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      Development of an Accelerometer-Linked Online Intervention System to Promote Physical Activity in Adolescents

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          Abstract

          Most adolescents do not achieve the recommended levels of moderate-to-vigorous physical activity (MVPA), placing them at increased risk for a diverse array of chronic diseases in adulthood. There is a great need for scalable and effective interventions that can increase MVPA in adolescents. Here we report the results of a measurement validation study and a preliminary proof-of-concept experiment testing the impact of Zamzee, an accelerometer-linked online intervention system that combines proximal performance feedback and incentive motivation features to promote MVPA. In a calibration study that parametrically varied levels of physical activity in 31 12-14 year-old children, the Zamzee activity meter was shown to provide a valid measure of MVPA (sensitivity in detecting MVPA = 85.9%, specificity = 97.5%, and r = .94 correspondence with the benchmark RT3 accelerometer system; all p < .0001). In a subsequent randomized controlled multi-site experiment involving 182 middle school-aged children assessed for MVPA over 6 wks, intent-to-treat analyses found that those who received access to the Zamzee intervention had average MVPA levels 54% greater than those of a passive control group (p < 0.0001) and 68% greater than those of an active control group that received access to a commercially available active videogame (p < .0001). Zamzee’s effects on MVPA did not diminish significantly over the course of the 6-wk study period, and were statistically significant in both females and males, and in normal- vs. high-BMI subgroups. These results provide promising initial indications that combining the Zamzee activity meter with online proximal performance feedback and incentive motivation features can positively impact MVPA levels in adolescents.

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          Moderate-to-vigorous physical activity from ages 9 to 15 years.

          Decreased physical activity plays a critical role in the increase in childhood obesity. Although at least 60 minutes per day of moderate-to-vigorous physical activity (MVPA) is recommended, few longitudinal studies have determined the recent patterns of physical activity of youth. To determine the patterns and determinants of MVPA of youth followed from ages 9 to 15 years. Longitudinal descriptive analyses of the 1032 participants in the 1991-2007 National Institute of Child Health and Human Development Study of Early Child Care and Youth Development birth cohort from 10 study sites who had accelerometer-determined minutes of MVPA at ages 9 (year 2000), 11 (2002), 12 (2003), and 15 (2006) years. Participants included boys (517 [50.1%]) and girls (515 [49.9%]); 76.6% white (n = 791); and 24.5% (n = 231) lived in low-income families. Mean MVPA minutes per day, determined by 4 to 7 days of monitored activity. At age 9 years, children engaged in MVPA approximately 3 hours per day on both weekends and weekdays. Weekday MVPA decreased by 37 minutes per year [corrected], while weekend MVPA decreased by 39 minutes per year [corrected]. By age 15 years, adolescents were only engaging in MVPA for 50 minutes per weekday [corrected] and 36 minutes per weekend day [corrected]. Boys were more active than girls, spending 18 and 14 more minutes per day [corrected] in MVPA on the weekdays and weekends, respectively. The rate of decrease in MVPA was the same for boys and girls. The estimated age at which girls crossed below the recommended 60 minutes of MVPA per day was approximately 13.2 years for weekday [corrected] activity compared with boys at 14.9 years [corrected], and for weekend activity, girls crossed below the recommended 60 minutes of MVPA at 12.7 years [corrected] compared with boys at 13.6 years [corrected]. In this study cohort, measured physical activity decreased significantly between ages 9 and 15 years.
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            Comparing methods of measurement: why plotting difference against standard method is misleading.

            When comparing a new method of measurement with a standard method, one of the things we want to know is whether the difference between the measurements by the two methods is related to the magnitude of the measurement. A plot of the difference against the standard measurement is sometimes suggested, but this will always appear to show a relation between difference and magnitude when there is none. A plot of the difference against the average of the standard and new measurements is unlikely to mislead in this way. We show this theoretically and by a practical example.
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              A randomized, controlled trial of financial incentives for smoking cessation.

              Smoking is the leading preventable cause of premature death in the United States. Previous studies of financial incentives for smoking cessation in work settings have not shown that such incentives have significant effects on cessation rates, but these studies have had limited power, and the incentives used may have been insufficient. We randomly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs (442 employees) or to receive information about programs plus financial incentives (436 employees). The financial incentives were $100 for completion of a smoking-cessation program, $250 for cessation of smoking within 6 months after study enrollment, as confirmed by a biochemical test, and $400 for abstinence for an additional 6 months after the initial cessation, as confirmed by a biochemical test. Individual participants were stratified according to work site, heavy or nonheavy smoking, and income. The primary end point was smoking cessation 9 or 12 months after enrollment, depending on whether initial cessation was reported at 3 or 6 months. Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cessation programs. The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment (14.7% vs. 5.0%, P<0.001) and 15 or 18 months after enrollment (9.4% vs. 3.6%, P<0.001). Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program (15.4% vs. 5.4%, P<0.001), completion of a smoking-cessation program (10.8% vs. 2.5%, P<0.001), and smoking cessation within the first 6 months after enrollment (20.9% vs. 11.8%, P<0.001). In this study of employees of one large company, financial incentives for smoking cessation significantly increased the rates of smoking cessation. (ClinicalTrials.gov number, NCT00128375.) 2009 Massachusetts Medical Society
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                26 May 2015
                2015
                : 10
                : 5
                : e0128639
                Affiliations
                [1 ]HopeLab Foundation, Redwood City, California, United States of America
                [2 ]West Virginia University, Morgantown, West Virginia, United States of America
                [3 ]Santech Inc., La Jolla, California, United States of America
                [4 ]Department of Pediatrics, Division of Adolescent Medicine, Stanford Medical School, Stanford, California, United States of America
                Arizona State University, UNITED STATES
                Author notes

                Competing Interests: The authors have read the journal's policy and have the following conflicts: The Zamzee intervention system studied in this research was developed by the nonprofit HopeLab Foundation. Nicole Guthrie, Jana Haritatos, Fred Dillon, and Steve Cole are employed by HopeLab Foundation. HopeLab develops behavioral interventions to improve health in young people. The design, conduct, analysis, and reporting of the intervention pilot study represents a scientific collaboration between HopeLab and Drs. Bradlyn, Yen, and Thompson. At the time of this research, Dr. Thompson was an employee of Santech Inc., which also develops behavioral interventions to improve health. Santech has no financial, intellectual property, or other interests in the Zamzee intervention system. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: NG AB ST SY JH SC. Performed the experiments: NG AB ST SY JH FD SC. Analyzed the data: NG SC. Contributed reagents/materials/analysis tools: NG FD JH SC. Wrote the paper: NG AB ST SY SC.

                Article
                PONE-D-14-05389
                10.1371/journal.pone.0128639
                4444279
                26010359
                04e6eb19-f0c0-44d4-957a-b84dda92c860
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 4 February 2014
                : 30 April 2015
                Page count
                Figures: 3, Tables: 1, Pages: 15
                Funding
                The research reported here was supported by the nonprofit HopeLab Foundation. HopeLab develops behavioral interventions to improve health in young people. The design, conduct, analysis, and reporting of this study represents a scientific collaboration between HopeLab and Drs. Bradlyn, Yen, and Thompson. Nicole Guthrie, Jana Haritatos, Fred Dillon, and Steve Cole are employed by HopeLab Foundation, which funded this research, had a role in study design, data collection and analysis, decision to publish, and preparation of the manuscript. None of the authors have any financial or other conflicting interest in the scientific results of this study. Santech Inc. provided support in the form of a salary for author SKT, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the author contributions section.
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