Journal of Physiotherapy 68 (2022) 278

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j p hy s

Appraisal

Critically appraised paper: An intervention to reduce household recreational

screen media usage improves physical activity in children
Synopsis

Summary of: Pedersen J, Rasmussen MGB, Sørensen SO, Mortensen electroencephalography and change in the adult’s non-sedentary
SR, Olesen LG, Brønd JC, et al. Effects of Limiting Recreational Screen activity. In addition, changes in moderate-to-vigorous physical
Media Use on Physical Activity and Sleep in Families With Children: A activity and non-sedentary activity on weekends and weekdays were
Cluster Randomized Clinical Trial. JAMA Pediatr 2022:e221519. assessed for both adults and children. Results: Eighty-three
households completed the study (157 children, 87% with primary
Question: Does reducing household recreational screen media use
outcome data). At the end of the 2-week intervention, the change in
improve physical activity and sleep in children and adults? Design:
leisure non-sedentary activity in the intervention group children
Cluster randomised controlled trial with concealed allocation and
was greater than the control group by 46 minutes (95% CI 28 to
blinded assessment. Setting: Ten municipalities in Southern
64 minutes). Children in the intervention group also had greater
Denmark. Participants: A household of more than one child aged 6 to
moderate-to-vigorous activity leisure time and both weekday and
10 years residing full time and one adult with self-reported
weekend non-sedentary time. There was no difference in outcomes
recreational screen use . 2.4 hours/day. Households with children
for sleep measures or any adult outcomes. Conclusion: A household
aged , 4 years or where the responding parent was unemployed or a
intervention to reduce recreational screen media use increased
shift worker were excluded. Randomisation of 89 households
physical activity levels in children but not adults, and had no effect on
allocated 45 households to the screen media reduction group and 44
sleep outcomes for children or adults.
households to screens as usual group. Interventions: The screen
media reduction group surrendered portable media devices for 2
weeks. Participants were provided with a phone that could only be Provenance: Invited. Not peer reviewed.
used for calls and text messages, and instructed to reduce recreation
screen use to , 3 hours/week during the intervention. The control
group was able to use screen media as usual. Outcome measures: The Alicia Spittle
primary outcome was change in the child’s non-sedentary activity, Department of Physiotherapy, University of Melbourne, Australia
which was measured with accelerometery. Secondary outcome
measures included sleep measured at home using single-channel https://doi.org/10.1016/j.jphys.2022.08.003

Commentary

The benefits of participating in physical activity in childhood are
well established, including more favourable cardiometabolic status,
bone health, fitness and cognitive and motor development.1,2 However,
many children are failing to meet the 24-hour movement guidelines,3
which are an integration of physical activity, sedentary behaviour and
sleep recommendations.4 Given that adherence to the 24-hour move-
ment guidelines is linked with many favourable outcomes, including
healthy dietary patterns and better health-related quality of life,3
effective interventions are needed to improve children’s physical
activity, decrease their sedentary behaviour and optimise their sleep.
The SCREENS trial demonstrated that a 2-week screen media
reduction intervention increased children’s physical activity but had
little effect on their sleep. The intervention had minimal effect on adult
physical activity outcomes. The long-term effects of the intervention
are unclear due to the short length of follow-up. Intervention
compliance, defined as  7 hours of screen media use over the study
period, was excellent (96% for families); however, it is unclear if it was
acceptable for families. Measuring intervention acceptability is
important, as it can increase the likelihood that the intervention ad-
dresses the needs/preferences of the communities who will use it,5
supporting translation into practice. To be eligible for the
intervention, at least one parent and all children were required to
hand over their smartphones/tablets. Screen media use was tracked
using a non-commercial app and a custom-made television monitor,
which was installed by a researcher. Given these stringent methods to
ensure compliance, it is unclear whether it is realistic to expect fam-
ilies to abide by such an intervention in the real-world context.
Provenance: Invited. Not peer reviewed.
Tara L FitzGerald
Department of Physiotherapy, The University of Melbourne, Australia
https://doi.org/10.1016/j.jphys.2022.08.004
References
1. Carson V, et al. BMC Public Health. 2017;17:854.
2. Poitras V, et al. Appl Physiol Nutr Metab. 2016;41:S197–S239.
3. Rollo S, et al. J Sport Health Sci. 2020;9:493–510.
4. Australian Government Department of Health. 2019.
5. Sekhon M, et al. BMC Health Serv Res. 2017;17:88.

https://doi.org/10.1016/j.jphys.2022.08.004
1836-9553/© 2022 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).