Exergaming and obesity in youth: current perspectives

Figures & data

Figure 1 Flow diagram of studies through the review process.

Notes: *Reasons for study exclusion included ineligible age, ineligible populations, ineligible exergaming types, and ineligible outcomes. Many studies were excluded for multiple reasons.

Table 1 Summary of exergaming studies

Study description	Sample and design	Types of AVGs	Outcomes	Dose	Findings
To evaluate the physiologic cost, relative reinforcing value, and liking of playing Wii versus a traditional sedentary video game in lean and overweight/obese children (USA)^Citation15	Children aged 8–12 years (overweight/obese participants, n=11; lean participants, n=13); comparison design	Wii Sports Boxing	HR, VO2, liking, and relative reinforcing value	All children completed four 10 min activity conditions: resting, treadmill walking, traditional SVG play, and physically interactive video game play	Average HR, VO2, and liking were significantly greater for Nintendo Wii than all other conditions. Lean children displayed a greater peak responding for access to Wii relative to SVG, while overweight/obese children did not.
To evaluate the efficacy and feasibility of a multifaceted, community-based weight intervention program for children using exergaming technology (USA)^Citation16	40 overweight or obese children aged 8–16 years; pre–post test	DDR, Nintendo Wii tennis and boxing, PlayStation 2, etc.	BMI, psychological and behavioral outcomes	120 minutes per week ×10 weeks	The average BMI significantly decreased; the average Global Self-Worth score improved; screen time and soda intake reduced; and exercise hours per week increased after intervention.
To examine whether a 20-week exergame (ie, videogame that requires gross motor activity) intervention can produce weight loss and improve psychosocial outcomes (USA)^Citation17	African-American adolescents aged 15–19 years (competitive exergame, n=19; cooperative exergame, n=19; control, n=16); RCT	Nintendo Wii	Weight, peer support, self-efficacy, and self-esteem	30–60 minutes per school day ×20 weeks	Cooperative exergame players lost significantly more weight than the control group, which did not lose weight. The competitive exergame players did not differ significantly from the other groups. Self-efficacy of cooperative exergame players also significantly increased compared to the control group, and peer support also increased significantly in both the exergame groups compared to the control group.
To examine the influence of exergaming on adolescent girls’ body composition and cardiovascular risk factors (USA)^Citation18	Obese girls aged 14–18 years (dance exergaming group, n=21; self-directed care control group, n=20); RCT	Xbox Kinect (Just Dance and Dance Central)	Body size and composition, blood pressure, cholesterol, triglycerides, glucose, and insulin	60 minutes per session ×3 times per week ×12 weeks	Per protocol (attended >75%), abdominal subcutaneous adiposity decreased significantly and trunk and spine BMD increased in the intervention group. Per protocol (>2600 steps/session), leg percentage of fat decreased significantly and abdominal subcutaneous and total adiposity decreased in the intervention group.
To evaluate the effects of exergaming on physical activity and weight loss in overweight and obese children (USA)^Citation19	Overweight and obese children aged 8–12 years (exergame + weight management group, n=31; weight management group, n=38); RCT	Xbox Kinect (Kinect Adventures and Kinect Sports)	Physical activity levels, percentage overweight, and BMI	60 minutes per day ×16 weeks	Participants in the program and active gaming group exhibited significant increases in moderate- to-vigorous and vigorous physical activity at week 16. In the program-only group, a decline or no change was observed in the moderate-to-vigorous and vigorous physical activity. Participants in both the groups exhibited significant reductions in percentage overweight and BMI at week 16.(br)However, the program and active gaming group exhibited significantly greater reductions in percentage overweight and BMI.
To investigate the impact of dance-based exergaming on a diverse sample of obese adolescents’ perceived competence to exercise, psychological adjustment, and BMI (USA)^Citation20	Obese adolescents aged 12–18 years (exergame group, n=20; control group, n=20); RCT	DDR	BMI, psychological adjustment, and perceived competence to exercise	3 times a week for 40 minutes in the first session and 75 min in subsequent sessions ×10 weeks	Compared with controls, participants in the dance-based exergaming group exhibited significant increase in self-reported perceived competence to exercise regularly and reported significant improvement in relationship with parents from baseline to end-of-treatment. Mothers of adolescents in the exergaming group reported significant reductions in both composite scores of internalizing and externalizing symptomatology. No pre–post differences in BMI were seen within or between groups.
To examine the efficacy of interactive video game stationary cycling in comparison with stationary cycling to music on adherence, energy expenditure measures, submaximal aerobic fitness, body composition, and cardiovascular disease risk markers in overweight and obese adolescents (Canada)^Citation21	Overweight or obese adolescents aged 12–17 years (interactive video game cycling group, n=13; stationary bike music group, n=13); RCT	Sony PlayStation 2	Exercise adherence, body composition, aerobic fitness, and exercise behavior	Twice per week for 60 minutes per session ×10 weeks	The music group had a higher percentage of attendance. There were no significant differences in peak HR, peak workload, time to exhaustion, body weight, BMI, fat mass, fat-free mass, waist circumference, and blood work parameters.
To examine the effects of 1-hour AVG play on lean and obese adolescents’ energy expenditure (Canada)^Citation22	Adolescent boys aged 12–15 years (exergame group, n=19 obese; control group; n=12 lean); CT	XBOX 360 Kinect Sport Boxing	Body weight, BMI, BF, EE, HR, METs	60 minutes	Body weight, BMI, and body fat were significantly higher in obese adolescents. Absolute EE was significantly higher in obese adolescents but not when corrected for body composition. Maximal HR reached during AVG was significantly higher in lean adolescents. Time spent between three and six METs was not different between the groups but time spent above six METs was higher in lean adolescents.
To evaluate the effects of stationary cycling to music versus interactive video game cycling on psychosocial functioning in obese adolescents (Canada)^Citation23	Overweight or obese adolescents aged 12–17 years (interactive video game cycling group, n=13; stationary bike music group, n=13); RCT	Sony PlayStation 2	Scholastic competence, social competence, athletic competence, body image, self-esteem, aerobic fitness, and body composition	Twice per week for 60 minutes per session ×10 weeks	Although no differences emerged between the exercise groups over time, when collapsed across exercise modality, significant pre–post improvements were found for body image, perceived scholastic competence, and social competence. Changes in aerobic fitness, but not body composition, were positively associated with psychosocial functioning.
To evaluate the effects of active video games over a 6-month period on weight, body composition, physical activity, and physical fitness (New Zealand)^Citation24	Overweight and obese children aged 10–14 years (exergame group, n=160; control group, n=162); RCT	Sony PlayStation EyeToy	BMI, BF, physical activity, cardiorespiratory fitness, video game play, and food snacking	60 minutes of moderate-to-vigorous PA on most days of the week ×24 weeks	The treatment effect on BMI favored the intervention group. BMI increased in the control group but remained the same in the intervention group. There was also evidence of a reduction in BF in the intervention group. The change in daily time spent playing active video games at 24 weeks increased in the intervention group accompanied by a reduction in the change in daily time spent playing non-active video games.
To investigate the effects of exergaming on overweight and obese children’s functional fitness (South Africa)^Citation25	Overweight and obese children aged 9–12 years (exergame group, n=11; control group A, n=10; control group B, n=10); CT	Nintendo Wii	Functional fitness (ie, agility, speed, balance, reaction time, and coordination)	3 days per week for 30 minutes per session ×6 weeks	The exergame group showed significant improvement in their level of functional fitness. Specifically, coordination, reaction time, and speed and agility increased by magnitudes of 28%, 94%, and 37% respectively.
To investigate the effects of an exergaming platform on perceived exertion, self-efficacy, positive expectations, and satisfaction in overweight/obese children and adolescents as compared with normal-weight children (Spain)^Citation26	Children and adolescents aged 6–16 years (walking on a treadmill with the support of the videogame platform group, n=21; walking on a treadmill group, n=21); comparison design	Wii Fit	Satisfaction, self-efficacy, positive expectations, RPE, HR, VO2, MET	In both the conditions, the treadmill program was 4 minutes in duration at a fixed speed of 4.2 km/h, with 4 additional minutes at 5.7 km/h (brisk walking speed).	The obese children scored significantly higher in expectations and satisfaction in the exergame condition but not in self-efficacy, perceived exertion, or physiological measures.

Abbreviations: AVG, active video game; BF, body fat; BMD, bone mineral density; BMI, body mass index; CT, control trial; DDR, Dance Dance Revolution; EE, energy expenditure; HR, heart rate; MET, metabolic equivalent task; PA, physical activity; RCT, randomized controlled trial; RPE, rate of perceived exertion; SVG, sedentary video game; VO₂, maximal oxygen consumption.

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