Does Exercising With a Screen or Music Lead to Post-exercise Energy Compensation in Adolescents?
Phase: NA
Conditions: Healthy
Sponsor: Children's Hospital of Eastern Ontario

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
  
BACKGROUND 
Exercising is a common strategy used by individuals to get health benefits and to 
control weight. However, compensatory adaptations in components of energy balance 
(i.e., energy intake and energy expenditure) are generally observed with exercise (1-3). 
The degree to which individuals compensate by increasing their food intake and/or 
decreasing their physical activity level subsequent to the exercise intervention is 
variable between individuals and may depend on many factors (4, 5). External stimuli 
such as screen time or music have been reported to increase food intake compared to a 
control condition with no distraction (6-8). However, previous studies have not looked at 
the influence of these stimuli on energy balance while exercising, thereby limiting 
inferences on whether exercising with or without a screen/music leads to different post-
exercise energy compensation that may ultimately impact body weight control. 
 
Electronic screen devices and/or music while exercising can serve as motivating 
factors, making it more pleasant and even easier for some people to exercise (9, 10). 
This finding may have positive implications for fitness professionals encouraging new 
exercisers and it is certainly something to keep in mind when one prescribes exercise. 
However, whether watching a screen or listening to music while exercising impacts 
components of energy balance is unknown. Gaining information on this issue will help to 
determine if people should care about the use of personal music players and/or screen 
devices while exercising with regard to body weight control. 
 
OBJECTIVE AND HYPOTHESIS 
The objective of this study will be to examine the effects of watching a screen or 
listening to music while exercising on acute energy intake and expenditure. We 
hypothesize that the post-exercise energy compensation will be greater in both 
conditions with stimuli (i.e., screen and music) compared with the control condition (i.e., 
exercise alone).       
 
STUDY DESIGN AND RESEARCH METHODS 
Study Design 
Randomized, 3-condition crossover study (within-subjects experimental design).  
 
Participants 
The present study will recruit 25 male adolescents between the ages of 13 and 17 
years. Participants will be recruited via advertisements in the community (e.g., grocery 
stores, fitness centers, restaurants), at CHEO, and through word of mouth. Volunteers 
will be excluded for any of the following reasons: smoking, unstable body weight (±4 kg) 
during the 3 months preceding testing, excessive alcohol intake (>15 drinks/week), 
celiac disease, metabolic disease (e.g., thyroid disease, heart disease, diabetes), 
medication use that could interfere with the outcome variables, highly restrained eating 
behavior (score of ≥12 for cognitive dietary restraint on the Three-Factor Eating 
Questionnaire), irregular sleeping pattern (e.g., shift work or working overnight shifts), 
and inability to comply with the protocol. Following a phone call with the potential 
participant to confirm eligibility and explain the study, consent forms will be mailed and 

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
will need to be returned to us in the pre-paid envelope provided before any testing can 
begin. Participants who are capable of consenting will be asked to do so on their own 
behalf; otherwise, written informed parental consent and child assent will be obtained. 
Ethical approval will be obtained from the Children’s Hospital of Eastern Ontario 
Research Ethics Boards. Participants will receive $30 per condition for their participation 
in the study ($120 total).   
 
Overview of the Study Protocol 
Preliminary Visit 
The participants will attend one baseline session and three experimental sessions, each 
separated by at least one week. All sessions will begin at 07:30, and the participants will 
be instructed to fast and abstain from structured exercise for 12 hours before each visit. 
The preliminary visit will include measurements related to anthropometry (body weight, 
height, waist circumference), resting metabolic rate and cardiorespiratory fitness (VO2 
peak). Participants will also complete questionnaires in order to better characterize 
them. During this initial visit, participants will be asked to identify any food allergies or 
intolerances that might impact the standardized breakfast and buffet meals provided 
during the experimental sessions. 
 
Experimental Sessions  
Each participant will be engaged in each of the following three 30-min experimental 
conditions followed by an ad libitum lunch: (1) walking/jogging on a treadmill at 60% 
of VO2 peak while watching a screen (exercise + screen); (2) walking/jogging on a 
treadmill at 60% of VO2 peak while listening to music (exercise + music); and (3) 
walking/jogging on a treadmill at 60% of VO2 peak with no other stimulus (control 
condition). These 3 conditions will be randomly assigned by using a computerized 
randomization scheme. Participants will be free to watch whatever they want on the 
screen and listen the music of their choice using a personal music player.                 
 
One at a time, on 3 separate occasions, the participant arrives at the laboratory 
(Children’s Hospital of Eastern Ontario Research Institute, Ottawa) at 07:30 after fasting 
for 12 hours. An accelerometer will be attached immediately on arrival and will be worn 
until bedtime. Visual analogue scales (VAS) will be used to record subjective measures 
of appetite at 07:45 (and at other time points during the day), and the participant will be 
provided a standardized breakfast at 08:00. The participant will then refrain from eating 
until the ad libitum lunch. The 30-min experimental intervention consists of 1 of the 3 
conditions, starting at 10:30. Participants will be asked to relax on a comfortable chair 
between the end of the breakfast and the beginning of the testing condition. After the 
experimental condition, an ad libitum test lunch will be given to the participant to 
evaluate spontaneous food intake. A dietary record will be used to assess food intake 
for the remainder of the day. A schematic overview of the study protocol is presented in 
the Appendix. 
 
Measurements  
Anthropometric Measurements 

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
Body weight will be measured without shoes in light clothing, after voiding, to the 
nearest 0.1 kg on a calibrated electronic scale. Height will be measured to the nearest 
0.1 cm with the participant standing against a wall-mounted stadiometer, feet together, 
without shoes and with the head in the Frankfort plane, after a deep inspiration. Body 
mass index (BMI) will be determined and interpreted with the WHO BMI-for-age growth 
charts (11). Waist circumference will be measured to the nearest 0.1 cm using a non-
extendable linen tape and measured midway between the lower border of the last rib 
and the upper border of the iliac crest at the end of a normal expiration.     
 
Breakfast  
A standardized breakfast will be given to the participants at 08:00, consisting of 2 pieces 
of whole-wheat bread (78 g, 837 kJ; D’Italiano), peanut butter (18 g, 452 kJ; Kraft 
Smooth Peanut Butter), raspberry jam (16 mL, 218 kJ; Kraft Pure Raspberry), cheddar 
cheese (21 g, 335 kJ; Kraft Cracker Barrel Marble), and orange juice (200 mL, 418 kJ; 
Minute Maid 100% Orange Juice). Participants will eat alone in a room with no 
distractions, and will need to consume the entire breakfast within 15 min. Participants 
with food intolerances will have individual food items replaced; however, they will 
receive an identical breakfast at each of the three visits.         
 
Ad libitum lunch 
Spontaneous food intake, including liquids, will be assessed by using an ad libitum food 
menu immediately after each experimental condition, which will allow us to assess both 
total energy intake and macronutrient preference (12). The food menu contains a variety 
of meal-type foods (both hot and cold), beverages, and snacks differing in macronutrient 
composition (74 items in total). The foods will be offered in large amounts, and the 
participants will be instructed to eat ad libitum, alone, in a room without distractions, with 
no restrictions on the amount to be consumed. The participants will be given 30 min for 
this meal, and all foods will be measured to the nearest 0.1 g before and after ingestion. 
Ad libitum energy intake will be measured by a food technician using calculations 
performed on the amount of the meal consumed. This type of food menu, which has a 
high appreciation of food items on the menu, has been shown to produce a reliable 
measure of energy intake inside the laboratory in both adults and adolescents (12, 13).     
 
Appetite Sensations 
For each condition, the participants will be instructed to complete 9 VAS for their 
sensations of hunger, satiety, prospective food consumption, fullness, and desire to eat 
something sweet, salty, or rich in fat. They will also rate their opinion on the general 
appreciation of the meal and on the overall satisfaction/enjoyment of the experimental 
conditions, from “extremely boring” to “extremely pleasant”. The VAS is a line (100 mm 
in length) with statements anchored at each end expressing the most positive and most 
negative rating of the participants’ appetite sensations. The VAS have been shown to 
be both reproducible and valid for measurement of appetite sensations in a laboratory 
setting (14). The VAS will be completed during each experimental condition: at fasting 
(07:45), before the experimental condition (10:25), immediately after the experimental 
condition (11:05), and immediately after the ad libitum lunch.   
 

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
Dietary Record    
All participants will be instructed to complete a dietary record (15), with help from the 
parents, after each experimental condition to evaluate the degree of potential 
compensation in food intake for the remainder of the day. Participants will be instructed 
on how to complete the dietary record and on how to measure quantities of ingested 
foods. The food records will be reviewed with each participant upon their return to 
improve the validity of the information provided. Mean energy and macronutrient intakes 
will be calculated by using the Food Processor SQL software (version 9.6.2; ESHA 
Research).       
 
Resting Metabolic Rate and Cardiorespiratory Fitness Measurements 
Resting metabolic rate (RMR) will be measured during the preliminary visit by indirect 
calorimetry (Vmax 229 series metabolic cart; SensorMedics). RMR will be measured for 
30 min after a 30-min rest period and a 12-h overnight fast. The first and last 5 min will 
be excluded from the calculations; thus, minutes 6-25 will be used in the calculation. 
Mean RMR will be calculated by using the Weir equation (16). VO2 peak will be 
measured using the same metabolic cart and using the Dubowy graded treadmill 
protocol (17). Exercise sessions on the treadmill will be set at 60% of VO2 peak 
(moderate-intensity physical activity).  
 
Perceived Exertion 
Ratings of perceived exertion (RPE) will be used to quantify participants’ perceived 
exertion during the experimental conditions by using the OMNI scale of perceived 
exertion. The scale ranges from 0 (extremely easy) to 10 (extremely hard) and has been 
previously validated in the pediatric population (18). Participants may find the exercise 
session easier to perform with the use of a stimulus (e.g., music or TV program). It is 
also possible that the RPE may influence post-exercise energy compensation. 
Participants will rate their RPE at every 5 min during the conditions and the area under 
the curve (AUC) will be calculated using the trapezoid method.            
 
Physical Activity Energy Expenditure Compensation 
Changes in physical activity after each condition will be assessed by using an Actical 
accelerometer (Philips Respironics). The accelerometer, on an elastic belt, will be 
positioned on the right iliac crest in midaxillary position immediately on arrival at the 
laboratory (07:30) and worn until bedtime. The Actical measures and records time-
stamped acceleration in all directions (omni-directional), and the digitized values are 
summed over a user-specified interval of 1 minute. The Actical has been validated to 
measure physical activity in children and adolescents (19) and has better instrument 
reliability than other accelerometer models (20). Accelerometry data will undergo 
standardized quality control and data reduction procedures, as previously reported (21). 
Physical activity energy expenditure (PAEE) will be determined from the Actical by 
using validated equations (19).   
 
Questionnaires 
To better characterize the adolescents, some questionnaires will be administered during 
the preliminary visit. The 51-item Three-Factor Eating Questionnaire (22) will be used to 

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
verify that the participants are not restrained eaters (those with a score ≥12 for cognitive 
dietary restraint will not be eligible). The purpose of this questionnaire is to assess 3 
factors related to cognition and eating behaviours: cognitive dietary restraint (intent to 
control food intake), disinhibition (overconsumption of food in response to cognitive or 
emotional cues), and susceptibility to hunger (food intake in response to feelings and 
perceptions of hunger). This questionnaire has been validated, and its 3 scales have 
been reported to show good test–retest reliability (23). In addition, participants will 
complete the Pittsburgh Sleep Quality Index (24), a self-rated questionnaire that 
assesses sleep quality and disturbances over the preceding month. Sleep hygiene will 
be assessed in this study because sleep has been shown to influence appetite 
sensations (25). A total score >5 is associated with poor sleep. The physical activity 
pattern of participants will be assessed by using the Physical Activity Questionnaire for 
Adolescents, a self-report measure of physical activity that has been validated in white 
Canadian samples (26). A score of 1 and a score of 5 indicate low and high physical 
activity participation, respectively. Finally, the pubertal status of adolescents will be 
evaluated with a self-assessment questionnaire that aims to measure pubertal status by 
using gender-specific line drawings of the Tanner puberty stages (27).     
 
POTENTIAL RISKS 
The procedures of the proposed study have been chosen to minimize the burden and 
risk posed to the personal safety of study participants. Participants with food allergies 
will be excluded from the study because many food items we serve have been 
associated with allergic reactions (e.g. peanuts, wheat, etc.). The foods are prepared by 
our research coordinators in our experimental kitchen and we adhere to the Canadian 
food safety guidelines for families. The aerobic fitness test will be performed under the 
supervision of a certified exercise physiologist, with CPR and first aid certifications, and 
who is specifically trained to screen-out participants prior to the test, terminate the test 
in the face of specific contraindications, and manage any adverse events should they 
occur. A proper warm-up and cool-down will also be conducted to prevent injuries. In 
the unlikely event that participants experience an injury, medical or other crisis (e.g. 
chest pain, heart attack, psychotic episode, panic attack, etc) during the fitness test, a 
safety protocol is in place in the HALO laboratory and the hospital emergency response 
team will be contacted immediately. Staff will immediately accompany unstable 
participants to the emergency room at CHEO, and stay with them until they are 
assessed. Parents will be contacted and informed of this emergency for participants.   
Finally, if participants feel uncomfortable with some of the questions being asked in the 
questionnaires, they may choose not to answer a question. 
 
CONFIDENTIALITY AND PRIVACY 
Personal information will be kept strictly confidential except as required or permitted by 
law. The data produced from this study will be stored in a locked filing cabinet. Only 
members of the research team will have access to the data. Following completion of the 
research study the data will be kept for 7 years after the last publication of this study. 
They will then be destroyed. Participants will not be identified in any publication or 
presentation of this study.  
 

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
STATISTICAL CONSIDERATIONS 
Outcome Measures 
The primary outcome measure will be post-exercise energy compensation. The food 
intake outcome will be assessed by using an ad libitum test meal immediately after the 
conditions and a dietary record for the remainder of the day. The energy expenditure 
outcome will be assessed by using an Actical accelerometer until bedtime. Total energy 
expenditure (TEE) will be calculated by using the following formula: TEE = (PAEE from 
the Actical + RMR) x 1.11 (28) where the thermic effect of food is fixed at 10% of TEE. 
The secondary outcome measures will include appetite sensations (VAS) and the RPE 
(OMNI scale).   
  
Sample Size Calculation 
It is estimated that a sample size of 25 participants will provide 90% power at 5% level 
of significance (two-sided) to detect a minimal group difference of 100 kcal in energy 
intake and expenditure, assuming a standard deviation of 200 kcal. This is based on 
previous studies by our group, using a similar crossover design, that compared active 
video game play with passive video game play in adolescents (29, 30). We used a 
conservative SD estimate because large variability is generally observed for energy 
intake (especially with the use of dietary records) and to increase the likelihood of 
detecting a significant difference between conditions.          
 
Statistical Analysis 
Before statistical analysis, all data will be tested for normality by using the Shapiro-Wilk 
W test and variance homogeneity and will be log-transformed if necessary. Repeated 
measures analysis using the mixed model will be used to assess the effect of the 3 
interventions on outcome measures, with effects for age, condition, pubertal status and 
BMI. The models will be adjusted for covariates if they are found to significantly interact 
with the outcome variables. To account for the fact that repeated measures are taken 
across conditions, the models will include a participant-specific random effect. Effect 
sizes will be examined by using the Cohen’s d method, reflecting the magnitude of the 
difference between groups in SD units. Cohen’s d is computed by subtracting the 
average score of the control group from the average score of the intervention group and 
then dividing the difference by the pooled SD. Effect sizes are considered negligible if 
<0.2, small if between 0.2 and 0.5, moderate if between 0.5 and 0.8, and important if 
>0.8. Correlations will be used to examine if the RPE are associated with post-exercise 
energy compensation. Differences will be considered significant at P<0.05 and data will 
be presented as mean values and SDs. All statistical analyses will be performed by 
using SPSS Statistics 23.0 (SPSS Inc, Chicago, IL, USA).  
 
FACILITIES AND EQUIPMENT 
The present project will be carried out in our facilities at the Children’s Hospital of 
Eastern Ontario Research Institute in Ottawa. As a national centre of excellence for 
research, leadership, training and advocacy, our research group strives to provide 
international leadership and research excellence as it relates to healthy active living and 
obesity in children and youth (www.haloresearch.ca). All of the proposed methods are 
routinely performed in our laboratories and the research staff is highly qualified for the 

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
purpose of the study. The personnel needed for this study and the infrastructure and 
equipment required to conduct the research is available and accessible. The main 
investigators involved in the proposed research project are also very experienced in 
designing and conducting studies in this field of research.   
 
KNOWLEDGE TRANSLATION APPROACH    
The dissemination of study findings will occur after results are obtained. We intend to 
publish the findings in a good peer-reviewed journal (e.g., American Journal of Clinical 
Nutrition or Medicine & Science in Sports & Exercise). Other methods that will be used 
for disseminating and communicating findings include scientific meetings, blogs, and 
local and national media. It is worth noting that our Research Institute has a 
communication department who will assist with knowledge translation activities. The 
target audience includes the scientific community, health professionals and the general 
population (including teenagers and their parents).   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
BUDGET 
 
Breakfast: $6/meal x 25 participants x 4 sessions = $600 
Ad libitum lunch: $25/meal x 25 participants x 3 sessions = $1875 
Indirect calorimetry: in-kind 
Cardiorespiratory fitness: in-kind 
Actical accelerometers: in-kind 
Parking fees: $14/visit x 25 participants x 4 visits = $1,400 
Participant compensation: $30/visit x 25 participants x 4 visits = $3,000 
 
Total = $6,875 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
Protocol Version date:  13-Sep-2017 
 
 
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Appendix. Overview of the study protocol. Black dots = visual analogue scales; gray 
rectangle = dietary record and accelerometry.