Effects of exergaming on executive functions of children: a systematic review and meta-analysis from 2010 to 2023.

BACKGROUND: Executive function plays a crucial role in children's cognitive development, academic performance, as well as their physical and mental health. This study aims to assess the impact of exergaming on executive functions in pediatric populations. METHODS: The criteria of inclusion were randomized controlled trials of exergaming intervention and evaluation of executive function in children aged 4-12 years. A meta-analysis was performed in databases of China National Knowledge Infrastructure (in Chinese), Wan Fang (in Chinese), Web of Science, Embase, and PubMed, from January 2010 to February 2023, following the PRISMA guidelines. Risk of bias was assessed by the Jadad scale, the Cochrane risk of bias assessment tool, funnel plot, and regression-based Egger test. The Review Manager 5.3 was used to analyze the included articles using a random-effects model, and the effects were calculated as standardized mean difference (SMD). RESULTS: Eleven experimental studies with children (n = 508) were included. Exergaming was found to have a positive impact on children's cognitive flexibility (SMD = 0.34, 95%CI [0.17,0.52], P < 0.01), inhibitory control (SMD = 0.57, 95%CI [0.31,0.83], P < 0.01), and working memory (SMD = 0.26, 95%CI [0.02,0.51], P < 0.05). The publication bias were observed. CONCLUSIONS: Exergaming has the potential to improve executive functions in children. More studies with rigorous designs are warranted to explore the specific effects of exergaming intervention. This study was registered on the PROSPERO (CRD42023401526).

Associations of Home-Based Screen Time and Its' Changes With Follow-up Body Mass Index in Chinese Preschool-Aged Children.

This study aimed to explore the associations of screen time (ST) and its' changes with follow-up body mass index (BMI) in preschool children. Parents of 805 preschoolers participated in our study at baseline and were followed up after 1 year in China. Linear regression models were used to analyze the dynamic relationship between ST and BMI in preschool children. A total of 662 preschoolers, including 342 boys (51.7%) and 320 girls (48.3%) were followed up. The changes in ST (from the initial ≤1 h/day to >1 h/day at follow-up vs keep ≤1 h/d, ß(SE) = 0.21(0.09), P = .016) and follow-up ST of preschool children (>1 h/d vs ≤1 h/d, ß(SE) = 0.17(0.07), P = .013) were significantly associated with an increase in the preschoolers' z-scored BMI at follow-up after adjusting for potential confounding factors. We concluded that the unfavorable change in ST was associated with increased BMI in preschool children.

Longitudinal Association of Changes in Parental Correlates With Screen Time in Chinese Preschoolers.

BACKGROUND: This study aimed to explore the relationship between the changes in parent-related factors and preschoolers exceeding screen time (ST) recommendations. METHODS: A longitudinal analysis using 2-year follow-up data from 4 kindergartens (n = 409) was conducted in Zhejiang, China, from 2019 to 2021. Multivariate logistic regression models were used to determine the potential parental modifiable predictors. RESULTS: The significant associations of baseline ST, change in screen accessibility, and the interaction of preschooler ST with maternal ST change with preschooler follow-up ST were observed. For preschool-aged children with baseline ST ≤ 1 hour per day, the follow-up of preschoolers with ST > 1 hour per day increased significantly when parental clarity of their ST rules decreased or remained low. For preschool children with baseline ST > 1 hour per day, follow-up ST increased significantly when their father kept ST >2 hours per day, when the screen accessibility became or remained easy, or when parental awareness of the ST decreased. CONCLUSIONS: Changes in parental correlates played an important role in preschooler ST based on 2-year longitudinal data. Early interventions should focus on improving the clarity of parental rules and perceptions, as well as on reducing parental ST and accessibility of home screens.

Correlates of preschoolers' screen time in China: parental factors.

BACKGROUND: With the advent of the electronic age, the prolonged screen time (ST) of preschoolers in China is relatively high and is on the rise, which is likely to affect preschoolers' physical and mental health. This study aimed to explore the factors influencing ST in preschoolers, especially the role of parental factors, and to provide a basis for the prevention, control, and intervention of ST in preschoolers in China. METHODS: A questionnaire was completed by the parents of 1,546 preschoolers from four kindergartens in Pinghu City, Zhejiang Province, China, and a multivariate logistic regression model was used to analyze the correlates of excessive ST in preschoolers. RESULTS: A total of 43.8% of preschoolers aged 3 to 6 years, of which 50.3% were boys and 49.7% were girls, had > 1 h/day of ST. Older preschoolers, greater screen accessibility, greater frequency of eating in front of a screen, longer ST of parents, and unclear rules of screen-based behavior were the risk factors for ST being > 1 h/day (P < 0.05). After additional adjusting of maternal correlates, the relationship between the ST of fathers and ST of preschoolers was still significant (P < 0.01), and the dose-effect relationship was also observed (P < 0.001). CONCLUSION: Prolonged parental ST (especially of fathers) and lack of rules for screen behavior were independent risk factors for prolonged preschoolers' ST in this study.

Associations of Sedentary Behavior with Physical Fitness and Academic Performance among Chinese Students Aged 8-19 Years.

Background: Existing evidence regarding how time spent on various types of sedentary behavior (SB) in relation to physical fitness (PF) and academic performance (AP) in children and adolescents is limited. This cross-sectional study aimed to explore the associations of SB types with PF and AP among 8-19-year-old Chinese students. Methods: A total of 1164 students were recruited from five schools in Zhejiang province, China. Children's SB was assessed by a valid questionnaire and AP was represented by scores on four courses. PF was measured by Chinese National Student PF Standard battery. The associations were assessed using linear mixed-effects models adjusted for age, school, grade, and class. Results: Students' screen-based SB was observed to be negatively associated with PF in girls (p < 0.05). Screen-based SB was inversely associated with AP in both girls and boys (p < 0.001). The significant interaction between weekdays and weekends, and SB on AP was observed in girls (p < 0.001). On weekends, screen-based SB ≥ 6 h/day (<3 h/day as reference group) was significantly and negatively associated with AP (p < 0.01 for both sex). Conclusions: Longer screen-based SB, especially on weekends, was related to poorer AP in 8-19-year-old Chinese students. Our findings suggest that restrictions on any type of screen-based SB for leisure on weekends are beneficial to AP in Chinese students.

Effects of School-Based Exergaming on Urban Children's Physical Activity and Cardiorespiratory Fitness: A Quasi-Experimental Study.

BACKGROUND: Modern-day technology is appealing to children. Few studies, however, have conducted longitudinal analyses of a school-based exergaming program's effect on physical activity (PA) behaviors and fitness in children. Therefore, this study examined the longitudinal effect of an 8-month school-based exergaming intervention on children's objectively-measured PA and cardiorespiratory fitness (CRF). MATERIALS AND METHODS: Eighty-one fourth grade students (X̅age = 9.23 ± 0.62; 39 girls; 54.3% African American, 30.9% Non-Hispanic White, 14.8% other) participated in this study from 2014-2015. The intervention school's children participated in a once-weekly 50-minute exergaming intervention during recess throughout the school year, while the control school continued regular recess. Children's in-school PA and sedentary behavior (SB) were measured with ActiGraphGT3X+ accelerometers, with CRF assessed via the half-mile run. All measurements were taken at baseline, mid-intervention (four months) and post-intervention (eight months). Repeated-measures two-way ANCOVAs using age and race as covariates were conducted to examine between-school differences over time for SB, light PA (LPA), moderate-to-vigorous PA (MVPA), and CRF. RESULTS: Significant time by group interactions were observed for LPA, F(1, 79) = 7.82, η2 = 0.09, p < 0.01, and MVPA, F(1, 79) = 4.58, η2 = 0.06, p < 0.05, as LPA increased among the control group, while MVPA increased among intervention group. Children in both groups experienced decreased SB during the intervention (intervention: -7.63 minutes; control: -17.59 minutes), but demonstrated lower CRF over time (intervention: +46.73 seconds; control: +61.60 seconds). CONCLUSIONS: Observations suggested that school-based exergaming implementation may be effective in increasing children's MVPA and decreasing their SB over the course an academic year (i.e., ~eight months). More research is needed, however, to discern how modifications to school-based exergaming might also promote improved CRF in children.

Cohort profile: the Lanxi Cohort study on obesity and obesity-related non-communicable diseases in China.

PURPOSE: The Lanxi Cohort was established to systematically investigate the aetiology and interplay of body fat distribution and multiple factors with obesity and obesity-related non-communicable diseases in China. PARTICIPANTS: The baseline investigation of the Lanxi Cohort study took place between June 2015 and August 2017 in Lanxi, Zhejiang Province, China. Permanent residents from one urban community and four rural villages were involved in this study. The baseline investigation included questionnaire survey, physical examination, dual-energy X-ray absorptiometry (DXA) scan, blood samples collection and traditional Chinese medicine (TCM) inquiry. FINDINGS TO DATA: A total of 5132 participants, aged 18 to 80 years, were recruited at baseline; among them, 38.7% were men and 64.8% were from the urban area. The mean age was 53.04±12.77 years. The completion rates of physical examination, DXA scan, blood collection and TCM inquiry were 99.9%, 98.5%, 99.9% and 96.5%, respectively. The mean body mass index (BMI) was 23.42±3.20 kg/m2 with 8.1% of the study population being obese (BMI ≥28 kg/m2). The crude prevalence of hypertension, diabetes and metabolic syndrome were 34.9%, 10.0% and 30.4%, respectively. FUTURE PLANS: All participants will be monitored annually for cause-specific mortality and morbidity and hospital admission and will be followed up by in-person survey every 4 years. The baseline population is considered to expand in the future depending on the availability of funding support. ETHICS APPROVAL: This study was approved by the Ethical Committee of the School of Public Health, Zhejiang University.

Associations of nicotine dependence and fat distribution in Chinese male adults: a cross-sectional study in Lanxi, China.

INTRODUCTION: Previous studies have showed association between smoking and central fat distribution. However, the impact of smoking on whole body fat distribution, particularly peripheral fat distribution remains unclear. METHODS: Nicotine dependence was assessed in a total of 1264 male adults aged 18-80 years using the Fagerström Test for Nicotine Dependence (FTND). Smoking status was categorised as non-smokers, former and current smokers with very low, low/moderate, or high FTND scores. Body fat distribution was determined using the dual energy X-ray absorptiometry and anthropometric measurements. Multivariable linear regression models were applied to examine the adjusted associations between body fat distribution and smoking in all participants, and its association with FTND scores in the current smokers. RESULTS: Greater waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), trunk fat percentage (%TF), android fat percentage (%AF) and android-to-gynoid fat mass ratio (AOI); but lower legs fat percentage (%LegF), limb fat percentage (%LimbF) and gynoid fat percentage (%GF) were found in current smokers with high FTND scores compared with non-smokers. In current smokers aged 60 years or older, FTND scores had positive associations with WC, WHR, WHtR, %TF, %AF and AOI, and negative associations with %LegF, %LimbF and %GF. CONCLUSIONS: Nicotine dependence was positively associated with central fat distribution and negatively associated with peripheral fat distribution in Chinese male adults, particularly in those older or heavy smokers, and these associations were independent from body mass index, which might be due to long exposure to smoking.

Association between sleep quality and bone mineral density in Chinese women vary by age and menopausal status.

OBJECTIVE: Sleep quality is closely related to bone health. Aging and estrogen deficiency are known determinants of poor sleep quality and osteoporosis. However, the impact of aging and menopause on the associations between sleep quality and bone mineral density (BMD) remains unclear. This study aimed to examine the association between sleep quality and BMD in Chinese women vary by age groups and menopausal status. METHODS: A total of 2067 women aged 18-80 years were included. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and the score >7 was indicative of poor sleep quality. BMD was determined using the dual-energy X-ray absorptiometry. Participants were categorized into three age groups. Multiple linear regression models were conducted to evaluate the associations between sleep quality and BMD. Covariates included in the models were age, menopausal status, weight, height, percent body fat, physical activity, alcohol drinking, calcium supplement use, marital status, education and metabolic diseases. RESULTS: We observed that poor sleep quality was correlated to low total BMD and legs BMD in middle-aged women after adjusting for potential confounders. Furthermore, when we reran the regression models based on menopausal status in middle-aged women, significant associations between BMD and sleep quality were observed in premenopausal and early postmenopausal groups. CONCLUSION: Our findings showed a more robust association between sleep quality and BMD in premenopausal and early menopausal groups. Further studies should be conducted to explore whether sleep quality intervention would improve bone health of women in these periods and prevent osteoporosis in their late life.

Impact of Exergaming on Children's Motor Skill Competence and Health-Related Fitness: A Quasi-Experimental Study.

This study was designed to examine the effectiveness of a combined exergaming and physical education (PE) program on children's motor skill competence (MSC) and health-related fitness (HRF) as compared to traditional PE. A total of 261 second- and third-grade children (127 boys; 8.25 ± 0.66 years for male; 8.29 ± 0.74 years for female; 73.6% non-Hispanic white) participated in the nine-month study from 2012 to 2013. Children were assigned to one of the two groups: (a) intervention group (125 min of alternating PE and exergaming weekly); and (b) comparison group (125-min weekly PE). MSC was assessed via product scores in two locomotor and two object control skills. HRF included the cardiorespiratory fitness, musculoskeletal fitness, and body mass index (BMI). A multivariate analysis of variance (MANOVA) was performed to analyze the effect of the combined exergaming⁻PE program on children's MSC and HRF. There were significant group by time interaction effects for BMI, p < 0.01, η² = 0.20; musculoskeletal fitness, p < 0.01, η² = 0.13; and object control skills (the comparison group demonstrating greater improvement), p = 0.01, η² = 0.03. The findings suggest that the combined exergaming program can have a positive effect on children's BMI and musculoskeletal fitness, indicating that exergaming can be an alternative school-based program to supplement traditional PE.

Associations of Body Composition with Blood Pressure and Hypertension.

OBJECTIVE: The present study investigated the associations of body composition, including skeletal muscle and fat mass, with blood pressure (BP) and hypertension. METHODS: Data from 3,130 participants aged 18 to 80 years were analyzed. Body composition and total skeletal muscle (TSM) were measured or calculated based on dual-energy x-ray absorptiometry. Multivariate linear and logistic regression models were used to analyze the associations of TSM, body fat percentage, android to gynoid fat ratio, and leg and arm lean body mass (LBM) with BP and hypertension. The Wald test was used to estimate the differences in the coefficients. RESULTS: TSM indices, body fat percentage, and android to gynoid fat ratio were significantly associated with higher odds ratio for prehypertension and hypertension, except for TSM/weight, after controlling for potential confounders. The standardized beta coefficients of arm LBM indices for systolic and diastolic BP were higher than relevant indices of leg LBM. CONCLUSIONS: Different indices of TSM, especially in arm LBM, were all positively associated with elevated BP, prehypertension, and hypertension in Chinese adults, after considering potential confounding factors, including body fat and fat distribution. Future longitudinal studies are warranted to confirm our findings.

Correlates of screen time among 8-19-year-old students in China.

BACKGROUND: Previous studies have shown that prolonged time spent on screen-based sedentary behavior was significantly associated with lower health status in children, independent of physical activity levels. The study aimed to explore the individual and environmental correlates of screen time (ST) among 8-19-year-old students in China. METHODS: The study surveyed ST using a self-administered questionnaire in Chinese students aged 8-19 years; 1063 participants were included in the final analysis. Individual and environmental correlates of ST were assessed using a mixed-effects model (for continuous outcome variables) and multiple logistic regression model (for binary outcome variables). RESULTS: Prolonged ST was observed in 14.7% of boys and 8.9% of girls. Of the ST, weekend and mobile phone/tablet use represented 80% and 40%, respectively. A positive relationship was observed between media accessibility and ST in both boys and girls (p < 0.05), whereas the presence of parents/others while using screens was a negative factor for longer ST (p < 0.05). Among the assessed correlates, access to a television (TV) in students' bedrooms was associated with prolonged total and weekend ST (p < 0.05 and p < 0.001, respectively). However, spending time on a mobile phone/tablet or a computer rather than viewing a TV, along with increased media accessibility, increased ST. CONCLUSIONS: These results indicate that greater media accessibility was positively associated and the presence of parents/others was negatively associated with prolonged ST in both Chinese boys and girls. Development of new and effective strategies against prolonged ST are required, especially for small screen device-based ST on weekends.

Risk factors of non-specific neck pain and low back pain in computer-using office workers in China: a cross-sectional study.

OBJECTIVES: Several studies have found that inappropriate workstations are associated with musculoskeletal disorders. The present cross-sectional study aimed to identify the risk factors of non-specific neck pain (NP) and low back pain (LBP) among computer-using workers. DESIGN: Observational study with a cross-sectional sample. SETTING: This study surveyed 15 companies in Zhejiang province, China. PARTICIPANTS: After excluding participants with missing variables, 417 office workers, including 163 men and 254 women, were analyzed. OUTCOME MEASURES: Demographic information was collected by self-report. The standard Northwick Park Neck Pain Questionnaire and Oswestry Low Back Pain Disability Index, along with other relevant questions, were used to assess the presence of potential occupational risk factors and the perceived levels of pain. Multinomial logistic regression analysis, adjusted for age, sex, body mass index, education, marital status and neck/low back injury, was performed to identify significant risk factors. RESULTS: Compared with low-level NP, the computer location (monitor not in front of the operator, but on the right or left side) was associated with ORs of 2.6 and 2.9 for medium- and high-level NP, respectively. For LBP, the computer location (monitor not in front) was associated with an OR of 3.2 for high-level pain, as compared with low-level pain, in females. Significant associations were also observed between the office temperature and LBP (OR 5.4 for high vs low), and between office work duration ≥5 years and NP in female office workers (OR 2.7 for medium vs low). CONCLUSIONS: Not having the computer monitor located in front of the operator was found to be an important risk factor for NP and LBP in computer-using female workers. This information may not only enable the development of potential preventive strategies but may also provide new insights for designing appropriate workstations.

Duration of television viewing and bone mineral density in Chinese women.

Studies on the relationship between television (TV) viewing and bone mineral density (BMD) in adults are limited. The purpose of this study was to examine whether longer duration of TV viewing increased the risk of lower BMD in Chinese women. A total of 626 female adults were voluntarily recruited into the study. Anthropometric measurements were obtained using standard procedures. Body composition including total body and regional BMD was estimated using dual-energy X-ray absorptiometry. The duration of TV viewing was categorized into 4 groups: <1 h, 1 to <2 h, 2 to <3 h, and ≥3 h. Multiple linear regression models were applied to analyze the associations between duration of TV viewing and total and regional BMD in all subjects and in subjects stratified by age of 45 years, respectively. After adjusting for age, BMI, alcohol use, smoking, education, income, urbanicity, leisure time physical activity, occupational physical activity, and menopause, the significant trend of pelvic BMD across categories of TV viewing was observed in all subjects (p < 0.05). Further analysis revealed that women aged <45 years, the 1 to <2 h group, the 2 to <3 h group, and the ≥3 h group were significantly associated with lower total body and regional BMD compared to women aged <45 years in the <1 h group. We concluded that the duration of TV viewing was negatively associated with BMD in Chinese women, especially in those aged 18-44 years. It might be sensible to reduce TV viewing time to prevent bone loss in young women.