@Article{info:doi/10.2196/60185,
author="Legarra-Gorgo{\~{n}}on, Gaizka
and Garc{\'i}a-Alonso, Yesenia
and Ram{\'i}rez-V{\'e}lez, Robinson
and Alonso-Mart{\'i}nez, Loreto
and Izquierdo, Mikel
and Alonso-Mart{\'i}nez, Alicia M",
title="Effect of a Gamified Family-Based Exercise Intervention on Adherence to 24-Hour Movement Behavior Recommendations in Preschool Children: Single-Center Pragmatic Trial",
journal="JMIR Serious Games",
year="2025",
month="Mar",
day="4",
volume="13",
pages="e60185",
keywords="children; gamification; exercise; physical fitness; domains of physical activity; game; fitness; child; family-based; exercise program; randomized controlled trial; strength",
abstract="Background: Adherence to 24-hour movement behavior recommendations, including physical activity (PA), sedentary time, and sleep, is essential for the healthy development of preschool children. Gamified family-based interventions have shown the potential to improve adherence to these guidelines, but evidence of their effectiveness among children is limited. Objective: This study aimed to evaluate the effectiveness of a gamified family-based exercise intervention in promoting adherence to 24-hour movement behavior recommendations among preschool-aged children. Methods: This 12-week study is a single-center, pragmatic randomized controlled trial that included 80 preschool children (56{\%} boys) and their families, who were randomly assigned to either the gamification group (n=40) or the control group (n=40). The ``3, 2, 1 Move on Study'' incorporates family-oriented physical activities and gamification techniques to increase PA domains, reduce sedentary behavior, and improve sleep patterns. The primary outcome was to increase{\thinspace}moderate to vigorous PA (MVPA) by 5 minutes/day, as measured by accelerometer at follow-up. Accelerometer-determined daily time spent (PA domains, sedentary behavior, and sleep), physical fitness (cardiorespiratory, speed-agility, muscular, physical fitness z-score), basic motor competencies (self-movement and object movement), and executive function (memory, cognitive flexibility, and inhibitory control) were also included as secondary outcomes. Results: The 71 participants included in the per-protocol analyses (32 girls, 45{\%}; 39 boys, 55{\%}) had a mean (SD) age of 5.0 (0.5) years. Change in MVPA per day after the intervention (12 weeks) increased in both groups by +25.3 (SD 24.6) minutes/day in the gamification group and +10.0 (SD 31.4) minutes/day in the routine care group, but no significant between-group differences were observed (8.62, 95{\%} CI --5.72 to 22.95 minutes/day, $\eta$p2=.025; P=.23). The analysis of secondary outcomes showed significant between-group mean differences in the change in physical behaviors derived from the accelerometers from baseline to follow-up of 26.44 (95{\%} CI 8.93 to 43.94) minutes/day in favor of light PA ($\eta$p2=.138; P=.01) and 30.88 (95{\%} CI 4.36 to 57.41) minutes/day in favor of total PA, which corresponds to a large effect size ($\eta$p2=.087; P=.02). Likewise, the gamification group substantially increased their score in standing long jump and physical fitness z-score from baseline (P<.05). Conclusions: In the ``3, 2, 1 Move on Study,'' a gamified intervention showed a modest but relevant increase in MVPA and other domains of 24-hour movement behavior among preschool-aged children. Therefore, gamified family-based interventions may provide a viable alternative to improve adherence to 24-hour movement behavior recommendations. Trial Registration: ClinicalTrials.gov NCT05741879; https://clinicaltrials.gov/study/NCT05741879?tab=history ",
issn="2291-9279",
doi="10.2196/60185",
url="https://games.jmir.org/2025/1/e60185",
url="https://doi.org/10.2196/60185"
}