The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers : A randomized controlled trial

RESEARCH ARTICLE The e ec o a mo emen - o-music ideo p og am on he objec i ely measu ed seden a y ime and physical ac i i y o p eschool-aged child en and hei mo he s: A andomized con olled ial Pipsa P. A. Tuominen 1,2 *, Pauliina Husu 1 , Jani Rai anen 1,3 , U ho M. Kujala 2 , Rii a M. Luo o 1,3 1The UKK Ins i u e o Heal h P omo ion Resea ch, Tampe e, Finland, 2Facul y o Spo and Heal h Sciences, Uni e si y o Jy a ¨skyla ¨, Jy a ¨skyla ¨, Finland, 3Facul y o Social Sciences, Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland *[email p o ec ed] (PPAT), pipsa [email protected] (PPAT) Abs ac Regula physical ac i i y (PA) and he a oidance o p olonged si ing a e essen ial o chil- d en’s heal hy g ow h, and o he physical and men al wellbeing o bo h child en and adul s. In he con ex o exe cise, music may p omo e beha io al change h ough inc eased exe - cise adhe ence and pa icipa ion. The pu pose o his s udy was o de e mine whe he a mo emen - o-music ideo p og am could educe seden a y beha io (SB) and inc ease PA in mo he -child pai s in he home en i onmen . A andomized con olled ial was conduc ed in he Pi kanmaa egion, Finland, in 2014–2016. The pa icipan s consis ed o 228 mo he - child pai s (child age 5–7 yea s). The p ima y ou comes o in e es we e i-axial accele om- e e -de i ed SB and PA, which we e measu ed in weeks one (baseline), wo, and eigh in bo h he in e en ion and con ol g oups. Fu he , he mo he s and child en in he in e en- ion g oup used a mo emen - o-music ideo p og am om he beginning o week wo o he end o week eigh . Seconda y ou comes included sel - epo ed sc een ime. The s a is ical me hods employed comp ised an in en ion- o- ea and linea mixed e ec s model design. No s a is ically signi ican di e ences be ween g oups we e ound in p ima y o seconda y ou comes. Among he child en in he con ol g oup, ligh PA dec eased signi ican ly o e ime and sc een ime inc eased om 89 (s anda d de ia ion, SD 37) o 99 (SD 41) min/d. Among mo he s and child en in he in e en ion g oup, no s a is ical di e ences we e ound. In supplemen a y analysis, he child en who s ayed a home ins ead o a ending dayca e/ p eschool had on a e age 25 (95% con idence in e al, CI 19–30) min/d mo e seden a y ime and 11 (95% CI 8–14) min/d less mode a e- o- igo ous PA han hose who we e a day- ca e/p eschool. The highe body mass index o mo he s was ela ed wi h 5 (95% CI 2–7) min/d mo e seden a y ime and 1 (95% CI 0–2) min/d less mode a e- o- igo ous PA. The mo emen - o-music ideo p og am did no change he objec i ely measu ed SB o PA o he mo he -child pai s. Howe e , mo he s and child en seemed o be mo e seden a y a PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 1 / 21 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Ci a ion: Tuominen PPA, Husu P, Rai anen J, Kujala UM, Luo o RM (2017) The e ec o a mo emen - o-music ideo p og am on he objec i ely measu ed seden a y ime and physical ac i i y o p eschool-aged child en and hei mo he s: A andomized con olled ial. PLoS ONE 12(8): e0183317. h ps://doi.o g/10.1371/jou nal. pone.0183317 Edi o : Jose A. L. Calbe , Uni e sidad de las Palmas de G an Cana ia, SPAIN Recei ed: Feb ua y 22, 2017 Accep ed: July 19, 2017 Published: Augus 31, 2017 Copy igh : ©2017 Tuominen e al. This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal au ho and sou ce a e c edi ed. Da a A ailabili y S a emen : Due o e hical es ic ions o he local E hics Commi ee da a a e a ailable om he UKK Ins i u e o Heal h P omo ion Resea ch, Tampe e, Finland o esea che s who mee he c i e ia o access o con iden ial da a. S udy pa icipan s did no consen o ha e hei da a publicly a ailable. Music and ideo con en a e p o ec ed by copy igh law. Howe e , he da a behind he esul s can be ob ained o scien i ic use om he UKK Ins i u e home, and he e o e in e en ions o dec easing SB and inc easing PA should be a ge ed in he home en i onmen . In oduc ion Low le els o physical ac i i y (PA) and high amoun s o seden a y beha io (SB), especially excessi e si ing, a e associa ed wi h a highe isk o ca dio-me abolic heal h indica o s, obe- si y, ele a ed blood p essu e, poo physical i ness, and lowe academic achie emen among bo h child en and adul s [1–4]. Regula mode a e- o- igo ous PA (MVPA) mi iga es hese isks and is essen ial o child en’s heal hy g ow h and de elopmen , as well as he physical and men al wellbeing o bo h child en and adul s [4,5]. The bene i s o music in he spo s and exe cise con ex ha e been s udied mos ly in adul s. The e ec s o music on PA and mo i a ion ha e been s udied, o example, in indi idual exe - cise and wo kou s, such as wa m-up [6] and cool-down ou ines [7,8], s eng h-based wo k- ou s [9], ca dio- espi a o y wo kou s, especially unning [10,11] and cycling [12,13], and classes and g oup ac i i ies wi h music, speci ically ae obics [14] and ci cui aining [15]. I has been ound ha du ing exe cise, mo i a ional music may enhance he e ec , educe a ings o pe cei ed exe ion, imp o e ene gy e iciency, and lead o inc eased wo k ou pu [8,16,17]. In addi ion, music could p omo e beha io al change wi h inc eased exe cise adhe ence and pa icipa ion [18]. Among child en, music is o en included in PA p og ams o child en wi h disabili ies by using hy hms, ins uc ions se o music, lis ening o music, and mo emen - o-music in o de o mo i a e child en o engage in PA [19]. The p eschool-aged (5–6-yea s-olds) heal hy chil- d en’s a o i e musical ac i i ies in dayca e ha e been ound o be mo emen - o-music ( o example, dancing), singing songs, and playing ins umen s [20]. Fu he , egula ly p o ided, s uc u ed PA p og ams wi h music ha e been ound o inc ease he amoun and in ensi y o PA in child en, and o imp o e hei mo o skills [21]. We conduc ed a pilo s udy (n = 24 mo he -child pai s) ha ound ha o e wo weeks (baseline and in e en ion), he mo he s and child en who used a mo emen - o-music ideo p og am (i.e., he in e en ion g oup) demons a ed less seden a y ime du ing he in e en ion week compa ed o baseline week: he opposi e was ue in he con ol g oup [22]. Howe e , o ou knowledge, high-quali y an- domized con olled ials (RCT) ha e no been conduc ed in he a ea o mo emen - o-music- based exe cise, SB, and PA. Thus, in ligh o he ea lie s udies, i is unclea whe he he use o music as pa o an exe cise p og am can educe SB and inc ease PA in he long e m. S udies on he in e gene a ional ansmission o SB and PA ha e shown ha pa en s play a c i ical ole in hei child en’s SB and PA [23–25]. Bo h he PA and TV iewing o pa en s a e signi ican ly associa ed wi h hese beha io s in p eschool child en [26], especially du ing weekends [27]. Rebold e al. (2016) ound ha pa en al di ec supe ision and pa icipa ion du ing PA is an impo an ac o in imp o ing child en’s PA beha io [28]. Fu he , Xu e al. (2014) epo ed ha pa en ’s suppo o PA can inc ease hei child en’s PA, and he pa en ac ing as a ole model by wa ching less TV can lead o he dec eased sc een ime o hei chil- d en [25]. In addi ion, he in luence o he sex-ma ched pa en appea ed o be impo an o he child en’s TV iewing [26]. I has been sugges ed ha 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 a home [24,29]. The PA guidelines o adul s ecommend a leas 150 min o mode a e-in ensi y (3–6 METs, me abolic equi alen ) o 75 minu es o igo ous (6 METs) PA, o an equi alen Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 2 / 21 o Heal h P omo ion Resea ch, Tampe e, Finland ([email p o ec ed]). Funding: Funding o he ial was p o ided unde an Academy o Finland esea ch g an (numbe 277079, h p://www.aka. i/en) o Rii a M Luo o and ia Compe i i e Resea ch Funding om Pi kanmaa Hospi al Dis ic (code 9S034, h ps:// www.pshp. i/en-US/Hospi al_Dis ic ) o Rii a M Luo o and he esea ch g oup o 4 yea s’ ime (2014 – 2017) o NELLI – Li es yle, counseling and exe cise in ma e ni y ca e p ojec 5-yea ollow-up s udy. The unde s had no ole in s udy design, da a collec ion and analysis, decision o publish, o p epa a ion o he manusc ip . Compe ing in e es s: The au ho s ha e decla ed ha no compe ing in e es s exis . Abb e ia ions: BMI, body mass index; CI, con idence in e al; LME, linea mixed e ec s model; LPA, ligh physical ac i i y; MET, me abolic equi alen ; MVPA, mode a e- o- igo ous physical ac i i y; PA, physical ac i i y; RCT, andomized con olled ial; SB, seden a y beha io ; SD, s anda d de ia ion; SS, s anding s ill; VAS, isual analog scale. combina ion o ae obic ac i i ies e e y week in sessions o 10 min o mo e [5]. Muscle- s eng hening ac i i ies and/o balance aining o all majo muscle g oups a e also ecom- mended on wo o mo e days a week [5]. The impo ance o li es yle counseling and mo i a - ing exe cise p og ams is ob ious, because based on objec i e measu emen by accele ome e , ecen s udies ha e shown ha adul s a e seden a y 55–62% o hei waking hou s and MVPA co e s only 4–6% o he measu emen ime [30,31]. In Finland, unde a qua e o adul s mee he ae obic pa o he cu en PA ecommenda ions, and among women, aged 30–39 yea s, SB accoun ed o 57%, s anding s ill (SS) 18%, ligh PA 16%, and MVPA 10% o he waking wea ime pe day [31]. In Finland, child en s a school in he au umn o he yea , hey u n 7 yea s o age. One yea be o e school age, child en mus ake pa in a yea -long p eschool o ganized in day-ca e cen e s and schools. Thus, he exac age o p eschoole s a ies om 5 o 7 yea s, depending on he bi h da e o he child and he ime o assessmen . A he same ime, child en ha e a igh o a end dayca e (pa ime) o s ay a home wi h a pa en o o he nu sing s a . Fo child en unde 7 yea s, he mos ecen PA guidelines ecommend a leas 180 minu es ac i i y a any in ensi y sp ead h oughou he day [32–36]. Acco ding o a e iew by Hna iuk e al. (2014), he p opo ion o ime p eschool child en spen seden a y has been epo ed o ange om 34% o 94%, he p opo ion o ligh PA om 4% o 33%, and p opo ion o MVPA om 2% o 41% [37]. In Finland, he amoun o ime child en spend seden a y is high, and o e all PA le - els a e low [38]. Fu he , o mos o he ime spen a childca e, PA le els and ac i i y ypes a e seden a y in na u e [39]. Based on accele ome e measu emen s, he seden a y ime was 5.5 hou s pe day in 3–6-yea -old child en [40,41]. In addi ion, Finland’s mos ecen Repo Ca d on Physical Ac i i y (2016) s a es ha only 29% o h ee-yea -old child en and 49% o p ima y-school-aged child en engage in a leas 60 minu es o MVPA [41]. The e is a gap in objec i ely measu ed SB and PA da a ega ding p eschool-aged child en. Such in o ma ion would help o ollow changes in SB and PA h ough childhood and o a ge ac i i ies a hose child en who need i he mos . Thus, he pu pose o he p esen s udy was o in es iga e he e ec s o a mo emen - o- music ideo p og am on SB and PA in 5–7-yea old child en and hei mo he s. We es ed he hypo hesis ha he mo emen - o-music ideo p og am de eloped o mo he -child pai s would i) dec ease he SB o mo he s and hei child en, and ii) inc ease he amoun o hei PA. The ou comes we e objec i ely measu ed by accele ome e s. Ma e ials and me hods The cu en andomized con olled ial (RCT) was egis e ed a ClinicalT ials.go (NCT02270138). The s udy was app o ed by he Pi kanmaa E hics Commi ee in Human Sci- ences (ETL-Code R14039, s a emen 23/2014), and all mo he s ga e in o med consen on hei own and hei child’s behal . The s udy was conduc ed in acco dance wi h p e ailing e hics p inciples. The epo ing o he me hods and indings o his ial was guided by he CON- SORT 2010 checklis o epo ing andomized ials [42]. Pa icipan s Pa icipan s we e mo he s and hei child en ec ui ed be ween No embe 2014 and Janua y 2016 om he coho o NELLI: P egnancy as a window o he u u e heal h o mo he s and child en: he 7-yea ollow-up o a ges a ional li es yle in e en ion in he Pi kanmaa a ea, Fin- land (ISRCTN33885819; see h p://www.con olled- ials.com/). The a ionale and me hods o he cu en s udy ha e been published p e iously by Tuominen e al. (2015) [43]. The ollow- ing inclusion c i e ia we e used: child included in he o iginal NELLI coho , child aged 5–7 Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 3 / 21 yea s, amily had access o a DVD playe o could wa ch a YouTube ideo, bo h mo he and child could use he accele ome e as ins uc ed, and nei he he mo he no he child had any obs acles o pe o ming PA. S udy in o ma ion was gi en o he mo he s bo h o ally and in w i ing du ing he con ac o he examina ion ha was pa o he NELLI s udy. I he mo he was willing and he mo he and child eligible o pa icipa e in he s udy, he mo he -child pai was andomized in o ei he he in e en ion g oup o he con ol g oup by means o sealed en elopes by labo a o y s a . Randomiza ion was pe o med wi h a andom numbe gene a o o blocks o ou mo he - child pai s in a 2:2 a io: wo mo he -child pai s we e assigned o he in e en ion g oup and wo pai s o he con ol g oup. Fou andom numbe s we e gene a ed, and he pai s associa ed wi h he wo la ges we e assigned o he in e en ion g oup and he wo lowes o he con ol g oup. A e andomiza ion nei he he pa icipan s no he esea che s we e blinded. In e en ion All mo he s and child en we e ins uc ed o use an accele ome e e e y day du ing waking hou s o weeks one (baseline), wo, and eigh . In addi ion, all mo he s comple ed exe cise dia- ies o hemsel es and hei child o he same weeks. The i s measu emen week (i.e., week one) was used as he baseline measu emen in bo h g oups be o e he s a o he in e en ion. Fu he , he mo he s and child en in he in e en ion g oup we e ins uc ed o use he mo e- men - o-music ideo p og am DVD e e y o he day om he beginning o week wo o he end o week eigh . The mo emen - o-music ideo p og am consis ed o h ee sepa a e exe cise p og ams, each las ing 10 minu es. As pe he ins uc ions, he ideos could be used indi idu- ally o consecu i ely in o de o allow he mo he and child o choose he sui able amoun o exe cise o hemsel es. The con en s o ideo p og am ha e been p e iously desc ibed by Tuominen e al. (2015) [43]. Mo he s and child en who used accele ome e s o a leas ou days du ing any o he mea- su emen weeks and o a leas 10 hou s pe day we e included in he analysis. Pa icipan s whose daily measu emen ime exceeded 20 hou s we e conside ed o ha e slep wi h he accele ome e . Thus, o a oid possible bias in SB ime, hei waking wea ime was limi ed o 20 hou s, wi h he deduc ion coming om hei lying-down ime (o om si ing ime, i he lying-down ime was sho e han he exceeded p opo ion). The a iables o SB and PA a e p esen ed as a p opo ion o he o al measu emen ime (waking hou s) du ing measu emen days. Measu emen s The p ima y ou comes o he s udy we e SB and PA, which we e assessed objec i ely by means o he accele ome e (Hookie AM20, T axmee L d, Espoo, Finland), and u he examined ia he exe cise dia ies and ques ionnai es. The accele ome e collec ed and s o ed he i-axial accele a ion signal in aw mode wi h a 100 Hz sampling equency and a ±16 g ( he Ea h’s g a i y) measu emen ange caused by any mo emen . The collec ed aw accele a ion da a we e ans o med in o ac ual g-uni s [44,45]. The da a was analyzed as he mean signal ampli- ude de ia ion (MAD) o he esul an accele a ion o each epoch [44]. The esul an , which indica es he magni ude o he accele a ion, was calcula ed o e e y measu ed sample. The da a we e analyzed a a 6-second epoch leng h. S anding, si ing, and lying down we e iden i ied by applying he i-axial in o ma ion om he accele ome e . Walking was used as a e e ence and since he body pos u e du ing walking is up igh and he di ec ion o Ea h’s g a i y ec o is cons an , he e ical posi ion (angle) o he accele ome e can be iden i ied du ing no mal walking. This known posi ion (i.e., he Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 4 / 21 angle o he accele ome e ) can hen be used o he pu poses o ecognizing di e en body pos u es. In s anda dized condi ions, s anding can be sepa a ed om si ing o lying wi h 100% accu acy, si ing om lying wi h 99% accu acy, and s anding om si ing wi h 93% accu acy [31,46]. Lying and si ing down (<1.5 MET) was combined as SB, while s anding s ill (SS <1.5 MET) and ligh PA (LPA 1.5–2.9 MET) we e analyzed sepa a ely [47,48]. Mode a e- o- igo ous PA (MVPA) consis ed o mode a e PA (MPA 3.0–5.9 MET) and igo ous PA (VPA 6.0 MET) [48]. The accele ome e has been shown o be a alid measu emen ool among adul s [45] and young people [49,50]. Based on ou pilo s udy, he Hookie-accele om- e e is a easible ool also among p eschool child en [22]. Fo he exe cise dia y da a, mo he 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, biking, gym wo kou s, and dancing). In addi ion, he mo he s we e gi en dia ies o he child en, in which hey eco ded he child’s dayca e o p eschool ime, exe cises, and he ime spen engaged in PA. The seconda y ou come o he s udy was sc een ime, which was e alua ed by means o sel - epo ed in o ma ion a baseline and a e eigh weeks ia a ques ionnai e. The baseline ques- ionnai e also included in o ma ion on he pa icipan s’ backg ound, socioeconomic s a us, PA, sc een ime, heigh , weigh , musculoskele al diso de s o symp oms, and pe cei ed heal h s a us. The ques ionnai e on he pa icipan s’ cu en PA and ime spen in a si ing posi ion was u ilized in he na ional Heal h 2011 Su ey [51] and he FINRISKI s udy [52] in Finland o asce ain whe he o no people mee he PA ecommenda ions and how much hey end o si in a ious con ex s (in he o ice, a home in on o he compu e o TV, du ing anspo a- ion). Diso de s and symp oms, as well as pe cei ed heal h we e conside ed impo an ele- men s in unc ional capaci y and heal h [53]. Pe cei ed heal h was measu ed ia a isual analog scale (VAS). The ques ionnai e o he child en was based on he LATE (Heal h moni- o ing among child en and you h in Finland) p ojec [54]. Pa en s epo ed hei child’s beha io , and he ques ionnai e included sepa a e ques ions on ou side ac i i ies, exe cises, and sc een ime. S a is ical analysis Sample size calcula ion was based on he Mo ing Sound pilo s udy [22], whe e he mean sed- en a y ime o he mo he s was 7 h 40 min pe day a baseline. The a e age educ ion in seden- a y ime in he in e en ion g oup a he end o he s udy was assumed o be a ound 6%, while he con ol g oup would emain unchanged. Powe calcula ions o he s udy ha e been epo ed ea lie by Tuominen e al. (2015). B ie ly, di e ences in g oupwise means we e es ed ia - es s. When he wo-sided signi icance le el was 0.05 and he powe o he s udy was 80%, he e ec size a ied om 0.357 o 0.500 (depending on he changes in seden a y ime). Based on hese calcula ions, he es ima ed sample size o he s udy was 63–124 mo he -child pai s pe g oup [43]. Baseline cha ac e is ics and p ima y and seconda y ou comes we e epo ed as means and s anda d de ia ions (SD) o con inuous a iables and as equencies and pe cen ages o ca ego ical a iables, since he da a we e no mally dis ibu ed based on alues o skewness and ku osis. The p ima y ou comes (p opo ion o measu emen ime in SB, SS, LPA, and MVPA) we e analyzed on he basis o he linea mixed e ec s model (LME) wi h g oup (in e - en ion o con ol), ime (day), and in e ac ion be ween g oup and ime. Uns uc u ed co a i- ance ype was used o epea ed measu emen analysis, based on he assump ion ha e e y e m ( he a iances and he co ela ion be ween wo sepa a e measu emen s) may be di e en [55]. Fu he , he model o mo he s was adjus ed o he mo he ’s body mass index (BMI), numbe o child en, wo king s a us (yes/no), sel - epo ed musculoskele al diso de s o Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 5 / 21 symp oms (yes/no), and pe cei ed heal h s a us (VAS 0–100). The model o child en was adjus ed o he child’s BMI, dayca e o p eschool (yes/no), and numbe o siblings. Po en ial con ounding ac o s we e included in he analyses by adding hem one by one o he model as a as he es ima e o in e ac ion e m changed in he p ima y ou comes. The change o he es ima e o in e ac ion e m was no essen ial when he child’s age o gende was added o he model, and he e o e hey we e omi ed. The sel - epo ed seconda y ou come (sc een ime) was analyzed using a LME model wi hin wo ime poin s (baseline and end). Ou lie s we e emo ed p io o he analysis i s anda dized alues (z-sco e) we e less han -3.30 o g ea e han 3.30. A Pea son co ela ion coe icien was compu ed o assess he ela ionship be ween he mo he s’ and child en’s SB, PA, and sc een ime. All he da a we e analyzed using he in en ion- o- ea analysis p inciple. A mixed e ec s model uses all da a a ailable a each ime poin (i.e., e e y measu emen day); hus, da a om accele ome e s du ing weeks 1, 2, and/o 8 we e used when he mo he s and/o child en had he da a o a leas ou days pe week. As sensi i i y analyses, we also pe o med he LME models o he mo he s and child en who esponded o all h ee ime poin s (i.e., had accep - able measu emen s om weeks one, wo, and eigh ), and, also o hose mo he s and child en who used he mo emen - o-music ideo p og am (based on he dia ies) du ing week 8 ( he las in e en ion week). In he d opou analysis, Fishe ’s exac es was used o dicho omous a iables (g oup, gen- de o he child, being in wo k, he child s aying in dayca e o p eschool), and he independen samples - es was used o con inuous a iables (age, BMI, pe cei ed heal h) o ind ou whe he he e we e di e ences be ween hose who discon inued he s udy compa ed o hose who con inued un il he end. All analyses we e pe o med wi h IBM SPSS S a is ics 24.0. Resul s The e we e 228 mo he -child -pai s who we e andomized (Fig 1), bu 13 mo he s in he in e - en ion g oup and 11 mo he s in he con ol g oup wi hd ew immedia ely a e andomiza- ion o did no e u n he signed in o med consen , and we e he e o e excluded om he da a. One mo he , who was andomized o he con ol g oup, e u ned an in o med consen signed, bu did no wan o wea an accele ome e and did no e u n any o he da a. She was he e o e also excluded. In o al, 203 mo he -child pai s we e included (in e en ion g oup 101 mo he -child pai s, con ol g oup 102 mo he -child pai s) in he in en ion- o- ea analy- sis. O he mo he -child pai s included, 164 (81% o included pa icipan s) comple ed he s udy up o he 8-week ime (in e en ion g oup 79 mo he -child pai s, con ol g oup 85 mo he -child pai s). A mo he -child pai was conside ed o pa icipa e un il he end o he s udy i he mo he e u ned he accele ome e , exe cise dia y, and/o ques ionnai e a e he whole in e en ion pe iod. The backg ound cha ac e is ics o he pa icipan s a e p esen ed in Table 1. The mo he s in he in e en ion and con ol g oups did no di e om each o he . Rega ding he child en, he in e en ion g oup seemed o include mo e boys han gi ls, while he con ol g oup had sligh ly mo e gi ls han boys. Howe e , he di e ences be ween he g oups we e no s a is i- cally signi ican . In addi ion, based on he Conso 2010 s a emen , any di e ences in baseline cha ac e is ics a e he esul o chance a he han bias [56] (h p://www.conso -s a emen . o g/checklis s/ iew/32-conso /510-baseline-da a). Using a isual analog scale (VAS), he mean o he mo he s’ sel - epo ed pe cei ed heal h was 74.5 (SD 13.3) in he in e en ion g oup and 76.3 (SD 12.1) in he con ol g oup, indica ing a ai ly good heal h s a us in bo h g oups. Based on he mo he s’ sel - epo s, 33% o he in e - en ion g oup (n = 97) and 39% o he con ol g oup (n = 97) me he PA ecommenda ion o Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 6 / 21 Fig 1. Flowcha o he s udy. (Abb e ia ions: n = numbe o pa icipan s, n BL = numbe o pa icipan s a baseline, n END = numbe o pa icipan s a he end, n 1 = numbe o measu ed pa icipan s a he i s week, n 2 = numbe o measu ed pa icipan s a he second week, n 8 = numbe o measu ed pa icipan s a he eigh h week). h ps://doi.o g/10.1371/jou nal.pone.0183317.g001 Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 7 / 21 ae obic PA, and 30% o he in e en ion g oup and 32% o he con ol g oup me he muscle- s eng hening/balance ecommenda ion. Howe e , only 12% o he in e en ion g oup and 14% o he con ol g oup mo he s me bo h ecommenda ions. Accele ome e da a (a leas ou days pe week and 10–20 hou s/day) was used in he anal- ysis i he e was a leas one accep able measu emen week o he accele ome e da a (see Table 2). Mo he s A baseline, he p opo ion o seden a y ime was highe in he in e en ion g oup compa ed o he con ol g oup, bu he di e ence was no s a is ically signi ican . O e he s udy pe iod, he p opo ion o SB dec eased sligh ly in he in e en ion g oup and inc eased in he con ol g oup, bu he change in ime be ween g oups was no signi ican , no we e he changes o e Table 1. Backg ound cha ac e is ics o he pa icipan s. (Abb e ia ions: n = numbe o pa icipan s, SD = s anda d de ia ion). In e en ion Con ol n Mean (SD) / % n Mean (SD) / % Mo he s Age (in 2015) 101 37.0 (4.7) 102 37.9 (5.0) Ma i al s a us 97 99 ma ied 77.3% 78.8% cohabi ing 13.4% 19.2% di o ced 6.2% 2.0% unma ied 3.1% - Employmen 97 99 ull- o pa - ime wo k 69.1% 76.8% ma e ni y, pa en al, o child ca e lea e 13.4% 11.1% unemployed o laid o 7.2% 5.1% o he 10.3% 7.1% P egnan 97 99 no 96.9% 98.0% yes 3.1% 2.0% BMI (includes only non-p egnan women wi h measu ed weigh ) 94 27.7 (5.3) 93 26.2 (4.7) Musculoskele al diso de s 96 96 no 90.6% 88.5% yes 9.4% 11.5% Musculoskele al symp oms 94 96 no 23.4% 30.2% yes 76.6% 69.8% Pe cei ed heal h 96 74.5 (13.4) 99 76.3 (12.1) Child en Age (a he beginning o he measu emen s) 101 6.5 (0.5) 102 6.5 (0.5) Gende 101 102 gi l 44.6% 54.9% boy 55.4% 45.1% BMI (based on measu ed weigh , ansmi ed o adul scale) 99 21.9 (4.4) 97 21.8 (4.0) gi l 44 20.7 (3.3) 50 20.9 (3.7) boy 55 22.8 (4.9) 47 22.8 (4.1) Childca e o p eschool a leas h ee days pe week 101 65.3% 102 65.7% h ps://doi.o g/10.1371/jou nal.pone.0183317. 001 Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 8 / 21 ime wi hin g oups. The adjus ed model did no show a signi ican di e ence o e ime be ween he g oups ei he (Table 3,Fig 2). The p opo ion o SS a baseline was lowe in he in e en ion g oup han in he con ol g oup, bu he di e ence was no signi ican . O e ime, he p opo ion o SS sligh ly inc eased in he in e en ion g oup and dec eased in he con ol g oup, bu he change o e ime be ween he g oups was no signi ican in ei he he unadjus ed o adjus ed (p= 0.063, sepa- a ely) model. Table 2. The use o he accele ome e o e he s udy: numbe o use s (n), weekly a e age (days/week), and daily a e age (SD) in hou s (h). Week 1 (baseline) Week 2 ( he i s in e en ion week) Week 8 ( he las in e en ion week) Accep able measu emen da a o any week Accep able measu emen da a o all weeks Mo he s Con ol g oup (n = 102) n = 94, 6.73 d/wk, 14.7 h (1.3) n = 91, 6.26 d/wk, 14.5 h (1.1) n = 74, 6.60 d/wk, 14.6 h (2.0) 94% 68% In e en ion g oup (n = 101) n = 93, 6.67 d/wk, 14.6 h (1.1) n = 84, 6.24 d/wk, 14.5 h (1.2) n = 65, 6.61 d/wk, 14.6 h (1.9) 95% 60% Child en Con ol g oup (n = 102) n = 89, 6.43 d/wk, 13.2 h (1.2) n = 86, 6.05 d/wk, 13.1 (1.3) n = 63, 6.17 d/wk, 13.1 h (2.0) 89% 60% In e en ion g oup (n = 101) n = 86, 6.52 d/wk, 13.3 h (1.3) n = 77, 5.99 d/wk, 13.4 h (1.2) n = 56, 6.56 d/wk, 13.5 h (2.1) 87% 50% h ps://doi.o g/10.1371/jou nal.pone.0183317. 002 Table 3. Change wi hin and be ween he g oups o mo he s in seden a y beha io and physical ac i i y o e ime as a p opo ion o measu emen ime (es ima es, 95% con idence in e als and p- alue). Unadjus ed (n = 191) Adjus ed*(n = 170) Mo he s es ima e (95% CI) p- alue es ima e (95% CI) p- alue Seden a y beha io ** di e ence a baseline ( e = con ol) 1.89 (-0.6 o 4.4) 0.135 1.87 (-0.61 o 4.36) 0.139 change in ime, con ol 0.008 (-0.015 o 0.03) 0.486 0.015 (-0.010 o 0.041) 0.234 change in ime, in e en ion -0.009 (-0.034 o 0.017) 0.495 -0.008 (-0.034 o 0.019) 0.566 in e en ion e ec ( e = con ol) -0.017 (-0.052 o 0.015) 0.330 -0.023 (-0.060 o 0.014) 0.215 S anding s ill** di e ence a baseline ( e = con ol) -1.01 (-2.38 o 0.37) 0.150 -0.88 (-2.33 o 0.56) 0.228 change in ime, con ol -0.008 (-0.024 o 0.008) 0.329 -0.011 (-0.028 o 0.006) 0.191 change in ime, in e en ion 0.014 (-0.003 o 0.031) 0.101 0.012 (-0.006 o 0.029) 0.183 in e en ion e ec ( e = con ol) 0.022 (-0.001 o 0.045) 0.063 0.023 (0.001 o 0.048) 0.063 Ligh physical ac i i y** di e ence a baseline ( e = con ol) -0.067 (-1.29 o 1.16) 0.914 -0.22 (-1.51 o 1.06) 0.730 change in ime, con ol -0.003 (-0.015 o 0.008) 0.580 -0.005 (-0.017 o 0.007) 0.433 change in ime, in e en ion -0.003 (-0.015 o 0.009) 0.621 -0.003 (-0.016 o 0.009) 0.606 in e en ion e ec ( e = con ol) 0.0002 (-0.016 o 0.017) 0.983 0.002 (-0.016 o 0.019) 0.860 Mode a e- o- igo ous physical ac i i y** di e ence a baseline ( e = con ol) -0.82 (-1.72 o 0.08) 0.073 -0.77 (-1.71 o 0.17) 0.109 change in ime, con ol 0.003 (-0.006 o 0.011) 0.489 0.001 (-0.008 o 0.011) 0.786 change in ime, in e en ion -0.0003 (-0.009 o 0.009) 0.951 -0.001 (-0.010 o 0.009) 0.909 in e en ion e ec ( e = con ol) -0.003 (-0.016 o 0.009) 0.603 -0.002 (-0.015 o 0.012) 0.786 *Adjus ed o mo he ’s BMI, numbe o child en, wo k, diso de s o symp oms, and pe cei ed heal h ** P opo ion o measu emen ime h ps://doi.o g/10.1371/jou nal.pone.0183317. 003 Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 9 / 21 age, he lack o a ie y), eigh weeks migh be oo long o he use o a ideo wi hou any in e - ac i e unc ion o o he mo i a ing ac ion. A e iew by Biddish and I win (2010) epo ed ha ac i e ideo games could p omo e ligh - o-mode a e PA among child en and young people [62]. Mos o he e iewed s udies we e, howe e , conduc ed among child en/young people only, wi hou he pa en s’ ac i e ole in hese s udies, and mos o hese child en we e olde han he child en in ou s udy. Fu he , in ou s udy some o hose mo he -child pai s who epo ed using he ideo du ing week 8 epo ed ha no only he mo he -child pai bu also he whole amily pe o med he exe cises. The way in which some amilies mo i a e hemsel es o e eigh weeks is in line wi h Paez e al. (2009), who ound ha pa en al and pee pa icipa- ion may play a ole in child en’s ini ial and sus ained pa icipa ion in PA s udies [63]. In addi- ion, based on he mo he s’ epo s, o e ime some child en disco e ed hei own mo emen s and igu es o music ins ead o he ins uc ed ones included in ou s udy. S eng hs and limi a ions o he s udy To ou knowledge, his is he i s s udy examining objec i ely measu ed SB and PA using a mo emen - o-music ideo p og am in he home en i onmen a he same ime among mo h- e s and hei child en. The majo s eng h o he s udy is he RCT design and he use o alid [45] and easible [22] i-axial accele ome e o measu emen s. Lying and si ing could be eli- ably sepa a ed om s anding [46], which p oduced mo e de ailed knowledge, no only o PA bu speci ically, o SB. Howe e , we should also discuss he na u e o hip-wo n accele ome- e s, which a e likely o unde es ima e shaking mo emen s and jiggling o he hands and/o legs du ing he mo emen - o-music ideo p og am. Ne e heless, he accele ome e is able o de ec o e all PA and SB [44], which was he main ocus o he s udy. The mean wea ing imes pe day (13.3 h/d among child en and 14.6 h/d among mo he s) we e simila o hose epo ed in he o he s udies [31,50], and he pa icipan s had on a e age 6.0–6.7 alid days pe week, which inc eases he eliabili y o he measu ed SB and PA. Finally, mo e han 80% o he included (n = 203) mo he -child pai s pa icipa ed un il he end o he s udy, which is a high pa icipa ion a e. The p ima y weakness o ou s udy is ha ou ideo was aimed a younge child en han hose in ol ed. The abo e-men ioned di icul ies in main aining mo i a ion o e eigh weeks because o he lack o a ie y possibly unde mined he e ec o he mo emen - o-music ideo. Since we know how impo an a ole mo i a ion plays o less SB and mo e PA, i would be in e es ing o s udy he e ec o he cu en ideo among younge child en, o o s udy he e ec o a ious ideos o some o he kind music ac i i ies wi h he same age g oup. In ea lie s udies, music- ela ed in e en ions ha e been shown o be e ec i e in bo h adul s [8,18] and child en [19,21,22]. In ou s udy, mo he s we e asked o epo hei own and hei child’s exe cise adhe ence in dia ies du ing weeks 1, 2, and 8. They we e also asked o e alua e on a e age how many imes pe week and o how long hey had exe cised du ing he whole in e en ion pe iod. Howe e , he second weakness o ou s udy is ha he di e ence in exe cise adhe ence epo ed in he eigh week dia ies and ques ionnai e was essen ial. An addi ional limi a ion could be ew dia ies which we e comple ed showing mo he s and child en had exe cised using he ideo du ing week eigh . In o de o ensu e compliance, we should ha e had he mo he s keep dia ies du ing he whole in e en ion pe iod. The hi d weakness is ela ed o he coho . The mo he s who pa icipa ed in he NELLI 7-yea ollow-up s udy migh be mo e ac i e and mo e awa e o heal hie li es yles han he a e age women. This may ha e biased he esul s and educed hei gene alizabili y, and may u he pa ly explain he small changes o e ime wi hin and be ween g oups. Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 16 / 21 Conclusion The mo emen - o-music ideo p og am did no change objec i ely measu ed SB o PA. How- e e , mo he s and child en seem o be mo e seden a y a home han a wo k and p eschool o dayca e, and he e o e, in e en ions o dec ease SB and inc ease PA should be a ge ed espe- cially a he home en i onmen . In addi ion, o hose mo he s and young child en who ha e di icul ies in exe cising ou side he home, he mo emen - o-music ideo p og am migh ep- esen a way o be physically ac i e. Wi h ega d o child en’s and pa en ’s SB and PA, mo e high-quali y andomized con olled ials a e needed o examine he e ec o music-based exe cise p og ams. Wi h he limi a ions men ioned abo e, ou s udy was pionee ing o his pu pose. Suppo ing in o ma ion S1 Table. Change wi hin and be ween g oups o mo he s in seden a y beha io and physi- cal ac i i y o e ime as a p opo ion o measu emen ime (es ima es, 95% con idence in e als and p- alue). Including mo he s (n = 130) who had accep able accele ome e use o all h ee weeks. (PDF) S2 Table. Change wi hin and be ween g oups o child en in seden a y beha io and physi- cal ac i i y o e ime as a p opo ion o measu emen ime (es ima es, 95% con idence in e als and p- alue). Including child en (n = 111) who had accep able accele ome e use o all h ee weeks. (PDF) S3 Table. Change wi hin and be ween g oups o mo he s in seden a y beha io and physi- cal ac i i y o e ime as a p opo ion o measu emen ime (es ima es, 95% con idence in e als, and p- alues). Including hose mo he s who used he mo emen - o-music ideo p og am (based on dia ies, n = 9) a week 8 and hose who belonged o he con ol g oup (n = 96). (PDF) S4 Table. Change wi hin and be ween g oups o child en in seden a y beha io and physi- cal ac i i y o e ime as a p opo ion o measu emen ime (es ima es, 95% con idence in e als, and p- alues). Including hose child en who used he mo emen - o-music ideo p og am (based on dia ies, n = 10) a week 8 and hose who belonged o he con ol g oup (n = 91). (PDF) S1 Tex . CONSORT 2010 checklis . (PDF) S2 Tex . Resea ch p oposal o E hics Commi ee o he human sciences. (PDF) Acknowledgmen s We hank Minna Huo ilainen o he Uni e si y o Helsinki and Lau a Sokka om he Finnish Ins i u e o Occupa ional Heal h o hei help in planning o he s udy. We also hank Ee a- Leena Pokela and Soili Pe kio¨ om he Sibelius Academy o hei wo k in planning and p e- pa ing he mo emen - o-music ideo o he s udy wi h hei s uden s. We a e g a e ul o Hen i Va¨ha¨-Ypya¨ om he UKK Ins i u e o his help wi h he accele ome e da a, and o Ulla Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 17 / 21 Hakala, Ta u Helenius, Ulla Honkanen, and Si ke Rasinpe a¨ om he UKK Ins i u e labo a- o y o hei impo an e o s in he collec ion o he da a. Au ho Con ibu ions Concep ualiza ion: PPAT PH UMK RML. Da a cu a ion: PPAT JR. Fo mal analysis: PPAT JR. Funding acquisi ion: RML. In es iga ion: RML. Me hodology: PPAT PH JR UMK. P ojec adminis a ion: RML. So wa e: JR. Supe ision: PH UMK RML. Visualiza ion: PPAT JR. W i ing – o iginal d a : PPAT. W i ing – e iew & edi ing: PPAT PH JR UMK RML. Re e ences 1. de Rezende LF, Rod igues Lopes M, Rey-Lopez JP, Ma sudo VK, Luiz Odo C. Seden a y beha io and heal h ou comes: an o e iew o sys ema ic e iews. PLoS One 2014 Aug 21; 9(8):e105620. h ps:// doi.o g/10.1371/jou nal.pone.0105620 PMID: 25144686 2. LeBlanc AG, Spence JC, Ca son V, Conno Go be S, Dillman C, Janssen I, e al. Sys ema ic e iew o seden a y beha iou and heal h indica o s in he ea ly yea s (aged 0–4 yea s). Appl Physiol Nu Me ab 2012 Aug; 37(4):753–772. 3. T emblay MS, LeBlanc AG, Kho ME, Saunde s TJ, La ouche R, Colley RC, e al. Sys ema ic e iew o seden a y beha iou and heal h indica o s in school-aged child en and you h. In J Beha Nu Phys Ac 2011 Sep 21; 8:98-5868-8-98. 4. Janssen I, Leblanc AG. Sys ema ic e iew o he heal h bene i s o physical ac i i y and i ness in school-aged child en and you h. In J Beha Nu Phys Ac 2010 May 11; 7:40-5868-7-40. 5. Physical Ac i i y Guidelines Ad iso y Commi ee. Physical ac i i y guidelines ad iso y commi ee epo , 2008. Washing on, DC: U.S. Depa men o Heal h and Human Se ices. Re ie ed om h p:// www.heal h.go /paguidelines/. 2008. 6. Ch ou ou H, Ja aya M, Aloui A, Hammouda O, Souissi N. The e ec s o music du ing wa m-up on anae obic pe o mances o young sp in e s. Science & Spo s 2012 12; 27(6):e85–e88. 7. Sa i ha D, Mallika juna RN, Rao C. E ec o di e en musical empo on pos -exe cise eco e y in young adul s. Indian J Physiol Pha macol 2010 Jan-Ma ; 54(1):32–36. PMID: 21046917 8. Ka ageo ghis CI. Applying music in exe cise and spo . Champaign, IL. London, UK: Human Kine ics; 2016. 9. Biagini MS, B own LE, Cobu n JW, Judelson DA, S a le TA, Bo a o M, e al. E ec s o Sel -Selec ed Music on S eng h, explosi eness, and mood. Jou nal o S eng h & Condi ioning Resea ch (Lippinco Williams & Wilkins) 2012 07; 26(7):1934–1938. 10. Ba wood MJ, Wes on NJV, Thelwell R, Page J. A mo i a ional music and ideo in e en ion imp o es high-in ensi y exe cise pe o mance. Jou nal o Spo s Science and Medicine 2009; 8(3):435–442. PMID: 24150008 11. Bood RJ, Nijssen M, an de Kamp J, Roe dink M. The Powe o Audi o y-Mo o Synch oniza ion in Spo s: Enhancing Running Pe o mance by Coupling Cadence wi h he Righ Bea s. Plos One 2013 AUG 7; 8(8):e70758. h ps://doi.o g/10.1371/jou nal.pone.0070758 PMID: 23951000 Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 18 / 21 12. A kinson G, Wilson D, Eubank M. E ec s o music on wo k- a e dis ibu ion du ing a cycling ime ial. In J Spo s Med 2004 No ; 25(8):611–615. h ps://doi.o g/10.1055/s-2004-815715 PMID: 15532005 13. Bacon CJ, Mye s TR, Ka ageo ghis CI. E ec o music-mo emen synch ony on exe cise oxygen con- sump ion. J Spo s Med Phys Fi ness 2012 Aug; 52(4):359–365. PMID: 22828457 14. Zale el P, Gab ilo G, Pe ic M. The aining e ec s o dance ae obics: A e iew wi h an emphasis on he pe spec i es o in es iga ions. Coll An opol 2013 May; 37 Suppl 2:125–130. 15. Ka ageo ghis CI, P ies DL, Williams LS, Hi ani RM, Lannon KM, Ba es BJ. E gogenic and psychologi- cal e ec s o synch onous music du ing ci cui - ype exe cise. Psychol Spo Exe c 2010 No 2010; 11 (6):551–559. 16. Ka ageo ghis CI, P ies DL. Music in he exe cise domain: a e iew and syn hesis (Pa I). In Re Spo Exe c Psychol 2012 Ma ; 5(1):44–66. h ps://doi.o g/10.1080/1750984X.2011.631026 PMID: 22577472 17. Ka ageo ghis CI, P ies DL. Music in he exe cise domain: a e iew and syn hesis (Pa II). In Re Spo Exe c Psychol 2012 Ma ; 5(1):67–84. h ps://doi.o g/10.1080/1750984X.2011.631027 PMID: 22577473 18. Cla k IN, Bake FA, Taylo NF. 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 dic Jou nal o Music The apy 2016 JAN 2; 25(1):76–104. 19. Die inge ST, Po e a D, Gumm E. Using Music The apy P inciples o Enhance Physical Ac i i y Pa ic- ipa ion In Child en and Adolescen s Wi h Disabili ies. Palaes a 2013 09; 27(3):42–46. 20. Denac O. A Case S udy o P eschool Child en’s Musical In e es s a Home and a School. Ea ly Child- hood Educa ion Jou nal 2008 Ap 2008; 35(5):439–444. 21. Wa d DS, Vaughn A, McWilliams C, Hales D. In e en ions o inc easing physical ac i i y a child ca e. Med Sci Spo s Exe c 2010 Ma ; 42(3):526–534. h ps://doi.o g/10.1249/MSS.0b013e3181cea406 PMID: 20068495 22. Tuominen PP, Husu P, Rai anen J, Luo o RM. Di e ences in seden a y ime and physical ac i i y among mo he s and child en using a mo emen - o-music ideo p og am in he home en i onmen : a pilo s udy. Sp inge plus 2016 Jan 28; 5:93-016-1701-z. eCollec ion 2016. 23. Jago R, Sebi e SJ, Edwa ds MJ, Thompson JL. Pa en al TV iewing, pa en al sel -e icacy, media equipmen and TV iewing among p eschool child en. Eu J Pedia 2013; 172(11):1543–1545. h ps:// doi.o g/10.1007/s00431-013-2077-5 PMID: 23812514 24. O’Dwye MV, Fai clough SJ, Knowles Z, S a on G. 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. In J Beha Nu Phys Ac 2012 Oc 1; 9:117-5868-9-117. 25. Xu H, Wen LM, Rissel C. Associa ions o pa en al in luences wi h physical ac i i y and sc een ime among young child en: a sys ema ic e iew. J Obes 2015; 2015:546925. h ps://doi.o g/10.1155/2015/ 546925 PMID: 25874123 26. Abbo G, Hna iuk J, Timpe io A, Salmon J, Bes K, Heske h KD. C oss-sec ional and Longi udinal Associa ions Be ween Pa en s’ and P eschoole s’ Physical Ac i i y and Tele ision Viewing: The HAPPY S udy. J Phys Ac Heal h 2016 Ma ; 13(3):269–274. h ps://doi.o g/10.1123/jpah.2015-0136 PMID: 26181513 27. McMu ay RG, Be y DC, Schwa z TA, Hall EG, Neal MN, Li S, e al. Rela ionships o physical ac i i y and seden a y ime in obese pa en -child dyads: a c oss-sec ional s udy. BMC Public Heal h 2016 Feb 6; 16:124-016-2795-5. 28. Rebold MJ, Lepp A, Kobak MS, McDaniel J, Ba kley JE. The E ec o Pa en al In ol emen on Chil- d en’s Physical Ac i i y. J Pedia 2016 Ma ; 170:206–210. h ps://doi.o g/10.1016/j.jpeds.2015.11.072 PMID: 26725460 29. Dumuid D, Olds TS, Lewis LK, Mahe C. Does home equipmen con ibu e o socioeconomic g adien s in Aus alian child en’s physical ac i i y, seden a y ime and sc een ime? BMC Public Heal h 2016; 16 (1):736. 30. Spi aels H, Van Cauwenbe ghe E, Ve bes el V, De Mees e F, Van Dyck D, Ve loigne M, e al. Objec- i ely measu ed seden a y ime and physical ac i i y ime ac oss he li espan: a c oss-sec ional s udy in ou age g oups. In J Beha Nu Phys Ac 2012 Dec 18; 9:149-5868-9-149. 31. Husu P, Suni J, Vaha-Ypya H, Sie anen H, Tokola K, Valkeinen H, e al. Objec i ely measu ed seden- a y beha io and physical ac i i y in a sample o Finnish adul s: a c oss-sec ional s udy. BMC Public Heal h 2016 Sep 1; 16:920-016-3591-y. 32. Recommenda ions o physical ac i i y in ea ly childhood 2016. Joy, play and doing oge he . Minis y o Educa ion and Cul u e 2016;21: Finland, 2016. Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 19 / 21 33. T emblay MS, Leblanc AG, Ca son V, Choque e L, Conno Go be S, Dillman C, e al. Canadian Physi- cal Ac i i y Guidelines o he Ea ly Yea s (aged 0–4 yea s). Appl Physiol Nu Me ab 2012 Ap ; 37 (2):345–369. h ps://doi.o g/10.1139/h2012-018 PMID: 22448608 34. Aus alian Go e nmen , Depa men o Heal h. Make you mo e—si less, be ac i e o li e! Aus alia’s physical ac i i y and seden a y beha io guidelines o 5–12 yea s. Commonweal h o Aus alia 2014. 35. Aus alian Go e nmen , Depa men o Heal h and Ageing. Mo e and play e e y day: Na ional physical ac i i y ecommenda ions o child en 0–5 yea s. Commonweal h o Aus alia: Depa men o Heal h and Ageing 2010. 36. Depa men o Heal h, Physical Ac i i y, Heal h Imp o emen and P o ec ion. S a ac i e, s ay ac i e: A epo on physical ac i i y o heal h om he ou home coun ies’ Chie Medical O ice s. Uni ed King- dom 2011. 37. Hna iuk JA, Salmon J, Hinkley T, Okely AD, T os S. A Re iew o P eschool Child en’s Physical Ac i i y and Seden a y Time Using Objec i e Measu es. Am J P e Med 2014 10; 47(4):487–497. h ps://doi. o g/10.1016/j.amep e.2014.05.042 PMID: 25084681 38. Tammelin TH, Ai a A, Hakamaki M, Husu P, Kallio J, Kokko S, e al. Resul s F om Finland’s 2016 Repo Ca d on Physical Ac i i y o Child en and You h. J Phys Ac Heal h 2016 No ; 13(11 Suppl 2): S157–S164. 39. Soini A, Willbe g J, Gubbels J, Meh a ¨la ¨A, Ke unen T, Poskipa a M. Di ec ly obse ed physical ac i i y among 3-yea -olds in Finnish childca e. IJEC 2014; 46:253–269. 40. Anne Soini. Always on he mo e? Measu ed physical ac i i y o 3-yea -old p eschool child enUni e si y o Jy a ¨skyla ¨; 2015. 41. Finland’s Repo Ca d 2016 on Physical Ac i i y o Child en and You h. LIKES Resea ch epo s on physical ac i i y and heal h 320. Jy a ¨skyla ¨: LIKES Resea ch Cen e o Physical Ac i i y and Heal h 2016. 42. Schulz KF, Al man DG, Mohe D, CONSORT G oup. CONSORT 2010 S a emen : upda ed guidelines o epo ing pa allel g oup andomised ials. BMC Med 2010 Ma 24; 8:18-7015-8-18. 43. Tuominen PP, Husu P, Rai anen J, Luo o RM. 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 2015 Oc 5; 15:1016-015-2347-4. 44. Vaha-Ypya H, Vasanka i T, Husu P, Suni J, Sie anen H. A uni e sal, accu a e in ensi y-based classi i- ca ion o di e en physical ac i i ies using aw da a o accele ome e . Clin Physiol Func Imaging 2015 Jan; 35(1):64–70. h ps://doi.o g/10.1111/cp .12127 PMID: 24393233 45. Vaha-Ypya H, Vasanka i T, Husu P, Man a i A, Vuo imaa T, Suni J, e al. Valida ion o Cu -Poin s o E alua ing he In ensi y o Physical Ac i i y wi h Accele ome y-Based Mean Ampli ude De ia ion (MAD). PLoS One 2015 Aug 20; 10(8):e0134813. h ps://doi.o g/10.1371/jou nal.pone.0134813 PMID: 26292225 46. Sie a ¨nen H, Va ¨ha ¨-Ypya ¨H, Husu P, Suni J, Vasanka i T. A uni e sal me hod o accu a e classi ica ion o physical ac i i y and seden a y beha io wi h i-axial accele ome y. Med Sci Spo s Exe c 2014; 46: S438. 47. Seden a y Beha io Resea ch Ne wo k. S anda dized use o he e ms "seden a y" and "seden a y beha io s". Appl Physiol Nu Me ab 2012; 37:540–542. h ps://doi.o g/10.1139/h2012-024 PMID: 22540258 48. T emblay MS, Colley RC, Saunde s RP, Healy GN, Owen N. Psysiological and heal h implica ions o a seden a y li es yle. Appl Physiol Nu Me ab 2010; 35(2):725–740. 49. Ai asalo M, Vaha-Ypya H, Vasanka i T, Husu P, Jussila AM, Sie anen H. 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’ physi- cal ac i i y i espec i e o accele ome e b and. BMC Spo s Sci Med Rehabil 2015 Aug 7; 7:18-015- 0010-0. eCollec ion 2015. 50. Husu P, Vaha-Ypya H, Vasanka i T. Objec i ely measu ed seden a y beha io and physical ac i i y o Finnish 7- o 14-yea -old child en- associa ions wi h pe cei ed heal h s a us: a c oss-sec ional s udy. BMC Public Heal h 2016 Ap 16; 16:338-016-3006-0. 51. Koskinen S, Lundq is A, Ris iluoma N. Te eys, oimin akyky ja hy in oin i Suomessa 2011. 2012;2012_068. 52. Husu P, Pa onen O, Suni J, Vasanka i T. Suomalais en yysinen ak ii isuus ja kun o 2010. Te ey a ¨ edis a ¨ a ¨n liikunnan nyky ila ja muu okse . [Physical ac i i y and i ness o Finns in 2010: The cu en s a us o , and changes in, heal h enhancing physical ac i i y], wi h English summa y. 2011;15/2011. 53. Benjamins M, Humme R, Ebe s ein I, Nam C. Sel - epo ed heal h and adul mo ali y isk: An analysis o cause-speci ic mo ali y. Soc Sci Med (1982) 2004; 59(6):1297–1306. Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 20 / 21 54. Ma ¨ki P, Laa ikainen T, Koponen P, Hakulinen-Vii anen T. The de elopmen o heal h moni o ing among child en and he young, LATE p ojec . 2008;B28. 55. Kincaid C. Guidelines o selec ing he co a iance s uc u e in mixed model analysis. In P oceedings o he Thi een h Annual SAS Use s G oup In e na ional Con e ence Ap il 2005;No. 198–30. 56. Mohe D, Hopewell S, Schulz KF, Mon o i V, Gø zsche PC, De e eaux PJ, e al. CONSORT 2010 Explana ion and Elabo a ion: upda ed guidelines o epo ing pa allel g oup andomised ials. J Clin Epidemiol 2010 8; 63(8):e1–e37. h ps://doi.o g/10.1016/j.jclinepi.2010.03.004 PMID: 20346624 57. Maloney AE, Ca e Be hea T, Kelsey KS, Ma ks JT, Paez S, Rosenbe g AM, e al. A Pilo o a Video Game (DDR) o P omo e Physical Ac i i y and Dec ease Seden a y Sc een Time. Obesi y 2008 Sep 2008; 16(9):2074–80. h ps://doi.o g/10.1038/oby.2008.295 PMID: 19186332 58. E win H, Kou oudakis R, Beighle A. Child en’s Physical Ac i i y Le els Du ing Indoo Recess Dance Videos. J Sch Heal h 2013 05; 83(5):322–327 6p. h ps://doi.o g/10.1111/josh.12034 PMID: 23516999 59. Jago R, Fox KR, Page AS, B ockman R, Thompson JL. 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 child en? BMC Public Heal h 2010 Ap 15; 10:194-2458-10-194. 60. Can ell M, C aw o d SG, Dewey D. Daily physical ac i i y in young child en and hei pa en s: A desc ip- i e s udy. Paedia Child Heal h 2012 Ma ; 17(3):e20–4. PMID: 23450045 61. Jago R, Thompson JL, Sebi e SJ, Wood L, Pool L, Zah a J, e al. C oss-sec ional associa ions be ween he sc een- ime o pa en s and young child en: di e ences by pa en and child gende and day o he week. In J Beha Nu Phys Ac 2014 Ap 23; 11:54-5868-11-54. 62. Biddiss E, I win J. 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 2010 Jul; 164(7):664–672. h ps://doi.o g/10.1001/a chpedia ics. 2010.104 PMID: 20603468 63. Paez S, Maloney A, Kelsey K, Wiesen C, Rosenbe g A. 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 2009 Fall; 21(3):245–253. Seden a y ime, physical ac i i y, and mo emen - o-music ideo p og am among child en and mo he s PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0183317 Augus 31, 2017 21 / 21