title: Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland
  Study design and 1-year interim report on the feasibility of the lifestyle intervention programme Do Motion Controllers Make Action Video Games Less Sedentary? A Randomized Experiment Comparison Between Nintendo Wii Fit Aerobics and Traditional Aerobic Exercise in Sedentary Young Adults Physical activity in U.S. older adults with diabetes mellitus: prevalence and correlates of meeting physical activity recommendations. Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Testing the effectiveness of exercise videogame bikes among families in the home-setting: a pilot study. The health benefits of interactive video game exercise. Active video games as a form of exercise and the effect of gaming experience: a preliminary study in healthy young adults. Activity and energy expenditure in older people playing active video games. Interactive video dance games for healthy older adults Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Heart Rate and Perceived Exertion During Self-Selected Intensities for Exergaming Compared to Traditional Exercise in College-Age Participants Energy expended playing Xbox Kinect™ and Wii™ games: a preliminary study comparing single and multiplayer modes. Comparison of Acute Exercise Responses Between Conventional Video Gaming and Isometric Resistance Exergaming
abstract: Aims /hypothesis . The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  Type II ( non-insulin-dependent ) diabetes mellitus in subjects with impaired glucose tolerance , to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance . Methods . A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were r and omised to either a control or intervention group . The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits . The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aim ed at reducing weight , the intake of saturated fat and increasing the intake of dietary fibre . Intervention subjects were also guided individually to increase their physical activity .  Results . During the first year , weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group , respectively ( p < 0.001 ) . The plasma glucose concentrations ( fasting : 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l , p < 0.001 ; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l , p < 0.05 ) were significantly lower in the intervention group after the first year of intervention . Favourable changes were also found in blood pressure , serum lipids and anthropometric indices in the intervention group . Conclusion /interpretation . The interim results show the efficacy and feasibility of the lifestyle intervention programme . [ Diabetologia ( 1999 ) 42 : 793–801 Sports- and fitness-themed video games using motion controllers have been found to produce physical activity . It is possible that motion controllers may also enhance energy expenditure when applied to more sedentary games such as action games . Young adults ( N = 100 ) were r and omized to play three games using either motion-based or traditional controllers . No main effect was found for controller or game pair ( P > .12 ) . An interaction was found such that in one pair , motion control ( mean [ SD ] 0.96 [ 0.20 ] kcal · kg−1 · hr−1 ) produced 0.10 kcal · kg−1 · hr−1 ( 95 % confidence interval 0.03 to 0.17 ) greater energy expenditure  than traditional control ( 0.86 [ 0.17 ] kcal · kg−1 · hr−1 , P = .048 ) . All games were sedentary . As currently implemented , motion control is unlikely to produce moderate intensity physical activity in action games . However , some games produce small but significant increases in energy expenditure , which may benefit health by decreasing sedentary behavior Abstract Douris , PC , McDonald , B , Vespi , F , Kelley , NC , and Herman , L. Comparison between Nintendo Wii Fit aerobics and traditional aerobic exercise in sedentary young adults . J Strength Cond Res 26(4 ) : 1052–1057 , 2012—Exergaming is becoming a popular recreational activity for young adults . The purpose was to compare the physiologic and psychological responses of college students playing Nintendo Wii Fit , an active video game console  , vs. an equal duration of moderate-intensity brisk walking .  Twenty-one healthy sedentary college-age students ( mean age 23.2 ± 1.8 years ) participated in a r and omized , double cross-over study , which compared physiologic and psychological responses to 30 minutes of brisk walking exercise on a treadmill vs. 30 minutes playing Nintendo Wii Fit “ Free Run ” program . Physiologic parameters measured included heart rate , rate pressure product , respiratory rate , and rating of perceived exertion . Participants ' positive well-being , psychological distress , and level of fatigue associated with each exercise modality were quantified using the Subjective Exercise Experience Scale . The mean maximum heart rate ( HRmax ) achieved when exercising with Wii Fit ( 142.4 ± 20.5 b·min−1 ) was significantly greater ( p = 0.001 ) compared with exercising on the treadmill ( 123.2 ± 13.7 b·min−1 ) . Rate pressure product was also significantly greater ( p = 0.001 ) during exercise on the Wii Fit . Participants ' rating of perceived exertion when playing Wii Fit ( 12.7 ± 3.0 ) was significantly greater ( p = 0.014 ) when compared with brisk walking on the treadmill ( 10.1 ± 3.3 ) . However , psychologically when playing Wii Fit , participants ' positive well-being decreased significantly ( p = 0.018 ) from preexercise to postexercise when compared with exercising on the treadmill . College students have the potential to surpass exercise intensities achieved when performing a conventional st and ard for moderate-intensity exercise when playing Nintendo Wii Fit “ Free Run ” with a self-selected intensity . We concluded that Nintendo Wii Fit “ Free Run ” may act as an alternative to traditional moderate-intensity aerobic exercise in fulfilling the American College of Sports Medicine requirements for physical activity OBJECTIVES To compare the prevalence and correlates of meeting current recommendations for physical activity  in older adults with and without diabetes mellitus ( DM ) in the United States . DESIGN A cross-sectional , population -based sample . SETTING The 2007 Behavioral Risk Factor Surveillance Survey , which employs r and om-digit dialing to interview noninstitutionalized U.S. adults . PARTICIPANTS Ninety-nine thous and one hundred seventy-two adults ( 18,370 with DM ) aged 65 and older . MEASUREMENTS The age-adjusted prevalence and the odds ratios for physical activity patterns ( defined on the basis of the physical activity guidelines from the American Diabetes Association ( ADA 2007 ) and the Department of Health and Human Services ( DHHS 2008 ) ) were obtained using multiple logistic regression analyses . The correlates of meeting physical activity recommendations were assessed using log-binomial regression analyses . RESULTS Overall , 25 % and 42 % of older adults with diabetes mellitus met recommendations for total physical activity based on the ADA 2007 and the DHHS 2008 guidelines , respectively . Adults with DM were 31 % to 34 % ( P < .001 ) less likely to engage in physical activity at recommended levels and 13 % to 19 % ( P < .001 ) less likely to be physically active at insufficient levels than those without DM . Analyses limited to participants who reported no disability yielded similar results . In adults with DM , older age ( ≥ 75 ) ; being female ; being non-Hispanic black ; and having obesity , coronary heart disease , and disability were associated with less likelihood , whereas advanced educational status was associated with greater likelihood of meeting physical activity recommendations . CONCLUSION In the United States , efforts to boost physical activity participation in older adults with DM are needed Clinical trials have demonstrated that lifestyle changes can prevent type 2 diabetes , but the importance of leisure-time physical activity ( LTPA ) is still unclear . We carried out post hoc analyses on the role of LTPA in preventing type 2 diabetes in 487 men and women with impaired glucose tolerance who had completed 12-month LTPA question naires . The subjects were participants in the Finnish Diabetes Prevention Study , a r and omized controlled trial of lifestyle changes including diet , weight loss , and LTPA .  There were 107 new cases of diabetes during the 4.1-year follow-up period . Individuals who increased moderate-to-vigorous LTPA or strenuous , structured LTPA the most were 63 - 65 % less likely to develop diabetes . Adjustment for changes in diet and body weight during the study attenuated the association somewhat ( upper versus lower third : moderate-to-vigorous LTPA , relative risk 0.51 , 95 % CI 0.26 - 0.97 ; strenuous , structured LTPA , 0.63 , 0.35 - 1.13 ) . Low-intensity and lifestyle LTPA  and walking also conferred benefits , consistent with the finding that the change in total LTPA ( upper versus lower third : 0.34 , 0.19 - 0.62 ) was the most strongly associated with incident diabetes . Thus increasing physical activity may substantially reduce the incidence of type 2 diabetes in high-risk individuals BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects BACKGROUND Interactive stationary bikes provide positive affective experiences and physiological benefits ; however , research is limited . METHODS This study compared usage of GameBikes to traditional stationary bikes among families in the home following a 6-week r and omized , controlled trial design . Parents completed question naires featuring constructs of the theory of planned behavior ( TPB ) . Usage was tracked by all family members and belief elicitation with GameBike families followed the trial . RESULTS Usage across the trial was significantly different for children in favor of the  GameBike group ( t36 = 2.61 , P = .01 , d = .85 ) . No differences were identified for parents .  Significant time effects for parents '  ( F5,48 = 5.07 , P < .01 ; η2 = .35 ) and  children 's  ( F5,32 = 8.24 , P < .01 ; η2 = .56 ) usage were found with declines across 6 weeks . Affective attitude was the only significant TPB variable between groups at both time one ( t57 = 2.53 , P = .01 ; d = .65 ) and follow-up ( t52 = 2.70 , P = .01 ; d = .74 ) in favor of the GameBike group . Elicited beliefs were primarily affective- and control-based . CONCLUSIONS The results provide support for use of interactive video games to augment current PA initiatives . Larger-scale trials with longer duration s are warranted The purpose of this study was to evaluate the effectiveness of interactive video games ( combined with stationary cycling ) on health-related physical fitness and exercise adherence in comparison with traditional aerobic training ( stationary cycling alone ) . College-aged males were stratified ( aerobic fitness and body mass ) and then assigned r and omly to experimental ( n = 7 ) or control ( n = 7 ) conditions . Program attendance , health-related physical fitness ( including maximal aerobic power ( VO2 max ) , body composition , muscular strength , muscular power , and flexibility ) , and resting blood pressure were measured before and after training ( 60%-75 % heart rate reserve , 3 d/week for 30 min/d for 6 weeks ) . There was a significant difference in the attendance of the interactive video game and traditional training groups ( 78 % + /- 18 % vs. 48 % + /- 29 % , respectively ) . VO2 max was significantly increased after interactive video game ( 11 % + /- 5 % ) but not traditional ( 3 % + /- 6 % ) training . There was a significantly greater reduction in resting systolic blood pressure after interactive video game ( 132 + /- 6 vs. 123 + /- 6 mmHg ) than traditional ( 131 + /- 7 vs. 128 + /- 8 mmHg ) training . There were no significant changes in body composition after either training program . Attendance mediated the relationships between condition and changes in health outcomes ( including VO2 max , vertical jump , and systolic blood pressure ) . The present investigation indicates that a training program that links interactive video games to cycle exercise results in greater improvements in health-related physical fitness than that seen after traditional cycle exercise training . It appears that greater attendance , and thus a higher volume of physical activity , is the mechanism for the differences in health-related physical fitness OBJECTIVES To examine the energy expenditure and heart rate response while playing active video games  , and the effect of gaming experience on energy expenditure . DESIGN Cross-sectional study . PARTICIPANTS AND INTERVENTIONS Twenty-eight healthy participants ( 18 male , age 19 to 27 years ) played either Wii Sports Boxing , Tennis and Baseball , or Wii Sports Boxing and Wii Fit Free Jogging . MAIN OUTCOME MEASURES Percentage maximal heart rate ( % HRmax ) and metabolic equivalents ( METs ) were measured during 15 minutes of rest and during each game . RESULTS Mean % HRmax and METs while playing each of the four games were as follows : Wii Fit Free Jogging 71 % [ st and ard deviation ( SD ) 13 % ] , 5.9 ( SD 1.8 ) ; Wii Sports Boxing 58 % ( SD 13 % ) , 3.2 ( SD 1.1 ) ; Wii Sports Baseball 42 % ( SD 6 % ) , 2.0 ( SD 0.5 ) ; and Wii Sports Tennis 42 % ( SD 7 % ) , 2.0 ( SD 0.4 ) . Subjects with gaming experience achieved a lower heart rate playing Wii Sports Tennis compared with subjects without gaming experience . CONCLUSIONS Wii Sports Boxing , Tennis and Baseball are light-intensity activities , and Wii Fit Free Jogging is a moderate-intensity activity . Experience of gaming may affect the exercise intensity of games requiring controller skill UNLABELLED Tayl OBJECTIVES To quantify energy expenditure in older adults playing  interactive video games  while st and ing and seated , and secondarily to determine whether participants ' balance status influenced the energy cost associated with active video game play . DESIGN Cross-sectional study . SETTING University research center . PARTICIPANTS Community-dwelling adults ( N=19 ) aged 70.7±6.4 years . INTERVENTION Participants played 9 active video games , each for 5 minutes , in r and om order . Two games ( boxing and bowling ) were played in both seated and st and ing positions . MAIN OUTCOME MEASURES Energy expenditure was assessed using indirect calorimetry while at rest and during game play . Energy expenditure was expressed in kilojoules per minute and metabolic equivalents ( METs ) . Balance was assessed using the mini-BESTest , the Activities-specific Balance Confidence Scale , and the Timed Up and Go ( TUG ) . RESULTS Mean ± SD energy expenditure was significantly greater for all game conditions compared with rest ( all P≤.01 ) and ranged from 1.46±.41 METs to 2.97±1.16 METs . There was no significant difference in energy expenditure , activity counts , or perceived exertion between equivalent games played while st and ing and seated . No significant correlations were observed between energy expenditure or activity counts and balance status . CONCLUSIONS Active video games provide light-intensity exercise in community-dwelling older people , whether played while seated or st and ing . People who are unable to st and may derive equivalent benefits from active video games played while seated . Further research is required to determine whether sustained use of active video games alters physical activity levels in community setting s for this population Background Physical activity promotes health in older adults but participation rates are low . Interactive video dance games can increase activity in young persons but have not been design ed for use with older adults . The purpose of this research was to evaluate healthy older adults ’ interest and participation in a dance game adapted for an older user . Methods Healthy older adults were recruited from 3 senior living setting s and offered three months of training and supervision using a video dance game design ed for older people .  Before and after the program , data was collected on vital signs , physical function and self reported quality of life . Feedback was obtained during and after training . Results Of 36 persons who entered ( mean age 80.1 + 5.4 years , 83 % female ) , 25 completed the study . Completers were healthier than noncompleters . Completers showed gains in narrow walk time , self-reported balance confidence and mental health . While there were no serious adverse events , 4 of 11 noncompleters withdrew due to musculoskeletal complaints . Conclusions Adapted Interactive video dance is feasible for some healthy older adults and may help achieve physical activity goals BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin Kraft , JA , Russell , WD , Bowman , TA , Selsor III , CW , and Foster , GD . Heart rate and perceived exertion during self-selected intensities for exergaming compared to traditional exercise in college-age participants . J Strength Cond Res 25(6 ) : 1736 - 1742 , 2011—Exergames may be useful for promoting physical activity in younger population s.  Heart rate ( HRs ) responses and rating of perceived exertion ( RPE ) at self-selected intensities were compared in college-age participants during 2 modes of exergame activity vs. traditional exercise .  Thirty-seven participants ( men : 20 , women : 17 ) completed 3 30-minute self-selected intensity trials : ( a ) video game interactive bicycle ergometer ( GB ) ( CatEye GB300 ) , ( b ) interactive video dance game ( Dance Dance Revolution [ DDR ] ) , and ( c ) traditional cycle ergometer ( CE ) while watching television . Mean HR , peak HR ( PkHR ) , and minutes above target HR ( THR ) were significantly higher for GB ( 144 ± 22 b·min−1 [ 57 % HR reserve ( HRR ) ] , 161 ± 23 b·min−1 , and 22.5 ± 11.1 minutes ) than for DDR ( 119 ± 16 b·min−1 [ 37 % HRR ] , 138 ± 20 b·min−1 , and 11.2 ± 11.9 minutes ) or for CE ( 126 ± 20 b·min−1 [ 42 % HRR ] , 144 ± 24 b·min−1 , and 14.2 ± 12.6 minutes ) . The RPE was significantly higher for GB ( 4.2 ± 1.5 ) and CE ( 3.8 ± 1.2 ) than for DDR ( 2.7 ± 1.3 ) . Recovery HR ( RecHR ) ( 15 minutes postexercise ) was significantly higher for GB ( 91 ± 14 b·min−1 ) than for DDR ( 80 ± 11 b·min−1 ) and neared significance vs. CE ( 84 ± 14 b·min−1 , p = 0.059 ) . No difference in PkHR , RecHR , or minutes above THR was observed between DDR and CE . Session RPE was significantly higher for GB ( 4.6 ± 1.7 ) and CE ( 4.1 ± 1.6 ) than for DDR ( 2.8 ± 1.5 ) . All modes elicited extended proportions of time above THR ; GB : 75 % , DDR : 37 % , and CE : 47 % . Results support that exergames are capable of eliciting physiological responses necessary for fitness improvements . Practitioners might consider exergames as periodic activity options for clients needing motivation to be regularly active OBJECTIVES It has been reported that a higher galvanic skin response is seen when playing video games against another human player than when playing alone , which suggests increased effort . The objectives of this study were to compare energy expenditure when playing two popular active video game consoles , and to compare energy expenditure when playing in single and multiplayer modes . DESIGN Crossover trial with r and omised playing order . PARTICIPANTS Fourteen healthy adults with a mean age of 21 [ st and ard deviation ( SD ) 3 ] years . METHODS AND INTERVENTIONS Energy expenditure was measured using an indirect calorimeter at rest , during 10 minutes of play on Xbox Kinect ™ Reflex Ridge in both single and multiplayer modes , and during 10 minutes of play on Wii ™ Sports Boxing in both single and multiplayer modes . MAIN OUTCOME MEASURES Metabolic equivalents ( METs ) , heart rate , oxygen consumption and kilocalories expended . RESULTS The energy expenditure during all gaming conditions was of a light intensity . Playing on the Xbox Kinect elicited greater energy expenditure than playing on the Wii [ mean difference=0.9 METs , 95 % confidence interval ( CI ) 0.2 to 1.5 ] . Playing games in multiplayer mode led to greater energy expenditure ( mean difference=0.5 METs , 95 % CI 0.1 to 0.9 ) and heart rate ( mean difference=7.9 beats/minute , 95 % CI 2.0 to 13.8 ) than playing in single player mode . CONCLUSIONS No gaming condition required moderate-intensity activity in this group of young healthy adults . Potential explanations for the difference in energy expenditure seen between consoles and modes are discussed Bonetti , AJ , Drury , DG , Danoff , JV , and Miller , TA . Comparison of acute exercise responses between conventional video gaming and isometric resistance exergaming . J Strength Cond Res 24(7 ) : 1799 - 1803 , 2010-Exergaming is a relatively new type of entertainment that couples physical activity and video gaming . To date , research that has focused on the physiologic responses to exergaming has been focused exclusively on aerobic-type activities . The purpose of this project was to describe the acute exercise responses ( i.e. , oxygen uptake [ & OV0312;O2 ] , heart rate , and rate of perceived exertion [ RPE ] ) to exergaming using full-body isometric muscle resistance and to determine whether these responses are different during single- versus opponent-based play . Male subjects ( n = 32 ) were r and omly and equally divided into either an experimental ( EXP ) or control ( CON ) group . Acute exercise responses ( & OV0312;O2 , heart rate , and RPE ) were measured in all subjects during both solo- and opponent-based video game play . Subjects in the EXP group played using a controller that relied on full-body isometric muscle resistance to manipulate the on-screen character , whereas CON subjects used a conventional h and held controller . During solo play , the EXP group exhibited significantly higher values for & OV0312;O2 ( 9.60 ±0.50 mL/kg/min ) and energy expenditure ( 3.50 ± 0.14 kcal/min ) than the CON group ( & OV0312;O2 5.05 ± 0.16 mL/kg/min ; energy expenditure 1.92 ± 0.07 kcal/min ) . These changes occurred with no significant differences in RPE or heart rate between the groups . These results suggest that whole-body isometric exergaming results in greater energy expenditure than conventional video gaming , with no increase in perceived exertion during play . This could have important implication s regarding long-term energy expenditure in gamers
target: However , effects of exergaming in terms of changes in these intensity parameters varied significantly between game modes and consoles as well as because of the vastly differing duration s of exergame activity between studies .
  Conclusion This review suggests that exergames are able to increase PA among overweight individuals .
  However , the inconsistent results and the overall poor or moderate method ological quality do not permit judgment on whether exergames are suitable to meet PA guidelines in this target group .
background: Background The majority of patients with overweight and type 2 diabetes show insufficient levels of daily physical activity ( PA ) and usually are among the least likely to engage in or adhere to any form of generic PA .
  Active video games ( exergames ) may be a solution to motivate these individuals to overcome their sedentary lifestyle .
  Objectives This systematic review was conducted to review the current evidence for the effectiveness of exergaming in overweight and type 2 diabetes mellitus and thus to evaluate the suitability of these games to be used as tools for exercise promotion that meet current PA guidelines .