UMMS Affiliation

Department of Family Medicine and Community Health; Eunice Kennedy Shriver Center

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Behavioral Medicine | Exercise Science | Health Services Administration | Health Services Research | Mental and Social Health | Nervous System Diseases | Nutritional and Metabolic Diseases | Pediatrics | Psychiatry | Psychiatry and Psychology


BACKGROUND: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences.

OBJECTIVE: This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs.

METHODS: Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA.

RESULTS: Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (-58.8 min; P=.04) but not for the intervention group (-5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames.

CONCLUSIONS: AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing.

TRIAL REGISTRATION: NCT03665415; Marilyn Augustyn, Mediatrix Mbamalu, Carol Curtin, Linda Bandini, Aviva Must, Amanda E Staiano. Originally published in JMIR Formative Research (, 14.05.2021.


adolescent, children, diet, exercise, exergaming, health promotion, mental health, sleep, telehealth

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Copyright © April B Bowling, James Slavet, Chelsea Hendrick, Robbie Beyl, Phillip Nauta, Marilyn Augustyn, Mediatrix Mbamalu, Carol Curtin, Linda Bandini, Aviva Must, Amanda E Staiano. Originally published in JMIR Formative Research (, 14.05.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

DOI of Published Version



Bowling AB, Slavet J, Hendrick C, Beyl R, Nauta P, Augustyn M, Mbamalu M, Curtin C, Bandini L, Must A, Staiano AE. The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study. JMIR Form Res. 2021 May 14;5(5):e24566. doi: 10.2196/24566. PMID: 33988508; PMCID: PMC8164124. Link to article on publisher's site

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JMIR formative research

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.