Usability and Effects of a Combined Physical and Cognitive Intervention Based on Active Video Games for Preschool Children

Round 1

Reviewer 1 Report

The manuscript evaluates the effectiveness in improving executive functions (EF) and the acceptability of regular 4-week exergame participation compared to conventional physical activity training in preschool children. Results indicate that exergames training results in larger EFs improvements (inhibition, shifting, and working memory) than conventional physical activity training. The topic is of considerable interest, especially considering studies showing the benefits of exercise on mental (including cognitive) / brain health and the lack of studies – as suggested by the authors - in this age group. In the following I, however, have a few questions and comments on the manuscripts in its current form:

 

Abstract:

1. I would recommend avoiding statistical analysis/methods terms in the abstract.

2. I would suggest rephrasing the term “better increases” – steeper/stronger increase in EF?

 

Introduction

3. Line 38 onwards: “… interventions that consider both their socio-emotional and physical development are more beneficial [6]. Given their ecological validity, physical activities have been recommended as a promising approach to improving children's EFs” -> Could the authors elaborate on why interventions are particularly beneficial when considering both, socio-emotional and physical development. How is the socio-emotional aspect addressed in the current study? 

 

Methods

4.  Line 88: Children were required to be in “normal general physical healthy and development” Could you elaborate what that means? How was that assessed? Does this include all children without medical conditions listed in line 90 onwards?

5. Please introduce the abbreviation IRB (line 166).

6. Did the authors assess hobbies and/or general free time related exercise/sports of the children? Further, was assessed if and how often children play the “Just Dance” game in their free time/ novelty (similarly for the conventional physical activities)?

7.  Would the authors consider the setting to be relevant? I.a. would you expect a similar outcome outside a preschool setting? Or is the closeness to the cognitive aspect/ learning relevant?

8. Did the children in the exergame group take part in conventional physical activities as well and is it the regular programme of the preschool?

9. Since research is conducted often “on children” instead of with children (participatory approached), did the authors collect any information on interest and or recommendations of the children themselves on what kind of physical exercises they prefer in general and could image to be beneficial? 

 

Results

10. Why did the authors decide to exclude response times below 300 ms in the GoNogo task? Some literature appears to exclude reaction times below 100 to 150 ms? Could the authors please elaborate on this.

11. Why were blocks removed without a selected response -> “blocks with GO accuracy > 20 % and NO-GO accuracy < 80 %”? Would this not automatically remove impulsive individuals and hence only leave children with high performance and thus a small variability? (To remove non-responsive blocks on the other hand appears more straightforward to avoid including children that misunderstood the task)

12.  I might be mistaken, but could the authors please elaborate why “time” is not included in the tables even though it is stated that time was included in the linear mixed-effects models (line 211 onwards)?

 

Results

13. Do the error bars in Figure 3 depict the standard deviation or the standard error? It is somehow not as clear from the diagrams that the difference in the increase in switching ability between the groups is as great as the statistics show. This also applies to a few other comparisons, yet might appear that way due to the different scales of the EFs tasks – could the authors please elaborate on this?

14. Maybe add percentages to the Table 6?

 

Discussion

15.  I agree with the authors that novelty of the exergames might indeed have played a role – and it might also be linked to a positive emotional experience and enjoyment as well. Traditional physical activity in healthy children is probably more of a "norm" so you wouldn't see as much short-term benefit because it's already having an impact?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

I believe that the Introduction section should be expanded. I recommend expanding the literature on the impact of video games on preschool children.

 

In the Material and Method section, I recommend presenting the type of study carried out and its characteristics.

 

The Results section is well organized. Statistical analysis is adequate and well described. However, a mixed type study would increase their interest.

 

I recommend presenting the limitations of the research, which do not compromise its quality and relevance. Rather, they contribute to the definition of lines of future action.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

This is an interesting and well-done paper consisting in a randomised controlled trial aimed to assess the effects of exergames intervention training on preschool children’s executive functions (EFs). Although I think this paper should be published, I would suggest authors some revisions mainly concerning the methods, as follows:

1.       In the Introduction, it could be useful for readers to learn more about the processes through which EFs affect physical and mental health.

2.       How did authors assess inclusion criteria? Did they create specific questionnaires addressed to teachers, parents, or both? Furthermore, did they explain to the excluded children the reason for the exclusion? If so, how?

3.       Authors should report some statistics about reliability and validity of the measures used.

4.       The most significant critical point concerns the determination of the sample size. Did the authors conduct an a-priori power analysis to determine the appropriateness of the sample size? If no, I would suggest to perform a post-hoc power analysis or something else to provide evidence for the sample size.

5.       In the manuscript no registration of the clinical trial to recognized registers (e.g., ClinicalTrials.gov) has been reported. Is the information missing or the trial has not been registered? Authors should clarify this point.

6.       The last point concerns the absence of statistics relating to the effect size. I suggest authors to report the effect size for each significant result.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

The authors made a great job and I think that the paper can be published in its current form.