Home-based exergaming among children with overweight and obesity: a randomized clinical trial.

BACKGROUND: Given children's low levels of physical activity and high prevalence of obesity, there is an urgent need to identify innovative physical activity options. OBJECTIVE: This study aims to test the effectiveness of exergaming (video gaming that involves physical activity) to reduce children's adiposity and improve cardiometabolic health. METHODS: This randomized controlled trial assigned 46 children with overweight/obesity to a 24-week exergaming or control condition. Intervention participants were provided a gaming console with exergames, a gameplay curriculum (1 h per session, three times a week) and video chat sessions with a fitness coach (telehealth coaching). Control participants were provided the exergames following final clinic visit. The primary outcome was body mass index (BMI) z-score. Secondary outcomes were fat mass by dual energy X-ray absorptiometry and cardiometabolic health metrics. RESULTS: Half of the participants were girls, and 57% were African-American. Intervention adherence was 94.4%, and children's ratings of acceptability and enjoyment were high. The intervention group significantly reduced BMI z-score excluding one control outlier (intervention [standard error] vs. control [standard error]: -0.06 [0.03] vs. 0.03 [0.03], p = 0.016) with a marginal difference in intent-to-treat analysis (-0.06 [0.03] vs. 0.02 [0.03], p = 0.065). Compared with control, the intervention group improved systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein-cholesterol and moderate-to-vigorous physical activity (all p values <0.05). CONCLUSIONS: Exergaming at home elicited high adherence and improved children's BMI z-score, cardiometabolic health and physical activity levels. Exergaming with social support may be promoted as an exercise option for children.

Racial differences in intracerebral haemorrhage outcomes in patients with obesity.

OBJECTIVE: This study was conducted to determine the role of obesity and race in intracerebral haemorrhage (ICH) outcomes. METHODS: The Get with the guideline-Stroke database was queried for all admitted patients with spontaneous ICH. Secondary causes of ICH were excluded. Body mass index (BMI) was classified using the Center for Disease Control guidelines. Race was classified as White or non-White. Demographics, clinical, imaging data were retrieved. Outcome measures were hematoma expansion at 24 h and discharge disposition. RESULTS: A total of 428 patients were included in our analysis. Female gender, past history of congestive heart failure, diabetes mellitus, HbA1c, blood pressure, ICH volume, ICH location, intraventricular haemorrhage and hospital length of stay deferred across BMI categories. On multivariate analysis, along with obese categories, age, ICH location and ICH volume were independent predictors of poor outcomes (hematoma expansion and poor discharge disposition). After adjusting for these variables, obesity remained a predictor of poor disposition outcome compared with normal and overweight subjects; Normal vs. Obese OR 0.26 CI 0.115-0.593 p = 0.0014; Obese vs. Overweight OR 3.79 CI 1.68-8.52 p = 0.0013. Nonetheless, obesity did not influence hematoma expansion. Overall, BMI-race classification did not influence outcomes. However, among non-Whites, the obese category had higher odds of a poor disposition outcome than normal (OR 6.84 CI 2.12-22.22 p = 0.0013) or overweight (OR 8.45 CI 2.6-27.49 p = 0.0004) categories. CONCLUSION: An obesity paradox in ICH was not observed in our cohort. In the non-White population, patients with obesity were likely to be associated with poor disposition outcome. Similar findings were not observed in White population.

A randomized controlled trial of dance exergaming for exercise training in overweight and obese adolescent girls.

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