Clinical trial NCT01373762: The Fitness, Game Bike Adherence, Motivation and Exercise Study
Official title: Interactive Videogame Bikes and Their Effect on Exercise Adherence and Health Related Fitness Among Families
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Physical Activity
Keywords: Adherence
Motivation
Health-related fitness
Exercise videogames
Physical Activity
Lead sponsor: University of Victoria
Sponsor class: OTHER
Collaborators: name: Canadian Cancer Society (CCS)
name: University of British Columbia
name: Dalhousie University
name: University of Auckland, New Zealand
First posted: 2011-06-15
Enrollment: 74
Sex: ALL
Minimum age (years): 10
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: The purpose of this study is to determine whether an interactive exercise videogame bike is effective in improving physical activity adherence, motivations to do physical activity, and physical fitness among families. Families receive either an interactive videogame bike and gaming console, or a traditional stationary bike which is placed in front of the television, to keep in their home for six months. It is expected that families within the videogame bike condition will show greater exercise adherence. It is also expected that these families will have higher self-reported physical activity levels, greater motivation to do physical activity, and improved cardiovascular fitness at the end of the three month period compared to the families in the stationary bike condition.

Detailed description: Short title: Fit Game: Fitness \& Game Bike Adherence, Motivation and Exercise Study

Study period: 3 years Clinical phase: Phase III trial

Background:

Cancer is a significant economic burden in Canada, through direct costs to the health-care system (e.g., care and rehabilitation related to disease) and indirectly through lost economic output (e.g., missed work due to illness, premature death). At least half of all new cancer cases and deaths worldwide can be prevented, thus it is imperative that primary prevention become a focus of research. Recent research suggests a strong relationship between physical activity and many of the most prevalent forms of cancer including breast, lung, and colon cancer (i.e., the more an individual exercises the less likely they are to develop cancer). Despite these findings, over half of the Canadian population fails to meet levels of physical activity recommended as a preventative measure. Additionally, it has been found that the largest declines in physical activity occur early in life; thus, promotion efforts targeting critical transitions to physical inactivity early in life are paramount. Findings from a Canadian Community Health Survey note that only 21% of Canadian youth are accumulating enough daily activity to meet international guidelines for optimal growth and development. As well, national cross-sectional and cohort studies on physical inactivity/overweight prevalence demonstrate that the most prominent deflection point is between ages 25 to 35, and this has been linked convincingly to the demands of parenthood. Thus, two important target groups for disease prevention are parents and their children through family-based physical activity initiatives. Unfortunately, interventions of this type are limited and have resulted in little changes in physical activity. Previous studies have focused heavily on education about the benefits/barriers of physical activity, followed by a self-monitoring and self-regulatory (e.g., goal-setting) component. One area that has been overlooked when trying to increase physical activity participation among youth, despite its reliable and robust association with physical activity, is the modification of affective expectations or judgements (expected pleasure or enjoyment).

The introduction of new, enjoyable, and engaging exercise activities may present a novel approach to increase physical activity. One group of activities with this potential is interactive exercise video gaming including games such as the Game Bike system, Sony PlayStation EyeToy, and Nintendo Wii. These games allow players to interact physically (using leg, arm, or whole-body movement) in response to some on-screen virtual activity and provide a controlled opportunity for physical activity and exercise in a family environment.

Emerging evidence suggests that these games can significantly increase energy expenditure similar to moderate to vigorous intensity physical activities that can translate into health-related fitness improvements. Our systematic review of existing active video game interventions highlight the potential of this approach to increase physical activity in children and young people. Additionally, our previous research with these games has also demonstrated the health-related fitness gains even when compared to standard cycling conditions.

Despite these positive effects, there is very little information present to understand adherence to exercise videogames (EV). Our own research with university-aged males showed that an intervention group using an interactive Game bike attended 30% more sessions than a control group using traditional stationary exercise bikes. Even fewer studies on EV have evaluated the motivational properties of these games and the potential reasons for this improved adherence over control physical activity conditions. Only two studies have measured psychological constructs to examine effects of EV on motivation. Results of our previous work suggests that EV can effectively change affective judgments about physical activity and subsequent behaviour unlike most prior intervention efforts.

Despite early positive findings, EV research has notable limitations. First, the populations employed in EV research have been limited to convenience samples of male undergraduate students. Research needs to expand to other samples in order to examine the reach of EV. Second, EV research has almost been exclusively conducted in a laboratory setting. While helpful for initial pilot/efficacy phase research, EV research needs to be conducted in ecologically valid locations. The family home seems an excellent test for whether EVs can still affect psychological, behavioural, and fitness outcomes when situated in a naturalistic location with other leisure-time stimuli. Finally, the length of EV trials has been limited to six-week longitudinal tests or single exposure examinations. Trials of longer duration would be very helpful to examine continuing interest in EV and subsequent adherence. It may be that EV provides a powerful novel experience in the short term but wanes similar to other exercise initiatives across time. Our proposed study will overcome these past limitations and advance the current knowledge of EV.

Objectives:

The primary objective of this study is to evaluate the effect of an interactive exercise video bike (i.e., Active Cycle) in comparison to a stationary bike (Active Cycle without the videogame controllers) in front of a TV on physical fitness, use of the bikes, and perceptions of the bikes. We will also explore whether season (winter/summer), age (parents/kids) and gender (males/females) affect the use of the various bikes.

Study population:

The targeted population will be inactive families within the Greater Victoria Area, British Columbia and the Greater Halifax Area, Nova Scotia, Canada.

Number of subjects:

A total of 160 families will be recruited (n=80 per group). 120 families will be recruited at the Greater Victoria site. The remainder will be recruited from Greater Halifax.

Each family in the EV-interactive condition will receive a videogame bike (Hogan Health Industries, West Jordan, Utah) that will be linked into the family's Sony Playstation 2 or 3® (Sony Computer Entertainment America Inc, Foster City, California). If the family does not own a Sony Playstation 2 or 3® it will be provided to them for the duration of the intervention. Families will choose five videogames from a variety of Sony Playstation 2 or 3® videogames. At 3 months, families will be given the opportunity to select five new videogames, if they wish. Each family in the control group will receive a traditional stationary bike (i.e., an Active Cycle without the videogame controllers) which will be placed in front of their television.

Statistical methods:

Study power:

A sample size of 160 families (80 per group) will be recruited to detect a small-medium effect size (f2 = .10) in adherence to physical activity (primary outcome) with a type one error of .05, an average correlation of .75 across time for our dependent variable (DV) of interest, and a power of .80. Our sample size also considers the main 2 (group) x 2 (parent/child) x 4 (time)repeated measures design and a potential 15% attrition rate. The prediction-based research will be examined by group condition as well as via the collapsed sample for mediation analyses. Considering an average of 5 predictor independent variables (Theory of Planned Behavior (TPB) or Self-Determination Theory (SDT) models), and using a small-medium effect size (f2 = .10) we will have sufficient power (.80) to evaluate these predictors at an alpha of .05.

Statistical analysis:

Intention to treat analysis will be used to evaluate the main treatment effect. Missing data in the primary outcome measures will be imputed using a pre-specified approach. Research question 1 will be analyzed using a 2 (condition) x 4 (time) repeated measures factorial ANOVA on the primary outcome of child adherence to the bikes. A child (i.e., the target child) from each household in the eligibility range will serve for this analysis (chosen through randomization procedures). Post hoc examinations using Tukey follow-up procedures will be utilized if necessary.

Our secondary objectives (parent; parent/child; gender; season; fitness variables, etc.), will also be analyzed using a variant of this design with the addition of factors. Cluster analysis/Hierarchical Linear Modelling will be used for parent/child collinearity. Our pilot study (r = .21) and prior research suggests limited collinearity but it is appropriate to explore findings with these approaches given these are naturally clustered environments (i.e., family home). Prediction using our models (TPB, SDT) and questions of mediation will be achieved via multiple regression analyses following standard procedures for these types of tests.

The qualitative analyses will incorporate the following processes: 1) Invite participants to review the transcripts of interviews, and summarize their perception of the data, for accuracy, and check for the trustworthiness of the data; 2) Conduct a thematic analysis using a reciprocal coding approach where researchers engage in open dialogue about themes and data interpretation. In doing so, each transcript is first reviewed independently, then through dialogue composite themes and related critical issues are developed; and 3) Manage the data using the NVivo software program. NVivo enables theory building, testing and elaboration. With NVivo, 'free nodes' can be created during the coding process, capturing participants' perspectives and the investigators' critical issues.

Eligibility criteria: Inclusion Criteria:

* Married or common law parents with children between the ages of 10 and 14
* self-report low family physical activity
* At least 1 parent is not meeting Canada's Physical Activity Guidelines
* Target child is not meeting Canada's Physical Activity Guidelines

Exclusion Criteria:

* Participant is unsafe to participate in physical activity as determined by answers to the Physical Activity Readiness Questionnaire (PAR-Q)

Primary outcomes:
measure: Children's self-reported adherence
timeFrame: Usage log will be filled in for 3 month duration
Secondary outcomes:
measure: parent's self-reported adherence
timeFrame: Usage log will be filled in for 3 month duration
measure: Change from baseline in motivation at 6 weeks
timeFrame: baseline & 6 weeks
measure: Change in baseline in self-reported physical activity at 6 weeks
timeFrame: baseline & 6 weeks
measure: Change from baseline in health-related quality of life / psychosocial distress at 3 months
timeFrame: baseline & 3 months
measure: Change from baseline in depression and anxiety at 3 months
timeFrame: baseline & 3 months
measure: Change from baseline in physical self-perception at 3 months
timeFrame: baseline & 3 months
measure: Change from baseline in physical home environment at 3 months
timeFrame: baseline & 3 months
measure: Change from baseline in body composition at 3 months.
timeFrame: baseline & 3 months
measure: Change from baseline in cardiovascular fitness at 3 months
timeFrame: baseline & 3 months
measure: Change from baseline in motivation at 3 months
timeFrame: baseline & 3 months
measure: Change from baseline in self-reported physical activity at 3 months
timeFrame: Baseline & 3 months
measure: Change from baseline in self-reported physical activity at 3 months
timeFrame: baseline & 3 months
Other outcomes:
Locations:
city: Victoria
country: Canada
facility: Behavioural Medicine Laboratory
state: British Columbia
city: Halifax
country: Canada
facility: Cardiovascular Research Unit
state: Nova Scotia
Study officials:
affiliation: University of Victoria
name: Dr. Ryan R Rhodes, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Dalhousie University
name: Dr. Chris Blanchard, PhD
role: STUDY_CHAIR
affiliation: University of Auckland, New Zealand
name: Dr. Ralph Maddison, PhD
role: STUDY_CHAIR
affiliation: University of British Columbia
name: Dr. Darren Warburton, PhD
role: STUDY_CHAIR
affiliation: University of British Columbia
name: Dr. Shannon Bredin, PhD
role: STUDY_CHAIR
affiliation: University of British Columbia
name: Dr. Mark Beauchamp, PhD
role: STUDY_CHAIR
References:
citation: Health Canada. Economic burden of illness in Canada 1998. Ottawa: Health Canada, 2002.
citation: Harvard Report on Cancer Prevention. Volume 1: Causes of human cancer. Cancer Causes Control. 1996 Nov;7 Suppl 1:S3-59. doi: 10.1007/BF02352719. No abstract available.
citation: Adami HO, Day NE, Trichopoulos D, Willett WC. Primary and secondary prevention in the reduction of cancer morbidity and mortality. Eur J Cancer. 2001 Oct;37 Suppl 8:S118-27. doi: 10.1016/s0959-8049(01)00262-3.
citation: Health Canada. Canadian tobacco use monitoring survey (CTUMS) 2008, 2008.
citation: Monninkhof EM, Elias SG, Vlems FA, van der Tweel I, Schuit AJ, Voskuil DW, van Leeuwen FE; TFPAC. Physical activity and breast cancer: a systematic review. Epidemiology. 2007 Jan;18(1):137-57. doi: 10.1097/01.ede.0000251167.75581.98.
citation: Tardon A, Lee WJ, Delgado-Rodriguez M, Dosemeci M, Albanes D, Hoover R, Blair A. Leisure-time physical activity and lung cancer: a meta-analysis. Cancer Causes Control. 2005 May;16(4):389-97. doi: 10.1007/s10552-004-5026-9.
citation: Harriss DJ, Atkinson G, Batterham A, George K, Cable NT, Reilly T, Haboubi N, Renehan AG; Colorectal Cancer, Lifestyle, Exercise And Research Group. Lifestyle factors and colorectal cancer risk (2): a systematic review and meta-analysis of associations with leisure-time physical activity. Colorectal Dis. 2009 Sep;11(7):689-701. doi: 10.1111/j.1463-1318.2009.01767.x. Epub 2009 Jan 17.
citation: Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, McTiernan A, Gansler T, Andrews KS, Thun MJ; American Cancer Society 2006 Nutrition and Physical Activity Guidelines Advisory Committee. American Cancer Society Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2006 Sep-Oct;56(5):254-81; quiz 313-4. doi: 10.3322/canjclin.56.5.254.
citation: Health Canada. Health Canada's Physical Activity Guide. http://www.hc-sc.gc.ca/english/lifestyles/physical_activity.html. Accessed August, 2004.
citation: Canadian Fitness and Lifestyle Research Institute. Increasing physical activity: Trends for planning effective communication. http://www.cflri.ca/cflri/resources/pub.php#2003capacity. Accessed February 24, 2006.
citation: Friedenreich CM. Physical activity and cancer prevention: from observational to intervention research. Cancer Epidemiol Biomarkers Prev. 2001 Apr;10(4):287-301.
citation: Jedwab J. Actively Canadian: Who's the most active of us all?: Association for Canadian Studies; 2005.
citation: Statistics Canada. Canadian Community Health Survey 1994-2003. http://www.acs-aec.ca/Polls/Physical%20Activity%20and%20Obesity.pdf. Accessed April 13, 2005.
citation: O'Connor TM, Jago R, Baranowski T. Engaging parents to increase youth physical activity a systematic review. Am J Prev Med. 2009 Aug;37(2):141-9. doi: 10.1016/j.amepre.2009.04.020.
citation: Gustafson SL, Rhodes RE. Parental correlates of physical activity in children and early adolescents. Sports Med. 2006;36(1):79-97. doi: 10.2165/00007256-200636010-00006.
citation: Statistics_Canada. Canadian Community Health Survey 1994-2003. http://www.acs-aec.ca/Polls/Physical%20Activity%20and%20Obesity.pdf. Accessed April 13, 2005.
citation: Bellows-Riecken KH, Rhodes RE. A birth of inactivity? A review of physical activity and parenthood. Prev Med. 2008 Feb;46(2):99-110. doi: 10.1016/j.ypmed.2007.08.003. Epub 2007 Aug 15.
citation: Rhodes RE, Symons Downs D, Bellows Riecken KH. Delivering inactivity: A review of physical activity and the transition to motherhood. In: Allerton LT, Rutherfode GP, eds. Exercise and Women's Health Research. Hauppauge, NY: Earthlink Science Press; 2008:105-127.
citation: Dishman RK, Buckworth J. Increasing physical activity: a quantitative synthesis. Med Sci Sports Exerc. 1996 Jun;28(6):706-19. doi: 10.1097/00005768-199606000-00010.
citation: Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW, Corso P. The effectiveness of interventions to increase physical activity. A systematic review. Am J Prev Med. 2002 May;22(4 Suppl):73-107. doi: 10.1016/s0749-3797(02)00434-8.
citation: van Sluijs EM, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ. 2007 Oct 6;335(7622):703. doi: 10.1136/bmj.39320.843947.BE. Epub 2007 Sep 20.
citation: Fishbein M, Triandis HC, Kanfer FH, Becker M, Middlestadt SE, Eichler A. Factors influencing behavior and behavior change. In: Baum A, Revenson TA, eds. Handbook of health psychology. Mahwah, New Jersey: Lawrence Erlbaum Associates; 2001:3-17.
citation: Davison KK, Birch LL. Childhood overweight: a contextual model and recommendations for future research. Obes Rev. 2001 Aug;2(3):159-71. doi: 10.1046/j.1467-789x.2001.00036.x.
citation: Rhodes RE, Fiala B, Conner M. A review and meta-analysis of affective judgments and physical activity in adult populations. Ann Behav Med. 2009 Dec;38(3):180-204. doi: 10.1007/s12160-009-9147-y.
citation: Maddison R, Mhurchu CN, Jull A, Jiang Y, Prapavessis H, Rodgers A. Energy expended playing video console games: an opportunity to increase children's physical activity? Pediatr Exerc Sci. 2007 Aug;19(3):334-43. doi: 10.1123/pes.19.3.334.
citation: Sell K, Lillie T, Taylor J. Energy expenditure during physically interactive video game playing in male college students with different playing experience. J Am Coll Health. 2008 Mar-Apr;56(5):505-11. doi: 10.3200/JACH.56.5.505-512.
citation: Widman LM, McDonald CM, Abresch RT. Effectiveness of an upper extremity exercise device integrated with computer gaming for aerobic training in adolescents with spinal cord dysfunction. J Spinal Cord Med. 2006;29(4):363-70. doi: 10.1080/10790268.2006.11753884.
citation: Warburton DE, Bredin SS, Horita LT, Zbogar D, Scott JM, Esch BT, Rhodes RE. The health benefits of interactive video game exercise. Appl Physiol Nutr Metab. 2007 Aug;32(4):655-63. doi: 10.1139/H07-038.
citation: Mark R, Rhodes RE, Warburton DER, Bredin SSG. Interactive video games and physical activity: A review of literature and future directions. Health and Fitness Journal of Canada. in press.
citation: Warburton DE, Sarkany D, Johnson M, Rhodes RE, Whitford W, Esch BT, Scott JM, Wong SC, Bredin SS. Metabolic requirements of interactive video game cycling. Med Sci Sports Exerc. 2009 Apr;41(4):920-6. doi: 10.1249/MSS.0b013e31819012bd.
citation: Rhodes RE, Warburton DE, Bredin SS. Predicting the effect of interactive video bikes on exercise adherence: An efficacy trial. Psychol Health Med. 2009 Dec;14(6):631-40. doi: 10.1080/13548500903281088.
citation: Annesi JJ, Mazas J. Effects of virtual reality-enhanced exercise equipment on adherence and exercise-induced feeling states. Percept Mot Skills. 1997 Dec;85(3 Pt 1):835-44. doi: 10.2466/pms.1997.85.3.835.
citation: Baranowski T, Anderson C, Carmack C. Mediating variable framework in physical activity interventions. How are we doing? How might we do better? Am J Prev Med. 1998 Nov;15(4):266-97. doi: 10.1016/s0749-3797(98)00080-4.
citation: Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes 50:179-211, 1991.
citation: Rhodes RE, Blanchard CM, Matheson DH. A multicomponent model of the theory of planned behaviour. Br J Health Psychol. 2006 Feb;11(Pt 1):119-37. doi: 10.1348/135910705X52633.
citation: Rhodes RE, Courneya KS. Investigating multiple components of attitude, subjective norm, and perceived control: an examination of the theory of planned behaviour in the exercise domain. Br J Soc Psychol. 2003 Mar;42(Pt 1):129-46. doi: 10.1348/014466603763276162.
citation: Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behavior. New York: Plenum Press; 1985.
citation: Hagger M, Chatzisarantis NLD, eds. Intrinsic Motivation and Self-Determination in Exercise and Sport. Champaign, IL.: Human Kinetics; 2007.
citation: Standage M, Duda JL, Ntoumanis N. Students' motivational processes and their relationship to teacher ratings in school physical education: a self-determination theory approach. Res Q Exerc Sport. 2006 Mar;77(1):100-10. doi: 10.1080/02701367.2006.10599336.
citation: Lonsdale C, Sabiston CM, Raedeke TD, Ha AS, Sum RK. Self-determined motivation and students' physical activity during structured physical education lessons and free choice periods. Prev Med. 2009 Jan;48(1):69-73. doi: 10.1016/j.ypmed.2008.09.013. Epub 2008 Oct 19.
citation: Deci EL, Ryan RM. The "what" and "why" of goal pursuits: Human needs and the self-determination of behaviour. Psychological Inquiry. 2000;11:227-268.
citation: Armitage CJ, Conner M. Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol. 2001 Dec;40(Pt 4):471-99. doi: 10.1348/014466601164939.
citation: Hagger M, Chatzisarantis NLD, Biddle SJH. A meta-analytic review of the theories of reasoned action and planned behavior in physical activity: Predictive validity and the contribution of additional variables. Journal of Sport and Exercise Psychology. 2002;24:1-12.
citation: Hausenblas HA, Carron AV, Mack DE. Application of the theories of reasoned action and planned behavior to exercise behavior: A meta-analysis. Journal of Sport and Exercise Psychology. 1997;19:36-51.
citation: Godin G, Kok G. The theory of planned behavior: a review of its applications to health-related behaviors. Am J Health Promot. 1996 Nov-Dec;11(2):87-98. doi: 10.4278/0890-1171-11.2.87.
citation: Rhodes RE, Courneya KS. Self-efficacy, controllability, and intention in the theory of planned behavior: Measurement redundancy or causal independence? Psychology and Health. 2003;18:79-91.
citation: Rhodes RE, Courneya KS. Differentiating motivation and control in the theory of planned behavior. Psychology, Health and Medicine. 2004;9:205-215.
citation: Ajzen I. Construction of a theory of planned behavior intervention. http://www-unix.oit.umass.edu/~aizen/pdf/tpb.intervention.pdf. Accessed April 4, 2007.
citation: French DP, Sutton S, Hennings SJ, et al. The importance of affective beliefs and attitudes in the theory of planned behavior: Predicting intention to increase physical activity. Journal of Applied Social Psychology. 2005;35:1824-1848.
citation: Lawton R, Conner M, McEachan R. Desire or reason: predicting health behaviors from affective and cognitive attitudes. Health Psychol. 2009 Jan;28(1):56-65. doi: 10.1037/a0013424.
citation: Lowe R, Eves F, Carroll D. The influence of affective and instrumental beliefs on exercise intentions and behavior: A longitudinal analysis. Journal of Applied Social Psychology. 2002;32:1241-1252.
citation: Kraft P, Rise J, Sutton S, Roysamb E. Perceived difficulty in the theory of planned behaviour: perceived behavioural control or affective attitude? Br J Soc Psychol. 2005 Sep;44(Pt 3):479-96. doi: 10.1348/014466604X17533.
citation: Public Health Agency of Canada. Canada's family guide to physical activity (6-9 years of age); 2002.
citation: Cohen J. A power primer. Psychol Bull. 1992 Jul;112(1):155-9. doi: 10.1037//0033-2909.112.1.155.
citation: GPOWER: A priori, post hoc, and compromise power analyses for MS DOS [computer program]. Version 2.0. Bonn, Germany: Dept. of Psychology; 1992.
citation: ACSM. Guidelines for exercise testing and prescription. Baltimore, Maryland: Lippincott, Williams & Wilkins; 2000.
citation: King AC, Stokols D, Talen E, Brassington GS, Killingsworth R. Theoretical approaches to the promotion of physical activity: forging a transdisciplinary paradigm. Am J Prev Med. 2002 Aug;23(2 Suppl):15-25. doi: 10.1016/s0749-3797(02)00470-1.
citation: Travers KD. The social organization of nutritional inequities. Soc Sci Med. 1996 Aug;43(4):543-53. doi: 10.1016/0277-9536(95)00436-x.
citation: Travers KD. Using qualitative research to understand the socio-cultural origins of diabetes among Cape Breton Mi'kmaq. Chronic Diseases in Canada. 1995;16:140-143.
citation: Dumas JE, Lynch AM, Laughlin JE, Phillips Smith E, Prinz RJ. Promoting intervention fidelity. Conceptual issues, methods, and preliminary results from the EARLY ALLIANCE prevention trial. Am J Prev Med. 2001 Jan;20(1 Suppl):38-47. doi: 10.1016/s0749-3797(00)00272-5.
citation: Plummer ML, Wight D, Obasi AI, Wamoyi J, Mshana G, Todd J, Mazige BC, Makokha M, Hayes RJ, Ross DA. A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme. Health Educ Res. 2007 Aug;22(4):500-12. doi: 10.1093/her/cyl103. Epub 2006 Oct 3.
citation: Benoit C, Jansson M, Leadbeater B, McCarthy B. The Impact of Stigma on Marginalized Populations' Work, Health and Access to Services. Canadian Institutes of Health Research; 2002-2005.
citation: Brown SG, Rhodes RE. Relationships among dog ownership and leisure-time walking in Western Canadian adults. Am J Prev Med. 2006 Feb;30(2):131-6. doi: 10.1016/j.amepre.2005.10.007.
citation: Rhodes RE, Plotnikoff RC. Can current physical activity act as a reasonable proxy measure of future physical activity? Evaluating cross-sectional and passive prospective designs with the use of social cognition models. Prev Med. 2005 May;40(5):547-55. doi: 10.1016/j.ypmed.2004.07.016.
citation: Rhodes RE, Macdonald HM, McKay HA. Predicting physical activity intention and behaviour among children in a longitudinal sample. Soc Sci Med. 2006 Jun;62(12):3146-56. doi: 10.1016/j.socscimed.2005.11.051. Epub 2006 Jan 9.
citation: Markland D, Tobin V. A modification to the behavioral regulation in exercise questionnaire to include an assessment of amotivation. Journal of Sport & Exercise Psychology. 2004;26:191-196.
citation: Wilson PM, Rodgers WM. The relationship between perceived autonomy support, exercise regulations and behavioral intentions in women. Psychology of Sport & Exercise. 2004;5:229-242.
citation: Gillison FB, Standage M, Skevington SM. Relationships among adolescents' weight perceptions, exercise goals, exercise motivation, quality of life and leisure-time exercise behaviour: a self-determination theory approach. Health Educ Res. 2006 Dec;21(6):836-47. doi: 10.1093/her/cyl139. Epub 2006 Nov 13.
citation: Godin G, Jobin J, Bouillon J. Assessment of leisure time exercise behavior by self-report: a concurrent validity study. Can J Public Health. 1986 Sep-Oct;77(5):359-62. No abstract available.
citation: Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985 Sep;10(3):141-6.
citation: Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993 Jan;25(1):81-91. doi: 10.1249/00005768-199301000-00012.
citation: Crocker PR, Bailey DA, Faulkner RA, Kowalski KC, McGrath R. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc. 1997 Oct;29(10):1344-9. doi: 10.1097/00005768-199710000-00011.
citation: Diener E, Emmons RA, Larsen RJ, Griffin S. The Satisfaction With Life Scale. J Pers Assess. 1985 Feb;49(1):71-5. doi: 10.1207/s15327752jpa4901_13.
citation: Gadermann AM, Schonert-Reichl KA, Zumbo BD. Investigating Validity evidence of the Satisfaction with Life Scale Adapted for Children. Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement. in press.
citation: Allison PD. Missing Data. Thousand Oaks: Sage Publications; 2002.
citation: Chuang JH, Hripcsak G, Heitjan DF. Design and analysis of controlled trials in naturally clustered environments: implications for medical informatics. J Am Med Inform Assoc. 2002 May-Jun;9(3):230-8. doi: 10.1197/jamia.m0997.
citation: Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986 Dec;51(6):1173-82. doi: 10.1037//0022-3514.51.6.1173.
citation: Cohen J, Cohen P. Applied multiple regression / correlation analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum; 1983.
citation: Aiken LS, West SG. Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage; 1991.
citation: Patton MQ. Qualitative Evaluation and Research Methods. second ed. Newbury Park, NJ: Sage; 1990.
citation: Crabtree BF, Miller WL. Doing Qualitative Research. Newbury Park, CA: Sage; 1992.
citation: Morales. Nintendo's Wii scores big sales. Tech bytes; 2007.
citation: Entertainment Software Association. Industry Facts; 2009.
citation: Manske SR. Explaining knowledge use among clients of the Program Training & Consultation Centre. Paper presented at: Toronto, 2001; University of Toronto.
citation: Lee RG, Garvin T. Moving from information transfer to information exchange in health and health care. Soc Sci Med. 2003 Feb;56(3):449-64. doi: 10.1016/s0277-9536(02)00045-x.
citation: Rhodes RE, Beauchamp MR, Blanchard CM, Bredin SSD, Warburton DER, Maddison R. Use of in-home stationary cycling equipment among parents in a family-based randomized trial intervention. J Sci Med Sport. 2018 Oct;21(10):1050-1056. doi: 10.1016/j.jsams.2018.03.013. Epub 2018 Apr 3.