A Position Paper Managing Youth Screen Time versus Physical

Activity

Encouraging Active Living in a Technological Focussed Generation

Reem Altamimi

, Keith Nesbitt

and Geoff Skinner

Faculty of Science and IT, University of Newcastle, University Drive, Callaghan, NSW, Australia

Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia

Keywords: Active Living Technologies, eHealth, Monitoring Technologies, Physical Activity.

Abstract: Childhood obesity is becoming increasingly prolific and problematic. Contributors to childhood obesity

include decreased levels of physical activity and increased sedentary behaviour. Screen-based entertainment

may be an important factor in the development of childhood obesity as children and adolescents prefer to

spend time using electronic devices than exercising. While it is difficult to encourage children to cease playing

video games, it is possible to change these passive screens to active ones. Information and Communication

Technologies (ICTs) have been utilized by academics and researchers to promote levels of physical activity

among young people. This position paper is part of our continuous research into the use of technology in the

facilitation and motivation of children to be more physically active. This paper presents the “MySteps”

framework that has been developed to manage youth screen time and exercise performance statistics. By

developing technology-based solutions, we intend to increase children and adolescents awareness of their

levels of physical activity and screen time. Consequently, self-monitoring and management of screen time

and physical activity levels may lead to more active living beginning at an early age and continuing in life.

1 INTRODUCTION

Levels of childhood obesity have been steadily

increasing over recent decades (Childhood Obesity,

2014; De Onis et al., 2010; Patricia and Anderson,

2006). The percentage of obese children in the United

States has increased from 7% in 1980 to 18% in 2012

(Childhood Obesity, 2014). Although the most recent

literature on childhood obesity in the United States

shows that there was no significant change in the

prevalence of obesity between 2003-2004 and 2011-

2012, the overall number of children considered

obese remains elevated (Ogden et al., 2014).

Worldwide, the prevalence of overweight and obese

children has increased from 4.2% in 1990 to 6.7% in

2010. It is estimated that the prevalence will reach

9.1% by 2020 (De Onis et al., 2010). These

predictions suggest the need for urgent and effective

interventions to combat the issue of childhood obesity

(De Onis et al., 2010). Obese children are more likely

to become obese adults and therefore children should

be specifically targeted, as the benefits of preventing

childhood obesity will flow on into adulthood

(Whitaker et al., 1998; Dietz, 1997; Whitaker et al.,

1997). Obese youth are more likely to have health

problems such as cardiovascular disease, diabetes and

cancer. Childhood obesity is also associated with

social and psychological problems such as depression

and low self-esteem (Childhood Obesity, 2014;

Daniels et al., 2005). The cluster of associated

medical conditions emphasise the need for the

development of effective interventions.

Researchers and health professionals alike are

alarmed by the wide spread nature of childhood

obesity and its associated health problems and have

strived to elucidate causes and contributing factors.

Energy intake relative to energy expenditure,

genetics, physical activity and sedentary behaviour

have all be identified as potential causes (Patricia and

Anderson, 2006). Lower levels of physical activity

and higher rates of television viewing are two

additional important determinants (Janseen et al.,

2005). The integration of technology into our

lifestyles and decreased supervision of children by

parents who work full time are two factors that may

also contribute to decreased levels of physical activity

and increased sedentary behaviour in children and

adolescents (Patricia and Anderson, 2006).

The literature has demonstrated a strong

association between time spent in front of screens,

180

Altamimi R., Nesbitt K. and Skinner G..

A Position Paper Managing Youth Screen Time versus Physical Activity - Encouraging Active Living in a Technological Focussed Generation.

DOI: 10.5220/0005475601800187

In Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AgeingWell-

2015), pages 180-187

ISBN: 978-989-758-102-1

 2015 SCITEPRESS (Science and Technology Publications, Lda.)

especially watching television, and the prevalence of

obesity (Patricia and Anderson, 2006; Janseen et al.,

2005; Dietz and Gortmaker, 1985). In one study, with

each additional hour of television viewed, the

prevalence of obesity increased by 2% (Dietz and

Gortmaker, 1985). Computers, mobile phones, video

game consoles and handheld Internet devices are

becoming increasing popular entertaining appliance

for children and adolescents. Television stations and

video games specifically developed for youth have

become a major source of enjoyment. With so much

content now available in a variety of media, it is not

surprising that children spend a large proportion of

their leisure time using electronic entertainment

devices (Roberts and Foehr, 2008). Screen time

should be considered an important contributing factor

to the increased numbers of obese children (Patricia

and Anderson, 2006).

Moreover, researchers have demonstrated an

inverse relationship between physical activity level

and body fat, particularly in males (Westerterp and

Goran, 1997) aged between 6 and 9 years (Ball et al.,

2001). This may contribute to the development of

childhood obesity (Ball et al., 2001). Therefore, an

important key in the management, prevention and

treatment of obesity in children and adolescents may

lie in increasing their levels of physical activity

(Daniels et al., 2005).

Increasing physical activity and decreasing sedentary

behaviour has social, emotional and intellectual

implications (Make your move, 2014). For example,

it reduces anti-social behaviour, assists in the

development of physical skills, and improves self-

esteem and confidence (Make your move, 2014).

Regular physical activity is also linked to improved

health outcomes and motor skills (Reilly et al., 2006)

and reduced risk of many diseases (Warburton et al.,

2006; Make your move, 2014). It contributes to the

prevention of several chronic diseases as the risk of

the developing these conditions begins in childhood

(Warburtonet al., 2006).

Health institutions across the world have set

physical activity recommendations for children and

adolescents to be at least 60 minutes of moderate-to-

vigorous physical activity per day (Australia’s, 2014;

Strong et al., 2005; Janssen, 2007). However, few

young people meet this recommendation (Janssen,

2007). Physical activity levels drop between

childhood and adolescence and continue to decrease

with advancing age (Troiano et al., 2008). It has been

reported that participation in physical activity has

declined and sedentary behaviour has become more

common especially among adolescents (Brodersen et

al., 2008).

Factors that influence levels of physical activity

and may prevent children and adolescents from

exercising have been identified. These include,

environmental barriers such as limited access to

exercise facilities and recreational programs (Sallis et

al., 2000), and neighbourhood safety (Molnar et al.,

2004). Furthermore, children’s motivation is an

important determinant of their level of physical

activity (Biddle and Goudas, 1996; Sallis, et al.,

2000). Weightless may not be an appropriate

motivator for young children to increase their level of

physical activity. Young children need to enjoy

physical activity in order to engage in it (Daniels et

al., 2005). For example, one mechanism that has been

suggested to motivate young children to be more

physically active is sport competence and the

encouragement of their desire to succeed (Biddle and

Goudas, 1996). Increased participation in physical

activity and decreased screen time should be the focus

of research into the prevention and treatment of

obesity and the promotion of health among children

and adolescents (Janseen et al., 2005; Lou, 2014).

Interventions should promote an active lifestyle and

be designed to motivate children to keep fit and

active.

Utilising Information and Communication

Technologies (ICTs) in physical activity

interventions has a positive effect on physical activity

behaviour change in children and adolescents (Lau et

al., 2011). ICT-based interventions apply techniques

such as Internet or SMS as delivery modes. A major

advantage of ICT-based interventions is that they are

more readily accessible to a wider audience.

Furthermore, these interventions can deliver video,

audio and animation content to targeted groups based

on their needs and preferences. Other advantages

include feedback, automatic reminders and social

support (Lau et al., 2011).

Children and adolescents enjoy using technology

and digital devices. A survey of 1,100 parent-child

pairs in 2004 showed that the vast majority of US

teens used the Internet daily to play games,

communicate with friends and seeking information.

Some reported using the Internet to search for health,

dieting or physical fitness information. Teens are also

like to communicate with friends online and share

links, photos and videos (Lenhart et al., 2005).

Therefore it is expected that developing technology-

based solutions for supporting regular participation in

physical activity would have positive results.

Our research is designed to explore the best available

technology-based solutions for physical activity

promotion in children and adolescents. In this paper,

we discuss the ‘MySteps’ solution, which was

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developed with the aim of managing screen time and

physical activity behaviour among children and

adolescents. This technology-based solution may

support the transition of youth behaviour away from

sedentary lifestyle and towards an active lifestyle.

‘MySteps’ utilises activity-monitoring technology

coupled with web-based feedback. Through this web

application, users can login and monitor their screen

time and physical activity performance statistics and

compare these to recommended levels.

The remainder of the paper provides background

information on the current levels of physical activity

and sedentary behaviour among children and

adolescents. The importance of technology-based

intervention within this context has also been

outlined. The following section details our proposed

solution ‘MySteps’ and its contribution to the active

living technology research domain. This paper

concludes with our aims and plans to future improve

our solution.

2 SCREEN TIME

Sedentary activity refers to activity that involves

sitting or lying down (Make your move, 2014).

“Screen time” activities are those done in front of a

screen, such as watching TV, working on a computer,

or playing video games (Kaneshiro, 2013). Screen

time is a sedentary activity that requires a very little

energy expenditure (Kaneshiro, 2013). Recreational

screen time is defined as the time spent in front of

screens for entertainment purposes and includes

watching TV, playing video games and chatting with

friends online (Recreational, 2013).

Spending numerous hours undertaking screen-

based activities may contribute to, or increase the risk

of, overweight and obesity in children and

adolescents (Lou, 2014). Spending large amounts of

time in front of screens reduces the amount of time

children spend exercising and contributes to

unhealthy eating habits such as snacking (Dietz and

Gortmaker, 1985; Kaneshiro, 2013; Recreational,

2013). Screen based food advertisements also play a

role in encouraging unhealthy eating habits (Dietz

and Gortmaker, 1985; Kaneshiro, 2013; Recreational,

2013). Furthermore, spending excessive hours in

front of screens may lead to sleep disturbance/

disorders (Switch Off, 2015), risk of attention

problems, anxiety, and depression (Kaneshiro, 2013).

Children and adolescents social skills may also be

negatively affected by too many hours spent in front

of screens (Switch Off, 2015).

The association between some specific screen

based activities and increased levels of adiposity has

been investigated (Robinson, 1999). Reducing

television, video and video game use does not

significantly affect levels of physical activity

(Robinson, 1999). However, it may be a promising

method to help prevent childhood obesity as reducing

screen time has been shown to affect BMI, triceps

skinfold thickness, waist circumference and waist-to-

hip ratio (Robinson, 1999). Considering these

implications, a screen time limit has been set for

children and adolescents. The current guidelines

suggest a maximum of two hours a day for children

aged between 5 and 18 years (Make your move, 2014;

Recreational, 2013; Switch Off, 2015).

The literature demonstrates a high prevalence

sedentary behaviour attributable to screen based

activities among children and adolescents (Lou, 2014;

Rideout et al., 2010). Children and adolescent spend

an average of 8 hours per day engaged in sedentary

behaviours and screen time (Lou, 2014; Wilson,

2012). This trend is likely to increase as technology

advances. Compared to 2003, in 2007, there were

fewer children complying with the recommended

screen time (Sisson et al., 2011). There were a

number of important findings from a 2010 study on

the quantity and nature of media used by young

Americans (Rideout et al., 2010). Firstly, between

2004 and 2009, the amount of time young people

spent using media increased from an average of 6

hours and 21 minutes to 7 hours and 38 minutes per

day (Rideout et al., 2010). Secondly this study

revealed that the average time spent using computers,

playing video games, watching TV and listening to

music and audio increased during this period whereas

the use of printed materials such as books declined

(Rideout et al., 2010). Thirdly this study found that

the advent of mobile media has facilitates the use of

media and expanded the number of hours children

and adolescents spend using media. Between 2004

and 2009, the percentage of young people who owned

a mobile phone increased from 39% to 66%. In

addition, the percentage of young people who own

other portable devices such as iPods increased from

18% to 76% in the same time period (Rideout et al.,

2010). Lastly, the number of homes with Internet

access expanded from 74% to 84% between 2004 and

2009 (Rideout et al., 2010).

Social networking and video sites like YouTube

constitute the majority of the home Internet use.

Australian health statistics reveal that in 2011-12;

children and adolescents spent greater than two hours

per day in front of screens, levels of physical activity

decreased and screen-based activity increased as age

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increased (Australian Health, 2013). Additionally, it

has been found that children whose parents and

caregivers limit media use or set media-related rules

spend less time in front of screens (Lou, 2014;

Rideout et al., 2010).

3 PHYSICAL ACTIVITY

Physical activity refers to any activity that requires

physical movement and that results in an increased

respiratory and heat rate (Make your move, 2014).

Examples include running, playing sports and

swimming. Moderate intensity physical activity

refers to physical exertion that does not result in

breathlessness, for example fast walking or bike

riding (Make your move, 2014). Vigorous physical

activity refers to activities that require a higher level

of physical effort and result in breathlessness, such as

running (Make your move, 2014).

Children and adolescents are encouraged to

participate in 60 minutes of moderate to vigorous

physical activity daily (Make your move, 2014).

These 60 minutes can be accumulated throughout the

day (Make your move, 2014). Rather than measure

physical activity in minutes, the criterion-referenced

standards for physical activity measure physical

activity in steps per day using a pedometer. The

median optimal number of steps per day for children

aged between 6 and 12 years is 12,000 for girls and

15,000 for boys. It is estimated that this is equivalent

to approximately 120 minutes of physical activity per

day for girls and 150 minutes per day for boys (Tudor-

Locke et al., 2004).

There have been a number of attempts to assess

the level and patterns of physical activity in children

and adolescents using objective measurements

(Riddoch et al., 2004; Troiano et al., 2008). However,

the lack of a validated tool that captures the multitude

of types of physical activity in children is a limitation

of research in this area (Riddoch et al., 2004). There

are many types of physical activity tracking tools,

however, these vary in their mechanisms of

measurement and accuracy. There is a need for an

accurate device that is able to collect information

about children’s activity levels. Such a device would

assist with assessing whether children meet the

recommended levels of physical activity. This

information along with information about what

influences and motivates children and adolescents to

be physically active would assist with the

development of a suitable invention to promote

sustained adherence to physically active behaviour

(Riddoch et al., 2004).

The level of physical activity in children and

adolescents is a topic of interest among researchers.

It has been reported that boys are more physically

active than girls (Riddoch et al., 2004; Troiano et al.,

2008; Brodersen et al., 2008; Salliset al., 2000) and

that younger children are more physically active and

spend more time engaged in moderate intensity

physical activity than adolescences (Riddoch et al.,

2004; Troiano et al., 2008). The 2003-2004 National

Health and Nutritional Examination Survey

conducted in the United States reported that 42% of

children met the recommended level of physical

activity compared to 8% of adolescents (Troiano et

al., 2008). Contrastingly, a European study reported

that a large majority of young children met the

recommended level of physical activity (Riddoch et

al., 2004). However, in support of the US study, the

European study found that few adolescents met the

criteria recommended for physical activity (Riddoch

et al., 2004).

A study of British children indicated remarkable

reductions in physical activity and increases in

sedentary, especially among adolescents (Brodersen

et al., 2008). Another study reported that only 7% of

Canadian children met the daily physical activity

recommendations (Wilson, 2012). In a 2011-12

Australian Health Survey of physical activity, only

one-third of children, and one in ten young people

undertook the recommended 60 minutes of physical

activity every day (Research, 2014). On average,

children and adolescents spend one and a half hours

per day physically active (Australian Health, 2013).

One study that measured physically activity in steps

per day using a pedometer reported that children

recorded an average of 9,140 Steps/day (Australian

Health, 2013). Younger children were most likely to

achieve the goal of 12,000 steps per day whereas only

7% of children aged 15 to 17 years did so (Australian

Health, 2013).

4 A TECHNOLOGY BASED

SOLUTION FOR PARITY

In response to the increased incidence of obesity in

children and adolescents, many interventions and

treatment programs have been developed with the aim

of combatting this problem (Epstein et al., 1994;

Reilly et al., 2006; Epstein et al., 1998). These

interventions have different focuses including diet

and exercise, surgical and drug treatments, behaviour

change, self-monitoring, and managing screen time

and physical activity levels (Shapiro et al., 2008;

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Robinson, 1999; Epstein et al., 1998). Several new

technologies have been developed and existing

technologies exploited for this purpose. For example,

Short Message Service (SMS) has been proposed as a

method of monitoring children and adolescents’

screen time and physical activity behaviour (Shapiro

et al., 2008). Results showed that children and

adolescents seems to be more affected by technology-

based programs compared to other traditional paper-

based methods of self-monitoring. Using electronic-

based programs might be more suitable and provide

adherence and acceptability in self-monitoring and

behavioural change among young generation

(Shapiro et al., 2008).

The literature supports the use of Information and

Communication Technologies in physical activity

interventions as a number of positive effects have

been documented for children and adolescents (Lau

et al., 2011). Electronic tools are useful in increasing

individuals’ awareness and enhancing their

adherence to self-monitoring because of their ability

to provide immediate feedback (Bartlett et al., 2002).

A survey of a US sample of 1100 parent-child pairs

found that 84% of teens owned at least one personal

media device: a desktop or laptop computer, mobile

phone or Personal Digital Assistant (Lenhart et al.,

2005). While personal technological devices are

widespread in their use, it remains to be determined

which device/s hold the most promise for motivating

children and adolescents to adhere to a more

physically active lifestyle. It is important that such

devices are designed to engage young people,

monitor activity accurately and support active

lifestyles.

A number of factors that positively affect

behavioural change, increase awareness of physical

activity and enhance adherence to self-monitoring

have been identified, for example home-based

tailored interactive programs targeted at children

(Bartlett et al., 2002; Shapiro et al., 2008).

Additionally, technology that provides immediate

feedback and facilitates self-monitoring (Shapiro et

al., 2008) as well as provides visual presentation of

activity level such as charts (Bartlett et al., 2002) has

been recommended. Studies have demonstrated a

strong relationship between parental support and

family inclusion, in the form of verbal encouragement

or direct assistance, and increased childhood physical

activity levels (Sallis et al., 2000; Bartlett et al., 2002;

Epstein et al., 1994).

There are a number of important design

considerations in developing technologies that

encourage physical activity. Firstly, this technology

should give users appropriate credit for their physical

activity. There is a problem with currently available

activity tracking technologies in that they do not

record all types of physical activity. Therefore,

designers should consider the most common physical

activities undertaken by their targeted users

(Consolvo et al., 2006). Secondly, technology should

allow users to access information regarding their past

and current physical activity levels with respect to

their goals. Thirdly, technology should include

features, such as the ability to share data with friends,

which support socializing and communication and

which may enhance motivation. Additionally, in

developing technology that encourages physical

activity, designers should be aware of the practical

constraints of users’ lifestyles. Finally, the

technology should provide reasonable goals that

encourage a sustainable increase in physical activity

(Consolvo et al., 2006).

A number of similar technology-based projects

have been developed with the aim of encouraging and

motivating physical activity in specific groups

including children, adults (Consolvo et al., 2006) and

seniors (Bickmore et al., 2005). An example is

‘Houston’, a prototype mobile phone application that

requires its user to wear a pedometer to count their

daily steps and then share these step counts with

friends. This system has been developed with the aim

of encouraging physical activity. Feedback gathered

regarding this application reported that it motivated

participants to plan increased levels of physical

activity (Consolvo et al., 2006).

5 ‘MYSTEPS’ ICT FRAMEWORK

5.1 Overview of the ‘MySteps’

Framework

The ‘MySteps’ solution is part of a larger body of

research being conducted to address the ever-growing

problem of childhood and adolescent obesity. Our

proposed solution focuses on the contributing factors

to the issue of increased screen time and decreased

physical activity among youth. It is widely accepted

that children and adolescents seek entertainment

though information and communication technologies.

On the basis of an extensive literature review and

investigations, we believe that the trend toward an

increasing number of overweight and obese children

is likely to worsen in the short term.

Furthermore, we acknowledge that it is

problematic to prevent children playing video games

or spending significant time in front of screens. We,

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therefore, feel that a more useful approach is to utilize

the very same technologies they are already prolific

in order to encourage a more balanced, active and

healthy lifestyle. We aim to employ a technology-

based solution to increase awareness of unhealthy

behaviour and support youth behaviour to be more

active. Hence, Managing Youth Screen Time and

Exercise Performance Statistics (MySteps) provides

an easy to access web-based application that

integrates a physical exertion tracking device to

review an individual’s daily activity behaviour.

5.2 Prototype Design and

Implementation

In our web-based platform, we have used the daily

step count as a measure of physical activity. We

focused on ‘recreational screen time’ – time that

children and adolescents spend in front of screens for

fun and entertainment purposes. Our system is

composed of two parts: hardware (Fitbit device and a

computer) and software (‘MySteps’ website).

For the hardware component we used a Fitbit

tracking device. After extensive product testing and a

review of the literature we selected the Fitbit Zip. The

Fitbit Zip is a wearable device that can be clipped to

pocket, belt, shoes or clothes. The Zip tacks steps

taken, calories burned and distance travelled. For our

solution we elected to use steps taken. This decision

was based on extensive evidence in the literature

regarding baseline recommended daily steps for

youths (15000 for males and 12000 for females). A

computer device, either a desktop or laptop computer

with internet access, is necessary to use MySteps.

This allows for physical activity and screen time data

to be uploaded to the MySteps website.

For the software component, we developed the

‘MySteps’ website. Users have to register and create

an account in order to manage and monitor their

screen time and physical activity counts on the

‘MySteps’ website. Fitbit provides a free API, which

we have integrated into the MySteps framework. On

registering and logging into MySteps at any given

time the user can authenticate with their Fitbit

account and their real time exercise statistics are

updated in the MySteps application. The screen time

element needs to be self-regulated (parent

participation is strongly encouraged for this

component of the App) and entered manually directly

into the MySteps App. This can be done at any time

and any number of times during the day to provide a

progressive cumulative total for each day. A history

of past behaviour is recorded.

Based on screen time and physical activity data, a

visual representation is provided. Each element is

mapped individually and in combination with the

second element against the recommended levels. The

graphs are easy to interpret so a young user can view

their performance and ideally adjust their behaviour

for the remainder of the day to meet the recommended

levels. Users are also able to monitor their behaviour

over the preceding week. The final sentence of a

caption must end with a period.

6 CONCLUSIONS AND FUTURE

WORK

This paper provides information regarding the

increased prevalence of childhood and adolescent

obesity and the risk this poses for the future due to the

associated health problems. It specifically highlights

increasing sedentary behaviour and decreasing levels

of physical activity among young people as major

contributing factors to the development of obesity.

Current data relating to levels of physical activity and

amount of time children and adolescents spend using

screen-based activities is provided. We suggest that

technology may help alleviate the problem of obesity

among young people. Information and

Communication Technologies have been previously

utilised for the promotion of physical activity among

children and adolescents. We aim to integrate the

best available technologies to keep children active.

Our previous work in this area found that the use of

active video games (Altamimi and Skinner, 2012;

Altamimi et al., 2014a; Altamimi et al., 2014),

activity monitoring technologies and a combination

of both of these technologies facilitated an active

lifestyle among children and adolescents (Altamimi

and Skinner 2013a; Altamimi et al., 2013; Altamimi

et al., 2014b; Altamimi and Skinner, 2013b). This

paper presents our solution, ‘MySteps’, a website

designed to manage youth screen time and daily step

counts.

The usability of ‘MySteps’ has been tested by the

authors who intend to publish the website and run a

small pilot to test its effectiveness in reducing screen

time and increasing physical activity among youths.

If this pilot demonstrates favourable results, we plan

to integrate more features such as a rewards based on

the physical exertion. We suggest that the

combination of ‘MySteps’ with exergaming

technology would have a further advantage. It is

expected that in-game reward and progress based on

physical exertion would act as a motivator for greater

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physical activity in children while simultaneously

reducing sedentary time spent in front of screens.

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FocussedGeneration

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