The effects of mothers’ musical background on sedentary behavior, physical activity, and exercise adherence in their 5-6-years-old children using movement-to-music video program

RESEARCH ARTICLE The effects of mothers’ musical background on sedentary behavior, physical activity, and exercise adherence in their 5-6-years-old children using movement-to-music video program Pipsa P. A. Tuominen 1,2 *, Jani Raitanen 1,3 , Pauliina Husu 1 , Urho M. Kujala 2 , Riitta M. Luoto 1,3 1The UKK Institute for Health Promotion Research, Tampere, Finland, 2Faculty of Sport and Health Sciences, University of Jyva ¨skyla ¨, Jyva ¨skyla ¨, Finland, 3Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland *[email protected],[email protected] Abstract Objectives The purpose of this study was to examine whether mothers’ musical background has an effect on their own and their children’s sedentary behavior (SB) and physical activity (PA). The aim was also to assess children’s and their mothers’ exercise adherence when using movement-to-music video program. Design Sub-group analysis of an intervention group in a randomized controlled trial (ISRCTN33885819). Method Seventy-one mother-child-pairs were divided into two categories based on mothers’ musical background. Each pair performed 8 weeks exercise intervention using movement-to-music video program. SB and PA were assessed objectively by accelerometer, and exercise activity, fidelity, and enjoyment were assessed via exercise diaries and questionnaires. Logistic regression model was used to analyze associations in the main outcomes between the groups. Results Those children whose mothers had musical background (MB) had greater probability to increase their light PA during the intervention, but not moderate-to-vigorous PA compared to those children whose mothers did not have musical background (NMB). SB increased in both groups. Mothers in the NMB group had greater probability to increase their light and moderate-to-vigorous PA and decrease their SB than mothers in the MB group. However, PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 1 / 15 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Tuominen PPA, Raitanen J, Husu P, Kujala UM, Luoto RM (2018) The effects of mothers’ musical background on sedentary behavior, physical activity, and exercise adherence in their 5-6-years-old children using movement-tomusic video program. PLoS ONE 13(4): e0195837. https://doi.org/10.1371/journal.pone.0195837 Editor: Lutz Ja¨ncke, University of Zurich, SWITZERLAND Received: November 7, 2017 Accepted: April 1, 2018 Published: April 18, 2018 Copyright: ©2018 Tuominen et al. 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. Data Availability Statement: Study participants did not consent to have their data publicly available. Music and video content are protected by copyright law. However, due to ethical restrictions of the local Ethics Committee data are available from the UKK Institute of Health Promotion Research, Tampere, Finland ([email protected]) for researchers who meet the criteria for access to confidential data. Funding: Funding for this study was provided under an Academy of Finland research grant exercise adherence decreased considerably in all groups. Completeness, fidelity, and enjoyment were higher among the NMB group compared to the MB group. Conclusions The present results showed that mothers without musical background were more interested in movement-to-music exercises, as well as their children. For further studies it would be important to evaluate an effect of children’s own music-based activities on their SB and PA. Introduction The current physical activity (PA) guidelines for children recommend at least 180 minutes activity at any intensity spread throughout the day [1,2]. Furthermore, excessive sitting should be avoided [2,3]. Adults are recommended to engage in regular moderate intensity physical activity for at least 150 minutes per week, vigorous PA for minimum of 75 minutes per week or a combination of these (moderate-to-vigorous PA, MVPA). Strength training should be performed at least twice a week and time spent in sedentary behaviors (SB) should be minimized [3,4]. In everyday context, recent studies have measured daily amount of PA objectively during one week by a hip-worn accelerometer [5,6] which detects overall PA and SB validly and reliably [7,8]. In laboratory context, energy efficiency and work output are widely measured and examined in relation to the psychological and physiological factors [9–12]. Questionnaires before and/or after exercise session or longer PA program are widely used to assess the psychological aspects of PA performance [5,13]. In addition, for assessing engagement or adherence to a physical training program in everyday context, diaries and/or questionnaires are needed to find out the frequency of exercises and length of a single exercise session [6,13]. The most common music activities are listening, singing, playing an instrument, and exercising, moving or dancing to music. Musical background can be defined as an engagement of activity, which means the individual’s active involvement or participation in the music-based activity, or formal music training [14,15]. Assessing musical behavior instead of musicality, musical abilities, or skills is relatively recent approach to assess musical background [14,16]. Studies documenting use of the music in children have found that 5–6-years-olds respond favorably towards involvement in all musical activities, but they prefer moving and playing based activities [17,18]. Movement-to-music is often included to PA programs for children, and regularly provided, structured exercises have been found to increase the amount and intensity of PA, as well as improve their motor skills [6,19]. Among adults, studies documenting the benefits of the music in sport and exercise context have found that music could increase exercise adherence and participation [9], and motivational music has found enhanced affect, reduced ratings of perceived exertion, improved energy efficiency, and lead to increased work output [10–12]. Completeness and fidelity have been used in earlier studies to explain the success of implementation, as well as evaluation tool for conceptual model to support increasing PA in children [20]. Based on a conceptual framework by Carroll et al. (2007) completeness is defined as quantity or perfection of dose, i.e., how fully the intervention components are met or whether all the people who should be participating in actually do so [21,22]. Fidelity is defined as quality of the intervention components, i.e., how well the intervention components are met or whether all the people implement the content of program [21,22]. Sedentary time, physical activity, and exercise adherence when using movement-to-music video program PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 2 / 15 (number 277079, http://www.aka.fi/en) to Riitta M Luoto and via Competitive Research Funding from Pirkanmaa Hospital District (code 9S034, https:// www.pshp.fi/en-US/Hospital_District) for Riitta M Luoto and the research group for 4 years’ time (2014-2017) for NELLI - Lifestyle, counseling and exercise in maternity care project 5-year follow-up study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Abbreviations: BMI, body mass index; BMRI, Brunel music rating inventory; CI, confidence interval; LPA, light physical activity; MAD, mean signal amplitude deviation; MB, musical background group; MET, metabolic equivalent; MVPA, moderate to vigorous physical activity; NMB, not musical background group; PA, physical activity; RCT, randomized controlled trial; SB, sedentary behavior; SD, standard deviation; SS, standing; Total-PA, light, moderate, and vigorous physical activity. Enjoyment of the activity may be an important element for exercise adherence and motivation. Remmers et al. (2015) found that enjoyment of PA was related with active behavior, specifically all PA intensities combined, in children [5]. Among adults, it was suggested that activities they like will be continued with greater engagement and adherence compared to activities they don’t like [13,23]. It is also known that individuals with musical background, specifically with formal music training, use music less for entertainment than individuals without musical background in their everyday life [15]. This might be critical in music-based exercises, because the long-term health benefits require regular engagement in PA and reduction of SB. Due to lack of previous studies in the combined field of movement-to-music exercises in the home environment and musical background, our aim is to study whether mothers’ musical background (i.e., music-based hobbies or profession) have an effect on their own and their children’s SB and PA. Based on earlier studies we are interested whether mothers and children without musical background could decrease SB and increase PA more than mothers and children with musical background. We also study children’s and their mothers exercise adherence when using movement-to-music video program. Materials and methods Participants and study design The current study is a subgroup analysis of an intervention group in randomized controlled trial (RCT) called Moving Sound [24,25], in where the main outcomes were children’s and their mothers’ sedentary time and PA during eight weeks’ period. The participants of the Moving Sound study were recruited between November 2014 and January 2016 from the cohort of NELLI: Pregnancy as a window to the future health of mothers and children, the 7-year follow-up of a gestational lifestyle intervention in the Pirkanmaa area, Finland (ISRCTN33885819; http://www.controlled-trials.com/). The Moving Sound study was approved by the Pirkanmaa Ethics Committee in Human Sciences (Tampere, Finland), and RCT was registered at ClinicalTrials.gov (NCT02270138). All the mothers provided written consent on their and their child’s behalf. In this study, only those mother-child pairs who belonged to the Moving Sound intervention group and answered to the questions about mothers’ musical background (71 motherchild pairs) were included to the analyses. For the analyses, the intervention group was divided into two categories based on mothers’ musical background. The musical background was defined as musical behavior including four items: playing an instrument, singing, listening to music, and dancing or having other movement-to-music activities. In order to study the participants’ musical background similar to previous studies [15], we asked their formal or informal music training and movement-to-music activities, the number of years of these musicbased activities, and their activity as music listeners. To indicate mothers’ musical background, they had to had music as their job, were studying music professionally, or three out of four items listed above had to be positive (music as a hobby). All mothers and children were instructed to use an accelerometer every day during waking hours for weeks one (baseline/reference week), two (the first intervention week), and eight (the last intervention week). Further, for the same weeks mothers were instructed to complete exercise diaries (the type and duration of exercise) for themselves and their child. Mothers and children were instructed to use the movement-to-music video program DVD every other day from the beginning of week two to the end of week eight. The movement-to-music video program was based on PA recommendations and included three separate exercise programs, each lasting 10 minutes. In order to allow mother and child to choose the suitable amount of exercise for themselves, the videos could be used individually or consecutively. In addition, every Sedentary time, physical activity, and exercise adherence when using movement-to-music video program PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 3 / 15 movement had one to three variations. The detailed contents of video program have been previously described by Tuominen et al. (2015). Measurements The primary outcomes of the study were SB and PA, which were assessed objectively by the triaxial hip-worn accelerometer (Hookie AM20, Traxmeet Ltd, Espoo, Finland) for three weeks (baseline week, the first intervention week, and the last intervention week). Participants were instructed to use the accelerometer in elastic belt on their right side of the hip during waking hours for 7 consecutive days on each measurement week, excluding water-based activities (e.g., shower or swimming). The data was analyzed as the mean amplitude deviation (MAD) of the resultant acceleration for each 6-second epoch [7]. The MAD values were further converted to metabolic equivalents (MET) and intensity was calculated of these estimated MET values [7]. Lying and sitting down (<1.5 MET) were combined to SB, standing still (<1.5 MET) and light PA (LPA 1.5–2.9 MET) were analyzed separately, and further, moderate PA (MPA 3.0–5.9 MET) and vigorous PA (VPA 6.0 MET) were combined as moderate-to-vigorous PA (MVPA) [26,27]. The secondary outcome of the study was exercise adherence which was divided for exercise activity with movement-to-music video (completeness), fidelity (quality), and enjoyment examined via the exercise diaries and questionnaires. Mothers were also asked to assess the motivational effects of songs in the video using Brunel Music Rating Inventory (BMRI-2) [28,29]. Based on these assessments mothers were classified to one of the three groups: highly, moderately, or neutrally motivated by music. Exercise diaries were completed during the same weeks when accelerometer was used. Mothers were asked to fulfill the diaries for themselves and for their child’s behalf. Questionnaires were completed at baseline, at the end of the first intervention week, and at the end of the study. Completeness was defined as adherence to training program based on number of completed exercises with movement-to-music video program during the first and the last intervention week. Self-reported number of exercises were based on diaries. Fidelity was defined as the content of the exercise, and it was assessed via questionnaires to find out whether the children and their mothers moved as instructed during the video watching. Enjoyment was defined as children and their mothers having fun with the video program. The data for enjoyment was collected from questionnaires by classifying free comments of the children and their mothers. Statistical analysis Analyses within the intervention group were conducted by dividing this group into two categories based on the mother’s musical background. This binary variable was used as an independent variable to assess differences in exercise activity between both children and their mothers. Baseline characteristics were reported as means and standard deviations (SD) for continuous variables and as frequencies and percentages for categorical variables. Differences between the groups at baseline were tested by Mann-Whitney U test for continuous variables and Fisher’s exact test was for categorical variables. Changes in the proportion of measurement time in SB, SS, LPA, and MVPA were modified into dichotomy variables (having a positive or negative change), and binary logistic regression was used to analyze the primary outcomes. Further, the model was adjusted for baseline level of these behaviors. After fitting logistic regression models, predicted probabilities for positive change were calculated by converting odds. Based on values of skewness and kurtosis, Wilcoxon signed-rank test was used to assess for significant differences in the changes of exercise Sedentary time, physical activity, and exercise adherence when using movement-to-music video program PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 4 / 15 activity (completeness) within groups and Mann-Whitney U test was used to assess differences between the groups. Fisher’s exact test was used to assess differences between the groups in fidelity. Enjoyment was described as percentage of children and their mothers in different categories based on classified comments of children and their mothers. Two-tailed significance level of 0.05 was used for analyses. All analyses were performed using IBM SPSS Statistics 24.0. Results Based on questionnaire, 25 mothers had musical activities as their job (n = 0), were studying music professionally (n = 2), or had music as a hobby (n = 23) indicating mothers’ musical background. The most common instruments among participants were piano (17 mothers, mean number of playing years was 17.6), singing lessons, choir, or band (16 mothers, 5.9 years), flute (2 mothers, 10.0 years), and violin (2 mothers, 4.5 years). Dancing (including for example ballet, couple dancing, and folk dances) was reported by 8 mothers (8.1 years) and having other movement-to-music activities (such as aerobics or dance-exergames) by 17 mothers (8.2 years). All the mothers reported listening to music regularly, mostly on the radio (68 mothers), CDs (49 mothers), streaming services (46 mothers), or live (35 mothers). At baseline, there were no statistically significant differences between the groups of mothers or children (Table 1). Objective measurements Children. At baseline week and at the first intervention week, in total 21 children in the MB group and 40 children in the NMB group had a valid accelerometer measurement. The corresponding numbers of children at the last intervention week were 14 and 32, respectively. In total, 12 children in the MB group and 29 children in the NMB group had valid accelerometer measurement in all three weeks. At baseline there were no statistically significant differences between the MB and NMB groups. Based on the objective measurements, the average proportion of MVPA, LPA, SS, and SB with 95% confidence intervals (CIs) of each value at baseline, the first and the last intervention week are presented in Fig 1. Table 1. Background characteristics. Having a musical background (n = 25) Not having a musical background (n = 46) p-value Mothers Age (in 2015) 38.2 ±5.4 36.1 ±4.0 0.069 1 Married or cohabiting 95.8 (n = 24) 93.5 1.00 2 Number of children 2.7 ±1.3 2.5 ±0.8 0.76 1 Employment, at work 70.8 (n = 24) 80.4 0.38 2 BMI 27.3 ±4.5 26.6 ±5.6 0.35 1 Children Age 6.7 ±0.4 6.5 ±0.5 0.18 1 Gender, girls 60.0 41.3 0.15 2 BMI-for-age 22.7 ±4.6 (n = 13) 21.2 ±3.1 (n = 26) 0.46 1 Daycare or preschool 68.0 77.3 (n = 44) 0.41 2 Data are presented mean ±SD or %. 1 Mann-Whitney U test 2 Fisher’s exact test https://doi.org/10.1371/journal.pone.0195837.t001 Sedentary time, physical activity, and exercise adherence when using movement-to-music video program PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 5 / 15 Regarding children, quantitative results are presented in Table 2. Statistically significant differences were found between the weeks 1 and 8 in LPA (OR = 7.64, p= 0.014) and between the weeks 1 and 2 in SS (OR = 0.18, p= 0.043). Thus, children in the MB group had greater probability to belong to category of positive change in LPA and smaller probability to belong to category of positive change in SS compared to the NMB group. Further, probability for increased MVPA was 25% in the MB group and 55% in the NMB group. The corresponding values for increased LPA was 62% and 18%, increased SS 11% and 36%, and increased SB 66% and 62%, respectively. Mothers. At baseline week and at the first intervention week, in total 23 mothers in the MB group and 42 mothers in the NMB group had valid accelerometer measurement. The corresponding numbers of mothers during the last intervention week were 19 and 33, respectively. In total, 17 mothers in the MB group and 32 mothers in the NMB group had valid Fig 1. The average proportion of MVPA, LPA, SS, and SB with 95% confidence intervals (CIs) in the week 1, 2, and 8 in children who had a valid accelerometer measurement in all three weeks. https://doi.org/10.1371/journal.pone.0195837.g001 Sedentary time, physical activity, and exercise adherence when using movement-to-music video program PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 6 / 15 accelerometer measurement in all three weeks. At baseline there were no statistically significant differences between the MB and NMB groups. Based on the objective measurements, the average proportion of MVPA, LPA, SS, and SB with 95% confidence intervals (CIs) of each value at baseline, the first and the last intervention week are presented in Fig 2. Regarding mothers, quantitative results are presented in Table 3. Statistically significant differences were found between the weeks 1 and 8 in LPA (OR = 0.21, p= 0.021) and in total-PA (OR = 0.13, p= 0.004) indicating that mothers in the MB group had smaller probability to belong to category of positive change in LPA and total-PA compared to the NMB group. We also found that between the weeks 2 and 8 mothers in the MB group had greater probability to belong to category of positive change in total-PA (OR = 3.87, p= 0.047) and smaller probability to belong to category of positive change in SS (OP = 0.16, p= 0.009) compared to the NMB group. Mothers in the MB group had greater probability to belong to category of positive change (which means negative result, i.e., growing) in SB compared to the NMB group between the weeks 2 and 8 (OR = 3.82, p= 0.038). Table 2. Odds ratios (ORs) with 95% confidence intervals (CIs) from logistic regression models in children. Association between groups and changes in MVPA, LPA, Total-PA, SS, and SB. Having musical background Not having musical background (ref. group) n positive change, n (%) positive change, n (%) OR (95% CI) p-value MVPA Weeks 1–2 61 11 (52) 19 (48) 1.17 (0.40–3.42) 0.77 41 6 (51) 14 (48) 1.09 (0.28–4.19) 0.91 Weeks 2–8 41 6 (51) 14 (48) 1.06 (0.27–4.09) 0.94 Weeks 1–8 41 3 (25) 16 (55) 0.27 (0.06–1.22) 0.089 LPA Weeks 1–2 61 9 (43) 14 (35) 1.40 (0.47–4.13) 0.54 41 5 (42) 8 (28) 2.07 (0.47–8.77) 0.33 Weeks 2–8 41 6 (50) 13 (45) 1.35 (0.34–5.37) 0.67 Weeks 1–8 41 7 (58) 6 (21) 7.64 (1.51–38.65) 0.014 Total-PA Weeks 1–2 61 11 (52) 26 (65) 0.60 (0.20–1.75) 0.35 41 7 (58) 20 (69) 0.64 (0.16–2.58) 0.64 Weeks 2–8 41 6 (50) 15 (52) 1.03 (0.26–4.06) 0.97 Weeks 1–8 41 5 (42) 14 (48) 0.73 (0.19–2.88) 0.65 SS Weeks 1–2 61 6 (29) 21 (53) 0.27 (0.08–0.95) 0.041 41 3 (25) 17 (59) 0.18 (0.04–0.95) 0.043 Weeks 2–8 41 8 (67) 12 (41) 2.89 (0.69–12.14) 0.15 Weeks 1–8 41 2 (17) 11 (38) 0.22 (0.03–1.47) 0.12 SB Weeks 1–2 61 12 (57) 24 (60) 0.93 (0.31–2.73) 0.89 41 9 (75) 18 (62) 1.87 (0.41–8.50) 0.42 Weeks 2–8 41 6 (50) 17 (59) 0.65 (0.17–2.59) 0.55 Weeks 1–8 41 8 (66) 18 (62) 1.17 (0.28–4.87) 0.83 Models were adjusted for baseline level of the particular outcome. https://doi.org/10.1371/journal.pone.0195837.t002 Sedentary time, physical activity, and exercise adherence when using movement-to-music video program PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 7 / 15 Further, probability for increased MVPA was 27% in the MB group and 54% in the NMB group. The corresponding values for increased LPA was 24% and 60%, increased SS 31% and 53%, and increased SB 71% and 43%, respectively. Exercise adherence Completeness (Exercise activity). Exercise diaries of the baseline and the first intervention weeks were returned by 24 mothers and 24 children in the MB (having a musical background) group. The corresponding values were 45 and 44 in the NMB (not having a musical background) group. Based on diaries, 15 mothers and 16 children in the MB group completed exercises at least once during the first week. Corresponding values in the NMB group were 36 mothers and 34 children. The groups did not differ in the number of completed exercises with movement-to-music video program (mothers’ p= 0.30, children p= 0.42) during the first intervention week. Fig 2. The average proportion of MVPA, LPA, SS, and SB with 95% confidence intervals (CIs) in the week 1, 2, and 8 in mothers who had a valid accelerometer measurement in all three weeks. https://doi.org/10.1371/journal.pone.0195837.g002 Sedentary time, physical activity, and exercise adherence when using movement-to-music video program PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 8 / 15 Diaries from the last week were returned by 18 mothers and 17 children in the MB group and by 35 mothers and 35 children in the NMB group. Only 2 mothers and 2 children in the MB group and 5 mothers and 6 children in the NMB group reported at least one completed exercise during the last week. Exercise activity (the number of completed exercises) with movement-to-music video program was significantly lower during the last than the first intervention week in all groups which indicates poor completeness of the program. Table 4 presents changes in self-reported exercise activity (number of exercises per week) with movement-tomusic video program. Fidelity. Questionnaires were returned by 24 children and 24 mothers in the MB group after the first intervention week and by 12 children and 14 mothers after the last intervention week. Questionnaires were returned by 44 children and 44 mothers in the NMB group after the first intervention week and by 23 children and 22 mothers after the last intervention week. Based on the questionnaires 75% of the children and 71% of the mothers in the MB group moved as instructed during the video watching during the first week. The corresponding values were 89% and 93% in the NMB group. During the last week, the corresponding values were 58% of the children and 71% of the mothers in the MB group and 96% of the children and 77% of the mothers in the NMB group. Most of those children who did not move as Table 3. Odds ratios (ORs) with 95% confidence intervals (CIs) from logistic regression models in mothers. Associations between groups and changes in MVPA, LPA, Total-PA, SS, and SB. Having musical background Not having musical background (ref. group) n positive change, n (%) positive change, n (%) OR (95% CI) p-value MVPA Weeks 1–2 65 11 (48) 23 (55) 0.71 (0.25–2.04) 0.53 49 8 (47) 19 (59) 0.54 (0.16–1.84) 0.32 Weeks 2–8 49 5 (29) 16 (50) 0.43 (0.12–1.52) 0.19 Weeks 1–8 49 5 (29) 17 (53) 0.32 (0.09–1.17) 0.085 LPA Weeks 1–2 65 12 (52) 22 (52) 0.99 (0.36–2.75) 0.98 49 10 (59) 18 (56) 1.09 (0.32–3.69) 0.89 Weeks 2–8 49 5 (29) 17 (53) 0.35 (0.10–1.30) 0.12 Weeks 1–8 49 4 (24) 19 (59) 0.21 (0.06–0.79) 0.021 Total-PA Weeks 1–2 65 11 (48) 18 (43) 1.22 (0.44–3.39) 0.70 49 8 (47) 12 (38) 1.46 (0.44–4.84) 0.54 Weeks 2–8 49 13 (77) 15 (47) 3.87 (1.02–14.78) 0.047 Weeks 1–8 49 4 (24) 22 (69) 0.13 (0.03–0.52) 0.004 SS Weeks 1–2 65 5 (22) 17 (41) 0.41 (0.13–1.31) 0.13 49 4 (24) 11 (34) 0.60 (0.16–2.28) 0.45 Weeks 2–8 49 7 (41) 25 (78) 0.16 (0.04–0.64) 0.009 Weeks 1–8 49 6 (35) 17 (53) 0.40 (0.11–1.50) 0.17 SB Weeks 1–2 65 16 (70) 21 (50) 2.29 (0.78–6.75) 0.13 49 12 (71) 15 (47) 2.76 (0.78–9.71) 0.11 Weeks 2–8 49 11 (65) 11 (34) 3.82 (1.08–13.55) 0.038 Weeks 1–8 49 12 (71) 14 (44) 3.27 (0.91–11.69) 0.069 Models were adjusted for baseline level of the particular outcome. https://doi.org/10.1371/journal.pone.0195837.t003 Sedentary time, physical activity, and exercise adherence when using movement-to-music video program PLOS ONE | https://doi.org/10.1371/journal.pone.0195837 April 18, 2018 9 / 15