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
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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
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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
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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
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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
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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.
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