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Evaluating the effects of exergaming on physical activity among inactive children in a physical education classroom

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Title:
Evaluating the effects of exergaming on physical activity among inactive children in a physical education classroom
Physical Description:
Book
Language:
English
Creator:
Fogel, Victoria A
Publisher:
University of South Florida
Place of Publication:
Tampa, Fla
Publication Date:

Subjects

Subjects / Keywords:
Childhood obesity
Interactive fitness
Video games
School interventions
XRcade
Dissertations, Academic -- Child and Family Studies -- Masters -- USF   ( lcsh )
Genre:
non-fiction   ( marcgt )

Notes

Abstract:
ABSTRACT: Childhood obesity is a serious concern that requires the attention of the behavioral community. The U.S. Department of Health and Human Services (2007) recommends that children engage in physical activity for 60 minutes per day. Children spend the majority of their day in school, making school an ideal environment to increase the opportunity for physical activity. Simple, straightforward interventions that can be applied in the school setting, which take into consideration the environment and focus on maintenance by making the process of engaging in physical activity reinforcing, are greatly needed. Video games have been noted in the literature as a contributor to childhood obesity; however, newer video gaming technology, called exergaming, has been designed to capitalize on the reinforcing effects of video games to increase physical activity in children. This study evaluated the effects of exergaming on physical activity among four inactive children in a physical education classroom. Results showed that the exergaming condition produced substantially more minutes of physical activity than the PE condition. In addition, the exergaming condition was socially acceptable to both the students and the PE teacher. Exergaming appears to hold promise as a method for increasing physical activity among inactive children and might be a possible intervention for childhood obesity.
Thesis:
Thesis (M.A.)--University of South Florida, 2009.
Bibliography:
Includes bibliographical references.
System Details:
Mode of access: World Wide Web.
System Details:
System requirements: World Wide Web browser and PDF reader.
Statement of Responsibility:
by Victoria A. Fogel.
General Note:
Title from PDF of title page.
General Note:
Document formatted into pages; contains 54 pages.

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University of South Florida Library
Holding Location:
University of South Florida
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 002063285
oclc - 556122483
usfldc doi - E14-SFE0002999
usfldc handle - e14.2999
System ID:
SFS0027316:00001


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ABSTRACT: Childhood obesity is a serious concern that requires the attention of the behavioral community. The U.S. Department of Health and Human Services (2007) recommends that children engage in physical activity for 60 minutes per day. Children spend the majority of their day in school, making school an ideal environment to increase the opportunity for physical activity. Simple, straightforward interventions that can be applied in the school setting, which take into consideration the environment and focus on maintenance by making the process of engaging in physical activity reinforcing, are greatly needed. Video games have been noted in the literature as a contributor to childhood obesity; however, newer video gaming technology, called exergaming, has been designed to capitalize on the reinforcing effects of video games to increase physical activity in children. This study evaluated the effects of exergaming on physical activity among four inactive children in a physical education classroom. Results showed that the exergaming condition produced substantially more minutes of physical activity than the PE condition. In addition, the exergaming condition was socially acceptable to both the students and the PE teacher. Exergaming appears to hold promise as a method for increasing physical activity among inactive children and might be a possible intervention for childhood obesity.
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Evaluating the Effects of Exergaming on Physical Ac tivity Among Inactive Children in a Physical Education Classroom by Victoria A. Fogel A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts Department of Child and Family Studies College of Behavioral and Community Sciences University of South Florida Major Professor: Raymond G. Miltenberger, Ph.D. Stephen W. Sanders, Ed.D. Trevor F. Stokes, Ph.D. Date of Approval: June 4, 2009 Keywords: childhood obesity, interactive fitness, v ideo games, school interventions, XRcade Copyright 2009, Victoria A. Fogel

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Dedication I dedicated this manuscript to my husband, Jon. Hi s sacrifice, support, and encouragement over the past seven years have afford ed me the opportunity to achieve many professional goals. Jon’s belief that I can e xcel in my profession truly has brought out the best in me.

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Acknowledgements First and foremost, I would like to acknowledge an d thank my advisor, Dr. Raymond Miltenberger for his amazing teaching capab ilities. I am eternally grateful for his brilliance, guidance, and patience throughout t he entire graduate school process. Secondly, I would like to thank Jan Montgomery for strongly recommending the ABA program at USF as well as advocating on my behalf. Jan has always been a wonderful mentor and friend. Furthermore, I am especially th ankful for the full support and backing from Dr. Alyce Dickenson, Dr. Joseph Morrow, and Ka ren Pryor in my pursuit of a higher education. I would also like to thank Drs. Trevor Stokes, Kwang-Sun Blair, and Kimberly Crosland for their time and invaluable ide as. In addition, I am extremely indebted to Larry Wolpert for his technical abiliti es, support, and time. If Larry did not volunteer his time and expertise, the data collecti on process would have been exceptionally time consuming and difficult. Moreov er, I would like to thank Bryon Neff and Wayne Sager for their flexibility and understan ding over the past two years. Bryon and Wayne were instrumental in making it possible f or me to function as a full-time graduate student and working behavior analyst. I w ould also like to express my gratitude to Rachel Graves and Shannon Koehler for their time feedback, and commitment. Lastly, this research would not have been possible without the assistance, time, enthusiasm, shared resources, and leadership from D r. Stephen Sanders, Lisa Hansen, and Lynda Correia.

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i Table of Contents List of Tables iii List of Figures iv Abstract v Introduction 1 Physical Activity 2 Interventions 4 Exergaming 9 Method 12 Participants and Settings 12 Exergaming Equipment 13 Dance Dance Revolution 13 Gamercize 13 Game cycle 13 Virtual Bikes 14 Virtual Sports 14 XrBoard 14 3 Kick 14 Dependent Variables 15 Physical Activity 15 Opportunity to Engage in Physical Activity 15 Percentage of Opportunity Engaged in Physical Act ivity 16 PE Teacher Scoring 16 Social Validity 16 Students’ Preference Ranking Survey 17 PE Social Validity Survey 17 PE Observer Survey 17 Interobserver Agreement 18 Experimental Design and Procedures 18 Regular PE 18 Exergaming 19 Results 21 Dependent Variables 21

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ii Physical Activity 21 Opportunity to Engage in Physical Activity 23 Percentage of Opportunity Engaged in Physical Act ivity 25 PE Teacher Scoring 27 Social Validity 28 Students’ Preference Ranking Survey 28 PE Social Validity Survey 30 PE Observer Survey 32 Discussion 34 References 42 Appendices 49 Appendix A: PE Teacher Scoring Survey 50 Appendix B: PE Teacher Social Validity Survey 51 Appendix C: PE Observer Survey 52 Appendix D: Exergaming Schedule Board 53 Appendix E: Exergaming Rules 54

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iii List of Tables Table 1. Percentage of Opportunity Engaged in Physi cal Activity by Condition 25 Table 2. Percentage of Opportunity Engaged in Physi cal Activity by Station 26 Table 3. Teacher’s Scoring Survey Results 27 Table 4. Students’ Preference Ranking Survey Result s 29 Table 5. PE Teacher Social Validity Survey Results 31 Table 6. PE Observer Survey Results 33

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iv List of Figures Figure 1. The total number of minutes spent engaged in physical activity per a thirty minute session across conditions for all fo ur participants. Closed squares = regular PE and closed circles = e xergaming. 22 Figure 2. Percentage of opportunity engaged in phys ical activity during designated activity time per a thirty minute sessi on across conditions for all four participants. Closed squares = regula r PE and closed circles = exergaming. 24

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v Evaluating the Effects of Exergaming on Physical Ac tivity Among Inactive Children in a Physical Education Classroom Victoria A Fogel ABSTRACT Childhood obesity is a serious concern that requir es the attention of the behavioral community. The U.S. Department of Health and Human Services (2007) recommends that children engage in physical activity for 60 mi nutes per day. Children spend the majority of their day in school, making school an i deal environment to increase the opportunity for physical activity. Simple, straigh tforward interventions that can be applied in the school setting, which take into cons ideration the environment and focus on maintenance by making the process of engaging in ph ysical activity reinforcing, are greatly needed. Video games have been noted in the literature as a contributor to childhood obesity; however, newer video gaming tech nology, called exergaming, has been designed to capitalize on the reinforcing effe cts of video games to increase physical activity in children. This study evaluated the eff ects of exergaming on physical activity among four inactive children in a physical educatio n classroom. Results showed that the exergaming condition produced substantially more mi nutes of physical activity than the PE condition. In addition, the exergaming condition was socially acceptable to both the students and the PE teacher. Exergaming appears to hold promise as a method for increasing physical activity among inactive childre n and might be a possible intervention for childhood obesity.

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1 Introduction Childhood obesity is a social problem of great magn itude with data showing that 17% of US children are overweight (U.S. Health and Human Services, 2007). Childhood obesity is roughly defined as occurring when a chil d’s weight is equal to or greater than the 95th percentile for children of the same sex and age (R eilly et al., 2005; U.S. Health and Human Services, 2007). The percentage of overw eight children may seem small, but it should be noted that the number has doubled in t he past 20 years and is much higher for adolescents (U.S. Department of Health and Human Se rvices, 2001). Such a rapid increase strongly indicates a serious problem that may continue to grow at a significant pace. The literature indicates many variables that may co ntribute to childhood obesity, including an increasing trend in sedentary behavior (e.g. video game-playing, television viewing, computer time, etc.), reduction in physica l education time and qualified instructors, reduction in time provided for recess in schools, lack of safe routes for children to walk or bike to and from school, lack o f safe and supervised places for children to play before and after school, convenien ce of fast food, increasing trend in eating out, lack of parent training on effective te chniques to modify eating, decreasing physical activity and exercise behavior, and parent s modeling non health-related behavior (American Academy of Pediatrics, 2003; Anderson et al., 1998; Crawford, Jeffery, & French, 1999; Daniels et al., 2005; Pisacano et al. 1978; Reilly et al., 2005; Robinson, 1999; Spear et al., 2007; U.S. Health and Human Se rvices, 2007). These variables

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2 correlated with obesity are all associated with dec reased exercise or physical activity and/or increased caloric consumption. Childhood obesity may result in devastating health and social consequences such as heart disease, type 2 diabetes, metabolic disord er, sleep apnea, hypertension, increased chance of being an obese adolescent or adult, prema ture death, alienation from peers, and/or depression (U.S. Department of Health and Hu man Services, 2001). Because of the prevalence of obesity and the potential, severe consequences associated with it, some behavioral researchers have focused on changing hea lth related behaviors with children. These articles included functional assessment of ea ting patterns (Klesges et al., 1983; Mckenzie, Sallis, Patterson, et al., 1991) and inte rventions for weight loss (Aragona, Cassady, & Drabman, 1975; DeLuca, & Holborn, 1992), increasing health food choices (Herbert-Jackson & Risley, 1977; Madsen, Madsen, & Thompson, 1974; Stark, Collins, Osnes, & Stokes, 1986), increasing exercise behavio r (DeLuca & Holborn, 1992), and increasing exercise-report correspondence (Wilson, Rusch, & Lee, 1992). Unfortunately, the majority of the articles were published in the late 70’s and early to mid 80’s. It is imperative that the behavioral community take a mor e active role in investigating strategies that result in long term healthy life st yle changes. These lifestyle changes include increasing exercise or physical activity an d decreasing overeating or consumption of unhealthy foods. Physical Activity The terms physical activity and exercise often are interchanged; however, there is a difference between the two. Physical activity is defined as, “bodily movement that is produced by the contraction of skeletal muscles and that substantially increases energy expenditure,” (American College of Sports Medicine, 2006, p.3). A few examples of

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3 physical activity would include walking, raking lea ves, washing a car, etc. Exercise is defined as, “Planned, structured, and repetitive bo dily movement done to improve or maintain one or more components of physical fitness (the ability to perform sport and motor skill performance as well as daily activities )” (American College of Sports Medicine, 2006, p.3). A few examples of exercise w ould include running, swimming, biking, etc. The main difference between physical activity and exercise is the intensity and duration of the behavior. Unfortunately, data suggest a declining rate of children engaging in both physical activity and exercise (Am erican Academy of Pediatrics, 2003; Brownson, Boehmer, & Luke, 2005). One of the suspected causes of obesity is an increa se in sedentary behavior or a lack of physical activity (U.S. Department of Healt h and Human Services, 2005). With the advancement of technology, children are exposed to more sedentary activities than ever before such as online communities, state of th e art video games, and virtual playgrounds for pretend play (Brownson et al., 2005 ). In addition, school and community environments may not provide the necessar y structure to allow children the opportunity to engage in physical activity. Often these environments lack supervision, equipment, safeguards, and safe routes needed for c hildren to engage in physical activity (Brownson et al., 2005; McKenzie, Cohen, Sehgal, Wi lliamson, & Golinelli, 2006). As a result of the accessibility of sedentary activities and the increasing barriers to physical activity, children may be more likely to engage in sedentary behavior. The U.S. Department of Health and Human Services (2 005) recommends that children engage in daily physical activity for a mi nimum of 60 minutes at a moderate to vigorous intensity. The statistic on the percentag e of American children meeting the national recommendation for physical activity under grade 9 could not be found for this

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4 review. However, data suggest that physical activi ty levels decrease as children get older and that 75% of adolescents (grades 9-12) do not me et the national recommendations for daily physical activity (U.S. Department of Health and Human Services, 2007). A study by Sallis and colleagues (1997) points to the possi bility that young children are not meeting the national recommendations for physical a ctivity. They found that physical education class provided only18 minutes per week of physical activity that was of moderate to vigorous intensity. Interventions A wide variety of interventions designed to modify eating, physical activity, and exercise behavior in children have been assessed ov er the decades. These interventions are comprised of specific behavioral procedures (e. g. goal setting, public posting, and reinforcement schedules) and complex treatment pack ages which may include many behavioral procedures in conjunction with other the oretical frameworks such as Social Cognitive Learning Theory and Behavioral Choice The ory as well as medical and nutritional models. A review of literature by Spea r and colleagues (2007) indicates that while interventions based on a variety of models an d theories can yield results, these interventions usually incorporate behavior modifica tion techniques which seem to be the factor that is most effective in impacting childhoo d obesity. Manipulating the environment in some capacity has p roven to be a successful behavioral strategy for changing eating, physical a ctivity, and exercise behavior. Sallis and colleagues (2003) implemented a program focused on changing the school environment and policies (e.g. requiring physical e ducation daily, added supervision, equipment, and organized activities when physical a ctivity was an option, and switching food venders that provided low-fat food choices) to increase physical activity, exercise,

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5 and health food consumption. These environmental m anipulations resulted in an increase in physical activity for the children participating in the program. Environmental manipulation is only one of the many behavioral strategies that are utilized in modifying eating, physical activity, an d exercise behavior. Procedures that focus on providing consequences contingent on physi cal activity, exercise, and eating behavior can be very effective in producing initial short-term behavior change. DeLuca and Holborn (1992) used a variable ratio schedule o f reinforcement within a changing criterion design to increase the rate of exercise o n a stationary bike. The researchers utilized an elaborate token system in which a stimu lus (light and bell) was activated and a point was delivered when the child pedaled at a spe cified level. The points accumulated during the sessions were later exchanged for prefer red items. An increase in exercise was achieved and a notable positive effect on the verba l behavior of the participants was reported (e.g. asking if friends could join and ask ing for a bike at home). The limitation of this study and many studies within this area is the lack of follow-up data to assess generalization and maintenance. More recently, Eps tein, Paluch, Kilanowski, and Raynor (2004) looked at stimulus control procedures (rule-setting and self monitoring) versus reinforcement procedures (contracting) and f ound that both resulted in a decrease in sedentary behavior and an increase in physical a ctivity and fruit and vegetable consumption. Environmental and consequence strategies often are combined to form a treatment package. Aragona and colleagues (1975) compared a treatment package which consisted of contracting, stimulus control techniques (not sp ecified), daily exercise instructions, self monitoring, graphing, nutritional information, and response cost (in which a preferred item was lost if weight loss was not achi eved) to the same package plus

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6 reinforcement (a preferred item was given for losin g weight). Both groups had greater weight loss than the control group. Nonetheless, a 31 week follow-up showed no treatment effect except for the response cost plus reinforcement group which showed a slower weight gain trend. The use of peers in combination with other behavior al strategies can be effective in producing behavior change. Foster, Wadden, and Brownell (1984) implemented a program in which peers conducted weigh-ins, checked lunches, provided feedback on food selection, and provided stickers and praise fo r healthy food choice and weight loss. Results of this study showed that children lost wei ght; however, the weight loss was only partially maintained at the 18 week follow-up. Even though behavioral strategies have proven to be effective in modifying health-related behavior, at least in the short term the majority of the researched interventions are treatment packages that consist o f other components in combination with behavioral procedures. These types of treatme nt packages have multiple components intended to increase the likelihood of b ehavior change and maintenance. Treatment packages designed to increase healthy foo d consumption, physical activity, and exercise typically are conducted in the school environment and incorporate some variation of the following: curriculum on nutrition self monitoring, goal setting, contracting, stimulus control procedures (which are rarely defined), daily exercise instructions, family involvement (e.g. training, ha ndouts, family nights, etc.), and rewards for goals met (Botvin et al.,1979; Brownell & Frede rick, 1982; Gortmaker, Cheung et al., 1999; Gortmaker, Petterson et al., 1999; Sahota et al., 2001; Seltzer & Mayer, 1970; Simons-Morton et al., 1991). The articles evaluat ing treatment packages often describe their procedures in vague terms and report small ef fects with little to no assessment of

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7 maintenance. The lack of detail in describing the procedures used in these studies makes replication and implementation of these procedures difficult for the research and practicing communities. In addition, due to the ma ny treatment components, it is extremely difficult to determine which variable is responsible for the change in behavior and which variables are unnecessary. Interventions that are comprised of multiple components may be particularly difficult to impleme nt and maintain. Therefore, it is imperative that researchers identify only the neces sary procedures for effective healthrelated behavior change. A researcher can have a seemingly well-constructed functional intervention, but if the environment does not support the intervention, it may fail. The school environment may be ideal for prevention and intervention strate gies for obesity. Children spend the majority of their day at school and often spend add itional time in this environment before and after school (U.S. Department of Health and Hum an Services, 2002). Interventions implemented in the school environment to increase p hysical activity are often focused at changing some aspect of the physical education clas s and usually are comprised of a treatment package. The treatment package implement ed in the physical education class often centers on changing the class environment, in cluding teacher behavior, through tasked analyzed curricula, instructions, behavioral skills training, and new equipment, in order to increase physical activity levels in child ren. McKenzie and colleagues (1993) implemented a health related curriculum through inservice training which incorporated task analyzed lessons, prompting, and instructional cues. Results showed an increase in effective instructional behaviors demonstrated by t he teacher and active students. Data also indicated that students were more active in ph ysical education classes that were taught by physical education specialists compared t o those taught by teachers. This

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8 finding may be due in part to the fact that special ists were handed picked and provided with bi-weekly training by the curriculum developer which clearly does not allow for an accurate assessment of the curriculum implemented i n a typical environment. Follow-up research on this study by McKenzie, Sallis, Kolody, and Faucette (1997) indicated that results maintained after 1.5 years for specialists and teachers who had previous training. In another study, Lupeker and colleagues (1996) imp lemented a treatment package with third graders called CATCH (The Child and Assessmen t for Cardiovascular Health) that modified lunch content; increased physical activity in the physical education classroom via a standardized curriculum, training, and booste r training; and included families through a family fun night (information and activit ies associated with nutrition). Results of this study showed improved eating and physical a ctivity for 3 years. Kelder and colleagues (2003) conducted a follow-up study and f ound no difference between schools that received treatment and control schools. They hypothesized that the CATCH program changed state practice in the states in whi ch the program was implemented so that control schools improved as well as experiment al schools. SPARK (Sport, Play, and Active Recreation for Kids) is another treatment pa ckage comprised of a physical education program, self management procedures (i.e. self reinforcement, self instruction, goal setting, self monitoring, and stimulus control procedures) designed to increase the likelihood of maintenance and generalization, homew ork and monthly newsletter to include the family, and rewards for meeting goals ( Sallis et al., 1997). In an evaluation of SPARK with 4th graders, physical activity increased during physic al education class but did not increase after school. The authors suggest that this limitation may be a result of poor design and/or poor implementation. Sallis and colleagues (1999) also assessed the effects of the SPARK program on academic performanc e. The authors found that

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9 increasing physical education to three times a week had no harmful effect on academic behavior. In addition to the school setting, after school spo rt programs have been used to increase physical activity and exercise. Weintraub and colleagues (2008) taught soccer skills to overweight children after school through positive feedback, social interaction, family involvement (participation in games), and th e provision of equipment. Soccer was chosen because it included a wide range of muscles. Results demonstrated an increase in physical activity and exercise, which maintained fo r 6 months. In another study utilizing a sport team to increase physical activity, Jette, Barry, and Pearlman (1977) taught Lacrosse after school and demonstrated improved hea rt rates; however, maintenance was not assessed. Researchers may add several components to an interv ention to increase the likelihood of behavior change and maintenance, but these additional components may have no effect on behavior change and thereby, woul d be unnecessary. Complex interventions can be difficult to implement, requir ing substantial time and effort. If unnecessary components are identified, effort and t ime may be reduced, ultimately increasing the acceptability of the intervention. Interventions targeting health-related behaviors may be more successful in long term behav ior change if based on assessment results, strategies are simple to implement and req uire the least amount of time and effort as possible, interventions fit into current environ ment, and/or interventions include strategies that plan for generalization and mainten ance. Exergaming Excessive video game play has been noted in the lit erature as a contributor to childhood obesity; however, newer gaming technology called exergaming, has been

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10 designed to capitalize on the reinforcing effects o f video games to increase physical activity (Sanders & Hansen, 2008). Exergaming is a technology that utilizes interactive games to increase exercise behavior. Video games o r various auditory or visual stimuli are paired with different types of exercise equipme nt and activities and, in order to play the game or produce the auditory or visual stimulat ion, the individual must engage in physical activity (Sanders & Hansen, 2008). Exergaming may be an effective way to manipulate th e PE environment to increase physical activity and reach large numbers of children. One of the critiques regarding treatments for childhood obesity is that behavioral interventions are not clearly laid out and often are very difficult for clinician s to implement (Spear et al., 2007). Exergaming holds promise as an intervention that is easy to implement, requires little effort from the PE teacher, and can be implemented with an entire class. Physical activity levels during PE may increase because clas s management time may decrease as children start engaging in physical activity right away during PE. In addition, opportunities for physical activity may increase by implementing an exergaming lab in the school system because these labs could also be available to students before and after school providing them with a safe location to engag e in physical activity. Research has just begun to investigate the effects of exergaming. Graves, Stratton, Ridgers, and Cable (2007) compared energy expended playing sedentary video games versus interactive video games and found that interactive video games resulted in more energy expenditure; however, the intensity of the energy expended was not high enough to contribute to the daily recommendations f or exercise. The limitation of this study is that they used lean children who were alre ady very active in sports. Results may vary with inactive children. In another study, Lan ningham-Foster and colleagues (2006)

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11 compared sedentary video games with interactive vid eo games to assess energy expenditure and found that interactive video games doubled energy expenditure with children. In addition, the results showed that obe se children had significantly greater increases in energy expenditure, suggesting that in teractive video games may be a possible intervention for childhood obesity. Exergaming in a school setting has yet to be scient ifically evaluated. Although implementing an exergaming lab into an elementary s chool could have substantial start up costs, if exergaming increases physical activity in children and develops exercising as a reinforcing activity, it could dramatically decre ase the amount of money spent on obesity related medical costs in the future (Hansen & Sanders, 2007). Due to the potential benefits of exergaming as an intervention for childhood obesity and the limited research in this area, it is clear that further res earch is needed to determine the effects of exergaming on physical activity in children. The p urpose of this study was to evaluate the implementation of exergaming in a typical PE cl assroom with inactive children and answer the following questions. First, does an ina ctive child spend more time engaged in physical activity in an exergaming PE environment o r in the traditional PE environment? Second, does an inactive child spend more of the ti me that is available for physical activity engaged in physical activity in the exerga ming environment? Finally, which environment do inactive children prefer and does pr eference correspond with the environment that resulted in the highest level of p hysical activity?

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12 Method Participants and Setting Four 5th grade physical education students from a southern public elementary school participated in this study. The participant s met the criterion of being physically inactive in the PE classroom, which is defined as s pending at least 30% of the time available to participate in physical activity eithe r standing, sitting, and/or watching others. Inactive children were chosen for this stu dy because inactivity is a variable correlated with childhood obesity. During pilot data collection, fitness test scores from the class were examined and children were selected based not only on being physically inactive in the PE classroom, but also on their fit ness test scores being the lowest in the class, having good attendance, the teacher’s assess ment of whether the child would engage in any property damage in the exergaming lab being overweight (as defined by the PE teacher), and the PE teacher’s assessment t hat the child would benefit from an increase in daily physical activity. Informed consent forms describing the study along with the researcher’s contact information were sent home to all students in this fifth grade physical education class. To ensure that caregivers understood the informed cons ent form, the option of either calling or meeting with the researcher to review the inform ed consent form was provided. After three weeks, four students were chosen from those s tudents that had consent to participate in the study. The study was conducted at the local public element ary school during the regularly scheduled PE class. Due to the PE teache r testing the exergaming equipment

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13 with multiple classes, all 25 students in this 5th grade class engaged in both conditions of the study, but data were only collected on the four students participating in the study. Exergaming Equipment A classroom was converted into an exergaming lab, in which 9 stations utilizing seven types of exergaming equipment to promote phys ical activity were available to the participants during the exergaming conditions. Bel ow is a description of each type of exergaming equipment that was utilized in this stud y (Hanson, 2008): Dance Dance Revolution (DDR). A dance pad on which a player moves his or her fee t to a set pattern that matches the general rhythm or beat of a song. Children stand on a “dance pad” in front of a monitor or television scr een and step, stomp, or hop in the direction (i.e., up, back, right, and left) of the arrows that scroll up the screen to the rhythm of the music. DDR is designed to improve ca rdiovascular endurance and muscular endurance in the leg muscles. Gamercize. A fitness machine with an interface to a video game ’s console. When in motion the fitness machine provides a signa l to the interface module. The interface allows interaction between the game contr oller and game’s console only when the signal is present. Gamercize therefore re quires the player to remain in motion in order to play the game. Gamercize is inte nded to improve cardiovascular endurance, balance, and coordination. Game Cycle. An upper body ergometer bike that requires children to control onscreen actions by pedaling and steering the bike with their arms instead of the legs. The Game Cycle is intended to improve muscular stre ngth and endurance in the arm muscles and also to improve cardiovascular enduranc e.

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14 Virtual Bikes. Virtual bikes resembling traditional bikes that allow child ren to control all on-screen actions, including steering, speed, turns, firing mechanisms and other strategies. The faster the player pedals, the faster the objects on the screen moves. The children also control the movement of t he objects on the screen using the steering wheel. Virtual bikes are intended to impr ove muscular strength and endurance in leg muscles and also to improve cardio vascular endurance. Examples of virtual bikes include the Cateye GameBike, the Expr esso Bike, and the Dog Fighter Bike. Virtual Sports. Virtual sports allow children to play tennis, go bo wling, practice boxing, or participate in a baseball game inside of a virtual world on a screen. Children may actually hold an implement that simula tes a bat, racquet, or paddle as well as wear a pair of boxing gloves during game pl ay. Virtual sporting games are intended to provide children with a variety of heal th benefits—including cardiovascular endurance, muscular endurance, balan ce, and flexibility—depending on the sport chosen. The Xavix console and Nintend o Wii are examples of virtual sport exergames. XrBoard. A balance board simulator that allows children to e xperience the thrill of snowboarding down a mountain or practicing compl icated skateboarding tricks. The XrBoard is intended to improve balance and coor dination, muscular strength and endurance in leg muscles, as well as ankle flexibil ity and stability. 3 Kick. A martial arts simulator designed with resilient foam pads that can be punched, kicked, slapped, or tapped with shoes or b are feet, a fist, or an open palm. A light comes on in the pad and an audible tone sound s, when the pad is hit the light goes off and randomly another comes on. The score is based on speed as more points

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15 are allocated the faster children are able to get t o a light. 3 Kick is intended to develop cardiovascular strength and endurance, muscular str ength and endurance, and flexibility. Dependent Variables The dependent variables in this study were the tota l minutes engaged in physical activity during each condition (PE and exergaming c lasses), the total minutes provided for physical activity, the percentage of opportuni ty engaged in physical activity during each condition, and a PE teacher scoring survey. Physical activity. Physical activity for the purposes of this study was defined as moving a large muscle group (legs, arms, back, and/ or abdominal) during an assigned task (designated by the PE teacher). Moving a larg e muscle group during any other time was not counted as physical activity. For example, movement during transition time, waiting time, or any other physical activity that w as not part of the designated PE assignment was not counted. Total minutes engaged i n physical activity for each participant was measured by utilizing a software pr ogram in which a button on the keypad of a PDA (personal digital assistant) was as signed to each participant. The researcher and/or research assistant started the ke ys at the beginning of class for all four participants once they engage in physical activity. When a participant stopped engaging in physical activity, his or her key was turned off and as soon as the participant started engaging in physical activity, the key was turned b ack on. This data collection process was repeated for the entire duration of the PE clas s, which was approximately 30 minutes. Opportunity to engage in physical activity. The total number of minutes the student had an opportunity to engage in physical activity ( OPA). For example, if the PE teacher

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16 delivered instructions for two minutes, there was n o opportunity for physical activity at that time; if all exergaming activities were occupi ed for 5 minutes, there was no opportunity for activity at that time; and if the t eacher stopped the class to deal with problems behaviors, there was no opportunity for ph ysical activity at that time. Percentage of opportunity engaged in physical activ ity The percentage of opportunity engaged in physical activity during the PE or exergaming conditions was calculated by dividing the number of minutes in whi ch each participant was engaged in physical activity by OPA.. In addition to the perc entage of opportunity engaged in physical activity, the percentage of opportunity en gaged in physical activity during the exergaming condition was also calculated by station towards the middle of the study to assess the differences across equipment and to iden tify exergaming activities that produced the highest and lowest percentage of oppor tunity engaged in physical activity (see Table 1). PE teacher scoring survey The PE teacher scoring survey was used to assess the teacher’s perceptions of how much time was spent de aling with behavior problems, providing instructions, and practicing PE skills, a nd how much time the class followed directions across conditions. The survey consisted of four statements and the PE teacher was asked to circle the percentage of time spent fo r each statement (see Appendix A). The survey was administered prior to (Pre) and at t he completion of the study (Post). Social Validity Three surveys were utilized to assess the social ac ceptance of exergaming. The students’ preference ranking survey was used to eva luate the participants’ preferences among the different types of exergaming equipment a nd the PE teacher social validity

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17 survey (see Appendix B) and the PE observer survey (see Appendix C) were used to assess the acceptability of exergaming to the PE te acher and a non biased observer. Students’ preference ranking survey. The students’ preference ranking survey was administered at the end of the study during the PE class. Each participant met with the researcher individually in the back of the exergami ng room. The students’ preference ranking survey consisted of eleven note cards with the name of one exergaming activity listed per card. Students were told to put the car ds in order of their most favorite to least favorite activity (1 as most preferred and 11 as le ast preferred). To ensure the directions were clear, prior to ranking the exergaming activit ies, the researcher handed the participant five cards with one type of food listed on each card (e.g. pizza, beans, carrots, hotdogs, and ice cream). The researcher asked the p articipant to pick his/her favorite and least favorite food. The researcher then told the p articipant to put the cards in order of their most to least favorite food. Once the partici pant had done this correctly, he/she was told to rank the exergaming activities. Following t he ranking survey, the researcher asked each participant three questions. The first questio n was, “Why did you put (most preferred) activity on top?” The second question wa s, “Why did you put (least preferred) activity on the bottom?” The last question was, “Wo uld you rather do regular PE activities or exergaming activities during PE class ?” After the participant answered these questions, he/she was thanked for speaking with the researcher. PE teacher social validity survey. To measure the acceptability of exergaming as a form of PE, a survey consisting of eight statements utilizing a Likert scale (1-5) was administered to the PE teacher at the completion of the study. PE observer survey. The PE observer survey was conducted in both the re gular PE and exergaming conditions. The purpose of this surv ey was to have a non-biased

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18 observer, whom was familiar with fitness standards, assess both conditions to provide an opinion about each environment. The observer was a fitness graduate assistant and held a personal trainer certification. A Likert type scale was used to assess nine statements about each environment. Two observations were conducted t hroughout the study. The observations were scheduled based on the observer’s availability. Interobserver agreement To assess interobserver agreement, physical activi ty and opportunity to engage in physical activity (OPA) data were collected by two additional independent observers across all conditions for 50% of the total data. I nterobserver agreement was assessed on a second by second basis throughout the observation session. An agreement was defined when both observers indicated that exercise was or was not occurring during each second of the observation. Agreement was calculated by ta king the total seconds of agreement divided by the total seconds of observation and the n multiplying by 100. Agreements averaged 96% across all observations with a range o f 92% to 98% for physical activity data and an average of 95% across all observations for OPA, with a range of 92% to 97%. Experimental Design and Procedures An alternating treatments design was used to assess the effectiveness of exergaming on physical activity. Two conditions we re assessed in this study: Regular PE (PE), and exergaming (E). Regular PE. During the regular PE condition, the fifth grade cl ass participated in a traditional PE class. In the PE condition, the t eacher conducted class as usual in the standard format consistent with her regular lesson plan. The standard format included providing instructions on a skill or activity; mode ling the skill or activity; providing an

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19 opportunity for the students to perform the skill o r activity while providing prompts and encouragement; and repeating this cycle if teaching more than one skill or activity per class. The PE teacher was provided with outcomes t hat each student must meet by the end of the year; however, the PE teacher was not re quired to follow a specific protocol or curriculum in order to teach these skills in the PE classes. Exergaming. During the exergaming condition, the fifth grade cl ass participated in exergaming. The exergaming class was conducted by the PE teacher. During the first class, the PE teacher provided instructions and mod eling on how to use each piece of equipment. A sign was posted on each piece of exer gaming equipment indicating the station number as well as simple instructions to as sist the students in starting up each activity. The PE teacher also provided instructions for station rotation and showed the class a schedule board indicating to each student t o which group he/she belonged and at which station each group would start for that class (see Appendix D). She reviewed five rules for the exergaming room (see Appendix E) and had the class repeat back the rules. Schedule boards were changed at the end of each cla ss so that each group would start on the station following the last one completed. For e xample, if a group ended at station 3, that group would start at station 4 the following e xergaming class. Students rotated stations approximately every 10 minutes upon the PE teacher turning the lights off. For all subsequent exergaming sessions, at the start of class, students were told to check the schedule board when they came into the room and the n to go to the assigned station. Stations continued to rotate approximately every 10 minutes. This study evaluated exergaming under typical envir onmental conditions to ensure an accurate depiction of what would be obser ved in the natural environment by

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20 utilizing the standard format that was currently in place for traditional PE and a station rotation format for implementing exergaming in the PE classroom.

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21 Results Dependent Variables Physical activity. Based on the data collected across ten sessions, th e exergaming condition resulted in higher levels of physical act ivity for all four participants (Drew, M=9.1 minutes; Hannah, M=9.2; Ryan, M= 9.6; Marley, M=9) than the PE condition (Drew, M=1.8 minutes; Hannah, M=1.4; Ryan, M=1.7; M arley, M=1.6) (see Figure 1). The exergaming condition resulted in an average of 9.2 minutes of physical activity per session across participants whereas the PE conditio n resulted in an average of 1.6 minutes of physical activity. Both the exergaming and PE co nditions produced stable data patterns; however, the last two PE sessions showed a very slight increasing trend. Unfortunately, the school changed the time of the P E class after session ten and a decision was made to conclude data collection as th e schedule change might have influenced the data. Due to student absences, Drew missed one session and Marley missed four sessions and therefore, Drew and Marley were not exposed to the same number of sessions for both conditions as were Hann ah and Ryan. However, the patterns in the data are the same across participants regard less of number of sessions.

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22 Figure 1. Minutes of physical activity per session by conditi on. Drew Hannah Ryan Marley

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23 Opportunity to engage in physical activity. The exergaming condition resulted in higher levels of OPA for all four participants (Dre w, M=12.4 minutes; Hannah, M=12; Ryan, M= 10.6; Marley, M=11.7) than the PE conditio n (Drew, M=3.1 minutes; Hannah, M=3.4; Ryan, M=3.6; Marley, M=4.4) (see Figure 2). The exergaming condition produced an average of 11.6 minutes of physical act ivity per session across participants whereas the PE condition produced an average of 3.8 minutes of physical activity. A clear separation between the exergaming and PE cond itions is demonstrated for 3 out of 4 participants. The data for Ryan shows overlap betwe en one data point in the PE condition and two data points in the exergaming condition. Th e data for the exergaming condition shows a decreasing trend for 3 out of 4 participant s; however, as indicated previously data collection was stopped due to changes in the P E class schedule.

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24 Drew Hannah Ryan Marley

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25 Figure 2. OPA per session by condition. Percentage of opportunity engaged in physical acti vity. For the majority of the exergaming sessions across participants, the percen tage of opportunity spent engaged in physical activity was greater than 80% (Drew, range was 46% to 90%, M= 79%; Hannah, 52% to 97%, M=80%; Ryan, 61% to 92%, M= 75%; Marle y, 56% to 97%, M=79%). In the PE condition, percentage of opportunity spent e ngaged in physical activity was quite varied across sessions (Drew, range was 13% to 100% M= 65%; Hannah, 23% to 81%, M=58%; Ryan, 16% to 88%, M= 63%; Marley, 21% to 90% M=53%). Percentage of opportunity spent engaged in physical activity show ed a decreasing trend in the first two PE sessions and an increasing trend in the last two PE sessions (see Table 1). Data collected on the percentage of opportunity sp ent engaged in physical activity across exergaming activities showed that DDR and th e 3 Kick produced the highest percentages across participants (range, 88% to 100% ). The Wii tennis and baseball produced the lowest percentages across three partic ipants (range, 12% to 20%) (Data on the Wii were not collected for Marley due to absenc es) (see Table 2). Table 1. Percentage of Opportunity Engaged in Physical Activ ity by Condition Exergaming PE Drew 85, 90, 46, 89, 86 63, 13, 100, 82 Hannah 66, 84, 96, 52, 83, 97 57, 23, 81, 70 Ryan 66, 83, 85, 61, 61, 92 68, 16, 100, 90 Marley 56, 85, 97 48, 21, 80 Note: All numbers are percentages

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26 Table 2 Percentage of Opportunity Engaged in Physical Activ ity by Station Exergaming Activity Drew Hannah Ryan Marley Boxing/Monster 83 83 99 DDR 2 100 100,95 98 93 3 Kick 97 96,100 88 100 Dog Fighter 90,95 85,89 92 Batman and Robin 70 68 82,95 DDR 6 95 100 93,96 Wii Tennis & Baseball 12 15 20 XR Board 81 89 100 Dirt Biking 47 72 51 Note. Monster and Boxing and Wii Tennis and Baseball were separate exergaming activities but made up one station, therefore perce ntage of opportunity engaged in physical activity was combined for these activities DDR is listed twice because there were two different types of DDR that made up two se parate stations. The percentage of opportunity engaged in physical activity by station began midway through the study thereby data were only collected twice for a few ac tivities for Hannah and Ryan and due to student absences; data were not collected on sev eral stations for Marley and one station for Drew.

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27 Teacher scoring survey. Results of the teacher scoring survey showed that t he teacher reported a 30% reduction in time spent deal ing with behavior problems, a 30% increase in students following directions, and a 50 % increase in time spent having students practice a PE skill/activity per session a cross conditions (see Table 3). Table 3 Teacher Scoring Survey Results Survey Statement Pre Post The average percentage of time spent dealing with behavior problems 50 20 The average percentage of time the class follows directions 50 80 The average percentage of time spent providing instruction on a PE skill/activity 20 20 The average percentage of time spent having students practice a PE skill/activity 30 80 Note. Due to a life situation experienced by the PE teach er, she was away from school for two weeks so the post survey was administered two w eeks following the last session in which data were collected.

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28 Social Validity Students’ preference ranking survey. The students’ preference ranking surveys indicated that the most preferred exergaming activi ties were boxing (Drew and Marley), DDR (Hannah), and Wii baseball (Ryan). The preferen ce for DDR and for boxing corresponded with a high percentage of opportunity engaged in physical activity. However, the Wii baseball did not correspond with a high percentage of opportunity engaged in physical activity. The least preferred e xergaming activities were forms of gamercize; Batman and Robin (Drew, Ryan, and Marley ), which was a stepper and the Monster 4X4 (Hannah), which was a hand bike. The Ba tman and Robin and the Monster 4X4 exergaming game did not correspond with the low est percentage of opportunity engaged in physical activity; however, the Batman a nd Robin did produce lower percentages of opportunity engaged in physical acti vity across three participants (Drew, Hannah, and Ryan) (see Table 4). Drew and Ryan rep orted a preference for both PE activities and exergaming activities whereas Hannah and Marley reported a preference for exergaming (see Table 4).

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29 Table 4 Students’ Preference Ranking Survey Results Exergaming Activity Drew Hannah Ryan Marley Boxing 1 7 10 1 Monster 8 11 7 10 DDR 2 6 1 9 5 3 Kick 5 3 3 6 Dog Fighter 3 6 2 7 Batman and Robin 11 5 11 11 DDR 6 2 2 5 2 Wii Tennis 9 8 4 9 Will Baseball 7 9 1 8 XR Board 4 4 8 4 Dirt Biking 10 10 6 3 Follow-up questions Why did you put (most preferred activity on top? “Because it gives you arm strength, muscles, and coordination.” “You get to move your body more.” “Because I play baseball at home. It’s what I do.” “It has songs I listen to at home.” Why did you put (least preferred) activity on bottom? “I don’t get much exercise. Not interesting.” “You just move your arms.” “I don’t know what to do.” “Difficult. I didn’t know how to play.” Would you rather do regular PE activities or exergaming activities during PE class? “I like both.” “Exergaming because you get more exercise and it’s more fun.” “I like both.” “Exergaming because it is fun and it’s what kids are doing today.” Note. DDR is listed twice because there were two types of DDR which had different choices of music. A rank of 1 indicates most prefer red and 11 indicates least preferred.

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30 PE teacher social validity survey. Based on the results of the PE teacher social validity survey, the PE teacher reported that she s trongly agreed that exergaming was beneficial to the students, provided opportunities for students to work on skill development, and resulted in a reduction in behavio r problems during class time (see Table 5).

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31 Table 5 PE Teacher Social Validity Survey Results Survey Statement Strongly Disagree 1 Disagree 2 Neutral 3 Agree 4 Strongly Agree 5 PE time spent in the exergaming lab was beneficial to the students. X The PE exergaming lab provided opportunities for student to work on skill development. X Students followed directions in the PE exergaming lab. X PE time spent in the exergaming lab resulted in a reduction in behavior problems. X PE time spent in the exergaming lab provided an opportunity for me to assess students’ individual needs X PE time spent in the exergaming lab resulted in an increase in the amount of PE time allotted for student to be actively engaged. X PE time spent in the exergaming lab increased skill acquisition for students. X PE time spent in the exergaming and increased cardio vascular endurance for students. X Note. Due to a life situation experienced by the PE teach er, she was away from school for two weeks so the survey was administered two we eks following the last session in which data were collected.

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32 PE observer survey. The outcome of the PE observer survey showed slight differences between the conditions. The observer re ported a stronger agreement for exergaming with regards to students being on task, student and teacher enjoyment, and time engaged in physical activity. The greatest di fference reported was for the statement regarding the teacher providing praise and encourag ement for the students, which indicated a strongly agree for the exergaming condi tion and a neutral for the PE condition (see Table 6).

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33 Table 6 PE Observer Survey Results Survey Statement Strongly Disagree 1 Disagree 2 Neutral 3 Agree 4 Strongly Agree 5 The students were usually on task. P E The students seemed to enjoy the activity. P E The students usually followed directions. P E The teacher spent a lot of time providing instruction. P/E The teacher spent a lot of time dealing with behavior problems. P/E The teacher seemed to enjoy the activity. P E The students spent the majority of class time engaging in physical activity. P E The students were usually engaged in moderate intensity activities. P/E The teacher did a good job providing praise and encouragement to the students. P E Note. P stands for regular physical education class and E stands for exergaming physical education class.

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34 Discussion The current study evaluated the effects of exergam ing on physical activity among four inactive 5th grade students in a physical education classroom. The results of this study showed the exergaming condition producing sub stantially more minutes of physical activity among the four participants than did the P E condition. In addition, this study revealed that, in the PE condition, fewer minutes w ere available for students to engage in physical activity than were available in study by S allis and colleagues (1997), even though Sallis and colleagues only measured minutes of moderate to vigorous exercise. The PE class was scheduled for thirty minute, twice a week; however, after transition to PE, class management, instructions, waiting for a t urn, and school announcements, very little time was left for actual physical activity i n the PE environment (an average of 2 minutes were provided for physical activity per ses sion with the exception of one session in which 7 minutes were provided). Based on the da ta, the PE environment, provided approximately 4-6 minutes of opportunity to engage in physical activity per week and the participants engaged in approximately 2-6 minutes o f physical activity per week (see Figure 1 & 2 and Table 1). In the exergaming condition, opportunity to engage in physical activity was substantially higher than in the PE condition (an a verage of 12 minutes were provided for physical activity per session). The exergaming env ironment provided approximately 24 minutes of opportunity to engage in physical activi ty per week and the participants engaged in approximately 18 minutes of physical act ivity per week (see Figure 1 & 2).

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35 Based on the data collected in this study, the exer gaming condition produced an average of three to four times more minutes of physical act ivity than the PE condition. This study is important because data suggest that childhood obesity is on the rise and interventions that get children engaged in phys ical activity need to be identifued. The purpose of this study was to evaluate exergamin g as a potential intervention to increase physical activity among inactive children. This study was the first to assess the effects of exergaming on physical activity among sc hool children in a natural environment. The data collected in this study show ed that the implementation of exergaming did result in four students receiving mo re opportunity for physical activity and engaging in more phyiscal activity than in the PE condition. Based on three social validity surveys, the PE teacher, the students, and the non-biased observer found exergaming to be a socially acceptable form of PE. The findings of this study support exergaming as an effective, socially valid interven tion for producing more minutes of physical activity among inactive 5th graders. A benefit of this study was that it was conducted in the natural environment under normal conditions. It is very difficult to determin e whether results obtained in a controlled environment would be similar to results obtained in the natural environment, therefore, whenever possible, research should be co nducted under normal conditions. Although a necessity, implementing this study in th e natural environment proved to be extremely challenging. Several factors contributed to changes made in the original study’s protocol. First, the school had inservices days once a month, the PE teacher had two life situations resulting in her absence from s chool, and the school occassionally held a school event during the designated PE time. All of these factors resulted in lengthening the intervention data collection from s ix weeks to eight weeks. Second,

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36 during school-wide testing, which lasted three week s, the school banned PE class from outdoor activities (PE class is normally conducted outdoors), thereby resulting in a change in the pre-determined schedule of conditions Lastly, the school changed the PE class’s designated PE time after session 10 and, as a result of this change, the data collection was cut short, thus ending with a minor increasing trend in the PE condition for three of the four participants. Suggestions for future research in a school system, would be to 1) develop good rapport and communication which the PE teacher and adminstration so that notifcation of any modifications would be delivered in a timely ma nner; 2) get a school calendar of events prior to selecting a PE class (e.g. testing, holidays, inservice days, etc.); 3) before the study, speak with the PE teacher and principal regarding events that may effect the normal routine (e.g. Are there specific rules with regards to PE during test weeks?); 4) choose a time frame for the study that has the leas t amount of disruption (e.g. avoid time periods that have the most test weeks, inservice da ys, holidays, school events, etc.); 5) plan for delays by providing at least a month cushi on; and 6) after the time frame has been set for the study, meet with the principal and teacher and stress the importance of keeping the same routine for the course of the stud y. Another value of this study was the measurement of opportunity to engage in physical activity (OPA). This measurement provided information on how many minutes students were actually given to engage in physical activity per session (OPA) and the percentage of opportunity engaged in physical activ ity. In the PE condition, with regards to the last two PE sessions, when provided with opp ortunity to engage in physical activity, students engaged in physical activity on average of 84% of the time. However, the data showed that students were provided with ve ry little time to engage in physical

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37 activity (an average of 2-3 minutes). Whereas, in t he exergaming condition, students were provided with an average of 12 minutes of OPA and for the most part, engaged in physical activity on average 80% of the time. In table 1, the percentage of opportunity engaged in physical activity in the PE condition is higher in the last two sessions. The h igh percentages of opportunity engaged in physical activity observed in the last two sessi ons could be a result of three possible variables. 1) When given only 2-3 minutes of opport unity to engage in physical activity, it is quite possible that students choose to engage in physical activity for a short duration over other activities such as waiting in line. Howe ver, this would not explain the lower levels in the earlier PE sessions. 2) The effects of exergaming on physical activity could have generalized to the PE environment thereby acco unting for the increased trend in opportunity engaged in physical activity. However, this explanation is highly unlikely because of the third possible variable, fitness tes ting. 3) The last two PE sessions were not adminstered as usual. Fitness testing was condu cted during these last two sessions and the sessions were more structured. In addition, physical activity may have been preceived as required (e.g. testing in which studen ts are given specific instructions and monitored versus stations in which a student choose s an activity). It is the author’s belief that the difference in structure in the last two PE sessions (the testing format) resulted in the increase in percentage of opportunity engaged i n physical activity relative to earlier sessions which consisted of stations and games (e.g jump rope, football, hula hoop, around the world and bowling). The PE condition di d not have a standard format, in the first session a game format, bowling, was conducted in the second condition stations were conducted, and in the last two sessions a test ing format was implemented. Physical activity levels across participants were the highes t during the station format. In addition,

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38 OPA was the highest in the station format. It is po ssible, that when given a choice of preferred activities, inactive children are more li kely to engage in physical activity. Furthermore, the structure of stations may also pro vide more OPA. Future research should evaluate different PE formats to identify ef fective formats for producing more opportunities for physical activity and higher perc entages of opportunity engaged in physical activity. The U.S. Department of Health and Human Services ( 2005) recommends that children receive 60 minutes of moderate to vigorous physical activity per day. A limitation to this study is the absence of a measur ement system to identify the intensity of physical activity engaged in during exergaming and PE classes. Heart rate monitors were considered, but due to the time that would have bee n subtracted from the PE class by putting on and taking off heart rate monitor, a dec ision was made to not assess the intensity of physical activity during this study. The use of heart rate monitors in future studies would add great value in determining if exe rgaming and/or PE conditions provide moderate to vigorous physical activity. Furthermore the use of additional instruments that measure other potential benefits of physical a ctivity (e.g. BMI, % of body fat, resting heart rate, recovery heart rate, blood pressure, mu scular endurance, cardiovascular endurance) should also be incorporated into future studies. This study showed that with exergaming, the studen ts in this study met 15% of the recommended minutes for physical activity for 2 out of 7 days compared to the PE condition in which students only met 5% of the reco mmended minutes for physical activity for 2 out of 7 days. It is not feasible f or PE class to be the sole opportunity for students to meet the recommended 60 minutes of phys ical activity per day. Students should have opportunity to engage in physical activ ity during recess (if provided;

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39 however, some schools no longer provide recess), an d before and after school. Of course, with the reported increase in sedentary behavior an d rise in childhood obesity, it is unlikely that children are meeting this recommendat ion outside of PE class. Because children spend the majority of their day at school, it seems that 15% of the recommended physical activity for 2 out of 7 days is still too low. The focus of PE class may need to shift to establishing and maintaining an active lif estyle. This change will need to utilize methods that make engaging in physical activity rei nforcing so that children will be more likely to maintain an active lifestyle into their a dult years. In this study, PE class occurred at the end of the day and was often cut short due to announcements made during the last 15 minutes of the class. Furthermore, several days of PE class were missed due to inservice days, holidays, and school events. Future research should evaluate environmental changes that might increase the likelihood of providing more opportunity for physical activity in the PE classroom. These changes might include scheduling PE on days other than inse rvice days; scheduling PE at an earlier time during inservices days; scheduling on days that are least commonly used for school events; and scheduling PE at times that are least likley to be interrupted such as the end of the day. For these changes to take plac e, school districts and school administrators would need to see PE as a valuable a ctivity for children’s health and take steps to protect PE time. Results of the students’ ranking survey showed tha t students reported that they liked exergaming and found it to be fun. It is poss ible that percentages of opportunity engaged in physical activity were consistently high in the exergaming condition due to the reinforcing effects of exergaming. Students’ ra nking of stations revealed that the most preferred activities did correspond with high perce ntages of opportunity engaged in

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40 physical activity for 3 out of the 4 participants. However, a limitation of these findings is the fact that data collection for this variable was started in the middle of this study, thus resulting in few assessments per activity and no as sessments on several activities for two participants (Drew and Marley). A more thorough as sessment of percentages of opportunity engaged in physical activity by station /exergaming activity is needed. In addition, an evaluation of the components that prod uce high percentages of opportunity engaged in physical activity that are most prefered would be beneficial in identifying the factors that could be added to increase physical ac tivity in the regular PE environment. Futhermore, identifying the exergaming activities t hat were least preferred and produced the lowest percentgaes of opportunity engaged in ph ysical activity would be valuable so that these stations could be modified or eliminated In the PE teacher social validity survey as well a s the PE teacher scoring survey, the PE teacher reported a decrease in behavior prob lems as a result of exergaming. Data were not collected on problematic behavior, so thes e reports could not be verified. It is possible that exergaming might serve as an effectiv e intervention for reducing problematic behaviors among children in a school se tting. Therefore, it would be advantageous of researchers to evaluate the effects of exergaming on problematic behavior. A final recommendation for future research is to a ssess teacher behavior across conditions. Based on antedoctal data, teacher behav ior was observed to be different across conditions. For example, research assistants as well as the author noted that the PE teacher appeared to engage in more smiling, positiv e comments, and specific feedback in the exergaming condition than in the PE condition w here positive comments appeared to be given less often. The PE observer also reported a score of a strongly agree for the

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41 teacher providing praise and encouragement in the e xergaming condition compared to a neutral score for the PE condition. Perhaps, becaus e exergaming had children either actively engaged in physical activity or watching o ther children engage in physical activity during the entire class period this provid ed the opportunity for the teacher to give more specific feedback and praise. It is important to assess teacher behavior for two reasons; 1) to determine how teacher behavior effec ts physical activity levels in both an exergaming environment as well as the regular PE en vironment and 2) to identify what teacher behavior needs to occur in order to increas e physical activity levels and OPA. The present study demonstrated that the exergaming condition produced more minutes of physical activity across all four partic ipants than did the PE condition. Futhermore, exergaming was socially acceptable to the PE teacher and students in this study. Based on the data collected during this stud y, exergaming could be a possible intervention choice for increasing physical activit y among inactive 5th graders. Nonetheless, future research is needed to provide a further evaluation of the effects of exergaming on physical activity levels as well as h ealth factors among inactive children.

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42 References American Academy of Pediatrics: Committee on Nutrit ion (2003). Policy statement: Prevention of pediatric overweight and obesity. Pediatrics 112 424-430. American College of Sports Medicine (2006). ACSM’s guidelines for exercise testing and prescription. Philadelphia, PA: American College of Sports Medic ine. Anderson, R.E., Crespo, C.J., Barlett, S.J., Cheski n, L.J., & Pratt, M. (1998).Relationship of physical activity and television watching with b ody weight and level of fatness among children. Journal of the American Medical Association, 279, 938-942. Aragona, J., Cassady, J., & Drabman, R. (1975). Tre ating overweight children through parental training and contingency contracting. Journal of Applied Behavior Analysis, 8, 269-278. Botvin, G.J., Cantlon, A., Carter, B.J., & Williams C.L. (1979). Reducing obesity through a school health program. Journal of Pediatrics 59 295-298. Brownell, K.D., & Frederick, S.K. (1982). A schoolbased behavior modification, nutrition education, and physical activity program American Journal of Clinical Nutrition 35 277-283. Brownson, R.C., Boehmer, T.K., & Luke, D.A. (2005). Declining rates of physical activity in the united states: What are the contrib utors? Annual Review of Public Health, 26, 421-443. Crawford, D.A., Jeffery, R.W., & French, S.A. (1999 ). Television viewing, physical inactivity, and obesity. International Journal of Obesity 23 437-440.

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43 Daniels, S.R., Arnett, D.K., Eckel, R.H., Gidding, S.S., Hayman, L.L., Kumanyika, S., Robinson, T.N., Scott, B.J., Sachikco, S., & Willi ams, C.L. (2005). Overweight in children and adolescents. Circulation, 111, 1999-2012. De Luca, R.V., & Holborn, S.W. (1992). Effects of a variable-ratio reinforcement schedule with changing criteria on exercise in obes e and non obese boys. Journal of Applied BehaviorAnalysis, 25, 671-679. Epstein, L.H., Paluch, R.A., Kilanowski, C.K., & Ra ynor, H.A. (2004). The effect of reinforcement or stimulus control to reduce sedenta ry behavior in the treatment of pediatric obesity. Health Psychology, 23, 371-380. Foster, G.D., Wadden, T.A., & Brownell, K.D. (1984) A peer led program for the treatment and prevention of obesity in the schools: Short-term and long-term changes in weight, self-concept, and food selection Journal of Consulting and Clinical Psychology 53, 538-540. Gortmaker, S.L., Cheung, L.W.Y, Peterson, K.E., Cho mitz, G., Cradle, J.H., Dart, H., Fox, M.K., Bullock, R.B., Sobol, A.M., Colditz, G., Field, A.E., & Laird, N. (1999). Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school childr en. Archives of Pediatric Adolescent Medicine 153 975-983. Gortmaker, S.L., Petterson, K.E., Wiecha, J., Sobol A.M., Dixit, S., Fox, M.K., Laird, N. (1999). Reducing obesity via a school-based interd isciplinary intervention among youth. Archives of Pediatric Adolescent Medicine 153 409-418. Graves, L., Stratton, G., Ridgers, N.D., & Cable, N .T. (2007). Comparison of energy expenditure in adolescents when playing new genera tion and sedentary computer games: Cross sectional study. British Medical Journal 335 1282-1284.

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44 Hansen, L. (2008). Personal communication. October, 21. Hansen, L. & Sanders, S. (2007). Interactive gaming : Changing the face of fitness. Florida Alliance for Health, Physical Education, Re creation, Dance & Sport Journal, 46, 38-41. Herbert-Jackson, E., & Risley, T.R. (1977). Behavio ral nutrition: Consumption of foods of the future by toddlers. Journal of Applied Behavior Analysis, 10, 407-413. Jette, M., Barry, W., & Pearlman, L. (1977). The ef fects of an extracurricular physical activity program on obese adolescents. Canadian Journal of Public Health, 68, 39-42. Kelder, S.H., Mitchell, P.D., McKenzie, T.L., Derby C., Strikemiller, P.K., Luepker, R.V., & Stone, E.J. (2003). Long-Term Implementati on of the CATCH Physical Education Program. Health Education & Behavior, 30, 463-475. Klesges, R.C., Coates, T.J., Brown, G., Strurgeon-T illisch, J., Moldenhauer-Klesges, Holzer, B., Woolfrey, J., & Vollmer, J. (1983). Pa rental influences on children’s eating behavior and relative weight. Journal of Applied Behavior Analysis, 16, 371-378. Lanningham-Foster, L., Jensen, T.B., Foster, R.C., Redmond, A.B., Walker, B.A., Heinz, D., & Levine, J.A. (2006). Energy expenditure of s edentary screen time compared with active screen time for children. Pediatrics, 118, 1831-1835. Luepker, R.V., Perry, C.L., McKinlay, S.M., Nader, P.R., Parcel, G.S., Stone, E.J., Webber, L.S., Elder, J.P., Feldman, H.A., Johnson, C.C., Kelder, S.H., & Wu, M.(1996). Outcomes of a field trial to improve chi ldren’s dietary patterns and physical activity: The child and adolescent trial for cardiovascular health (CATCH). The Journal of the American Medical Association, 275(10), 768-776.

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45 Madsen, Jr., C.H., Madsen, C.K., & Thompson, F. (19 74). Increasing rural head start children’s consumption of middle-class meals. Journal of Applied Behavior Analysis, 7, 257-262. McKenzie, T. L., Cohen, D. A., Sehgal, A., Williams on, S., & Golinelli, D. (2006). System for Observing Play and Leisure Activity in Communities (SOPARC): Reliability and feasibility measures. Journal of Physical Activity and Health, 1, S203-217. McKenzie, T. L., Sallis, J. F., Faucette, N., Roby, J.L., & Kolody, B (1993). Effects of a curriculum and inservice program on the quantity a nd quality of elementary physical education. Research Quarterly for Exercise and Sport, 178(10). McKenzie, T. L., Sallis, J. F., Kolody, B., & Fauce tte, N. (1997). Long term effects of a physical education curriculum and staff developmen t program: SPARK. Research Quarterly for Exercise and Sport, 68, 280-291. (AERA SIG Exemplary Paper, 1998). McKenzie, T. L., Sallis, J. F., Patterson, T. L., E lder, J. P., Berry, C. C., Rupp, J. W., Atkins, C. J., Buono, M. J., & Nader, P. R. (1991) BEACHES: An observational system for assessing children's eating and physica l activity behaviors and associated events. Journal of Applied Behavior Analysis 24, 141-151. Pisacano, J.C., Lichter, H., Ritter, J., & Siegal, A.P. (1978). An attempt at prevention of obesity in infancy. Pediatrics 61 360-364. Reilly, J.J., Armstrong, J., Dorosty, A.R., Emmett, P.M., Ness, A., Rodgers, I., Steer, C., Sheffiff, A., & Avon Longitudinal Study of Parents and Children Study Team (2005). Early risk factors for obesity in childhoo d: Cohort study. British Medical Journal, 330, 1357-1363.

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47 Simons-Morton, B. G., Parcel, G. S., Baranowski, T. & Wilson, B. (1991). Promoting physical activity and a healthful diet among child ren: Results of a school-based intervention study. American Journal of Public Health, 81, 986-991. Spear, B.A, Barlow, S.E., Ervin, C., Ludwig, D.S., Saelens, B.E., Schetzina, K.E., & Taveras, E.M. (2007). Recommendations for treatmen t of child and adolescent overweight and obesity. Pediatrics 120 S254-S288. Stark, L. J., Collins, F.L., Osnes, P.G., & Stokes, T, F. (1986). Using reinforcement and cueing to increase healthy snack food choices in p reschoolers. Journal of Applied Behavior Analysis, 19, 367-379. U.S. Department of Health and Human Services: Cente r for Disease Control and Prevention (2007). Overweight and obesity. Retriev ed July 21, 2008, from http://www.cdc.gov/nccdphp/dnpa/obesity/ U.S. Department of Health and Human Services and U. S. Department of Agriculture (2005). Dietary guidelines for americans Washington, D.C.: U.S. Department Government Printing Office. U.S. Department of Health and Human Services (2001) The surgeon general’s call to action to prevent and decrease overweight and obes ity. Rockville, MD: U.S. Department of Health and Human Services, Public Hea lth, Office of the Surgeon General. Weintraub, D.L., Tirumalai, E.C., Haydel, K.F., Fuj imoto, M., Fulton, J,E, & Robinson, T.N. (2008). Team sports for overweight children. Archives of Pediatric Adolescent Medicine, 162 232-237. Wilson, P.G., Rusch, F.R., & Lee, S. (1992). Strate gies to increase exercise-report correspondence by boys with moderate mental retard ation: Collateral changes in

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48 intention-exercise correspondence. Journal of Applied Behavior Analysis, 25 681-690.

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49 Appendices

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50 Appendix A: PE Teacher Scoring SurveyOn a scale of 0% to 100%, please score the followin g statements The average percentage of time spent dealing with behavior problems 0 10 20 30 40 50 60 70 80 90 100 The average percentage of time the class follows directions 0 10 20 30 40 50 60 70 80 90 100 The average percentage of time spent providing instruction on a PE skill/activity 0 10 20 30 40 50 60 70 80 90 100 The average percentage of time spent having students practice a PE skill/activity 0 10 20 30 40 50 60 70 80 90 100

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51 Appendix B: PE Teacher Social Validity Survey Strongly Disagree Disagree Neutral Agree Strongly Agree PE time spent in the exergaming lab was beneficial to the students. 1 2 3 4 5 The PE exergaming lab provided opportunities for students to work on skill development. 1 2 3 4 5 Students followed directions in the PE exergaming lab. 1 2 3 4 5 PE time spent in the exergaming lab resulted in a reduction in behavior problems. 1 2 3 4 5 PE time spent in the exergaming lab provided an opportunity for me to assess students’ individual needs. 1 2 3 4 5 PE time spent in the exergaming lab resulted in an increase in the amount of PE time allotted for students to be actively engaged. 1 2 3 4 5 PE time spent in the exergaming lab increased skill acquisition for students. 1 2 3 4 5 PE time spent in the exergaming lab increased cardiovascular endurance for students. 1 2 3 4 5

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52 Appendix C: PE Observer Survey Strongly Disagree Disagree Neutral Agree Strongly Agree The students were usually on task 1 2 3 4 5 The students seemed to enjoy the activity 1 2 3 4 5 The students usually followed directions 1 2 3 4 5 The teacher spent a lot of time providing instruction 1 2 3 4 5 The teacher spent a lot of time dealing with behavior problems 1 2 3 4 5 The teacher seemed to enjoy the activity 1 2 3 4 5 The students spent the majority of class time engaging in physical activity 1 2 3 4 5 The students were usually engaged in moderate intensity activities 1 2 3 4 5 The teacher did a good job providing praise and encouragement to the students 1 2 3 4 5

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53 Appendix D: Exergaming Schedule Board

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54 Appendix E: Exergaming Rules SIX EXERGAMING RULES 1. Get into your group and check station board 2. Wait for instruction 3. Stay with group 4. Take turns in group 5. Lights off means rotate (by station signs 1-9) 6. Help: raise hand and wait for Coach XXX