Efectos de un programa de actividad física basado en los avances tecnológicos: los entornos virtuales motrices como promotores de salud

Edited by: D.A.A. Scientific Section Martos (Spain) [email protected] Received: 10/05/2020 Accepted: 18/06/2020 Correspondence to: M. J. Gomis-Gomis University of Alicante Department of Didactics Email: mjgo[email protected]m Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 31 Original EFECTOS DE UN PROGRAMA DE ACTIVIDAD FÍSICA BASADO EN LOS AVANCES TECNOLÓGICOS: LOS ENTORNOS VIRTUALES MOTRICES COMO PROMOTORES DE SALUD EFFECTS OF PHYSICAL ACTIVITY PROGRAM BASED ON TECHNOLOGICAL PROGRESS: EXER-GAMES AS HEALTH PROMOTERS Gomis-Gomis, M. J.1; Chacón-Borrego, F.2; Pérez-Turpin, J. A.1. 1Department of Didactics, University of Alicante (Spain) 2Department of Physical Education and Sport, University of Sevilla (Spain) Gomis-Gomis, M. J.; Chacón-Borrego, F.; Pérez-Turpin, J. A. (2022). Effects of physical activity program based on technological progress: exer-games as health promoters. Journal of Sport and Health Research. 14(1): 31-50. Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 32 RESUMEN La finalidad de este trabajo es analizar la mejora en la salud y calidad de vida de los niños/as y jóvenes detectados con sedentarismo y/o sobrepeso, mediante la aplicación de un programa de entrenamiento basado en los entornos virtuales motrices. En el estudio participaron un total de 359 niños y niñas de entre 3 y 12 años pertenecientes a cuatro centros escolares, de los que se seleccionaron 20 niños de entre 5 y 12 años, para formar dos grupos de 10 niños/as cada uno. El grupo experimental llevó a cabo el programa de entrenamiento, junto a pautas nutricionales, mientras que el grupo control no tuvo ninguna intervención. Las variables analizadas fueron el IMC y perímetro de la cintura, mediante mediciones antropométricas, el tiempo de uso de pantalla, el tipo de desplazamiento al colegio y el nivel de adherencia a la dieta mediterránea, medidos mediante cuestionario, y la imagen corporal, evaluado a través de las siluetas. Para complementar la investigación, se efectuaron valoraciones nutricionales iniciales y finales al grupo experimental. Se analizaron los estadísticos descriptivos para todas las variables, calculando para las variables cuantitativas la media, mediana y desviación típica; porcentajes y frecuencias para las variables cualitativas. Los resultados obtenidos pueden indicar que un programa de intervención motriz basado en los entornos virtuales motrices contribuye a promover la salud de los escolares con rasgos de sedentarismo y/o sobrepeso. Palabras clave: sedentarismo; sobrepeso; salud; entornos virtuales motrices; escolares. ABSTRACT The purpose of this work is to analyse the improvement in the health and quality of life of children and youth detected with sedentary lifestyle and/or overweight, through the application of a training program based on exer-games. A total of 359 boys and girls between the ages of 3 and 12 from four schools participated in the study, from which 20 children between the ages of 5 and 12 were selected, to form two groups of 10 children each. The experimental group carried out the training program, together with nutritional guidelines, while the control group had no intervention. The variables analysed were the BMI and waist circumference, through anthropometric measurements, screen time, the type of commute to school and the level of adherence to the Mediterranean diet, measured by questionnaire, and body image, evaluated at through the silhouettes. To complement the research, initial and final nutritional evaluations were carried out on the experimental group. Descriptive statistics for all variables were analysed, calculating the mean, median and standard deviation for the quantitative variables; percentages and frequencies for qualitative variables. The results obtained may indicate that a motor intervention program based on exer-games contributes to promoting the health of students with sedentary and/or overweight traits. Keywords: sedentary lifestyle; overweight; health; exer-games; schoolchild. Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 33 INTRODUCTION In today's developed societies, sedentary lifestyle and being overweight are a serious problem, especially among children and young people, since these stages are considered essential for acquiring healthy and active lifestyle habits that are far from the negative repercussions of inactivity. Physics (Sallis & Owen, 1999; Hernández, Varo & González, 2003). Numerous studies link overweight or obesity in the early ages with health problems and obesity in adulthood (World Health Organization, 2019; Dobashi, Takahshi, Nagahara, Tanaka & Itabashi, 2017), especially the relationship with diabetes and cardiovascular diseases, as well as with regard to mortality in adults (Ortega, Lavie & Blair, 2016; Bellisimo & Akhavan, 2015; De Ruiter, Olmedo-Requena, Sánchez-Cruz & Jiménez- Moleón, 2017; Fan, Song, Chen, Hui & Zhang, 2013; Eckel, Meidtner, Kalle-Uhlmann, Stefan & Schulze, 2016; Umer et al., 2017; Zapico, Blández & Fernández, 2010). According to the study carried out by NCD Risk Factor Collaboration (2017), the problem of excess weight in children worldwide, leads to health complications during the rest of life; it needs national and international measures for its treatment from comprehensive policies. Sedentary lifestyle refers to all behaviour that occurs especially in a sitting or lying position, whose energy expenditure is at a level equal to or less than 1.5 METS, considering a MET the energy consumed during the resting state (The Sedentary Behaviour and Obesity Expert Working Group, 2010; Sedentary Behaviour Research Network, 2012; cit. in Solomon- Moore et al., 2017). The WHO (World Health Organization, 2019) defines overweight and obesity as an accumulation of abnormal or excess fat associated with health problems. As fundamental causes of overweight and obesity, we find the change in world food towards foods composed mostly of fats and sugars, with a high calorie intake and with a minimal contribution of vitamins, minerals and healthy micronutrients; as well as the low physical activity and sedentary lifestyle associated with recreation that characterize current societies, together with the change in the type of transport (Santaliestra- Pasías et al.,2015; Sánchez-López et al., 2017; cit. in Sánchez-López, 2017; World Health Organization, 2019; Aguilar-Cordero et al., 2014; Ferrari et al., 2012). Active commuting to school is considered an important form of physical activity for children (Lubans, Boreham, Kelly & Foster, 2011; Chillón, Hales, Vaughn & Gizlice, 2014), investigations such as that carried out by Faulkner, Buliung , Flora & Fusco (2009) show that children who travel to school on foot, by bicycle or on a skateboard tend to be more physically active in general than children with a passive trip to school. We also highlight the increasing of screen time through television, video games, tablets ... along with the decrease in hours of sleep associated with these habits, increased in families with low levels of economic income and low educational level (AECOSAN, 2016; Varela-Moreiras et al., 2013; Ahrens et al., 2014). The International Obesity TaskForce (IOTF, 2019), also associates musculoskeletal problems, skin problems and infertility, respiratory difficulties, increased risk of premature death and certain types of cancer with obesity; in addition to hypertension and cholesterol. It also identifies the importance of the psychological consequences in obese people, such as low selfesteem, anxiety and depression. We emphasize in this sense the influence of overweight and obesity on body image and socialization (Varela-Moreiras et al., 2013). In this sense, Salvador, García-Gálvez & De la Fuente (2010) studied the relationship between the weight of young people with satisfaction or dissatisfaction with their body image and self-esteem, with body image being the vision that each person has about their body and parts of it, being decisive in the state of health of childhood and adolescence (Sánchez-Castillo, López- Sánchez, Ahmed & Díaz Suárez, 2019). The WHO (World Health Organization, 2019) indicates a series of general recommendations on the consumption of fruits and vegetables, legumes, cereals and nuts, avoiding the consumption of saturated fats and sugars, in addition to carrying out a physical activity of at least 60 minutes at day. Aguilar-Cordero et al. (2014), in their objective of analysing the main studies on physical activity to reduce overweight and obesity, find that the best physical activity program is the one that combines aerobic and anaerobic activities, with better results on the reduction of overweight and obesity if it is accompanied by nutritional guidelines; a diet-only program also has minor effects than the sum of diet and physical activity; in accordance with the results of the studies by Solís et al. (2015) and Zapico et al. (2010) who carried out a joint program between diet and physical activity. Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 34 The Mediterranean lifestyle is considered the best pattern for the prevention and treatment of sedentary lifestyle, overweight and obesity (Varela-Moreiras el al., 2013; Zapico et al. 2010); considering it in its three pillars: diet, physical activity and socialization; through its gastronomic culture prioritizing fresh and seasonal food, the social aspect of meals, regular physical activity and rest. Given this reality, one of the reasons for carrying out this study is the need to seek effective strategies to encourage voluntary participation in regular physical activities (Baranowski, Buday, Thompson & Baranoswski, 2008). The choice of activity is closely related to the level of enjoyment it brings (Mellecker & McManus, 2008; Epstein, Beecher, Graf & Roemmich, 2007), in fact, the reason that most often justifies participation in physical activities by of children is the extent of their “fun” character (Borra, Schwartz, Spain & Natchipolsky, 1995). Similarly, this motivation is what drives your interest in sedentary activities, such as video games. In a society immersed in technologies and with high rates of sedentary lifestyle, active video games or virtual motor games represent a new social phenomenon that can have benefits for public health. Recent review papers on the role that video games can play in promoting healthy behaviours (Baranowski et al., 2008) or the possibilities offered by new technologies to deal with childhood obesity (Hillier, 2008), have already made reference to the potential of active video games as a tool to promote physical activity. With a proper approach, the perception of enjoyment does not decrease even when the level of physical demand increases as a consequence of the inclusion of active video games (Berkovsky, Coombe, Freyne, Bhandari & Baghaei, 2010). Virtual reality can promote overweight or obese children to have fun exercising (Baños et al., 2016). We know that active videogames involve higher Energy Expenditure (GE), Heart Rate (FC) and Maximum Oxygen Consumption (VO2max) than conventional videogames or other sedentary behaviours such as watching television (Lanningham-Foster et al., 2009; Graves, Stratton, Ridgers & Cable, 2007; Graves, Ridgers & Stratton, 2008; Maddison et al., 2007; Mellecker & McManus, 2008). Given this reality, we propose as a general objective of this study to investigate the use of technological advances, to verify the improvement in the health of Spanish schoolchildren detected as sedentary and/or overweight, by applying a personalized training program, based on exer-games. As specific objectives, we intend to improve the health of detected schoolchildren who are treated with exer-games, assess the anthropometric changes produced in children, analyse the importance of the commuting to school for children in relation to the level of sedentary lifestyle and overweight, examine the influence of screen time as a determinant of sedentary lifestyle and overweight, assess the effect of nutritional guidelines on sedentary behaviour and excess weight, detect psychological factors related to physical inactivity and, of course , provide relevant information on the possibilities of evaluating sedentary lifestyle and overweight. METHODS Participants The reference sample size for the study consists of a voluntary initial sample of a total of 359 boys and girls (192 boys and 167 girls) aged between 3 and 12 years, 13 boys and 14 girls from Early Childhood Education and 179 boys and 153 girls of Primary Education, belonging to four schools in the province of Alicante. Of the 359 boys and girls who initially make up the sample, for our research we have finally selected a total of 20 boys and girls (10 boys and 10 girls) aged between 5 and 12 years, diagnosed as having a level of Body Mass Index (BMI) equal to or above the level listed by the WHO (World Health Organization, 2019) as overweight, presenting symptoms of sedentary lifestyle and/or convenience according to their family, school, social, cultural and psychological situation reported by the school. Considering BMI as an indicator of overweight or obesity, according to the WHO (World Health Organization, 2019), for adults, overweight corresponds to a BMI equal to or greater than 25; considering obesity a BMI equal to or greater than 30. For children, in addition to BMI, we must take into account age and gender when establishing levels of obesity or overweight. Up to the age of five, the weight for height that deviates from the median of the infant growth patterns established by the WHO by more than two standard deviations is considered overweight; obesity is due to more than three standard deviations. Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 35 From age five to nineteen, BMI is considered overweight for age that deviates from the median established by WHO child growth standards by more than one standard deviation; obesity corresponds to more than two standard deviations. As indicated by Varela-Moreiras et al. (2013), considering the BMI curves according to age and gender, obesity corresponds to a percentile equal to or greater than 95, overweight with a percentile equal to or greater than 85 to below 95. Design Depending on the nature of the objectives to be achieved, in this research a quasi-experimental design has been adopted, in which the subjects were chosen in accordance with certain criteria, taking measures before and after the intervention, in two groups, experimental group A and control group B. The experimental group was made up of a total of 10 children (4 girls and 6 boys). The experimental group underwent a physical activity program through technological advances, using exer-games for this. The experimental group was divided into two subgroups of 5 children each, each subgroup carrying out a total of 3 sessions lasting 60 minutes each, establishing one session per week, for a total of three weeks of intervention. The experimental group, during the three weeks of intervention, also underwent a nutrition program based on initial and final evaluations, in addition to an individual session with each boy and girl with their families, in which they were offered guidelines and advice nutritional. On the other hand, the control group made up of 10 children (6 girls and 4 boys) diagnosed in the initial evaluation with symptoms of sedentary lifestyle and overweight, did not participate in any of the programmed activities and only the initial and final measures were collected. In the present study, six variables were analysed as indicators of the level of sedentary lifestyle and/or overweight for the entire sample. Anthropometric measurements, specifically, firstly, BMI, for the calculation of which weight and height were measured, since it results from dividing the weight expressed in kilos by the height squared expressed in meters (Kg/m2); and secondly, the waist circumference. Thirdly, screen time, the type of commuting to school as the fourth study variable, the level of adherence to the Mediterranean diet in fifth place and, finally, body image as the last study variable. Regarding anthropometric measurements, we have followed the indications of the ALPHA project (Ruiz et al., 2011) for the choice of BMI and waist circumference as indicators of body composition in children from the six years, following their measurement criteria, using a Taurus model scale and a tape measure. We have based ourselves on the PREFIT battery of field tests (Ortega et al., 2015) for evaluation in pre-schoolers, that is, in boys and girls under the age of six (from three to five years), which is the continuation of the project ALPHA. The variable of screen time has been used as an indicator of sedentary lifestyle in children and, therefore, as a possible factor contributing to the level of overweight. It is considered that there is a relationship between hours of screen time with a poorer quality of life and greater chances of being overweight, with an exposure greater than or equal to 2 hours of screen time per day (Stiglic & Viner, 2019). Following Stiglic & Viner (2019), in the present study, the screen time referred to the time dedicated to the use of the computer, mobile, tablet or television, in an item of the questionnaire provided to children, distinguishing between 1 hour, 2 hours, 3 hours or 4 hours, assigning the 4-hour response as a level 0 for considering it excessive, and the rest with a level 1 for being less harmful to children's health. Following Rodríguez-Rodríguez, Cristi-Montero, Celis-Morales, Escobar-Gómez & Chillón (2017), to evaluate the type of displacement that each child goes to school, two categories belonging to an item of the questionnaire used were distinguished. in research, provided to children. Firstly, active displacement (riding or cycling) and passive displacement (car, motorcycle or bus). The KIDMED test for adherence to the Mediterranean diet is made up of 16 questions whose total score can lead to an optimal diet (score greater than or equal to 8), need for improvement (from 4 to 7) or of very low quality (Serra-Majem et al., 2007; cit. in Solís, 2015). In our case, we used the KIDMED test adapted to Early Childhood Education and the first years of Primary Education, with drawings to represent the Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 36 possible answers in 10 items. Each item was rated with a 1, if the answer was for a healthy diet, or 0, when the answer was for an unhealthy diet, adding up all the scores and obtaining an index. The higher the index, the greater adherence to the Mediterranean diet. Specifically, only in the experimental group, at the nutritional level, those related to body composition using portable bioimpedance (TANITA BC-601) and child anthropometry (measurements of the rest of body perimeters, skin folds and diameters) have also been used as quantitative tools. arm and leg bones); testing at the beginning and end of the study. In order to study eating habits, the self-administered short consumption frequency questionnaire (CFC) was also administered to parents at the beginning of the program, validated for the Spanish population (Trinidad-Rodríguez & Fernández-Ballart, 2008) and the 24-hour reminder (R24), used by Serra-Majem et al. (2004), among other authors, through a personal interview in the presence of the parents/guardians of each child, before and after the program. For the development of the nutritional advice session with families, the Hardvard balanced plate was used with the instructions for use, the Mediterranean healthy eating wheel with explanation, a table with the recommended frequency of consumption of the different food groups and an example of weekly distribution. The silhouettes of Stunkard, Sorensen and Schlusinger (1983) constitute an instrument for evaluating body image, consisting of nine silhouettes from the thinnest to the most obese, in which children must choose the image they think corresponds to their body and the image they would like to have (Stunkard et al., 1983; cit. in Sánchez-Miguel, González, Sánchez-Oliva, Alonso & Leo, 2018). In our case, the children rounded off the silhouette with which they felt most identified and were also asked to draw a tenth silhouette. Therefore, 10 figures formed the basis for evaluating the instrument. For each school, the lowest BMI in the sample and the highest BMI were chosen as references to form a segment, dividing this segment into 10 portions or sections and assigning to each section a minimum and maximum BMI value; in such a way that given the chosen figure rounded and considering the BMI assigned to that section, each section was subtracted 0.10 until reaching the section corresponding to its actual BMI. The children had a 1 point in the silhouettes as long as the value of their real BMI was within the section corresponding to that BMI. To carry out the training program, we were able to count on the basic gym equipment of each school (mats, cones, Swedish benches, balloons, chairs and rings). In addition, we use the following technological material: - Maxforce interactive dynamometer - Samsung Galaxy TAB A 10.1 ”32 GB T580 Tablet - Samsung Gear Fit 2 Pro Black Activity Tracker - Xbox 360 game console - Kinect Adventures action video game, with the Kinect sensor for Xbox 360 - Digital board and computer provided by each school The Maxforce interactive dynamometer is considered a motivating scientific instrument for measuring force and training a variety of muscle groups, given its audio-visual support in tablet or mobile format in which children view interactive games in which they participate with their dynamometer, working the force in the upper and lower body, in a variety of exercises; dynamometer whose validity and reliability have been endorsed by Pérez-Turpin, Gomis-Gomis, Pérez- Suárez & Suárez-Llorca (2019). Using the activity bracelet, we can record heart rate and heart zones and obtain statistics of the sessions carried out, in order to develop training sessions more appropriately and as a motivating element for children. The Xbox 360 video game console with the action video game Kinect Adventures was used as a tool in the training of children, and could be used as a more motivating instrument than traditional exercise, as shown by the study of this exergame by McDonough, Pope, Zeng , Lee & Gao (2018) and even have application in training for the rehabilitation of certain pathologies (Arman, Tarakci, Tarackci & Kasapcopur, 2019). Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 37 Procedures Prior to the start of the study, the management of the centre was informed about the objectives and type of tasks to be carried out during the course of the investigation. In addition, informed consent was obtained in writing from all the fathers, mothers or guardians of the children included in the study, who also collaborated in the study. The data collection in the initial phase was carried out at the facilities of the University of Alicante, where each school was invited one day to make an excursion in which they enjoyed a circuit of stations; anthropometric measurements constituted one of the stations and another station the silhouettes of Stunkard, Sorensen and Schlusinger (1983) together with the questionnaire. This questionnaire was made up of 10 nutritional items, 1 item related to screen time and a last item on the type of commute to school, with a total of 12 items that were answered directly by each child; with the help and explanation from professional collaborators. The intervention phase for the Experimental Group was carried out for 3 weeks, between the months of May and June 2018, which consisted of the application of a training program using exer-games together with nutritional guidelines, as well as specific measurements of the nutrition program. The measurements of the nutrition program were carried out the week before and the week after with respect to the duration of the training program, taking place in a session in each school in the morning and with the families to indicate the nutritional guidelines. The experimental phase was carried out by dividing into two groups of 5 children each, each subgroup carrying out a total of 3 sessions lasting 60 minutes each, one session a week for the 3 weeks duration, through games in five stations, in the afternoon after the end of the school day. In each session, the children had 4 coaches, with the sessions of the intervention phase being carried out in each school, in a classroom equipped for the program. The nutrition program and nutritional assessments were conducted by an experienced nutritionist, ISAK I anthropometrist. After the program, a session was held in each centre to evaluate and measure again the same variables as in the initial evaluation. Statistical Analysis For the analysis of the data, the Statistical Package for Social Sciences (SPSS) v. 25.0 for Windows, a normality and variance homogeneity test were initially performed, applying the Student's t test for independent samples, without statistically significant differences in the sample data. The level of significance was determined as p≤0.05 for significant values. Descriptive statistics for all variables were analysed, calculating the mean, median and standard deviation for the quantitative variables; percentages and frequencies for qualitative variables. The DIAL diet analysis program was used to analyse the results obtained in R24 for the experimental group. RESULTS This section shows the results obtained in the present investigation, with the graphic representation of the most relevant data. Firstly, the main descriptive statistics of the study variables are analysed, specifically, those referring to the anthropometric variables BMI and waist circumference, adherence to the Mediterranean diet as a factor related to nutritional intake and body image in Regarding the perception of health. Second, the frequencies and percentages of the categorical variables related to the screen time and the type of commuting to school are estimated. The descriptive study begins with Table 1 and Table 2. In Table 1 we can see the statistics referring to the pre-test, both in the control group and in the experimental group; Table 2 shows the statistics for the post-test; In both cases, an attempt was made to establish the mean, median and standard deviation for each variable, in addition to including the data referring to weight and height. Regarding the standard deviation in the experimental group, for each variable a decrease is observed from the results of the pre-test and the post-test, which seems to indicate more homogeneous results regarding the mean in this group after the intervention phase, especially in adherence to the Mediterranean diet and body image. Regarding the control group, less pronounced decreases in the standard deviation of the variables are observed, except for the case of the waist circumference. Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 38 The median for the BMI case in the control group remains the same in the post-test, while in the experimental group it decreases. The median waist circumference for the experimental group decreased after the intervention, going from 80.5 to 78.5, contrary to what occurs in the control group, with an increase from 74.2 to 78. Regarding adherence to the Mediterranean diet, in the experimental group it remains in the highest score, that is, 10; in the control group it decreases from 9.5 to 9. Lastly, the median body image remains the same in the control group, increasing in the experimental group to its value 1, which is the maximum. The graphical representation of the relationship of means between the pre-test and post-test for both groups is made from Table 3, with the comparison of means for each of the numerical variables of the study. Table 1. Pre-test statistics Weight Height BMI W cir. M.D. B imag. CG, n=10 Mean 41.992 1.3772 21.705 76.14 8.9 0.52 Median 44.45 1.4 22.35 74.2 9.5 0.5 S Dev. 9.28409 0.12503 1.5205 8.58943 1.37 0.09189 EG, n=10 Mean 50,75 1.43 24.789 75.9 9.4 0.84 Median 50,8 1.445 26.1 80.5 10 0.85 S Dev 12.0920 0.12018 4.7457 14.3329 1.265 0.14298 Table 2. Post-test statistics Weight Height BMI W cir. M.D. B imag. CG, n=10 Mean 44.79 1.393 22.72 76.3 9 0.53 Median 46.45 1.435 22.35 78 9 0.5 S Dev. 10.1018 0.12884 1.4987 7.14998 1.054 0.06749 EG, n=10 Mean 50,26 1.43 24.215 74 9.8 0.99 Median 51.15 1.445 25.215 78.5 10 1 S Dev 11.9482 0.12018 4.5391 13.7436 10.44 0.03162 Table 3. Comparison of means according to the group in Pre-test and Post-test Pre-test Post-test Control Group, n=10 Weight 41.992 44.79 Height 1.3772 1.393 BMI 21.705 22.72 Waist circumference 76.14 76.3 Mediterranean Diet Adher. 8.9 9 Body image 0.52 0.53 Experimental Group, n=10 Weight 50.75 50.26 Height 1.43 1.43 BMI 24.789 24.215 Waist circumference 75.9 74 Mediterranean Diet Adher. 9.4 9.8 Body image 0.84 0.99 In Figure 1, we observe how the mean BMI in the experimental group decreases from 24,789 to 24,215 after the intervention phase, while the mean BMI for the experimental group increases, from 21,705 to 22.72. The same trend follows the waist circumference, whose average increases for the control group, from 76.14 to 76.3, being lower in the post-test for the experimental group, going from an initial average of 75.9 to a final average of 74. at the mean values of adherence to the Mediterranean diet, improvement in both groups in the post-test; however, in the experimental group there is a greater increase, from 9.4 to 9.8, than in the control group in which it only improves from 8.9 to 9. Finally, in body image, the mean values rise in the experimental group of 0.84 to 0.99; while in the control group they improve only slightly, from 0.52 to 0.53. Figure 1. Representation of the means of the quantitative variables The following tables show the frequencies and percentages related to screen time and type of commute to school, for the pre-test (Table 4) and the post-test (Table 5). Regarding screen time, in the experimental group it remains the same both in the pre-test and in the posttest, in its maximum and most appropriate value, since 100% of the children who formed part of the intervention continues to be exposed to technological screens for a maximum of 3 hours a day. In the control group, on the contrary, a worsening occurs, since in the pre-test 100% of the children used the new technologies for a time of up to 3 hours; In the post-test, one of the children increased their screen Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 39 time to more than 3 hours, which corresponds to 10% of this control group. Table 4. Pre-test frequencies Frequency Percentage Valid percentage Accumulated percentage CG, n=10 Screen time Up to 3 h 10 100 100 100 More 3 h 0 0 0 0 Com. school Passive 10 100 100 100 Active 0 0 0 0 EG,n=10mG, Screen time Up to 3 h 10 100 100 100 More 3 h 0 0 0 0 Com.school Passive 3 30 30 30 Active 7 70 70 100 Table 5. Post-test frequencies Frequency Percentage Valid percentage Accumulated percentage CG, n=10 Screen time Up to 3 h 9 90 90 90 More 3 h 1 10 10 100 Com.school Passive 10 100 100 100 Active 0 0 0 0 EG,n=10erea Screen time Up to 3 h 10 100 100 100 More 3 h 0 0 0 0 Com. school Passive 1 10 10 10 Active 9 90 90 100 A more exhaustive analysis of the type of commuting to school can be done by looking at the following graphs that represent the percentage of active travel to school and the percentage of passive travel (Figure 2). It is alarming to verify that in the control group, the active displacement represents the value 0 for all children, therefore, 100% passively travels to school both in the pre-test and in the post-test. In contrast, the experimental group increased in terms of active displacement, going from 70% in the pre-test to 90% in the post-test; so, the passive displacement decreases from 30% to a final 10%. Figure 2. Percentage of active and passive commuting to school To conclude, below, we highlight the main results derived from the nutritional program carried out only for the experimental group, made up of an anthropometric analysis together with a series of nutritional tips and guidelines. To carry out the nutritional analysis, the experimental group was divided into two subgroups based on BMI, the first group with children with a BMI above the average, equivalent to 90% of the group, and the second group with a BMI below the average, which includes 10% of children. From the anthropometry performed in the pre-test, it is observed that the group with a BMI above the average, presents an average percentage of fat mass of 36.3 ± 6.8% and 40.4 ± 2.4% in terms of muscle mass; the group with the BMI below the average presented a fat percentage of 10% and a muscle mass of 42.8%. In the post-test, 100% of the children in the experimental group reduced the percentage of total fat by between 1% and 4%, in 30% the muscle mass decreased slightly (0.5-1%). Regarding the consumption frequency questionnaire (CFC), in the subgroup with the BMI below the average, its average consumption is 1366 kcal, in which proteins represent 12.5%, carbohydrates a 36.6% and fat 49.6%. The average consumption of the subgroup with BMI above the average is 1951 ± 366 kcal, with 15.6 ± 3% protein, 47 ± 7.1% fat and 38.8 ± 7.9% carbohydrates. As regards the results obtained from R24, comparing the results of R24 in pre-test and post-test, we observe that the distribution of macronutrients and fibre intake have not changed; although there has been a decrease in caloric intake of 630 kcal, reaching 1714 ± 247 kcal/day. Daily sodium and cholesterol intake have also been reduced in the post-test, with 1762 ± 599 mg for mean sodium values and 258 ± 88 mg for cholesterol. Intake of saturated fats has also decreased by 1.6%, with a lower intake of processed foods, rich Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 46 dance and bicycle games in overweight and nonoverweight youth. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 33(2), 124–131. 24. Fan, J., Song, Y., Chen, Y., Hui, R., & Zhang, W. (2013). Combined effect of obesity and cardio-metabolic abnormality on the risk of cardiovascular disease: A meta-analysis of prospective cohort studies. International Journal of Cardiology, 168, 4761–4768. https://doi.org/10.1016/j.ijcard.2013.07.230 25. Faulkner, G. E. J., Buliung, R. N., Flora, P. K., & Fusco, C. (2009). Active school transport, physical activity levels and body weight of children and youth: a systematic review. Preventive Medicine, 48(1), 3–8. 26. Ferrari, T. K., de M. Ferrari, G. L., da Silva Júnior, J. P., da Silva, L. J., Oliveira, L. C., & Matsudo, V. K. R. (2012). Modifications of adiposity in school-age children according to the nutritional status: a 20-year analysis. Jornal de Pediatria, 88(3), 239-245. https://doi.org/10.2223/jped.2191 27. Graves, L. E. F., Ridgers, N. D., & Stratton, G. (2008). The contribution of upper limb and total body movement to adolescents’ energy expenditure whilst playing Nintendo Wii. European Journal of Applied Physiology, 104(4), 617–623. 28. Graves, L., Stratton, G., Ridgers, N. D., & Cable, N. T. (2007). Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study. BMJ, 335(7633), 1282– 1284. 29. Hernández, J. A. M., Varo Cenarruzabeitia, J. J., & González, M. Á. M. (2003). Beneficios de la actividad física y riesgos del sedentarismo. Medicina, 121(17), 665–672. 30. Hillier, A. (2008). Childhood Overweight and the Built Environment: Making Technology Part of the Solution rather than Part of the Problem. The Annals of the American Academy of Political and Social Science, 615(1), 56–82. 31.International Obesity TaskForce (2019). Retrieved from https://web.archive.org/web/2004082405200 3/http://www.iotf.org/ 32. Lanningham-Foster, L., Foster, R. C., McCrady, S. K., Jensen, T. B., Mitre, N., & Levine, J. A. (2009). Activity-promoting video games and increased energy expenditure. The Journal of Pediatrics, 154(6), 819–823. 33. Larouche, R., Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada., … Tremblay, M. (2014). Associations Between Active School Transport and Physical Activity, Body Composition, and Cardiovascular Fitness: A Systematic Review of 68 Studies. Journal of Physical Activity and Health, 11, 206–227. https://doi.org/10.1123/jpah.2011-034 34. López-Sánchez, G. F., Sgroi, M., D’Ottavio, S., Díaz-Suárez, A., González-Víllora, S., Veronese, N., & Smith, L. (2019). Body Composition in Children and Adolescents Residing in Southern Europe: Prevalence of Overweight and Obesity According to Different International References. Frontiers in Physiology, 10, 130. 35. Lubans, D. R., Boreham, C. A., Kelly, P., & Foster, C. E. (2011). The relationship between active travel to school and health-related fitness in children and adolescents: a systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 8, 5. 36. Maddison, R., Mhurchu, C. N., Jull, A., Jiang, Y., Prapavessis, H., & Rodgers, A. (2007). Energy Expended Playing Video Console Games: An Opportunity to Increase Children’s Physical Activity? Pediatric Exercise Science, 19, 334–343. https://doi.org/10.1123/pes.19.3.334 37. Manonelles-Marqueta, P., Alcaraz-Martínez, J., Álvarez-Medina, J., Jiménez-Díaz, F., Luengo-Fernández, E., Manuz-González, B., … Villegas-García, J. A. (2008). La utilidad de la actividad física y de los hábitos adecuados de nutrición como medio de prevención de la obesidad en niños y adolescentes. Documento de consenso de la Federación Española de Medicina del Deporte Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 47 (FEMEDE). Archivos de medicina del deporte, 25(127), 333-353. 38. Maximova, K., McGrath, J. J., Barnett, T., O’Loughlin, J., Paradis, G., & Lambert, M. (2008). Do you see what I see? Weight status misperception and exposure to obesity among children and adolescents. International Journal of Obesity, 32(6), 1008–1015. 39. McDonough, D., Pope, Z., Zeng, N., Lee, J., & Gao, Z. (2018). Comparison of College Students’ Energy Expenditure, Physical Activity, and Enjoyment during Exergaming and Traditional Exercise. Journal of Clinical Medicine, 7, 433. https://doi.org/10.3390/jcm7110433 40. Mellecker, R. R., & McManus, A. M. (2008). Energy expenditure and cardiovascular responses to seated and active gaming in children. Archives of Pediatrics & Adolescent Medicine, 162(9), 886–891. 41. Nagy, P., Kovacs, E., Moreno, L. A., Veidebaum, T., Tornaritis, M., Kourides, Y., … IDEFICS consortium. (2014). Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study. International Journal of Obesity, 38 Suppl 2, S15–S25. 42. National Institute for Health Research (2019). Retrieved from https://www.nihr.ac.uk/research-and- impact/research/nihr-studies/ 43. NCD Risk Factor Collaboration (NCD-RisC) (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet, 387, 1377–96. 44. Ortega, F. B., Cadenas-Sánchez, C., Sánchez- Delgado, G., Mora-González, J., Martínez- Téllez, B., Artero, E. G., … Ruiz, J. R. (2015). Systematic Review and Proposal of a Field- Based Physical Fitness-Test Battery in Preschool Children: The PREFIT Battery. Sports Medicine, 45, 533–555. https://doi.org/10.1007/s40279-014-0281-8 45. Ortega, F. B., Lavie, C. J., & Blair, S. N. (2016). Obesity and Cardiovascular Disease. Circulation Research, 118(11), 1752–1770. 46. Pérez-Turpin, J. A., Gomis-Gomis, M. J., Pérez- Suárez, P., & Suárez Llorca, C. (2019). Maxforce: The new option in strength, health levels and life expectancy measurement. Journal of Human Sport and Exercise, 14(4), 841-855. https://doi.org/10.14198/jhse.2019.144.13 47. Reid-Chassiakos, Y. L., Radesky, J., Christakis, D., Moreno, M. A., Cross, C., & COUNCIL ON COMMUNICATIONS AND MEDIA. (2016). Children and Adolescents and Digital Media. Pediatrics, 138(5). https://doi.org/10.1542/peds.2016-2593 48. Rodríguez-Rodríguez, F., Cristi-Montero, C., Celis-Morales, C., Escobar-Gómez, D., & Chillón, P. (2017). Impact of Distance on Mode of Active Commuting in Chilean Children and Adolescents. International Journal of Environmental Research and Public Health, 14(11). https://doi.org/10.3390/ijerph14111334 49. Rosenberg, D. E., Sallis, J. F., Conway, T. L., Cain, K. L., & McKenzie, T. L. (2006). Active transportation to school over 2 years in relation to weight status and physical activity. Obesity, 14(10), 1771–1776. 50. Ruiz, J. R., Castro-Pinero, J., Espana-Romero, V., Artero, E. G., Ortega, F. B., Cuenca, M. M., … Castillo, M. J. (2011). Field-based fitness assessment in young people: the ALPHA health-related fitness test battery for children and adolescents. British Journal of Sports Medicine, 45, 518–524. https://doi.org/10.1136/bjsm.2010.075341 51. Sallis, J. F., & Owen, N. (1999). Physical activity and behavioral medicine. Thousand Oaks: Sage Publications. 52. Salvador, M., García-Gálvez, C., & De la Fuente, M. (2010). Creencias y estrategias para el control del peso, satisfacción con la imagen corporal y autoestima. European Journal of Education and Psychology, 3, 257. https://doi.org/10.30552/ejep.v3i2.39 53. Sánchez-Castillo, S., López-Sánchez, G. F., Ahmed, M. D., & Díaz Suárez, A. Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 48 (2019). Imagen Corporal y Obesidad mediante las Siluetas de Stunkard en Niños y Adolescentes Indios de 8 a 15 Años, 19(1), 20- 32. 54. Sánchez-López, A. M. (2017). Valoración de una intervención educativa y actividad física en niños y adolescentes con sobrepeso y obesidad. (tesis de maestría). Universidad de Granada, Granada. 55. Sánchez-Miguel, P. A., González, J. J. P., Sánchez-Oliva, D., Alonso, D. A., & Leo, F. M. (2018). The importance of body satisfaction to physical self-concept and body mass index in Spanish adolescents. International Journal of Psychology. https://doi.org/10.1002/ijop.12488 56. Santaliestra-Pasías, A. M., Mouratidou, T., Reisch, L., Pigeot, I., Ahrens, W., Mårild, S., … Moreno, L. A. (2015). Clustering of lifestyle behaviours and relation to body composition in European children. The IDEFICS study. European Journal of Clinical Nutrition, 69(7), 811–816. 57. Scagliusi, F. B., Alvarenga, M., Polacow, V. O., Cordás, T. A., de Oliveira Queiroz, G. K., Coelho, D., … Lancha, A. H., Jr. (2006). Concurrent and discriminant validity of the Stunkard’s figure rating scale adapted into Portuguese. Appetite, 47(1), 77–82. 58. Serra-Majem, L., Ribas, L., Ngo, J., Ortega, R. M., García, A., Pérez-Rodrigo, C., & Aranceta, J. (2004). Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutrition, 7(7), 931–935. 59. Solís, D. P., Pérez Solís, D., Díaz Martín, J. J., Álvarez Caro, F., Suárez Tomás, I., Suárez Menéndez, E., & Riaño Galán, I. (2015). Efectividad de una intervención escolar contra la obesidad. Anales de Pediatría, 83, 19–25. https://doi.org/10.1016/j.anpedi.2014.08.010 60. Solomon-Moore, E., Sebire, S. J., Macdonald- Wallis, C., Thompson, J. L., Lawlor, D. A., & Jago, R. (2017). Exploring parents’ screenviewing behaviours and sedentary time in association with their attitudes toward their young child's screen-viewing. Preventive Medicine Reports, 7, 198–205. 61. Stiglic, N., & Viner, R. M. (2019). Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ Open, 9(1), e023191. 62. Tan, B., Aziz, A. R., Chua, K., & Teh, K. C. (2002). Aerobic demands of the dance simulation game. International Journal of Sports Medicine, 23(2), 125–129. 63. Tomiyama, A. J., Hunger, J. M., Nguyen-Cuu, J., & Wells, C. (2016). Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005- 2012. International Journal of Obesity, 40(5), 883–886. 64. Trinidad Rodríguez, I., & Fernández Ballart, J. (2008). Validación de un cuestionario de frecuencia de consumo alimentario corto: reproducibilidad y validez. Nutrición, 23(3), 242-252. 65. Umer, A., Kelley, G. A., Cottrell, L. E., Giacobbi, P., Innes, K. E., & Lilly, C. L. (2017). Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis. BMC Public Health, 17. https://doi.org/10.1186/s12889-017-4691-z 66. Unnithan, V. B., Houser, W., & Fernhall, B. (2006). Evaluation of the energy cost of playing a dance simulation video game in overweight and non-overweight children and adolescents. International Journal of Sports Medicine, 27(10), 804–809. 67. Varela-Moreiras, G., Alguacil Merino, L. F., Alonso Aperte, E., Aranceta Bartrina, J., Ávila Torres, J. M., Aznar Laín, S., … Zamora Navarro, S. (2013). Obesidad y sedentarismo en el siglo XXI: ¿qué se puede y se debe hacer? Nutricion Hospitalaria: Organo Oficial de La Sociedad Espanola de Nutricion Parenteral Y Enteral, 28, 1–12. 68. Wells, J. C. K., Williams, J. E., Chomtho, S., Darch, T., Grijalva-Eternod, C., Kennedy, K., … Fewtrell, M. S. (2012). Body-composition reference data for simple and reference techniques and a 4-component model: a new Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 49 UK reference child. The American Journal of Clinical Nutrition, 96(6), 1316–1326. 69. World Health Organization (2019). Retrieved from https://www.who.int/es 70. Zapico, A., Blández ngel, J., y Fernández García, E. (2010). Sobrepeso, obesidad y adecuacin a la dieta mediterránea en adolescentes de la Comunidad de Madrid. Archivos de Medicina del Deporte, 27(138), 271-280. Journal of Sport and Health Research 2022, 14(1):31-50 J Sport Health Res ISSN: 1989-6239 50