Gerrit Niezen edited introduction.tex  over 10 years ago

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It is well established that peadiatric obesity is associated with numerous health implications in later life \cite{Freedman2007}. Despite evidence to suggest that the prevalence of obesity has plateaued in recent years within the UK \cite{Boddy2010} and internationally \cite{Rokholm2010}, there is no evidence of a decline, and a high proportion of children remain at risk of morbidity. Physical activity and sedentary behaviour are key variables implicated in childhood obesity due to their influence on energy balance \cite{Rowland2004}. Current physical activity guidelines recommend children between 5 and 18 years of age to engage in at least 60 minutes moderate-to-vigorous physical activity every day \cite{DOH2011}. Despite this, children, on average, are insufficiently active \cite{Hills2011} and engage in excessive sedentary behaviour. Specifically, only 41 percent of boys and 30 percent of girls in Wales meet these recommended guidelines\footnote{http://www.bhfactive.org.uk/young-people-key-facts/index.html}. Moreover, according to the Department of Health, more than 30 percent of 5 to 12 year old children in the UK are obese, with Wales leading at 36 percent\footnote{http://www.dh.gov.uk/health/2012/04/obesityfacts/}.   Many interventions have been conducted to reverse childhood overweight and obesity, employing a variety of strategies to enhance levels of habitual physical activity and reduce time spent in sedentary behaviours. Schools have been identified as a key context to implement such physical activity promoting interventions, given that children spend, on average, 40 percent of their waking time there \cite{Fox2004}. Despite this, school-based interventions have been conducted with varied success \cite{Summerbell2005}, which could be attributed to the different intervention strategies and variable methodological quality, such as lack of objective measurements of physical activity \cite{Mountjoy2011}. Furthermore, interventions targeting reduced sedentary behaviour tend to discourage highly valued behaviours, such as engagement with technology. Therefore, there is a need to integrate such technological behaviours into future interventions. Some interventions have sought to do this. Specifically, ambient displays, also known as glanceable displays, which are peripheral, aesthetically pleasing displays of information that support awareness of some data, can be utilised to make information visible in an appealing and socially interactive manner. They are designed to be looked at occasionally without distracting us from our activities \cite{Rogers2010}.Consolvoetala et al. \cite{Consolvoetala08,Consolvoetalb08} integrated an interactive mobile fitness application with a glanceable display finding that those individuals utilising an awareness display maintained their physical activity levels better in comparison to those with no ambient display. However, such devices have inherent problems, such as monitor placement \cite{Trost200}, \cite{Trost2005},  and have not been incorporated into a community-based settings, especially targeting children. Therefore, the aim of the present pilot study was to utilise ambient displays in order to provide near real-time visual feedback on physical activity levels during school time.