exercise and DHEA blood level changes. Understanding the biological mechanisms of exercise-induced mood changes is critical to utilizing exercise as a treatment for mood disorders.
Background:
A large number of people participate in individual or unorganized sports on a recreational level. Furthermore, many participants drop out because of injury or lowered motivation. Potentially, physical activity-related apps could motivate people during sport participation and help them to follow and maintain a healthy active lifestyle. It remains unclear what the quality of running, cycling, and walking apps is and how it can be assessed. Quality of these apps was defined as having a positive influence on participation in recreational sports. This information will show which features need to be assessed when rating physical activity-related app quality.
Objective:
The aim of this study was to identify expert perception on which features are important for the effectiveness of physical activity-related apps for participation in individual, recreational sports.
Methods:
Data were gathered via an expert panel approach using the nominal group technique. Two expert panels were organized to identify and rank app features relevant for sport participation. Experts were researchers or professionals in the field of industrial design and information technology (technology expert panel) and in the field of behavior change, health, and human movement sciences who had affinity with physical activity-related apps (health science expert panel). Of the 24 experts who were approached, 11 (46%) agreed to participate. Each panel session consisted of three consultation rounds. The 10 most important features per expert were collected. We calculated the frequency of the top 10 features and the mean importance score per feature (0-100). The sessions were taped and transcribed verbatim; a thematic analysis was conducted on the qualitative data.
Results:
In the technology expert panel, applied feedback and feedforward (91.3) and fun (91.3) were found most important (scale 0-100). Together with flexibility and look and feel, these features were mentioned most often (all n=4 [number of experts]; importance scores=41.3 and 43.8, respectively). The experts in the health science expert panels a and b found instructional feedback (95.0), motivating or challenging (95.0), peer rating and use (92.0), motivating feedback (91.3), and monitoring or statistics (91.0) most important. Most often ranked features were monitoring or statistics, motivating feedback, works good technically, tailoring starting point, fun, usability anticipating or context awareness, and privacy (all n=3-4 [number of experts]; importance scores=16.7-95.0). The qualitative analysis resulted in four overarching themes: (1) combination behavior change, technical, and design features needed; (2) extended feedback and tailoring is advised; (3) theoretical or evidence base as standard; and (4) entry requirements related to app use.
Conclusions:
The results show that a variety of features, including design, technical, and behavior change, are considered important for the effectiveness of physical activity-related apps by experts from different fields of expertise. These insights may assist in the development of an improved app rating scale.
As qualitative research becomes increasingly recognized and valued, it is imperative that it is conducted in a rigorous and methodical manner to yield meaningful and useful results. To be accepted as trustworthy, qualitative researchers must demonstrate that data analysis has been conducted in a precise, consistent, and exhaustive manner through recording, systematizing , and disclosing the methods of analysis with enough detail to enable the reader to determine whether the process is credible. Although there are numerous examples of how to conduct qualitative research, few sophisticated tools are available to researchers for conducting a rigorous and relevant thematic analysis. The purpose of this article is to guide researchers using thematic analysis as a research method. We offer personal insights and practical examples, while exploring issues of rigor and trustworthiness. The process of conducting a thematic analysis is illustrated through the presentation of an auditable decision trail, guiding interpreting and representing textual data. We detail our step-by-step approach to exploring the effectiveness of strategic clinical networks in Alberta, Canada, in our mixed methods case study. This article contributes a purposeful approach to thematic analysis in order to systematize and increase the traceability and verification of the analysis.
Background
Active video games (AVGs) capable of inducing physical activity offer an innovative approach to combating childhood obesity. Unfortunately, children’s AVG game play decreases quickly, underscoring the need to identify novel methods for player engagement. Narratives have been demonstrated to influence behaviors.
Objective
The objective of this study was to test the hypothesis that a narrative would motivate increased AVG play, though a feasibility study that investigated the motivational effect of adding a previously developed narrative cutscene to an originally nonnarrative AVG, Nintendo Wii Sports Resort: Swordplay Showdown.
Methods
A total of 40 overweight and obese 8- to 11-year-olds equally divided by sex played the AVG. Half (n=20) were randomly assigned to a narrative group that watched the narrative cutscene before game play. The other half played the game without watching it.
Results
Children in the narrative group had significantly (P<.05) more steps per 10-second period (mean 3.2, SD 0.7) and overall (mean 523, SD 203) during game play compared with the nonnarrative group (10-second period: mean 2.7, SD 0.7; overall: mean 366, SD 172).
Conclusions
The AVG with narrative induced increased physical activity. Additional research is needed to understand the mechanisms through which narrative increases physical activity during AVG game play.
Background:
Given the global prevalence of insufficient physical activity (PA), effective interventions that attenuate age-related decline in PA levels are needed. Mobile phone interventions that positively affect health (mHealth) show promise; however, their impact on PA levels and fitness in young people is unclear and little is known about what makes a good mHealth app.
Objective:
The aim was to determine the effects of two commercially available smartphone apps (Zombies, Run and Get Running) on cardiorespiratory fitness and PA levels in insufficiently active healthy young people. A second aim was to identify the features of the app design that may contribute to improved fitness and PA levels.
Methods:
Apps for IMproving FITness (AIMFIT) was a 3-arm, parallel, randomized controlled trial conducted in Auckland, New Zealand. Participants were recruited through advertisements in electronic mailing lists, local newspapers, flyers posted in community locations, and presentations at schools. Eligible young people aged 14-17 years were allocated at random to 1 of 3 conditions: (1) use of an immersive app (Zombies, Run), (2) use of a nonimmersive app (Get Running), or (3) usual behavior (control). Both smartphone apps consisted of a fully automated 8-week training program designed to improve fitness and ability to run 5 km; however, the immersive app featured a game-themed design and narrative. Intention-to-treat analysis was performed using data collected face-to-face at baseline and 8 weeks, and all regression models were adjusted for baseline outcome value and gender. The primary outcome was cardiorespiratory fitness, objectively assessed as time to complete the 1-mile run/walk test at 8 weeks. Secondary outcomes were PA levels (accelerometry and self-reported), enjoyment, psychological need satisfaction, self-efficacy, and acceptability and usability of the apps.
Results:
A total of 51 participants were randomized to the immersive app intervention (n=17), nonimmersive app intervention (n=16), or the control group (n=18). The mean age of participants was 15.7 (SD 1.2) years; participants were mostly NZ Europeans (61%, 31/51) and 57% (29/51) were female. Overall retention rate was 96% (49/51). There was no significant intervention effect on the primary outcome using either of the apps. Compared to the control, time to complete the fitness test was -28.4 seconds shorter (95% CI -66.5 to 9.82, P=.20) for the immersive app group and -24.7 seconds (95% CI -63.5 to 14.2, P=.32) for the nonimmersive app group. No significant intervention effects were found for secondary outcomes.
Conclusions:
Although apps have the ability to increase reach at a low cost, our pragmatic approach using readily available commercial apps as a stand-alone instrument did not have a significant effect on fitness. However, interest in future use of PA apps is promising and highlights a potentially important role of these tools in a multifaceted approach to increase fitness, promote PA, and consequently reduce the adverse health outcomes associated with insufficient activity.
Trial registration:
Australian New Zealand Clinical Trials Registry: ACTRN12613001030763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613001030763 (Archived by WebCite at http://www.webcitation.org/6aasfJVTJ).
The 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week (7.5 metabolic-equivalent hours per week) of aerobic activity for substantial health benefit and suggested additional benefits by doing more than double this amount. However, the upper limit of longevity benefit or possible harm with more physical activity is unclear.
To quantify the dose-response association between leisure time physical activity and mortality and define the upper limit of benefit or harm associated with increased levels of physical activity.
We pooled data from 6 studies in the National Cancer Institute Cohort Consortium (baseline 1992-2003). Population-based prospective cohorts in the United States and Europe with self-reported physical activity were analyzed in 2014. A total of 661 137 men and women (median age, 62 years; range, 21-98 years) and 116 686 deaths were included. We used Cox proportional hazards regression with cohort stratification to generate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Median follow-up time was 14.2 years.
Leisure time moderate- to vigorous-intensity physical activity.
The upper limit of mortality benefit from high levels of leisure time physical activity.
Compared with individuals reporting no leisure time physical activity, we observed a 20% lower mortality risk among those performing less than the recommended minimum of 7.5 metabolic-equivalent hours per week (HR, 0.80 [95% CI, 0.78-0.82]), a 31% lower risk at 1 to 2 times the recommended minimum (HR, 0.69 [95% CI, 0.67-0.70]), and a 37% lower risk at 2 to 3 times the minimum (HR, 0.63 [95% CI, 0.62-0.65]). An upper threshold for mortality benefit occurred at 3 to 5 times the physical activity recommendation (HR, 0.61 [95% CI, 0.59-0.62]); however, compared with the recommended minimum, the additional benefit was modest (31% vs 39%). There was no evidence of harm at 10 or more times the recommended minimum (HR, 0.69 [95% CI, 0.59-0.78]). A similar dose-response relationship was observed for mortality due to cardiovascular disease and to cancer.
Meeting the 2008 Physical Activity Guidelines for Americans minimum by either moderate- or vigorous-intensity activities was associated with nearly the maximum longevity benefit. We observed a benefit threshold at approximately 3 to 5 times the recommended leisure time physical activity minimum and no excess risk at 10 or more times the minimum. In regard to mortality, health care professionals should encourage inactive adults to perform leisure time physical activity and do not need to discourage adults who already participate in high-activity levels.
Background
In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals.Methods
An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran's chi-square test and quantified through an estimation of the I².ResultsOf the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2-7.7; p < 0.01) and 2.8 kg/m² in BMI loss (95% CI, 3.4-2.2; p < 0.01). Long-term interventions produced superior weight loss (11.3 kg) compared to short-term (7.2 kg) and intermediate-term (8.0 kg) interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p
Thematic analysis is frequently used to analyse qualitative data in psychology, healthcare, social research and beyond. An important stage in planning a study is determining how large a sample size may be required, however current guidelines for thematic analysis are varied, ranging from around 2 to over 400 and it is unclear how to choose a value from the space in between. Some guidance can also not be applied prospectively. This paper introduces a tool to help users think about what would be a useful sample size for their particular context when investigating patterns across participants. The calculation depends on (a) the expected population theme prevalence of the least prevalent theme, derived either from prior knowledge or based on the prevalence of the rarest themes considered worth uncovering, e.g. 1 in 10, 1 in 100; (b) the number of desired instances of the theme; and (c) the power of the study. An adequately powered study will have a high likelihood of finding sufficient themes of the desired prevalence. This calculation can then be used alongside other considerations. We illustrate how to use the method to calculate sample size before starting a study and achieved power given a sample size, providing tables of answers and code for use in the free software, R. Sample sizes are comparable to those found in the literature, for example to have 80% power to detect two instances of a theme with 10% prevalence, 29 participants are required. Increasing power, increasing the number of instances or decreasing prevalence increases the sample size needed. We do not propose this as a ritualistic requirement for study design, but rather as a pragmatic supporting tool to help plan studies using thematic analysis.
A significant body of research has investigated the effects of physical activity on sleep, yet this research has not been systematically aggregated in over a decade. As a result, the magnitude and moderators of these effects are unclear. This meta-analytical review examines the effects of acute and regular exercise on sleep, incorporating a range of outcome and moderator variables. PubMed and PsycINFO were used to identify 66 studies for inclusion in the analysis that were published through May 2013. Analyses reveal that acute exercise has small beneficial effects on total sleep time, sleep onset latency, sleep efficiency, stage 1 sleep, and slow wave sleep, a moderate beneficial effect on wake time after sleep onset, and a small effect on rapid eye movement sleep. Regular exercise has small beneficial effects on total sleep time and sleep efficiency, small-to-medium beneficial effects on sleep onset latency, and moderate beneficial effects on sleep quality. Effects were moderated by sex, age, baseline physical activity level of participants, as well as exercise type, time of day, duration, and adherence. Significant moderation was not found for exercise intensity, aerobic/anaerobic classification, or publication date. Results were discussed with regards to future avenues of research and clinical application to the treatment of insomnia.
Insufficient physical activity is a global health issue (1). Australian physical activity guidelines recommend children engage in 60 min or more of moderate- to vigorous-intensity physical activity every day (2). In 2011–2012, only 19% of Australian children met these recommendations (3). Fundamental movement skills (FMS; e.g., run, jump, catch, kick, hop) are the building blocks of physical activity and underpin successful participation in sports games. FMS are not, however, naturally acquired (4). Less than 50% of Australian school aged children demonstrate competence of key FMS (5, 6) and trends across the last decade are no better (7).
The present study was built upon a previous study on the new generation video game, exergame, in elementary school physical education (PE). The purpose of the study was to examine the effect of exergames on elementary children's in-class physical activity (PA) intensity levels and perceived situational interest over time. The results indicated that students' situational interest dropped dramatically over two semesters, but their PA intensity increased over time. The results showed that boys and girls were equally active in the exergaming lessons, but boys perceived their gaming experiences more enjoyable than girls did. The findings suggest that exergames may be a possible means to enhance PA in PE. However, whether exergaming is a sustainable way to motivate children in PA is questionable.
The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations.
The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study.
Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
The treatment of noncommunicable diseases (NCD), like coronary heart disease or type 2 diabetes mellitus, causes rising costs for the health system. Physical activity is supposed to reduce the risk for these diseases. Results of cross-sectional studies showed that physical activity is associated with better health, and that physical activity could prevent the development of these diseases. The purpose of this review is to summarize existing evidence for the long-term (>5 years) relationship between physical activity and weight gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimer's disease and dementia.
Fifteen longitudinal studies with at least 5-year follow up times and a total of 288,724 subjects (>500 participants in each study), aged between 18 and 85 years, were identified using digital databases. Only studies published in English, about healthy adults at baseline, intentional physical activity and the listed NCDs were included.
The results of these studies show that physical activity appears to have a positive long-term influence on all selected diseases.
This review revealed a paucity of long-term studies on the relationship between physical activity and the incidence of NCD.
There appears to be general agreement among social psychologists that most human behavior is goal-directed (e. g., Heider, 1958 ; Lewin, 1951). Being neither capricious nor frivolous, human social behavior can best be described as following along lines of more or less well-formulated plans. Before attending a concert, for example, a person may extend an invitation to a date, purchase tickets, change into proper attire, call a cab, collect the date, and proceed to the concert hall. Most, if not all, of these activities will have been designed in advance; their execution occurs as the plan unfolds. To be sure, a certain sequence of actions can become so habitual or routine that it is performed almost automatically, as in the case of driving from home to work or playing the piano. Highly developed skills of this kind typically no longer require conscious formulation of a behavioral plan. Nevertheless, at least in general outline, we are normally well aware of the actions required to attain a certain goal. Consider such a relatively routine behavior as typing a letter. When setting this activity as a goal, we anticipate the need to locate a typewriter, insert a sheet of paper, adjust the margins, formulate words and sentences, strike the appropriate keys, and so forth. Some parts of the plan are more routine, and require less conscious thought than others, but without an explicit or implicit plan to guide the required sequence of acts, no letter would get typed.
Background:
The high prevalence of obesity in America can be attributed to inadequate energy expenditure as a result of high levels of physical inactivity. This review presents an overview of the current literature on physical activity, specifically through active videogame systems (exergaming) and how these systems can help to increase physical activity levels.
Methods:
The search strategy for this review was to identify previous studies that investigated energy expenditure levels using a single active video game or a combination of active videogames.
Results:
Based on data from 27 studies, a strong correlation exists between exergaming and increased energy expenditure (up to 300% above resting levels). The majority of active videogames tested were found to achieve physical activity levels of moderate intensity, which meet American College of Sports Medicine guidelines for health and fitness.
Conclusions:
Exergaming is a new and exciting strategy to potentially improve physical activity levels and reduce obesity among Americans.
Background:
CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity.
Objectives:
The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions.
Methods:
In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed.
Results:
This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above.
Conclusions:
"BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
The case for exercise and health has primarily been made on its impact on diseases such coronary heart disease, obesity and diabetes. However, there is a very high cost attributed to mental disorders and illness and in the last 15 years there has been increasing research into the role of exercise a) in the treatment of mental health, and b) in improving mental well-being in the general population. There are now several hundred studies and over 30 narrative or meta-analytic reviews of research in this field. These have summarised the potential for exercise as a therapy for clinical or subclinical depression or anxiety, and the use of physical activity as a means of upgrading life quality through enhanced self-esteem, improved mood states, reduced state and trait anxiety, resilience to stress, or improved sleep. The purpose of this paper is to a) provide an updated view of this literature within the context of public health promotion and b) investigate evidence for physical activity and dietary interactions affecting mental well-being.
Narrative review and summary.
Sufficient evidence now exists for the effectiveness of exercise in the treatment of clinical depression. Additionally, exercise has a moderate reducing effect on state and trait anxiety and can improve physical self-perceptions and in some cases global self-esteem. Also there is now good evidence that aerobic and resistance exercise enhances mood states, and weaker evidence that exercise can improve cognitive function (primarily assessed by reaction time) in older adults. Conversely, there is little evidence to suggest that exercise addiction is identifiable in no more than a very small percentage of exercisers. Together, this body of research suggests that moderate regular exercise should be considered as a viable means of treating depression and anxiety and improving mental well-being in the general public.
Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations.
A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity.
Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity.
Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance
Human beings can be proactive and engaged or, alternatively, passive and alienated, largely as a function of the social conditions in which they develop and function. Accordingly, research guided by self-determination theory has focused on the social-contextual conditions that facilitate versus forestall the natural processes of self-motivation and healthy psychological development. Specifically, factors have been examined that enhance versus undermine intrinsic motivation, self-regulation, and well-being. The findings have led to the postulate of three innate psychological needs--competence, autonomy, and relatedness--which when satisfied yield enhanced self-motivation and mental health and when thwarted lead to diminished motivation and well-being. Also considered is the significance of these psychological needs and processes within domains such as health care, education, work, sport, religion, and psychotherapy.
The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.
Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design.
To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups).
We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed.
Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting.
The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
Pokémon Go™ (PG) is a mobile videogame that requires real-world walking to "catch" augmented reality (AR) virtual creatures. Media attention speculated that extensive physical activity (PA) could result from PG play, which could have public health benefit. Little is known about contextual factors related to PG play and how they may impact play initiation or duration. A systematic search of articles reporting the words PG was conducted with PubMed and Google Scholar. To understand the many possible influences on and outcomes of PG play, a scoping review was conducted by employing a conceptual model to organize the literature. Although large numbers of people started playing PG, these were a relatively small proportion of the relevant populations, but PG may have activated some of those most in need of PA. Diverse factors predicted who initiated PG play, but they tended to emphasize anticipated fun, escapism, nostalgia, social ties, and desire for PA. Environmental factors (e.g., unavailable GPS signals, trespassing laws) limited PG play for some. Diverse factors predicted duration of gameplay, but fun appeared to be prominent. The level of increases in PA from PG among youth and young adults appeared to be small or undetected, and of a relatively short duration (<2 months). Among older adults, however, there were modest increases in PA for up to 7 months post-release. This intensity and duration of increased PA appears to be inadequate to stem the epidemic of obesity but may have mental and social health benefits. Although many adverse outcomes from playing PG were reported, these appear to be low incidence, which should primarily influence PG players to knowingly exercise caution. Many research issues were identified to specify who might play AR games and effective strategies to enhance game design to increase PA.
Distance running or other forms of endurance exercise can produce a feeling called “runner’s high,” which is associated with a feeling of euphoria, a reduction in anxiety (anxiolysis) and pain (analgesia), and an increased sense of relaxation (sedation). Increased abundance of β-endorphin, an endogenous opioid, and anandamide, an endocannabinoid, are observed in the plasma of humans and mice after long distance running. However, β-endorphin cannot cross the blood-brain barrier. Fuss et al. used mice to investigate the molecular mechanisms that could result in runner’s high. After habituating the mice to the presence of running wheels and then blocking the wheels to establish a baseline, the wheels for one group were unblocked for 5 hours immediately before testing both groups (run group and control group) for anxiety-associated and pain-associated behaviors. Compared with the control group, the mice in the run group spent more time in the light-aversive bright area, an indication of reduced anxiety. Mice in the run group also displayed increased latency to either jump or lick their paws when placed on a hot plate, an indication of analgesia. After returning to the cage with the running wheel, the mice in the run group ran less than the control mice, which could reflect a sedation effect. The mice in the run group, but not in the control group, had increased abundance of endocannabinoids in the plasma but not in the brain or in the cerebrospinal fluid. Mice injected intraperitoneally with antagonists to cannabinoid receptor 1 (CB1) and then given access to the running wheel prior to behavioral testing did not exhibit the anxiolytic phenotype, spending the same amount of time in the light as mice that did not have access to a functional wheel. Injection of the run group with antagonists of the cannabinoid receptors CB1 or CB2 blocked the running-induced analgesic effect. Mice in the run group that were injected with naloxone, which blocks endorphin activity, displayed running-induced reduction of thermal pain sensitivity. Thus, the pharmacological data suggested that endocannabinoids rather than endorphins played a role in analgesia associated with running. To confirm that the effects were mediated by receptors in the brain, the authors examined mice lacking CB1 receptors in γ-aminobutyric acid (GABA) neurons (GABA-CB1–/–), which displayed more anxiety than wild-type mice both in the control nonrunning group and in the run group. The enhanced anxiolytic and analgesic effects of running were also absent in these CB1-deficient mice. Thus, this study suggests that endocannabinoids mediate some of the positive effects associated with endurance exercise and the runner’s high.
Background:
Increasing autonomy by manipulating the choice of available physical activity options in a laboratory setting can increase physical activity in older children and adults. However, the effect of manipulating the number of physically active choices has yet to be examined in young children in a gymnasium environment.
Methods:
Twenty children (n = 10 girls, 6.1 ± 1.4 years old) individually participated in two (low choice (LC), high choice (HC)), free-choice activity conditions for 30 minutes in a 4,360 square foot gymnasium. Children had access to two or eight physical activity options in the LC and HC conditions, respectively. Physical activity behavior was measured via accelerometry.
Results:
Children's 30-minute accelerometer counts increased (p < 0.03) from the LC (2,675 ± 294 counts · min-1) to the HC (3,224 ± 280 counts · min-1) condition.
Conclusions:
Providing greater autonomy through choice of a greater number of physically active options increased young children's physical activity participation by 20.5%.
Background: Although there are thousands of health and fitness smartphone apps currently available, little research exists regarding the effects of mobile app technology on physical activity behavior. Purpose: The purpose of this study was to test whether Exergame smartphone applications increase physical activity levels. Methods: This was a 12-week randomized, controlled, parallel group trial. The intervention consisted of the use of Exergame smartphone apps and motivational messaging. Validated instruments were used to measure physical activity, enjoyment, motivation, and competence. Results: Forty subjects were randomized and completed baseline assessments; 39 (97.5%) completed the 12-week follow-up. Median age was 32 years (interquartile range [IQR] = 25, 41.75); 85% were women. No differences between groups were identified in primary or secondary outcomes. Within group, physical activity decreased in the controls and autonomous motivation increased in the intervention group. Discussion: Exploratory findings were interesting regarding the use of Exergames to encourage physical activity. The intervention group showed less of a decline in activity, suggesting a possible attenuation of the observed seasonal fluctuation by the use of the Exergames. Translation to Health Education Practice Given their popularity, health educators should continue to explore the use of Exergame apps as a tool to facilitate physical activity.
Background
Given the popularity of mobile applications (apps) designed to increase exercise participation, it is important to understand their effects on psychological predictors of exercise behavior.
Purpose
This study tested a performance feedback-based app compared to a game-based app to examine their effects on aspects of immediate response to an exercise bout.
Methods
Twenty-eight participants completed a 30-min treadmill run while using one of two randomly assigned mobile running apps: Nike + Running, a performance-monitoring app which theoretically induces an associative, goal-driven state, or Zombies Run!, an app which turns the experience of running into a virtual reality game, theoretically inducing dissociation from primary exercise goals.
Results
The two conditions did not differ on primary motivational state outcomes; however, participants reported more associative attentional focus in the performance-monitoring app condition compared to more dissociative focus in the game-based app condition.
Conclusions
Game-based and performance-tracking running apps may not have differential effects on goal motivation during exercise. However, game-based apps may help recreational exercisers dissociate from exercise more readily. Increasing the enjoyment of an exercise bout through the development of new and innovative mobile technologies is an important avenue for future research.
Purpose: Physical activity has been associated with reduced blood pressure in observational epidemiologic studies and individual clinical trials. This meta-analysis of randomized, controlled trials was conducted to determine the effect of aerobic exercise on blood pressure. Data Sources: English-language articles published before September 2001. Study Selection: 54 randomized, controlled trials (2419 participants) whose intervention and control groups differed only in aerobic exercise. Data Extraction: Using a standardized protocol and data extraction form, three of the investigators independently abstracted data on study design, sample size, participant characteristics, type of intervention, follow-up duration, and treatment outcomes. Data Synthesis: In a random-effects model, data from each trial were pooled and weighted by the inverse of the total variance. Aerobic exercise was associated with a significant reduction in mean systolic and diastolic blood pressure (-3.84 mm Hg [95% Cl, -4.97 to -2.72 mm Hg] and -2.58 mm Hg [CI, -3.35 to -1.81 mm Hg], respectively). A reduction in blood pressure was associated with aerobic exercise in hypertensive participants and normotensive participants and in overweight participants and normal-weight participants. Conclusions: Aerobic exercise reduces blood pressure in both hypertensive and normotensive persons. An increase in aerobic physical activity should be considered an important component of lifestyle modification for prevention and treatment of high blood pressure.
Inflammatory processes are putative mechanisms underlying the cardioprotective effects of physical activity. An inverse association between physical activity and inflammation has been demonstrated, but no long-term prospective data are available. We therefore examined the association between physical activity and inflammatory markers over a 10-year follow-up period.
Participants were 4289 men and women (mean age, 49.2 years) from the Whitehall II cohort study. Self-reported physical activity and inflammatory markers (serum high-sensitivity C-reactive protein and interleukin-6) were measured at baseline (1991) and follow-up (2002). Forty-nine percent of the participants adhered to standard physical activity recommendations for cardiovascular health (2.5 h/wk moderate to vigorous physical activity) across all assessments. Physically active participants at baseline had lower C-reactive protein and interleukin-6 levels, and this difference remained stable over time. Compared with participants who rarely adhered to physical activity guidelines over the 10-year follow-up, the high-adherence group displayed lower log(e) C-reactive protein (β=-0.07; 95% confidence interval, -0.12 to -0.02) and log(e) interleukin-6 (β=-0.07; 95% confidence interval, -0.10 to -0.03) at follow-up after adjustment for a range of covariates. Compared with participants who remained stable, those who reported an increase in physical activity of at least 2.5 h/wk displayed lower log(e) C-reactive protein (β coefficient=-0.05; 95% confidence interval, -0.10 to -0.001) and log(e) interleukin-6 (β coefficient=-0.06; 95% confidence interval, -0.09 to -0.03) at follow-up.
Regular physical activity is associated with lower markers of inflammation over 10 years of follow-up and thus may be important in preventing the proinflammatory state seen with aging.
This paper reviews the concepts of immersion and presence in virtual environments (VEs). We propose that the degree of immersion can be objectively assessed as the characteristics of a technology, and has dimensions such as the extent to which a display system can deliver an inclusive, extensive, surrounding, and vivid illusion of virtual environment to a participant. Other dimensions of immersion are concerned with the extent of body matching, and the extent to which there is a self-contained plot in which the participant can act and in which there is an autonomous response. Presence is a state of consciousness that may be concomitant with immersion, and is related to a sense of being in a place. Presence governs aspects of autonomic responses and higher-level behaviors of a participant in a VE. The paper considers single and multi-participant shared environments, and draws on the experience of Computer-Supported Cooperative Working (CSCW) research as a guide to understanding presence in shared environments, The paper finally outlines the aims of the FIVE Working Group, and the 1995 FIVE Conference in London, UK.
Physical activity has been associated with reduced blood pressure in observational epidemiologic studies and individual clinical trials. This meta-analysis of randomized, controlled trials was conducted to determine the effect of aerobic exercise on blood pressure.
English-language articles published before September 2001.
54 randomized, controlled trials (2419 participants) whose intervention and control groups differed only in aerobic exercise.
Using a standardized protocol and data extraction form, three of the investigators independently abstracted data on study design, sample size, participant characteristics, type of intervention, follow-up duration, and treatment outcomes.
In a random-effects model, data from each trial were pooled and weighted by the inverse of the total variance. Aerobic exercise was associated with a significant reduction in mean systolic and diastolic blood pressure (-3.84 mm Hg [95% CI, -4.97 to -2.72 mm Hg] and -2.58 mm Hg [CI, -3.35 to -1.81 mm Hg], respectively). A reduction in blood pressure was associated with aerobic exercise in hypertensive participants and normotensive participants and in overweight participants and normal-weight participants.
Aerobic exercise reduces blood pressure in both hypertensive and normotensive persons. An increase in aerobic physical activity should be considered an important component of lifestyle modification for prevention and treatment of high blood pressure.
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