Differences in sedentary time and physical activity among mothers and children using a movement-to-music video program in the home environment: a pilot study
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Tuominen e al. Sp inge Plus (2016) 5:93
DOI 10.1186/s40064-016-1701-z
RESEARCH
Di e ences inseden a y ime
andphysical ac i i y amongmo he s
andchild en using a mo emen - o-music ideo
p og am in he home en i onmen : a pilo s udy
Pipsa P. A. Tuominen1,2*, Pauliina Husu1, Jani Rai anen1,3 and Rii a M. Luo o1
Abs ac
Measu ed objec i ely, less han a qua e o adul s and unde hal o p eschool child en in Finland mee he physical
ac i i y ecommenda ions. Mo eo e , highe seden a y ime among pa en s (such as wa ching ele ision) is associ-
a ed wi h highe seden a y ime o hei child en. The s udy in oduces an in e en ion based on educing seden a y
beha io among mo he s and hei child en. I u ilizes a combina ion o music and exe cise ia a mo i a ion- a ge ing
mo emen - o-music ideo p og am in he home en i onmen . Da a we e collec ed in summe 2014 om Finland’s
Pi kanmaa egion. Each mo he –child pai (n = 24, child age: 4–7 yea s) was assigned o he in e en ion and con-
ol g oup. Bo h g oups used an accele ome e and comple ed physical ac i i y dia ies o wo consecu i e weeks
(14 days) du ing waking hou s. In addi ion, he in e en ion g oup was ins uc ed o use he mo emen - o-music
ideo p og am du ing he second week. Di e ences be ween g oups we e expec ed in analysis o seden a y ime and
physical ac i i y be ween weeks 1 and 2. The pa ame e s assessed we e seden a y ime (i.e., lying down o si ing),
s anding s ill, and ime spen in physical ac i i y. Less seden a y ime was e ealed in week 2 han in week 1 among
bo h in e en ion g oup mo he s (56.6 s. 53.3 %) and o in e en ion g oup child en (49.5 s. 46.0 %). The opposi e
was ue o con ol g oup mo he s (52.1 s. 52.4 %) and child en (46.7 s. 49.8 %). Wi hin-g oup di e ences in mo he s’
seden a y ime co ela ed mode a ely wi h he child en’s seden a y ime (Spea man’s = 0.56). All g oups exhibi ed
sligh ly mo e s anding in he second week han in week 1. Bo h se s o in e en ion pa icipan s also engaged in
mo e ligh physical ac i i y in week 2, wi h he opposi e e iden o he wo con ol se s. In all g oups, excep he con-
ol child en, he p opo ion o mode a e o igo ous physical ac i i y was highe in he second week han he i s .
The use o music and ideo con en oge he may yield added bene i s in e o s o educe seden a y beha io and
inc ease physical ac i i y among mo he s and hei child en in he home en i onmen .
Keywo ds: Seden a y beha io , Physical ac i i y, Accele ome e , Mo emen o music, Video, Home en i onmen
© 2016 Tuominen e al. This a icle is dis ibu ed unde he e ms o he C ea i e Commons A ibu ion 4.0 In e na ional License
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p o ided you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons license,
and indica e i changes we e made.
Backg ound
Seden a y beha io (SB) is an e e -inc easing p oblem,
and many heal h- ela ed isks, including he isk o ype
2 diabe es, obesi y, b eas cance , ca dio ascula dis-
eases, and all causes o mo ali y o e all, g ow as sed-
en a y li es yles become mo e widesp ead (Biswas e al.
2015; B ocklebank e al. 2015; Ka zma zyk e al. 2009;
Pa el e al. 2010; de Rezende e al. 2014). SB is cha ac-
e ized by low (≤1.5 MET, me abolic equi alen ) ene gy
expendi u e while one is si ing o lying down du ing
waking hou s (Seden a y Beha io Resea ch Ne wo k
2012; T emblay e al. 2010). Physical ac i i y (PA), on he
o he hand, is associa ed wi h educed isk o me abolic
diso de s and a lowe numbe o isk ac o s o o he
ch onic diseases (Cho e al. 2009; Wool e al. 2008). The
PA guidelines o adul s ecommend a leas 150min o
mode a e-in ensi y (3–6 METs) o 75 min o igo ous
Open Access
*Co espondence: [email p o ec ed]
1 The UKK Ins i u e o Heal h P omo ion Resea ch, Kaupinpuis onka u 1,
PL 30, 33501 Tampe e, Finland
Full lis o au ho in o ma ion is a ailable a he end o he a icle
Page 2 o 10
Tuominen e al. Sp inge Plus (2016) 5:93
(≥6 METs) PA o an equi alen combina ion o ae obic
ac i i ies e e y week in sessions o 10min o mo e. Also
ecommended a e muscle-s eng hening ac i i ies o all
majo muscle g oups on wo o mo e days a week (Physi-
cal Ac i i y Guidelines Ad iso y Commi ee 2008). Fo
child en, he PA guidelines ecommend 60min o mo e
o ae obic ac i i y pe day, along wi h muscle- and bone-
s eng hening ac i i ies a leas 3days a week (Physical
Ac i i y Guidelines Ad iso y Commi ee 2008).
Objec i e measu emen s indica e ha unde a qua e
o adul s and ewe han hal o p eschool child en mee
he PA ecommenda ions (Hna iuk e al. 2014; Husu e al.
2014; Ke ne e al. 2013). Physical en i onmen a home
exe s an impo an in luence on child en’s SB and PA,
and he numbe o media de ices has a posi i e co ela-
ion wi h sc een-based SB (Mai land e al. 2013). Mo eo-
e , highe seden a y ime o pa en s (wa ching ele ision
e c.) is associa ed wi h g ea e seden a y ime o hei
child en (Jago e al. 2010, Jago e al. 2013). On he o he
hand, de ices used in PA (bicycles, spo s equipmen ,
ampolines, e c.) a home may inc ease ligh -in ensi y
ac i i y a he han mode a e o igo ous physical ac i -
i y (MVPA), and changes in he physical en i onmen a
home (such as limi ing TV iewing o engaging in ac i e
ideo gaming ins ead o passi e gaming) ha e po en ial
o a bene icial in luence on child en’s SB and PA (Mai -
land e al. 2013).
Objec i e measu emen wi h an accele ome e has
been ecommended o asce aining SB and PA pa e ns
in combina ion wi h dia y-based sel - epo ing (Rosen-
be g e al. 2014). The accele ome e con inuously meas-
u es i-axial accele a ion caused by any mo emen and
pe mi s p ecise assessmen o indi iduals’ SB and PA.
Domain-speci ic SB (such as wa ching TV, using a com-
pu e , o eading) is mo e eliably epo ed in dia ies han
o e all SB is. People end o unde - epo hei SB and
o e - epo igo ous PA when using sel - epo ing ools
as compa ed wi h an accele ome e (Dy s ad e al. 2014).
In addi ion, pa e ns o SB and PA can be cha ac e ized
in mo e de ail (wi h di e en ia ion among lying, si ing,
s anding, and si - o-s and mo emen s, and in e ms o
indi idual sessions o SB and PA and hei du a ion) by
means o an accele ome e (Rosenbe g e al. 2014).
Finnish women aged 30–39 used he accele ome e ,
on a e age, 14h 20min (SD 1h 56min) pe day in he
Finnish Heal h 2011 S udy. He e, SB accoun ed 57 %
o his measu emen ime, s anding s ill (SS) o 18%,
ligh physical ac i i y (LPA) o 20%, and MVPA o 5%
(Husu e al. 2014). Co esponding measu emen among
p eschool (i.e., 4–7-yea -old) child en has no been con-
duc ed in Finland. Acco ding o Soini e al. (2014a), o
mos o he childca e day, PA le els and ac i i y ypes o
child en a e seden a y in na u e. Howe e , he e emains
a esea ch gap in Finland speci ically in ela ion o he PA
o child en below school age and o he ole o amilies
he ein (G ås én e al. 2014). Fu he mo e, he measu e-
men ime has a ied g ea ly in s udies conduc ed among
child en, and he s udies ha e used di e se measu emen
ools and analysis algo i hms, wi h de ini ions o SB and
PA oo a ying be ween s udies (Soini e al. 2014b; Vo w-
e g e al. 2013; Wen e al. 2010).
S udies on in e gene a ional ansmission o PA and SB
ha e shown ha pa en s play a c i ical ole in hei chil-
d en’s PA and SB (Jago e al. 2013; O’Dwye e al. 2012;
Xu e al. 2014). Ea ly childhood is a good ime o p o-
mo e heal h ul li es yle habi s ( o example su iciency
o daily physical ac i i y), o g ea bene i o adap an
ac i e li es yle om young age o adul hood (Bellows
e al. 2011). Child en om amilies in which a leas one
pa en has a me abolic diso de (s oke, co ona y a e y
disease, hype ension, o diabe es) end o be mo e sed-
en a y han child en om amilies in which he e a e no
me abolic diso de s (Chen e al. 2012). Child en wi h
ac i e pa en s seem less likely o be o e weigh o obese
(E kelenz e al. 2014). In addi ion, he e ec s o PA and
SB in e en ions may be s onge o child en whose pa -
en s mee he PA ecommenda ions, who a e ac i e and
pa icipa e in spo s, and who ha e ewe media de ices
in he home (O’Dwye e al. 2012). Howe e , he weak
associa ion be ween he MVPA o 5–6-yea -old child en
and hei pa en s demons a es ha he ime o which
child en a e ac i e wi h hei pa en s is no a majo
sou ce o PA (Jago e al. 2014). Pa en s’ suppo o PA in
child en seems mo e impo an han pa en s’ ac ing as a
ole model (E kelenz e al. 2014). The e is some e idence
ha SB o child en in he o m o sc een ime can be
educed ia in luencing he sc een ime o pa en s (Jago
e al. 2013; Xu e al. 2014). Mo eo e , bo h PA p og ams
and pa en al encou agemen and suppo can inc ease
child en’s PA (Bellows e al. 2011; Xu e al. 2014).
The bene i s ound o music in he con ex o PA and
exe cise include a posi i e in luence on in ensi y o PA
and le el o pe cei ed exe ion, alongside ex ension o
wo kou s, bu hese ha e been s udied mainly o he a-
peu ic pu poses and among a hle es (Ka ageo ghis and
P ies 2012a, b). Mo i a ional elemen s o music may
imp o e adhe ence o exe cise plans by inc easing use s’
mo i a ion o PA (Cla k e al. 2015; Inzi a i e al. 2009;
Ka ageo ghis and P ies 2012a, b). In addi ion, audio is-
ual in e en ions such as iewing ideo ma e ial ha e a
po en ial e ec o shi ing a en ion om in e nal s im-
uli (physical sensa ions) o ex e nal cues (audi o y and
isual s imuli om he music and ideo con en ) (Ba -
wood e al. 2009; Hu chinson e al. 2014). Reg e ably,
he e gogenic e ec o combined mo i a ional music and
ideo in e en ions has seldom been examined. The ew
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Tuominen e al. Sp inge Plus (2016) 5:93
s udies ca ied ou in his connec ion poin o mo i a-
ional music combined wi h ideo con en as an elemen
s eng hening he posi i e e ec s o audio isual in e en-
ions (Ba wood e al. 2009; Hu chinson e al. 2014).
Mos wo k wi h audio isual in e en ions has exam-
ined he e ec s o a ious (in e ac i e) ideo games
(Adamo e al. 2010; Ba anowski e al. 2011, 2012; Paez
e al. 2009) o he use o music, ele ision, o ideos, in
isola ion o in combina ion (Annesi 2001; Bellows e al.
2011; Lin and Lu 2013), highligh ing changes in PA o
die a y habi s, any educ ion in pe cei ed exe ion, o
heal h ou comes in a eas such as ca dio espi a o y i -
ness, body composi ion, and choles e ol p o ile. The
indings om s udies o his na u e ha e p o en incon-
sis en , howe e . Ac i e ideo games ha e been shown o
inc ease ligh o mode a e PA (Biddiss and I win 2010;
LeBlanc e al. 2013) o o e all PA le els (Ni Mhu chu
e al. 2008), bu addi ional impac on child en’s PA was
no de ec ed in na u alis ic obse a ion when ac i e and
passi e ideo games ha e been compa ed (Ba anow-
ski e al. 2012). Lis ening o music CDs while he whole
amily dance o music as he pa icipa ing child en had
lea ned a school was ound use ul o imp o ing chil-
d en’s o e all PA le el (Bellows e al. 2011). In Dance
Re olu ion s udy, pa en s’ and iends’ use o an ac i e
ideo game was ound o be associa ed wi h child en’s
ini ial and sus ained pa icipa ion (Paez e al. 2009).
To ou knowledge, p e ious s udies ha e no con-
side ed a combined music and ideo in e en ion o
mo he s and hei child en ha is ocused on educing
SB. Wi h his mul imedia app oach, i migh be possible
o dec ease SB and inc ease PA. We ca ied ou a pilo
s udy o e alua e he easibili y o a la ge andomized
con olled ial (RCT) examining he e ec s o a ideo-
based p og am on mo he s’ and child en’s PA and SB.
Tha s udy in oduced a combina ion o music, exe cise,
and a po en ially mo i a ing mo emen - o-music ideo
p og am in he home en i onmen .
The co e esea ch ques ion is whe he he e a e di e -
ences in seden a y ime and PA when an accele ome e
and mo emen - o-music ideo p og am a e used ela i e
o an accele ome e only. The main ou come a iables
o he pilo s udy a e SB and PA, which we e assessed
objec i ely by means o he accele ome e and u he
examined ia PA dia ies. We hypo hesized ha a ideo
p og am de eloped o mo he –child pai s would be
associa ed wi h less seden a y ime han was only wea -
ing an accele ome e in a compa ison o he a e age
imes om he i s week and he second (in e en ion)
week, and ha he e would be no di e ences in MVPA,
hough he p opo ion o ligh -in ensi y PA would be
highe wi h he mo emen - o-music ideo (i.e., in he
second week).
Me hods
Pa icipan s
The pa icipan s in he pilo s udy we e ec ui ed om
he 5-yea ollow-up coho om a li es yle, counseling,
and exe cise in ma e ni y ca e p ojec (NELLI). The ocus
o he NELLI s udy was on p e en ion o ype 2 diabe-
es, me abolic synd ome, and obesi y among p egnan
women. The p o ocol and me hods o he NELLI s udy
ha e been epo ed upon in de ail p e iously (Luo o
e al. 2010). Fo ou s udy, 25 mo he and child (aged
4–7 yea s) pai s we e in i ed om Finland’s Pi kan-
maa egion o ake pa , and he mo he s ga e w i en
in o med consen . One mo he in i ed o pa icipa e
declined o ake pa in he s udy, making he inal num-
be o pa icipan s 24 mo he –child pai s. Ou s udy was
app o ed by he e hics commi ee o Pi kanmaa (wi h
e hics license code R14039).
The mo he –child pai s we e non- andomly assigned
o he in e en ion g oup (n= 11) o con ol g oup
(n=13). Assignmen was pe o med in 1:1 a ios ( he
i s mo he –child pai o he con ol g oup and nex one
o he in e en ion g oup) based on he mo he s’ in e es
in aking pa in he s udy. The backg ound o he mo h-
e s is p esen ed in Table1. Bo h g oups we e ins uc ed
o use a hip-wo n accele ome e (Hookie AM20, T ax-
mee , Finland) and ill in PA dia ies o wo consecu-
i e weeks (14days). In addi ion, he in e en ion g oup
ecei ed he mo emen - o-music ideo p og am o he
second week (days 8–14). Mo he s in he in e en ion
g oup we e ins uc ed o exe cise in acco dance wi h he
ideo’s di ec ions e e y o he day wi h hei child en.
The c i e ion o adequa e accele ome e use was me by
23 mo he s and 17 child en (a leas 6days each week,
Table 1 The mo he ’s backg ound s a us
a One mo he ’s weigh was unknown, n=12
In e en ion g oup
mo he s (n=10) Con ol g oup
mo he s (n=13)
Age (yea s) (mean, SD) 38.7 (4.3) 38.9 (5.8)
Heigh (cm) (mean, SD) 169.2 (6.6) 166.5 (5.8)
Weigh (kg) (mean, SD) 71.0 (13.7) 70.9 (9.2)a
Ma i al s a us
Ma ied 8 11
Cohabi ing 2 2
Employmen s a us
Wo king 7 7
In pa - ime wo k 0 1
On ma e ni y o child-
ca e lea e 2 1
Homemake 1 1
Unemployed 0 2
Unknown 0 1
Page 4 o 10
Tuominen e al. Sp inge Plus (2016) 5:93
10–20h pe day). Because some accele ome e and exe -
cise dia y da a we e missing, one mo he –child pai was
no conside ed in he analysis. Fu he mo e, ou chil-
d en in he in e en ion g oup, and wo in he con ol
g oup did no mee he c i e ion o using he accele om-
e e a leas 4days each week. Acco dingly, o analysis
pu poses he in e en ion g oup consis ed o 10 mo he s
and six child en, while he con ol g oup was made up o
13 mo he s and 11 child en. The wo g oups o mo he s
did no di e in backg ound cha ac e is ics (see Table1).
All child en we e bo n in 2008–2009, wi h he mean age
being 5.7 (SD 0.3) yea s in he in e en ion g oup, and
5.5 (SD 0.4) yea s in he con ol g oup. The in e en ion
g oup consis ed h ee gi ls and h ee boys, and he con-
ol g oup had wo gi ls and nine boys.
The mo emen ‑ o‑music ideo p og am
The mo emen - o-music p og am was p epa ed by
music-educa ion s uden s and hei eache s a Finland’s
Sibelius-Academy in a cou se speci ically on child en’s
music p og ams. The music in he ideos encompasses
child en’s ock, olk, and La in music, all pe o med by
a band and singe . The exe cises in he ideos a e based
on PA ecommenda ions and include exe cises designed
o imp o e o main ain ae obic i ness, muscle s eng h,
balance, and coo dina ion. The ma e ial akes he o m o
h ee sec ions, each las ing abou 10min. These could be
used indi idually o all h ee consecu i ely. The pu pose
o he ideo was o mo i a e mo he and child o exe -
cise oge he o he bea o he music. Ins uc ions we e
p o ided, o allow he mo he and child o choose sui -
able mo emen s o hemsel es om one o h ee a i-
a ions. The de ails o use o his ideo-based mo emen
p og am ha e been epo ed upon p e iously (Tuominen
e al. 2015).
Measu emen s
T i-axial accele ome e da a we e analyzed in aw
mode, wi h he ocus being on mean ampli ude de ia-
ion (MAD) o accele a ion (Vähä-Ypyä e al. 2015a). Fo
analysis pu poses, SB consis ed o lying and si ing down
(<1.5 METs). We analyzed s anding s ill (SS<1.5 METs)
and ligh PA (LPA 1.5–3 METs) sepa a ely, and mode a e
o igo ous PA o med he MVPA ca ego y (≥3 METs).
Only pa icipan s who had used he accele ome e o
10–20h on each o a leas ou days in each week we e
included in he analysis (He mann e al. 2013; Ma hews
e al. 2012; T os e al. 2005).
As o he PA dia y da a, pa icipan s we e asked o
eco d hei wo king hou s and he s a and end imes
o PA, such as walking, jogging, unning, swimming, bik-
ing, gym wo kou s, and dancing. The mo he s we e also
ins uc ed o assess he pe cei ed exe ion in ol ed in
hei PA wi h he numbe 1 (ligh ), 2 (mode a e), o 3
( igo ous). Also, he mo he s we e gi en dia ies o he
child en, in which hey we e o eco d he child’sday-
ca e o p eschool ime, exe cises, and he ime spen in
PA. Pa icipan s could epo mo e han one exe cise
pe o mance on a gi en day. The PA ypes and imes
epo ed in he dia ies we e examined o bo h mo he s
and child en. Pe cei ed exe ion was analyzed o he
mo he s.
S a is ical analysis
The e ec s o he in e en ion we e analyzed in line wi h
he in en ion- o- ea p inciple h ough compa ison o
he di e ences in he main ou come a iables be ween
he in e en ion and con ol g oups o he i s and he
second week. Desc ip i e analysis was used o ou line he
cha ac e is ics o he pa icipan s, wi h abula ion o e-
quencies (and p opo ions) o means and s anda d de ia-
ion (SD). The a e age o he o al measu emen imes o
each o he pa icipan g oups was used, and he a e age
SB, SS, LPA, and MVPA imes as a p opo ion o he o al
measu emen ime we e compa ed be ween he in e -
en ion and con ol g oups. The p opo ion o measu e-
men ime was used because he o al measu emen ime
di e ed be ween he wo weeks and also be ween he
g oups. On accoun o he non-no mal dis ibu ion o
he accele ome e a iables, he Wilcoxon signed- ank
es was used o epea ed measu emen s (wi hin-g oup
changes) and o de ed logis ic eg ession models (also
known as p opo ional odds models) o analyzing he
associa ion be ween he accele ome e a iables and he
independen g oups (in e en ion s. con ol). Fo he
use o o de ed logis ic eg ession models, con inuous
accele ome e a iables we e examined in e iles. The
models we e adjus ed o he ime o which he accele -
ome e was wo n du ing he i s week and he gende o
he pa icipa ing child en, and he assump ion o p opo -
ional odds (i.e., ha eg ession coe icien s a e cons an
ac oss he a ious le els o he dependen a iable) was
es ed o all models, wi h he es o pa allel lines. A p
alue below 0.05 was conside ed s a is ically signi ican .
Spea man’s co ela ion was used o es he associa ion
be ween mo he s and child en o changes in seden a y
ime.
Also, ou comes indica ed by he PA dia ies—sel -
epo ed exe cise ype, exe cise ime, and pe cei ed
exe ion in bo h he i s and he second week—we e
compa ed be ween he in e en ion and con ol g oup.
F equencies o a ious ypes o ac i i y we e calcula ed,
o desc ibe possible changes be ween he i s and second
week in he in e en ion and con ol g oups, sepa a ely.
The da a we e collec ed in summe 2014 and ana-
lyzed in au umn 2014 o sp ing 2015. All s a is ical
Page 5 o 10
Tuominen e al. Sp inge Plus (2016) 5:93
analyses we e conduc ed wi h he s a is ical analysis
so wa e package SPSS S a is ics ( e sion 22) om
IBM.
Resul s
The measu emen ime
The i s se o analyses conside ed he di e ences in
measu emen ime. The g oups’ ime wea ing he accel-
e ome e in he i s and he second week is shown in
Table2. On a e age, mo he s in he in e en ion g oup
wo e he accele ome e s mo e du ing he i s han he
second week. Mo he s in he con ol g oup used hei
accele ome e app oxima ely he same amoun be ween
he 2weeks bu less han mo he s in he in e en ion
g oup. As o he child en, hose in he in e en ion
g oup used he accele ome e mo e du ing he i s
week han in he second, on a e age, and, o e all, chil-
d en in he con ol g oup used i less han child en in
he in e en ion g oup did. The di e ence in measu e-
men ime among child en was in pa allel o ha o
mo he s.
Seden a y ime
Table3 p esen s seden a y ime as a p opo ion o he
measu emen ime in weeks 1 and 2. As was hypo h-
esized, bo h mo he s and child en in he in e en ion
g oup we e, on a e age, less seden a y in he second
week han in he i s . While he SB o he con ol g oup
pa icipan s was expec ed o emain unchanged, con ol
mo he s showed sligh ly mo e SB in he second week el-
a i e o he i s one. In con as o he o he g oups, he
con ol child en we e mo e seden a y du ing he second
week han in week 1. Howe e , he di e ence be ween
g oups was no s a is ically signi ican . Wi hin-g oup
di e ences we e no s a is ically signi ican in any o he
g oups ei he .
As is shown in Table3, all g oups a e aged mo e SS
in he second week han in he i s , bu nei he wi hin-
g oup no be ween g oup di e ences we e s a is ically
signi ican .
Pe cen age di e ences in mo he s’ seden a y ime co -
ela ed posi i ely wi h pe cen age di e ences in child en’s
seden a y ime. Spea man’s co ela ion o di e ences in
SB be ween indi idual mo he –child pai s (n=17) was
mode a e, =0.56.
Physical ac i i y asindica ed byaccele ome e da a
I can be seen om he da a in Table3 ha he in e -
en ion g oup mo he s and in e en ion g oup chil-
d en a e aged mo e LPA du ing week 2 han week 1, as
hypo hesized, bu he e e se was ue o he con ol (i
was expec ed ha o e all PA among he con ol mo h-
e s and con ol child en would emain unchanged, as
would SB). The wi hin-g oup di e ence be ween he i s
and second week was s a is ically signi ican among he
in e en ion child en bu no in he o he g oups. The
be ween g oups di e ence o nei he child en no mo h-
e s was s a is ically signi ican .
Child en in he in e en ion g oup engaged in mo e
MVPA du ing he second han in he i s week, and
mo e han child en in he con ol g oup du ing week 2
(see Table3). In con as o he in e en ion child en,
he g oup o con ol child en engaged in less MVPA in
he second week han in he i s week. The di e ences
be ween he 2weeks in MVPA o he wo g oups o
child en we e in opposi e di ec ions, and he di e ence
be ween g oups he e was s a is ically signi ican . Bo h
se s o mo he s showed mo e MVPA du ing he second
week han in he i s . None o he wi hin-g oup di e -
ences we e s a is ically signi ican , no we e di e ences
be ween he mo he g oups.
Physical ac i i y as epo ed in he PA dia ies
Mo he s illed in PA dia ies o hemsel es and he pa -
icipa ing child. In all, a comple ed dia y was e u ned o
22 mo he s and 21 child en (10 mo he s and 10 child en
belonging o he in e en ion g oup and 12 mo he s and
11 child en in he con ol g oup). Adequa e in o ma-
ion ( epo ed PA ype, PA imes, and pe cei ed exe ion
in he i s and second week) was ob ained om se en
mo he s and h ee child en in he in e en ion g oup
and om se en mo he s and i e child en in he con ol
g oup. Because he quan i y o missing da a (on ime
engaging in PA o le el o pe cei ed exe ion) was con-
side able, only PA equencies we e aken in o accoun in
he analyses.
Mo he s in he in e en ion g oup epo ed 48 occa-
sions o PA, o wha e e ype, in he i s week and 47
in he second week. The co esponding numbe s among
he con ol g oup mo he s we e 45 and 39, espec i ely.
The da a showed ha he h ee mos popula ypes o PA
Table 2 Times using he accele ome e du ing he i s andsecond week
In e en ion g oup mo he s
(n=10), ime pe day (SD) Con ol g oup mo he s
(n=13), ime pe day (SD) In e en ion g oup child en
(n=6), ime pe day (SD) Con ol g oup child en (n=11),
ime pe day (SD)
Week 1 14 h 29 min (1 h 23 min) 13 h 59 min (1 h 4 min) 13 h 21 min (39 min) 12 h 26 min (25 min)
Week 2 14 h 12 min (1 h 6 min) 13 h 58 min (1 h 12 min) 12 h 59 min (43 min) 12 h 25 min (49 min)
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Tuominen e al. Sp inge Plus (2016) 5:93
Table 3 Di e ences inseden a y beha io , s anding s ill, andphysical ac i i y be weenweeks 1 and2
I alic alues indica e s a is ical signi icance a p<0.05
*I +, seden a y ime inc eased, and i −, seden a y ime dec eased. The la e is a posi i e change
**I +, SS, LPA o MVPA inc eased, and i −, i dec eased. The i s is a posi i e change
G oup Pe cen age o measu emen
ime inweek 1, mean (SD) Pe cen age o measu emen
ime inweek 2, mean (SD) Median o change, pe cen ‑
age poin s (min., max.) Wilcoxon es (changes
wi hing oup), p alue O de ed logis ic eg ession,
adjus ed o ime wea ing
he accele ome e in he i s
week, es ima e (95% CI) andp
alue
Seden a y ime
In e en ion mo he s (n = 10) 56.6 (8.9) 53.3 (10.0) −3.9* (−12.9, 10.1) 0.20 −0.40 (−2.02 o 1.22), p = 0.63
Con ol mo he s (n = 13) 52.1 (7.9) 52.4 (7.4) −0.8 (−8.8, 19.7) 0.81
In e en ion child en (n = 6) 49.5 (5.4) 46.0 (5.9) −3.4 (−8.0, 0.6) 0.075 −1.09 (−2.94 o 0.76), p = 0.25
Con ol child en (n = 11) 46.7 (6.7) 49.8 (6.5) +1.7 (−5.9, 14.2) 0.11
S anding s ill
In e en ion mo he s (n = 10) 17.8 (5.6) 19.8 (5.4) +2.2** (−3.0, 6.0) 0.14 0.63 (−0.94 o 2.19), p = 0.43
Con ol mo he s (n = 13) 18.0 (6.2) 18.9 (5.7) +0.8 (−6.7, 5.8) 0.31
In e en ion child en (n = 6) 9.0 (3.1) 9.2 (3.4) +0.2 (−2.1, 1.9) 0.75 −0.98 (−2.82 o 0.86), p = 0.30
Con ol child en (n = 11) 7.9 (1.9) 8.0 (2.0) +0.1 (−2.4, 1.8) 0.79
Ligh physical ac i i y
In e en ion mo he s (n = 10) 21.6 (3.7) 22.3 (5.8) +0.6 (−6.5, 6.9) 0.65 0.82 (−0.74 o 2.38), p = 0.30
Con ol mo he s (n = 13) 25.6 (5.0) 24.0 (3.9) −0.2 (−16.9, 3.4) 0.55
In e en ion child en (n = 6) 31.2 (4.6) 33.2 (5.1) +1.3 (−0.4, 5.3) 0.046 0.70 (−0.98 o 2.39), p = 0.41
Con ol child en (n = 11) 32.5 (4.1) 31.2 (3.6) −0.4 (−8.6, 3.0) 0.33
Mode a e o igo ous physical
ac i i y
In e en ion mo he s (n = 10) 4.0 (1.5) 4.4 (1.6) +0.1 (−3.3, 3.3) 0.65 −0.45 (−1.98 o 1.08), p = 0.56
Con ol mo he s (n = 13) 4.3 (1.8) 4.6 (2.1) +0.7 (−3.2, 2.6) 0.15
In e en ion child en (n = 6) 10.4 (2.3) 11.6 (3.4) +1.7 (−1.0, 2.7) 0.26 1.99 (0.14 o 3.83), p = 0.035
Con ol child en (n = 11) 12.9 (2.6) 11.1 (2.5) −1.8 (−8.4, 2.6) 0.060
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Tuominen e al. Sp inge Plus (2016) 5:93
among bo h se s o mo he we e walking, cycling, and
unning du ing he i s week. In he second week, he
same ypes we e he mos popula in he con ol g oup,
bu he in e en ion g oup epo ed walking and cycling
also, along wi h gym isi s. In e en ion g oup child en
we e epo ed o be physically ac i e 24 imes du ing
he i s and 31 imes du ing he second week. The co -
esponding numbe s o he con ol child en we e 28
and 17. The mos popula ypes o ac i i y o child en in
bo h g oups in he i s week we e biking, swimming, and
socce , in dec easing o de o popula i y. In he second
week, he mos popula ypes o PA in he in e en ion
g oup we e s ill biking and socce , bu mo emen - o-
music wi h he ideo p og am was men ioned oo. Fo
he con ol g oup in week 2, biking, swimming, and walk-
ing we e a he op o he lis , wi h socce and o he exe -
cise also men ioned.
Discussion
The pilo s udy analyzed seden a y ime and PA among
mo he s and child en who we e using mo emen - o-
music ideo p og am a home. This s udy combined
p ac ical implemen a ion o PA measu emen wi h s udy
o mo i a ional music p og ams. Since he use o music
and ideo ma e ial oge he could aid in educing SB
and inc easing PA among hose mo he s who ha e di -
icul ies in exe cising ou side he home while ending o
young child en, he e is a possibili y o such in e en-
ions p oducing heal h bene i s h ough PA in he home.
The e o e, he s udy had po en ial o e eal one way o
dec easing SB and he eby p e en ing o he wise o h-
coming heal h p oblems.
The i s hypo hesis was ha he use o he mo emen -
o-music ideos wi hin he in e en ion g oup would be
associa ed wi h a dec ease in seden a y ime while sed-
en a y ime in he con ol g oups emained a he same
le el. The esul s indica ed ha he e was a end o less
seden a y ime in each se o in e en ion g oup pa ici-
pan s (mo he s and child en), on a e age, as a p opo ion
o measu emen ime in he second week as compa ed o
he i s week. This was ma ginally he case in he g oup
o con ol mo he s also. Di e ences in SB be ween he
wo g oups o child en we e no s a is ically signi ican
ei he , al hough he con ol child en seemed o be mo e
seden a y han he in e en ion ones du ing he second
week. Wi hou adjus men o he di e ences in meas-
u emen ime, he median posi i e di e ence (i.e., educ-
ion in SB) be ween he 2weeks was a ound 22min pe
day o bo h se s o mo he s and among he in e en ion
g oup child en. This ime is ully consis en wi h ind-
ings p esen ed in a sys ema ic e iew by Ma in e al.
(2015). In addi ion, he mode a e co ela ion o di e -
ences in seden a y ime shows ha highe seden a y ime
o mo he s was associa ed wi h highe seden a y ime o
hei child en. This esul oo is in ag eemen wi h ea lie
s udies (Jago e al. 2010).
Fu he mo e, accele ome e da a showed ha , as p e-
dic ed, bo h mo he s and child en in he in e en ion
g oup showed a end owa ds engaging mo e LPA du -
ing he second week han du ing he i s week, al hough
he wi hin g oup di e ences we e s a is ically signi ican
only o child en. The opposi e end was ue o he
con ol mo he s and con ol child en. All ou se s dis-
played sligh ly mo e SS in he second week as compa ed
o he i s . E en hough he di e ence be ween weeks
was small, hese indings suppo he asse ion ha he
in e en ion may yield posi i e changes in seden a y
ime. I has p e iously been shown ha use o ac i e
ideo games is associa ed wi h an inc ease in ligh o
mode a e in ensi y PA (LeBlanc e al. 2013), and i is pos-
sible ha he mo emen - o-music ideo p og am has he
same e ec .
The second hypo hesis was ha he e would be no di -
e ences in MVPA. Howe e , speci ically in he g oups
o child en he e we e g ea e di e ences han expec ed.
Bo h se s o mo he s and he in e en ion g oup chil-
d en pe o med mo e MVPA in he second week ela-
i e o he i s , while he e e se was ue o he con ol
child en. Wi hin-g oup di e ences we e no s a is ically
signi ican , no we e di e ences be ween he g oups o
mo he s. Howe e , di e ences be ween he wo se s o
child en we e s a is ically signi ican . The ideo p o-
g am’s ins uc ions on exe cise equency and he le el o
in ensi y ha mo ing o he p og am en ailed we e no
e y demanding, so we did no expec hese di e ences,
al hough some s udies ha e shown ha a mo i a ional
music and ideo in e en ion migh imp o e high-in en-
si y exe cise pe o mance (Ba wood e al. 2009). I is pos-
sible ha music and ideo con en in combina ion elici
he mos posi i e esponses no ma e he exe cise in en-
si y (Ba wood e al. 2009; Hu chinson e al. 2014).
Any conclusions based on he esul s mus ake he
measu emen ime in o conside a ion. When accele om-
e e s a e used du ing waking hou s only, i is impossible
o p edic how long each day he pa icipan s a e going
o use hem. Di e ences in measu emen ime be ween
weeks and be ween g oups we e aken in o accoun
h ough analysis based on pe cen ages o he measu e-
men ime. The measu emen ime and he SB, SS, LPA,
and MVPA p opo ions ound in ou s udy a e in line
wi h he co esponding igu es om he Finnish Heal h
2011 S udy (Husu e al. 2014).
The dia y da a indica e ha child en in he in e en ion
g oup exe cised mo e equen ly du ing he second week
han child en in he con ol g oup did. In addi ion, he
educ ion in he amoun o mo he s’ PA was less in he
Page 8 o 10
Tuominen e al. Sp inge Plus (2016) 5:93
in e en ion g oup han in he con ol g oup. These ind-
ings a e consis en wi h he accele ome e da a om he
pilo s udy. Howe e , i is no ewo hy ha people ha e a
endency o epo mo e MVPA and less seden a y ime
in dia ies han e lec ed in he accele ome e measu e-
men s (Dy s ad e al. 2014).
S eng hs andlimi a ions
The s udy is unique in implemen ing an in e en ion o
mo he s and hei child en a he same ime and being
aimed a educing SB in he home en i onmen . The
p ima y s eng h o he s udy lies in i s objec i e meas-
u emen o SB and PA. Fu he mo e, he s udy u ilized
a new me hod o analyzing accele ome e da a ha has
been p o en o be alid (Ai asalo e al. 2015; Vähä-
Ypyä e al. 2015b). The majo i y o he mo he s used he
accele ome e and illed in he PA dia y as ins uc ed,
al hough he e we e some imes missing da a, speci ically
he ime used o exe cising and he pe cei ed exe ion
du ing PA. Also, he e we e challenges in ob ain enough
accele ome e da a om he child en, especially in he
in e en ion g oup. Also, he e is a limi a ion linked o
he na u e o hip-wo n accele ome e s, which a e likely
o unde es ima e s a iona y mo emen s (such as exe -
cising in a gym o iding a bicycle) and unable o de ec
wa e -based ac i i ies. None heless, accele ome e s a e
he sensi i e de ice o de ec o e all PA and SB (Vähä-
Ypyä e al. 2015a), which was he main ocus o he s udy.
These challenges no wi hs anding, examining and imple-
men ing an in e en ion o wo gene a ions a he same
ime and using a mo emen - o-music ideo p og am a e
clea s eng hs o he s udy.
The main limi a ions a e he s udy’s small sample size
and sho ollow-up. In he pilo se ing, we de ec ed only
mino di e ences in SB and PA be ween he i s and sec-
ond week. I is easonable o assume ha a la ge numbe
o pa icipan s and a longe ollow-up ime would yield
mo e eliable esul s. Wi h hese condi ions, i should
also be possible o es ima e whe he changes in SB and
PA occu in he long un and he eby judge he in e en-
ion’s e ec i eness in ela ion o he PA ecommenda-
ions. The need o a s udy wi h a la ge sample size and
longe ollow-up ime will be in me in ongoing Mo ing
Sound s udy (Tuominen e al. 2015), egis e ed a Clini-
calT ials.go wi h ID NCT02270138.
Conclusions
This pilo s udy p o ided in o ma ion on he e ec i e-
ness o mo emen - o-music ideo ma e ial in in luencing
he le el o SB and PA among mo he s and hei chil-
d en. The use o music and ideo con en oge he may
hold addi ional o ce in educing SB and inc easing PA.
Fo hose mo he s and child en who ha e di icul ies in
exe cising ou side he home, a mo emen - o-music ideo
p og am migh ep esen an impo an elemen o mo i-
a ion o be physically ac i e.
Abb e ia ions
LPA: ligh physical ac i i y; MAD: mean ampli ude de ia ion; MET: me abolic
equi alen ; MVPA: mode a e o igo ous physical ac i i y; NELLI: li es yle modi-
ica ion, counseling, and exe cise in ma e ni y ca e 5-yea ollow-up s udy; PA:
physical ac i i y; SB: seden a y beha io ; SS: s anding s ill.
Au ho s’ con ibu ions
RL de eloped he idea o he s udy, and RL, PH and PPAT we e esponsible
o he ini ial design o he s udy. PH and PPAT designed he measu emen s o
physical ac i i y (wi h accele ome e s and ques ionnai es). PPAT is esponsible
o he Mo ing Sound pilo s udy in collabo a ion wi h RL, and PPAT and JR
a e esponsible o s a is ical analyses. PPAT p epa ed he i s e sion o he
manusc ip . All au ho s (PPAT, PH, JR and RML) we e in ol ed in e ising i
o con en and ha e gi en inal app o al o he e sion o be published. All
au ho s ead and app o ed he inal manusc ip .
Au ho de ails
1 The UKK Ins i u e o Heal h P omo ion Resea ch, Kaupinpuis onka u 1, PL
30, 33501 Tampe e, Finland. 2 Depa men o Heal h Sciences, Facul y o Spo
and Heal h Sciences, Uni e si y o Jy äskylä, Jy äskylä, Finland. 3 School
o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland.
Acknowledgemen s
Funding o he pilo s udy was p o ided unde an Academy o Finland
esea ch g an (numbe 277079) and ia Compe i i e Resea ch Funding om
Pi kanmaa Hospi al Dis ic (code 9S034) o Rii a Luo o and he esea ch
g oup o 4 yea s’ ime (2014–2017). P o esso Minna Huo ilainen, PhD (cogni-
i e science), and Lau a Sokka, MSc (psychology) om he Finnish Ins i u e
o Occupa ional Heal h a e acknowledged o hei help in planning o he
s udy. The Sibelius Academy’s Lec u e Ee a-Leena Pokela, ice head o music
educa ion, and Lec u e Soili Pe kiö p epa ed mo emen - o-music ideo o
he s udy wi h hei s uden s. The ollowing pe sons ha e gi en impo -
an ad ice du ing he p ojec : P o esso U ho Kujala, MD, PhD (spo s and
exe cise medicine), om he Uni e si y o Jy äskylä and Hen i Vähä-Ypyä, MSc
(enginee ing and accele ome e da a), o he UKK Ins i u e. M s. Ulla Hakala,
M s. Ta u Helenius, M s. Si ke Rasinpe ä and M s. Ulla Honkanen om he UKK
Ins i u e labo a o y pa icipa ed in he collec ion o da a. Physio he apis s
wi h Finland’s Rauhaniemi Hospi al a e acknowledged o hei pa icipa ion
in p e es ing o he ideo and ques ionnai e ma e ial, in a Mo ing Sound pilo
p ojec ca ied ou in he Kangasala egion o Finland. The language o he
manusc ip was e ised by a p o essional language edi o , Anna She l.
Compe ing in e es s
The au ho s decla e ha hey ha e no compe ing in e es s.
Recei ed: 22 June 2015 Accep ed: 11 Janua y 2016
Re e ences
Adamo KB, Ru he wood JA, Gold ield GS (2010) E ec s o in e ac i e ideo
game cycling on o e weigh and obese adolescen heal h. Appl Physiol
Nu Me ab 35:805–815
Ai asalo M, Vähä-Ypyä H, Vasanka i T, Husu P, Jussila A-M, Sie änen H (2015)
Mean ampli ude de ia ion calcula ed om aw accele a ion da a: a
no el me hod o classi ying he in ensi y o adolescen s’ physical ac i i y
i espec i e o accele ome e b and. BMC Spo s Sci Med Rehabil 7(1):18.
doi:10.1186/s13102-015-0010-0
Annesi JJ (2001) E ec s o music, ele ision, and a combina ion en e ainmen
sys em on dis ac ion, exe cise adhe ence and physical ou pu in adul s.
Can J Beha Sci 33(3):193–202
Ba anowski T, Ba anowski J, Thompson D, Buday R, Jago R, G i i h MJ, Islam N,
Nguyen N, Wa son KB (2011) Am J P e Med 40(1):33–38
Page 9 o 10
Tuominen e al. Sp inge Plus (2016) 5:93
Ba anowski T, Abdelsamad D, Ba anowski J, O’Conno TM, Thompson D,
Ba ne A, Ce in E, Chen T-A (2012) Impac o an ac i e ideo game on
heal hy child en’s physical ac i i y. Pedia ics 129:e636–e642
Ba wood MJ, Wes on NJV, Thelwell R, Page J (2009) A mo i a ional music and
ideo in e en ion imp o es high-in ensi y exe cise pe o mance. J Spo
Sci Med 8(3):435–442
Bellows L, Sil e nail S, Caldwell L, B yan A, Kennedy C, Da ies P, Ande son J
(2011) Pa en al pe cep ion on he e icacy i a physical ac i i y p og am
o p eschoole s. J Commun Heal h 36:231–237
Biddiss E, I win J (2010) Ac i e ideo games o p omo e physical ac i i y in child en
and you h. A sys ema ic e iew. A ch Pedia Adolesc Med 164(7):664–672
Biswas A, Oh PI, Faulkne GE, Bajaj RR, Sil e MA, Mi chell MS, Al e DA (2015)
Seden a y ime and i s associa ion wi h isk o disease incidence, mo al-
i y, and hospi aliza ion in adul s: a sys ema ic e iew and me a-analysis.
Ann In e n Med 162(2):123–132
B ocklebank LA, Falcone CL, Page AS, Pe y R, Coope AR (2015) Accele -
ome e -measu ed seden a y ime and ca diome abolic bioma ke s: a
sys ema ic e iew. P e Med 76:92–102
Chen S-C, Liao C-A, Lee S-D, Chen Y-L, Lin C-T, Kao C-L, Kuo C-H (2012) C oss-
gene a ion link be ween inac i e beha io o schoolchild en and me a-
bolic disease ca ego y o pa en s. Chin J Physiol 55(2):108–113
Cho ER, Shin A, Kim J, Jee SH, Sung J (2009) Leisu e- ime physical ac i i y is
associa ed wi h a educed isk o me abolic synd ome. Ann Epidemiol
19(11):784–792
Cla k IN, Bake FA, Taylo NF (2015) The modula ing e ec s o music lis ening
on heal h- ela ed exe cise and physical ac i i y in adul s: a sys ema ic
e iew and na a i e syn hesis. No d J Music The . doi:10.1080/08098131.
2015.1008558
de Rezende LF, Rod igues Lopes M, Rey-Lopez JP, Ma sudo VK, Luiz Odo C
(2014) Seden a y beha io and heal h ou comes: an o e iew o sys em-
a ic e iews. PLoS ONE 9(8):e105620
Dy s ad SM, Hansen BH, Holme IM, Ande ssen SA (2014) Compa ison o sel -
epo ed e sus accele ome e -measu ed physical ac i i y. Med Sci Spo
Exe c 46(1):99–106
E kelenz N, Kobel S, Ke ne S, D enowa z C, S einacke JM, he Resea ch
G oup “Join he Heal hy Boa - P ima y School” (2014) Pa en al ac i i y as
in luence on child en’s BMI pe cen iles and physical ac i i y. J Spo s Sci
Med 13:645–650
G ås én A, Liukkonen J, Jaakkola T, Tammelin T (2014) Finnish epo ca d
2014 on physical ac i i y o child en and you h. Uni e si y o Jy äskylä,
LIKES—Resea ch Cen e o Spo and Heal h Sciences, Liikku a koulu,
Finland (Finnish schools on he mo e)
He mann SD, Ba ei a TV, Kang M, Ainswo h BE (2013) How many hou s a e
enough? Accele ome e wea ime may p o ide bias in daily ac i i y
es ima es. J Phys Ac Heal h 10:742–749
Hna iuk JA, Salmon J, Hinkley T, Okely AD, T os S (2014) A e iew o p eschool
child en’s physical ac i i y and seden a y ime using objec i e measu es.
Am J P e Med 47(4):487–497. doi:10.1016/j.amep e.2014.05.042
Husu P, Suni J, Vähä-Ypyä H, Sie änen H, Tokola K, Valkeinen H, Mäki-Opas T,
Vasanka i T (2014) Suomalais en aikuis en kiih y yysmi a illa mi a u
yysinen ak ii isuus ja liikkuma omuus [The le el o physical ac i -
i y and seden a y beha iou in Finnish adul s]. Suom Lääkä ileh i
69(25–32):1861c–1866c (Summa y in English)
Hu chinson JC, Ka ageo ghis CI, Jones L (2014) See hea : psychological e ec s
o music and music- ideo du ing eadmill unning. Ann Beha Med
49(2):199–211. doi:10.1007/s12160-014-9647-2
Inzi a i M, G eenlee A, Hess R, Pe e a S, S udenski SA (2009) A i udes o
pos menopausal women owa d in e ac i e ideo dance o exe cise. J
Women’s Heal h 18(8):1239–1243
Jago R, Fox KR, Page AS, B ockman R, Thompson JL (2010) Pa en and child
physical ac i i y and seden a y ime: do ac i e pa en s os e ac i e chil-
d en? BMC Public Heal h 10:194. doi:10.1186/1471-2458-10-194
Jago R, Sebi e SJ, Edwa ds MJ, Thompson JL (2013) Pa en al TV iewing, pa en-
al sel -e icacy, media equipmen and TV iewing among p eschool
child en. Eu J Pedia 172:1543–1545
Jago R, Sebi e SJ, Wood L, Pool L, Zah a J, Thompson JL, Lawlo DA (2014)
Associa ions be ween objec i ely assessed child and pa en al physical
ac i i y: a c oss-sec ional s udy o amilies wi h 5-6 yea old child en. BMC
Public Heal h 14:655
Ka ageo ghis CI, P ies DL (2012a) Music in he exe cise domain: a e iew and
syn hesis (pa I). In Re Spo Exe c Psychol 5(1):44–66
Ka ageo ghis CI, P ies DL (2012b) Music in he exe cise domain: a e iew and
syn hesis (pa II). In Re Spo Exe c Psychol 5(1):67–84
Ka zma zyk PT, Chu ch TS, C aig CL, Boucha d C (2009) Si ing ime and mo -
ali y om all causes, ca dio ascula disease, and cance . Med Sci Spo
Exe c 41(5):998–1005
Ke ne S, Kobel S, Fischbach N, D enowa z C, D eyhaup J, Wi T, Koch B, S ein-
acke JM (2013) Objec i ely de e mined physical ac i i y le els o p ima y
school child en in sou h-wes Ge many. BMC Public Heal h 13(1):895
LeBlanc AG, Chapu JP, McFa lane A, Colley RC, Thi el D, Biddle SJ, Maddison R,
Lea he dale ST, T emblay MS (2013) Ac i e ideo games and heal h indi-
ca o s in child en and you h: a sys ema ic e iew. PLoS ONE 8(6):e65351
Lin J-H, Lu FJ-H (2013) In e ac i e e ec s o isual and audi o y in e en ion on
physical pe o mance and pe cei ed e o . J Spo s Sci Med 12:388–393
Luo o RM, Kinnunen TI, Ai asalo M, Ojala K, Mansikkamäki K, To opainen E,
Kolu P, Vasanka i T (2010) P e en ion o ges a ional diabe es: design
o a clus e - andomized con olled ial and one-yea ollow-up. BMC
P egnancy Childbi h 10:39
Mai land C, S a on G, Fos e S, B aham R, Rosenbe g M (2013) A place o
play? The in luence o he home physical en i onmen on child en’s
physical ac i i y and seden a y beha io . IJBNPA 10:99
Ma in A, Fi zsimons C, Jepson R, Saunde s DH, an de Ploeg HP, Teixei a PJ,
G ay CM, Mu ie N (2015) In e en ions wi h po en ial o educe seden-
a y ime in adul s: sys ema ic e iew and me a-analysis. B J Spo s Med
49:1056–1063
Ma hews CE, Hags öme M, Pobe DM, Bowles HR (2012) Bes p ac ices o
using physical ac i i y moni o s in popula ion-based R sea ch. Med Sci
Spo Exe c 44(1S):S68–S76
Ni Mhu chu C, Maddison R, Jiang Y, Jull A, P apa essis H, Rodge s A
(2008) Couch po a oes o jumping beans: a pilo s udy o he e ec
o ac i e ideo games on physical ac i i y in child en. IJBNPA 5:8.
doi:10.1186/1479-5868-5-8
O’Dwye MV, Fai clough SJ, Knowles Z, S a on G (2012) E ec o a amily
ocused ac i e play in e en ion on seden a y ime and physical ac i i y
in p eschool child en. IJBNPA 9:117
Paez S, Maloney A, Kelsey K, Wiesen C, Rosenbe g A (2009) Pa en al and
en i onmen al ac o s associa ed wi h physical ac i i y among
child en pa icipa ing in an ac i e ideo game. Pedia Phys The
21:245–253
Pa el AV, Be ns ein L, Deka A, Feigelson HS, Campbell PT, Gaps u SM, Coldi z
GA, Thun MJ (2010) Leisu e ime spen si ing in ela ion o o al mo ali y
in a p ospec i e coho o US adul s. Am J Epidemiol 172(4):419–429
Physical Ac i i y Guidelines Ad iso y Commi ee (2008) Physical ac i i y guide-
lines ad iso y commi ee epo . U.S. Depa men o Heal h and Human
Se ices, Washing on, DC. h p://www.heal h.go /paguidelines/
Rosenbe g DE, Lee I-M, Young DR, P ohaska TR, Owen N, Buchne DM (2014)
No el s a egies o seden a y beha io esea ch. Med Sci Spo s Exe c
47(6):1311–1315
Seden a y Beha iou Resea ch Ne wo k (2012) S anda dized use o he
e ms “seden a y” and “seden a y beha iou s”. Appl Physiol Nu Me ab
37:540–542
Soini A, Willbe g J, Sääkslah i A, Gubbels J, Meh älä A, Ke unen T, Poskipa a M
(2014a) Di ec ly obse ed physical ac i i y among 3-yea -olds in Finnish
childca e. IJEC 46:253–269
Soini A, Tammelin T, Sääkslah i A, Wa A, Villbe g J, Ke unen T, Meh älä A,
Poskipa a M (2014b) Seasonal and daily a ia ion in physical ac i i y
among h ee-yea -old Finnish p eschool child en. Ea ly Child De Ca e
184(4):589–601
T emblay MS, Colley RC, Saunde s RP, Healy GN, Owen N (2010) Physiological
and heal h implica ions o a seden a y li es yle. Appl Physiol Nu Me ab
35(2):725–740
T os SG, McI e KL, Pa e RR (2005) Conduc ing accele ome e -based ac i -
i y assessmen in ield-based esea ch. Med Sci Spo s Exe c 37(11
Suppl):S531–S543
Tuominen PPA, Husu P, Rai anen J, Luo o RM (2015) Ra ionale and me hods o
a andomized con olled ial o a mo emen - o-music ideo p og am o
dec easing seden a y ime among mo he –child pai s. BMC Public Heal h
15:1016. doi:10.1186/s12889-015-2347-4
Vähä-Ypyä H, Vasanka i T, Husu P, Suni J, Sie änen H (2015a) A uni e sal,
accu a e in ensi y-based classi ica ion o di e en physical ac i i ies using
aw da a o accele ome e . Clin Physiol Func I 35(1):64–70. doi:10.1111/
cp .12127