human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Sedentary activities such as video gaming are independently associated with obesity .  Active video games , in which players physically interact with images on screen , may help increase physical activity and improve body composition . OBJECTIVE The aim of this study was to evaluate the effect of active video games over a 6-mo period on weight , body composition , physical activity , and physical fitness . DESIGN We conducted a 2-arm , parallel , r and omized controlled trial in Auckl and , New Zeal and . A total of 322 overweight and obese children aged 10 - 14 y , who were current users of sedentary video games , were r and omly assigned at a 1:1 ratio to receive either an active video game up grade package ( intervention , n = 160 ) or to have no change ( control group , n = 162 ) . The primary outcome was the change from baseline in body mass index ( BMI ; in kg/m(2 ) ) . Secondary outcomes were changes in percentage body fat , physical activity , cardiorespiratory fitness , video game play , and food snacking . RESULTS At 24 wk , the treatment effect on BMI ( -0.24 ; 95 % CI : -0.44 , -0.05 ; P = 0.02 ) favored the intervention group . The change ( ±SE ) in BMI from baseline increased in the control group ( 0.34 ± 0.08 ) but remained the same in the intervention group ( 0.09 ± 0.08 ) . There was also evidence of a reduction in body fat in the intervention group ( -0.83 % ; 95 % CI : -1.54 % , -0.12 % ; P = 0.02 ) . The change in daily time spent playing active video games at 24 wk increased ( 10.03 min ; 95 % CI : 6.26 , 13.81 min ; P < 0.0001 ) with the intervention accompanied by a reduction in the change in daily time spent playing nonactive video games ( -9.39 min ; 95 % CI : -19.38 , 0.59 min ; P = 0.06 ) . CONCLUSION An active video game intervention has a small but definite effect on BMI and body composition in overweight and obese children . This trial was registered in the Australian New Zeal and Clinical Trials Registry at http://www.anzctr.org.au/ as ACTRN12607000632493 IMPORTANCE Active video games may offer an effective strategy to increase physical activity in overweight and obese children . However , the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown . OBJECTIVE To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence -based weight management program delivered in the community . DESIGN , SETTING , AND PARTICIPANTS Group-r and omized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts , Rhode Isl and , and Texas . Seventy-five overweight or obese children ( 41 girls [ 55 % ] , 34 whites [ 45 % ] , 20 Hispanics [ 27 % ] , and 17 blacks [ 23 % ] ) enrolled in a community-based pediatric weight management program . Mean ( SD ) age of the participants was 10.0 ( 1.7 ) years ; body mass index ( BMI ) z score , 2.15 ( 0.40 ) ; and percentage overweight from the median BMI for age and sex , 64.3 % ( 19.9 % ) . INTERVENTIONS All participants received a comprehensive family-based pediatric weight management program  ( JOIN for ME ) . Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program . Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program . MAIN OUTCOMES AND MEASURES Objective ly measured daily moderate-to-vigorous and vigorous physical activity , percentage overweight , and BMI z score . RESULTS Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous ( mean [ SD ] , 7.4 [ 2.7 ] min/d ) and vigorous ( 2.8 [ 0.9 ] min/d ) physical activity at week 16 ( P < .05 ) . In the program-only group , a decline or no change was observed in the moderate-to-vigorous ( mean [ SD ] net difference , 8.0 [ 3.8 ] min/d ; P = .04 ) and vigorous ( 3.1 [ 1.3 ] min/d ; P = .02 ) physical activity . Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16 . However , the program and active gaming group exhibited significantly greater reductions in percentage overweight ( mean [ SD ] , -10.9%[1.6 % ] vs -5.5%[1.5 % ] ; P = .02 ) and BMI z score ( -0.25 [ 0.03 ] vs -0.11 [ 0.03 ] ; P < .001 ) . CONCLUSIONS AND RELEVANCE Incorporating active video gaming into an evidence -based pediatric weight management program has positive effects on physical activity and relative weight . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01757925 Exergames are videogames that require gross motor activity , thereby combining gaming with physical activity . This study examined the role of competitive versus cooperative exergame play on short-term changes in executive function skills , following a 10-week exergame training intervention .  Fifty-four low-income overweight and obese African American adolescents were r and omly assigned to a competitive exergame condition , a cooperative exergame condition , or a no-play control group . Youths in the competitive exergame condition improved in executive function skills more than did those in the cooperative exergame condition and the no-play control group . Weight loss during the intervention was also significantly positively correlated with improved executive function skills . The findings link competitive exergame play to beneficial cognitive outcomes for at-risk ethnic minority adolescents Background Child fruit and vegetable intake is below recommended levels , increasing risk for chronic disease . Interventions to influence fruit and vegetable intake among youth have had mixed effects . Innovative , theory-driven interventions are needed . Goal setting , enhanced by implementation intentions ( i.e. , plans tightly connected to a behavioral goal ) , may offer a solution . Action plans state “ how ” a goal will be achieved , while coping plans identify a potential barrier and corresponding solution . The research reported here evaluated the short- and long-term effects of goal setting enhanced with implementation intentions on child fruit and vegetable intake in a 10-episode , theoretically-grounded serious videogame promoting fruit and vegetables . This is one of the first studies to test the efficacy of implementation intentions on the dietary intake of healthy children . Methods A four-group r and omized design with three data collection periods ( baseline , immediate post-intervention , 3 months post-intervention ) was employed . Groups varied on whether children created an implementation intention ( none , action , coping , both ) as part of goal setting . Participants were 4th and 5th grade children ( ~9 - 11 years old ) and one parent . An a priori power analysis indicated this would provide > 80 % power to detect a small effect ( Cohen ’s d = 0.17 ) . Children played a 10-episode online videogame ; parents received 10 electronic newsletters and access to a parent-only website . The primary outcome was child fruit and vegetable intake , assessed via three , dietitian-assisted telephone recalls at each data collection period . The primary analysis was conducted using a repeated measures analysis of covariance with a mixed model procedure . Secondary analyses examined intervention effects on fruit and vegetables separately . Results Four hundred parent/child dyads were recruited . A significant group-by-time interaction for fruit and vegetable intake ( p < 0.001 ) was found in only the Action group , which had significant increases in fruit and vegetable intake at post 1 ( p < 0.0001 ) and post 2 ( p < 0.0001 ) . No other significant interactions were observed ; however , there were significant time effects for fruit ( p < 0.0001 ) . Conclusions Action intentions may be an important component of successful interventions to increase and maintain fruit and vegetable intake in pre-adolescent children .  Videogames promoting healthy diets offer an effective vehicle for delivering behavior change interventions to children . Trial registration Clinical Trials.gov NCT01004094 Physical inactivity among children is a serious public health problem . It has been suggested that high levels of screen time are contributory factors that encourage sedentary lifestyles in young people . As physical inactivity and obesity levels continue to rise in young people , it has been proposed that new-generation active computer- and video-console games ( otherwise known as “ exergaming ” ) may offer the opportunity to contribute to young people 's energy expenditure during their free time . Although studies have produced some encouraging results regarding the energy costs involved in playing active video-console games , the energy costs of playing the authentic versions of activity-based video games are substantially larger , highlighting that active gaming is no substitute for real sports and activities . A small number of exergaming activities engage children in moderate-intensity activity , but most do not . Only 3 very small trials have considered the effects of exergaming on physical activity levels and /or other health outcomes in children . Evidence from these trials has been mixed ; positive trends for improvements in some health outcomes in the intervention groups were noted in 2 trials . No adequately powered r and omized , controlled trial has been published to date , and no trial has assessed the long-term impact of exergaming on children 's health . We now need high- quality r and omized , controlled trials to evaluate the effectiveness and sustainability of exergaming  , as well as its clinical relevance ; until such studies take place , we should remain cautious about its ability to positively affect children 's health Objective . To evaluate the efficacy and feasibility of a multifaceted , community-based weight intervention program for children using exergaming technology ( activity-promoting video gaming ) .  Design and Methods . This is a prospect i ve observational pilot study . Forty-eight children , between the ages of 8 and 16 years , who are overweight or obese , enrolled in Exergaming for Health , a multidisciplinary weight management program , which used active video gaming . Primary outcome measures were change in body mass index ( BMI ) z scores . Results . Most children ( n = 40 , 83 % ) completed the program and participated in outcome evaluations . The average BMI change was −0.48 kg/m2 ( SD = 0.93 ) , P < .002 ( BMI z-score change was −0.072 , SD = 0.14 , P < .0001 ) . The average Global Self-Worth score improved , screen time and soda intake reduced , and exercise hours per week increased . Conclusions . The Exergaming for Health program may be an effective weight management intervention that is feasible with high participation rates . A larger r and omized controlled trial is needed to confirm these results OBJECTIVE This study evaluated the effect of four active videogames ( AVGs ) varying in behavioral contingencies ( behavior-consequence relations ) on  adolescent AVG play and overall activity levels over 4 weeks . MATERIAL S AND METHODS Each AVG , manufactured by SSD/Xavix ( ® ) ( Shiseido Co. of Japan , Tokyo , Japan ) , was coded and scored for the number of positive and aversive behavioral contingencies within the games . " Bowling " and " Tennis " were classified as having " higher contingency scores , " and " Boxing " and aerobic fitness training were classified as having " lower contingency scores . " Adolescents ( n=63 ; 11 - 15 years old ; 62 % male ; 38 % Hispanic ; 44 % overweight or obese ) were r and omized to play one of the four AVGs at home and recorded game play sessions in a paper log . Baseline and week 4 assessment s were completed at home ; week 1 , 2 , and 3 assessment s were completed by telephone . Accelerometers were worn during baseline and weeks 1 and 4 . RESULTS Accelerometer-measured sedentary and light activity hours/day were stable over time , whereas moderate-vigorous physical activity minutes/day increased in the higher contingency group and decreased in the lower contingency group ( interaction effect , 6.43 , P=0.024 ) . Reported game play minutes decreased in both groups from week 1 to week 4 ( -29.42 minutes , P=0.001 ) . DISCUSSION There was some support for the hypothesis that AVGs with more behavioral contingencies , compared with AVGs with fewer behavioral contingencies , result in more physical activity . However , overall AVG play decreased substantially after the first week . Further study is needed to better underst and how behavioral contingencies can be used in AVGs to enhance their potential to provide health benefits to game players BACKGROUND Fruit , juice , and vegetable  ( FJV ) consumption among children is low . Innovative programs are needed to enable children to increase FJV intake . Psychoeducational multimedia permits the delivery of interventions as design ed and capitalizes on known behavior change principles . DESIGN Elementary school was the unit of recruitment , assignment , and analysis . Twenty-six elementary schools were pair matched on size and percentage of free or reduced-price lunch , and r and omly assigned to treatment or control groups . Data were collected just before and just after the program . SETTING / PARTICIPANTS All fourth- grade students in participating elementary schools were invited to participate . Data were collected on 1578 students . MAIN OUTCOME Servings of fruit , 100 % ju 
    Output:
    
agent
Reflecting public health interest in the potential of exergames to encourage PA , many review s of this literature have appeared.18 - 20 Some review s have been sympathetic,21,22 whereas others have been critical.23,24 A reasonably balanced assessment revealed that , in research laboratories , exergames could provide an intense workout that included moderate-to-vigorous PA  , but under less-supervised circumstances , children tended not to get much activity18 and their interest in the activity waned over 1 week or less .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Sedentary activities such as video gaming are independently associated with obesity .  Active video games , in which players physically interact with images on screen , may help increase physical activity and improve body composition . OBJECTIVE The aim of this study was to evaluate the effect of active video games over a 6-mo period on weight , body composition , physical activity , and physical fitness . DESIGN We conducted a 2-arm , parallel , r and omized controlled trial in Auckl and , New Zeal and . A total of 322 overweight and obese children aged 10 - 14 y , who were current users of sedentary video games , were r and omly assigned at a 1:1 ratio to receive either an active video game up grade package ( intervention , n = 160 ) or to have no change ( control group , n = 162 ) . The primary outcome was the change from baseline in body mass index ( BMI ; in kg/m(2 ) ) . Secondary outcomes were changes in percentage body fat , physical activity , cardiorespiratory fitness , video game play , and food snacking . RESULTS At 24 wk , the treatment effect on BMI ( -0.24 ; 95 % CI : -0.44 , -0.05 ; P = 0.02 ) favored the intervention group . The change ( ±SE ) in BMI from baseline increased in the control group ( 0.34 ± 0.08 ) but remained the same in the intervention group ( 0.09 ± 0.08 ) . There was also evidence of a reduction in body fat in the intervention group ( -0.83 % ; 95 % CI : -1.54 % , -0.12 % ; P = 0.02 ) . The change in daily time spent playing active video games at 24 wk increased ( 10.03 min ; 95 % CI : 6.26 , 13.81 min ; P < 0.0001 ) with the intervention accompanied by a reduction in the change in daily time spent playing nonactive video games ( -9.39 min ; 95 % CI : -19.38 , 0.59 min ; P = 0.06 ) . CONCLUSION An active video game intervention has a small but definite effect on BMI and body composition in overweight and obese children . This trial was registered in the Australian New Zeal and Clinical Trials Registry at http://www.anzctr.org.au/ as ACTRN12607000632493 IMPORTANCE Active video games may offer an effective strategy to increase physical activity in overweight and obese children . However , the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown . OBJECTIVE To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence -based weight management program delivered in the community . DESIGN , SETTING , AND PARTICIPANTS Group-r and omized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts , Rhode Isl and , and Texas . Seventy-five overweight or obese children ( 41 girls [ 55 % ] , 34 whites [ 45 % ] , 20 Hispanics [ 27 % ] , and 17 blacks [ 23 % ] ) enrolled in a community-based pediatric weight management program . Mean ( SD ) age of the participants was 10.0 ( 1.7 ) years ; body mass index ( BMI ) z score , 2.15 ( 0.40 ) ; and percentage overweight from the median BMI for age and sex , 64.3 % ( 19.9 % ) . INTERVENTIONS All participants received a comprehensive family-based pediatric weight management program  ( JOIN for ME ) . Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program . Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program . MAIN OUTCOMES AND MEASURES Objective ly measured daily moderate-to-vigorous and vigorous physical activity , percentage overweight , and BMI z score . RESULTS Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous ( mean [ SD ] , 7.4 [ 2.7 ] min/d ) and vigorous ( 2.8 [ 0.9 ] min/d ) physical activity at week 16 ( P < .05 ) . In the program-only group , a decline or no change was observed in the moderate-to-vigorous ( mean [ SD ] net difference , 8.0 [ 3.8 ] min/d ; P = .04 ) and vigorous ( 3.1 [ 1.3 ] min/d ; P = .02 ) physical activity . Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16 . However , the program and active gaming group exhibited significantly greater reductions in percentage overweight ( mean [ SD ] , -10.9%[1.6 % ] vs -5.5%[1.5 % ] ; P = .02 ) and BMI z score ( -0.25 [ 0.03 ] vs -0.11 [ 0.03 ] ; P < .001 ) . CONCLUSIONS AND RELEVANCE Incorporating active video gaming into an evidence -based pediatric weight management program has positive effects on physical activity and relative weight . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01757925 Exergames are videogames that require gross motor activity , thereby combining gaming with physical activity . This study examined the role of competitive versus cooperative exergame play on short-term changes in executive function skills , following a 10-week exergame training intervention .  Fifty-four low-income overweight and obese African American adolescents were r and omly assigned to a competitive exergame condition , a cooperative exergame condition , or a no-play control group . Youths in the competitive exergame condition improved in executive function skills more than did those in the cooperative exergame condition and the no-play control group . Weight loss during the intervention was also significantly positively correlated with improved executive function skills . The findings link competitive exergame play to beneficial cognitive outcomes for at-risk ethnic minority adolescents Background Child fruit and vegetable intake is below recommended levels , increasing risk for chronic disease . Interventions to influence fruit and vegetable intake among youth have had mixed effects . Innovative , theory-driven interventions are needed . Goal setting , enhanced by implementation intentions ( i.e. , plans tightly connected to a behavioral goal ) , may offer a solution . Action plans state “ how ” a goal will be achieved , while coping plans identify a potential barrier and corresponding solution . The research reported here evaluated the short- and long-term effects of goal setting enhanced with implementation intentions on child fruit and vegetable intake in a 10-episode , theoretically-grounded serious videogame promoting fruit and vegetables . This is one of the first studies to test the efficacy of implementation intentions on the dietary intake of healthy children . Methods A four-group r and omized design with three data collection periods ( baseline , immediate post-intervention , 3 months post-intervention ) was employed . Groups varied on whether children created an implementation intention ( none , action , coping , both ) as part of goal setting . Participants were 4th and 5th grade children ( ~9 - 11 years old ) and one parent . An a priori power analysis indicated this would provide > 80 % power to detect a small effect ( Cohen ’s d = 0.17 ) . Children played a 10-episode online videogame ; parents received 10 electronic newsletters and access to a parent-only website . The primary outcome was child fruit and vegetable intake , assessed via three , dietitian-assisted telephone recalls at each data collection period . The primary analysis was conducted using a repeated measures analysis of covariance with a mixed model procedure . Secondary analyses examined intervention effects on fruit and vegetables separately . Results Four hundred parent/child dyads were recruited . A significant group-by-time interaction for fruit and vegetable intake ( p < 0.001 ) was found in only the Action group , which had significant increases in fruit and vegetable intake at post 1 ( p < 0.0001 ) and post 2 ( p < 0.0001 ) . No other significant interactions were observed ; however , there were significant time effects for fruit ( p < 0.0001 ) . Conclusions Action intentions may be an important component of successful interventions to increase and maintain fruit and vegetable intake in pre-adolescent children .  Videogames promoting healthy diets offer an effective vehicle for delivering behavior change interventions to children . Trial registration Clinical Trials.gov NCT01004094 Physical inactivity among children is a serious public health problem . It has been suggested that high levels of screen time are contributory factors that encourage sedentary lifestyles in young people . As physical inactivity and obesity levels continue to rise in young people , it has been proposed that new-generation active computer- and video-console games ( otherwise known as “ exergaming ” ) may offer the opportunity to contribute to young people 's energy expenditure during their free time . Although studies have produced some encouraging results regarding the energy costs involved in playing active video-console games , the energy costs of playing the authentic versions of activity-based video games are substantially larger , highlighting that active gaming is no substitute for real sports and activities . A small number of exergaming activities engage children in moderate-intensity activity , but most do not . Only 3 very small trials have considered the effects of exergaming on physical activity levels and /or other health outcomes in children . Evidence from these trials has been mixed ; positive trends for improvements in some health outcomes in the intervention groups were noted in 2 trials . No adequately powered r and omized , controlled trial has been published to date , and no trial has assessed the long-term impact of exergaming on children 's health . We now need high- quality r and omized , controlled trials to evaluate the effectiveness and sustainability of exergaming  , as well as its clinical relevance ; until such studies take place , we should remain cautious about its ability to positively affect children 's health Objective . To evaluate the efficacy and feasibility of a multifaceted , community-based weight intervention program for children using exergaming technology ( activity-promoting video gaming ) .  Design and Methods . This is a prospect i ve observational pilot study . Forty-eight children , between the ages of 8 and 16 years , who are overweight or obese , enrolled in Exergaming for Health , a multidisciplinary weight management program , which used active video gaming . Primary outcome measures were change in body mass index ( BMI ) z scores . Results . Most children ( n = 40 , 83 % ) completed the program and participated in outcome evaluations . The average BMI change was −0.48 kg/m2 ( SD = 0.93 ) , P < .002 ( BMI z-score change was −0.072 , SD = 0.14 , P < .0001 ) . The average Global Self-Worth score improved , screen time and soda intake reduced , and exercise hours per week increased . Conclusions . The Exergaming for Health program may be an effective weight management intervention that is feasible with high participation rates . A larger r and omized controlled trial is needed to confirm these results OBJECTIVE This study evaluated the effect of four active videogames ( AVGs ) varying in behavioral contingencies ( behavior-consequence relations ) on  adolescent AVG play and overall activity levels over 4 weeks . MATERIAL S AND METHODS Each AVG , manufactured by SSD/Xavix ( ® ) ( Shiseido Co. of Japan , Tokyo , Japan ) , was coded and scored for the number of positive and aversive behavioral contingencies within the games . " Bowling " and " Tennis " were classified as having " higher contingency scores , " and " Boxing " and aerobic fitness training were classified as having " lower contingency scores . " Adolescents ( n=63 ; 11 - 15 years old ; 62 % male ; 38 % Hispanic ; 44 % overweight or obese ) were r and omized to play one of the four AVGs at home and recorded game play sessions in a paper log . Baseline and week 4 assessment s were completed at home ; week 1 , 2 , and 3 assessment s were completed by telephone . Accelerometers were worn during baseline and weeks 1 and 4 . RESULTS Accelerometer-measured sedentary and light activity hours/day were stable over time , whereas moderate-vigorous physical activity minutes/day increased in the higher contingency group and decreased in the lower contingency group ( interaction effect , 6.43 , P=0.024 ) . Reported game play minutes decreased in both groups from week 1 to week 4 ( -29.42 minutes , P=0.001 ) . DISCUSSION There was some support for the hypothesis that AVGs with more behavioral contingencies , compared with AVGs with fewer behavioral contingencies , result in more physical activity . However , overall AVG play decreased substantially after the first week . Further study is needed to better underst and how behavioral contingencies can be used in AVGs to enhance their potential to provide health benefits to game players BACKGROUND Fruit , juice , and vegetable  ( FJV ) consumption among children is low . Innovative programs are needed to enable children to increase FJV intake . Psychoeducational multimedia permits the delivery of interventions as design ed and capitalizes on known behavior change principles . DESIGN Elementary school was the unit of recruitment , assignment , and analysis . Twenty-six elementary schools were pair matched on size and percentage of free or reduced-price lunch , and r and omly assigned to treatment or control groups . Data were collected just before and just after the program . SETTING / PARTICIPANTS All fourth- grade students in participating elementary schools were invited to participate . Data were collected on 1578 students . MAIN OUTCOME Servings of fruit , 100 % ju 
    Output:
    