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Review Article |

Active Video Games to Promote Physical Activity in Children and Youth:  A Systematic Review FREE

Elaine Biddiss, PhD, MASc, BAS; Jennifer Irwin, BEng
[+] Author Affiliations

Author Affiliations: Bloorview Research Institute, Bloorview Kids Rehab (Dr Biddiss), and Institute of Biomaterials and Biomedical Engineering, University of Toronto (Ms Irwin), Toronto, Ontario, Canada.


Arch Pediatr Adolesc Med. 2010;164(7):664-672. doi:10.1001/archpediatrics.2010.104.
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Published online

Objectives  To systematically review levels of metabolic expenditure and changes in activity patterns associated with active video game (AVG) play in children and to provide directions for future research efforts.

Data Sources  A review of the English-language literature (January 1, 1998, to January 1, 2010) via ISI Web of Knowledge, PubMed, and Scholars Portal using the following keywords: video game, exergame, physical activity, fitness, exercise, energy metabolism, energy expenditure, heart rate, disability, injury, musculoskeletal, enjoyment, adherence, and motivation.

Study Selection  Only studies involving youth (≤21 years) and reporting measures of energy expenditure, activity patterns, physiological risks and benefits, and enjoyment and motivation associated with mainstream AVGs were included. Eighteen studies met the inclusion criteria. Articles were reviewed and data were extracted and synthesized by 2 independent reviewers.

Main Outcome Exposures  Energy expenditure during AVG play compared with rest (12 studies) and activity associated with AVG exposure (6 studies).

Main Outcome Measures  Percentage increase in energy expenditure and heart rate (from rest).

Results  Activity levels during AVG play were highly variable, with mean (SD) percentage increases of 222% (100%) in energy expenditure and 64% (20%) in heart rate. Energy expenditure was significantly lower for games played primarily through upper body movements compared with those that engaged the lower body (difference, −148%; 95% confidence interval, −231% to −66%; P = .001).

Conclusions  The AVGs enable light to moderate physical activity. Limited evidence is available to draw conclusions on the long-term efficacy of AVGs for physical activity promotion.

Figures in this Article

Physical inactivity is a well-established risk factor for many chronic conditions, such as diabetes, cardiovascular disease, and cancer,1 and is estimated to cause 1.9 million premature deaths globally per year.2 In 2004, the World Health Organization established the “Global Strategy on Diet, Physical Activity, and Health Promotion,” recognizing the key role that physical activity plays in disease prevention and promotion of lifelong health.3 Nearly half of preschool children4 do not meet recommended levels of physical activity (ie, ≥60 minutes daily) prescribed by the American Academy of Pediatrics.1 Reported barriers to physical activity include a preference for indoor pastimes, low energy levels, time constraints, unsafe neighborhoods, a lack of motivation, not feeling competent or skilled, a lack of resources, and insufficient social support from parents and peers.1,510

Many studies have explored strategies to reduce physical inactivity in youth. In a recent systematic review,11 compulsory aerobic physical activity emerged as the common component of effective programs. However, enforcing participation in physical activity is resource intensive, and the long-term success of these interventions remains unknown.11 Accessible effective strategies to encourage voluntary participation in daily physical activity are needed.12 Activity choice is largely dictated by level of enjoyment,13,14 and the most frequently reported reason for participation in physical activity by children is “fun.”15 This same motivation drives competing interest in sedentary activities, including video game play. A typical child aged 8 to 10 years spends approximately 65 minutes per day in video game play.16 Eighty-three percent of American youth have access to at least 1 video game console in their bedroom.13 Evidently, screen time activities are highly valued by children, and attempts to restrict these activities are met with resistance.17

Instead of competing against a highly valued activity, an alternative strategy is to replace passive screen time with active screen time. Video games that require physical activity beyond that of conventional hand-controlled games are referred to as active video games (AVGs).18 The state-of-the-art in AVGs is constantly changing and is best accessed through popular media. For an introductory review of commercially available AVG systems, see the studies by Mears and Hansen18 and Trout and Christie.19

Active video gaming is an emerging technology with the potential to overcome many of the current barriers to physical activity in children. A recent review20 of AVGs raises issues of long-term adherence while remaining cautiously positive about AVG play as a convenient exercise with low to moderate intensity to improve children's health and well-being. The goal of this review was to provide a more comprehensive and quantitative synthesis of the current state of knowledge pertaining to AVG play for physical activity promotion in children. Specifically, the objectives were (1) to systematically evaluate levels of energy expenditure and patterns of activity associated with AVG play in children and youth (≤21 years) and (2) to provide directions for future research and development of AVGs.

DATA SOURCES AND STUDY SELECTION

A systematic review of the literature via ISI Web of Knowledge, PubMed, and Scholars Portal was conducted using combinations of the following keywords (and their relevant suffixes): video game, exergame, physical activity, fitness, exercise, energy metabolism, energy expenditure, heart rate, disability, injury, musculoskeletal, enjoyment, adherence, and motivation. Additional studies were identified by reviewing bibliographies.

The search was limited to English-language communications in peer-reviewed journals published between January 1, 1998, and January 1, 2010, when the popularity of AVGs began to accelerate after the release of Konami's Dance Dance Revolution (DDR).21 Articles selected for in-depth qualitative review involved youth 21 years or younger and reported on (1) energy expenditure during AVG play, (2) promotion of physical activity through AVG play, (3) physiological risks and benefits of AVG play, and (4) enjoyment of and motivations for AVG play. Articles that targeted virtual reality rehabilitation, cognitive or behavioral therapies, or health education via computer and video games were excluded. Studies that used conventional video games or television as distracters during exercise activities were also excluded from this review. Only studies that reported on experimental results with mainstream AVGs and systems, such as the Wii, Sony EyeToy, XaviX, DDR, and Cateye, were included in the quantitative analyses.

DATA EXTRACTION AND SYNTHESIS

Each article was examined by 2 reviewers (E.B. and J.I.) to authenticate data extraction and interpretation. Data extracted included (1) methodological details (eg, study design, experimental context, sample size, participant age, and outcome measures) and (2) key findings pertaining to energy expenditure (eg, heart rate [HR] and oxygen consumption) and the potential for physical activity promotion (eg, adherence, motivations for play, enjoyment, and reported changes in sedentary behaviors, activity patterns, body mass index, and anthropometric measurements). The quality of randomized controlled trials evaluating AVG interventions were further assessed using the PEDro (Physiotherapy Evidence Database) evaluation scale.22,23 This well-established checklist is used to quantitatively describe the internal and statistical validity of study designs, particularly with respect to allocation, blinding, and dropout rates.

Data extracted from experimental studies were summarized, tabulated, and compared. Quantitative measures of physical activity (ie, percentage increase from resting HR and energy expenditure) were compiled and statistically described in aggregate and with reference to different game types.

The Figure provides a flowchart documenting the results of the study selection process. Eighteen articles were included in the quantitative analyses. Studies targeting adults (>21 years old)21,2429 were not included in the quantitative review. Methodological details and data extracted are summarized in Table 1 and Table 2 for energy expenditure and in Table 3 for patterns of activity and use of AVGs. The results presented herein are based on the data compiled in these tables.

Place holder to copy figure label and caption
Figure.

Flowchart documenting the article selection process. AVG indicates active video game.

Graphic Jump Location
Table Graphic Jump LocationTable 1. Summary of Studies That Explored Energy Expenditure During AVG Playa
Table Graphic Jump LocationTable 2. Summary of Heart Rates and Energy Expenditures During AVG Play
Table Graphic Jump LocationTable 3. Summary of Studies That Explored the Potential of AVGs for Physical Activity Promotion in the Home
ENERGY EXPENDITURE

Several studies13,3040 have demonstrated the potential of AVG play to increase energy expenditure from levels observed during sedentary or passive video game activities in children and adolescents (Table 1). Energy expenditure, when adjusted for body composition, seems to be comparable for overweight and nonoverweight participants38,39 but may be higher for boys than for girls.30,31,35

Sustained vigorous activity (eg, >6 metabolic equivalents of task) was generally not elicited during AVG play. Rather, AVG play was found to increase energy expenditure to light or moderate levels24,2629,37 (ie, intensities similar to brisk walking, skipping, jogging, and stair climbing). Child-specific metabolic equivalents of task (as defined by Maddison et al36) ranged from 2.013 to 5.036, with a mean (SD) of 3.3 (1) (n = 17). Table 2 tabulates these child-specific metabolic equivalents together with the percentage increases in HR and energy expenditure for a variety of AVGs. Energy expenditure during AVG play is highly variable, with percentage increases (from rest) ranging from 100%13 to 400%,13,36 with a mean (SD) of 222% (100%) (n = 21). Percentage increases in HR varied from 26%13 to 98%,13 with a mean (SD) increase of 64% (20%) (n = 17). For games that rely primarily on movements of the upper body (eg, bowling and tennis), the mean (SD) percentage increase in energy expenditure was 116% (15%) (n = 6) and in HR was 43% (10%) (n = 5). For DDR, which involves mainly lower body movement, the mean (SD) percentage increase in energy expenditure was 212% (49%) (n = 6) and in HR was 65% (13%) (n = 4). For games that require both upper and lower body movement (eg, boxing), mean (SD) percentage increases of 275% (86%) (n = 7) for energy expenditure and 75% (22%) (n = 6) for HR were observed. Percentage increases in HR (difference, −29%; 95% confidence interval, −47 to −11; P = .03) and energy expenditure (difference, −148%; −231% to −66%; P = .001) were significantly lower for games that require primarily upper body movements compared with those that engage the lower body as well. Evidently, energy expenditure largely depends on the game played, with more intense physical activity sustained during games that promote both upper and, especially, lower body movement.31,3335,38

PATTERNS OF ACTIVITY

Table 3 summarizes the results of several studies4146 that evaluated the potential of AVG systems for physical activity promotion in the home. Preliminary evidence suggests that home play of AVGs may provide some moderate increase in physical activity or decrease in sedentary screen time.4245 However, a variety of confounding factors and methodological limitations associated with these studies impede the strength of evidence presently available (Table 3). After 12 weeks, dropout rates ranged from 0%44 to 41%.42 Other quantitative measures (eg, duration of play) were difficult to compare between studies owing to variations in methods and documentation. These are reported for each study in Table 3. In general, changes in physiological measures, such as body mass index, were not observed at a statistically significant level as a result of AVG play.44,45 To date, home-based studies have been relatively short (ie, 1046 to 28 weeks45). As such, long-term use and efficacy remain unknown, although several studies41,42,45 noted a decrease in AVG play during the study for reasons ranging from technical difficulties to illness or changes in living arrangements. Nevertheless, participants generally reported enthusiasm for and enjoyment of the AVG intervention.43,45,46 Group or competitive play with peers seemed to improve interest and participation in AVGs41,42,46 and is an important direction for future research.

KEY FINDINGS

Baquet et al47 suggest that, to improve aerobic fitness in young people, exercise intensity must exceed 80% of the maximum HR (HRpeak). Only 2 studies39,40 (both with older youths) measured HRpeak. In each of these studies, average HR surpassed 60% of HRpeak during AVG play but did not exceed the 80% target. For rough estimations, an HRpeak of 200 beats/min48 is often assigned for children with the understanding that HRpeak has a large degree of interindividual variability. With this limitation in mind, AVG play generally raises HRs to a mean (SD) of 61% (8%) of HRpeak, with a range of 50% to 80% based on the data presented in this review. In light of the current evidence base, participation in AVG play should not be regarded as a replacement for vigorous physical activity but can increase energy expenditure from sedentary or passive video gaming levels to that associated with light to moderate physical activity. These results agree with those of several studies3235,37 in adults that also establish AVG play as a light- to moderate-intensity activity. In children and adults, activity intensity varies greatly among participants and games and is significantly greater for games that involve the lower body.

Nonprogrammed and lifestyle-related physical activities seem to be extremely important for sustaining weight loss and fitness.1,10 Provision of nonstructured opportunities for physical activity is in line with the American Academy of Pediatrics recommendations, which advocate the increase in structured and nonstructured physical activity of mixed forms (ie, team, individual, competitive, and noncompetitive).1 With indoor time increasingly dedicated to inactive pastimes,49 expansion of home-based opportunities for physical activity is essential. The AVGs are not constrained by typical barriers to participation, such as unsafe neighborhoods, lack of transportation, and seasonal conditions.50 Although AVGs eliminate many of these environmental barriers, spatial (eg, arrangement of furniture and television in multipurpose living areas) and auditory (eg, jumping or stepping may be disruptive in multilevel or shared living spaces such as apartment buildings) barriers to daily use have been reported.21,41,42 At this stage, the potential of AVG play for significantly decreasing childhood physical inactivity is inconclusive, although preliminary results of short-term interventions indicate some promise, particularly when opportunities for group play are provided.4245 Further research is greatly needed to strengthen the evidence base surrounding this emerging technology, which is, at present, relatively weak. Further study in this area must explore the long-term use and efficacy of AVGs and the changes to sedentary and physical activity patterns that they generate.

DIRECTIONS FOR FUTURE RESEARCH AND DEVELOPMENT

The second objective of this article was to provide directions for future research based on the findings of this review. The following subsections present a variety of areas in need of focused research efforts.

Unknown Physiological Risks

Unlike traditional sports, AVG play is not limited by physical strength, endurance, and training, which provide protection against upper extremity overuse syndrome, delayed-onset muscle soreness, and acute muscular and myotendinous strain.51 Minimal data are available on injury rates and quality of movement during AVG play. Several case studies5153 have reported Wii-related injuries due to prolonged or overly aggressive play. Tan et al40 reported no injuries during 201 hours of DDR play, which compares favorably with injury rates of 2.44 per 100 hours for runners. With the growing popularity of AVGs, research is needed that quantifies injury rates and the forces and eccentric loads exerted by muscle groups during play. This understanding would be beneficial for the development of prescriptive guidelines for physical activity, physical therapy, and general public health.

Energy Expenditure Associated With AVG Play in the Home Setting

It is unknown how well estimates of energy expenditure conducted in a laboratory setting translate to the home environment, where AVG play is often episodic and unsupervised. In the future, games may be designed to minimize interruptions and to promote higher levels of activity with healthy rest periods. Success in the game may be linked to energy expenditure measured using lightweight wearable sensors.54 The AVGs that encourage higher levels of stable physical activity while limiting the use of low-energy strategies (eg, a wrist flick in lieu of a swing in Wii Tennis) should be the focus of further developments. Systems such as the Sony EyeToy and new concepts for the Xbox 360 that translate body motions directly to on-screen play may achieve this goal. Advanced methods that enable game designers to simulate the physiological responses of players in the development and testing stages may also facilitate the creation of optimized systems to maximize the health benefits of the AVGs of the future.55

Outcome Measures

Significant changes in physiological outcomes were generally not observed in the studies reviewed. A focus solely on weight loss or body mass index may, however, miss other important benefits rendered by physical activity,1 including measures of fitness (eg, cardiovascular endurance, muscular endurance, muscular strength, balance, body composition, and flexibility) and changes in sedentary behaviors. Independent of increasing exercise time, reducing sitting time is vital to metabolic health.56 As emphasized by Pate,57 research targeting the behavioral aspects of AVG play is absolutely essential to the design and evaluation of AVGs, particularly with respect to the possible displacement of alternative activities that are either more sedentary (positive outcome) or more active (negative outcome). As such, it is important to understand how the introduction of AVGs affects the entire activity profile.

Designing for Long-term Adherence

Self-initiation and choice are important factors that motivate engagement in physical activity for children.58 The self-determination theory posits that initiation and continued performance of behaviors is driven and predicted by factors such as enjoyment, mastery, and achievement.12 The development of games that spark these intrinsic motivators in individuals of all ages and levels of physical ability is needed. The following strategies, based on the principles of behavioral economics,59 should be considered in the design of future AVG systems and interventions: (1) AVGs must provide positive reinforcement and be an accessible (ie, low-cost and easy-to-use) alternative to sedentary activity; (2) early exposure to active in lieu of passive games may increase their acceptance, suggesting the need for games that appeal to a wide range of ages and interests; (3) use of AVGs may be more prolonged and acceptable when perceived as a personal choice as opposed to a treatment or therapy; and (4) immediate reinforcement (eg, enjoyment and points) in addition to continued or long-term reinforcement (eg, progress toward goals and skills development) is important. Future research should address the individual's ability to set and attain goals, to initiate activity, and to achieve recommended intensities and durations of physical activity for a prolonged period.12 To date, home-based studies have been relatively short (ie, ≤28 weeks45). Long-term adherence and efficacy remain unknown. Strategies (eg, diversifying games provided, incorporating a story or plot development into games, and providing opportunities for group play) to maintain interest and enthusiasm in active play with AVGs require further exploration.

Remote Sports and Social Interaction

Mueller et al60 proposed the value of “sports over a distance” that enable individuals to motivate, participate, and compete against friends regardless of location. The AVGs offer opportunities for group play nonlocally (ie, over the Internet) or in a local setting. For example, in 2006, West Virginia introduced multiple DDR consoles into its schools' physical education programs.61 The current evidence base supports the hypothesis that group play encourages participation in AVG play.42,46 There are many opportunities for research in this area, including the exploration of virtual and nonvirtual AVG clubs to encourage group and competitive play to maximize acceptance and enjoyment of AVGs for physical activity and health.

Applicability to Disability Groups

For individuals with physical and cognitive disabilities, the physical, social, and environmental barriers to physical activity can be even greater.10 Providing expanded opportunities and promoting physical activity for children and adolescents with disabilities is a key priority in government health policy.62 Active video games may be particularly suited to children with disabilities who spend more time alone and engaged in sedentary activities than do their able-bodied peers.49 A few studies have used AVGs to elevate enjoyment of physical therapies in individuals with cerebral palsy,63,64 stroke,65 burns,66 spinal cord injury,67 and spina bifida.68 To our knowledge, no studies have evaluated energy expenditure elicited by AVG play in children with disabilities or have explored the potential of this pastime for increasing physical activity, independent of rehabilitation. Only 1 study69 has explored the potential use of an AVG adapted for virtual rehabilitation in the home. In this study, 5 children with hemiplegic cerebral palsy were provided with a system based on the Sony EyeToy for 10 days. The children enjoyed having the AVG system at home and used it for a mean (SD) of 29 (32) minutes per day.69 A final study70 exploring the potential of AVGs as a leisure activity in adults with intellectual and physical disabilities also observed high levels of enjoyment of this activity. More research is needed to develop prescriptive guidelines for the safe use of AVGs for individuals with disabilities71 and to determine appropriate measures to evaluate fitness outcomes; body mass index, for example, has been shown to have limited applicability to children with physical disabilities.62

MERITS AND LIMITATIONS

This study provides a systematic overview of the current state of knowledge and identifies a variety of opportunities for future research. The timing of this study is opportune given the growing prevalence of and interest in AVGs as an avenue for recreation, health promotion, and rehabilitation. This review provides important guidelines for future research and development in this area to ensure that the health and safety of children is protected while optimizing the health value of AVG play.

Limitations of this study are as follows. Regarding energy expenditure measurements, nonstandardized protocols may have contributed to some of the variations observed among studies. The current evidence base does not allow for strong conclusions to be drawn regarding daily use of AVGs in the home or their efficacy to promote physical activity or reduce sedentary behaviors. Quantitative interstudy comparisons of activity patterns were not feasible owing to variations in study methods (eg, study duration and outcome measures) and reporting (eg, units of measurement and variations in descriptive statistics reported). The randomized controlled trials included in this review were associated with a median score of 6 on a 10-point scale as assessed using the PEDro evaluation tool. The most common risks for bias included unconcealed allocation, lack of blinding (where possible), and selectively reported outcomes. Dissimilarities between control and intervention groups at baseline were often problematic given the small sample sizes. To strengthen the current evidence base, it is important to address these limitations in the design and dissemination of future studies evaluating the efficacy of AVG play for physical activity promotion.

Physical inactivity in children and youth remains a significant health issue that will likely be solved only through a multifaceted approach that includes education and structured interventions combined with the provision of enticing opportunities for voluntary daily physical activity. New-generation AVGs are an emerging technology that have recently entered the health care arena with promise to address the latter. Preliminary evidence seems to support AVG play as an enjoyable medium for self-directed physical activity of light to moderate intensity. It remains to be seen whether AVGs can be used effectively in the long term to help motivate increased daily physical activity and decreased sedentary pastimes. The AVGs designed to engage both the upper and lower body while providing opportunities for multiplayer participation may improve the quality and enjoyment of this activity. Providing accessible and appealing options for physical activity in the home will overcome many reported barriers to physical activity, particularly for high-risk disability groups.

Correspondence: Elaine Biddiss, PhD, MASc, BAS, Bloorview Research Institute, 150 Kilgour Rd, Toronto, ON M4G 1R8, Canada (elaine.biddiss@utoronto.ca).

Accepted for Publication: January 13, 2010.

Author Contributions: The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Biddiss. Acquisition of data: Biddiss and Irwin. Analysis and interpretation of data: Biddiss and Irwin. Drafting of the manuscript: Biddiss and Irwin. Critical revision of the manuscript for important intellectual content: Biddiss and Irwin. Statistical analysis: Biddiss and Irwin. Obtained funding: Biddiss. Administrative, technical, and material support: Biddiss and Irwin. Study supervision: Biddiss.

Financial Disclosure: None reported.

Funding/Support: This study was supported by the Natural Sciences and Research Council of Canada, by the Canadian Institutes of Health Research, and by the Bloorview Kids Foundation.

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Ni Mhurchu  CMaddison  RJiang  YJull  APrapavessis  HRodgers  A Couch potatoes to jumping beans: a pilot study of the effect of active video games on physical activity in children. Int J Behav Nutr Phys Act 2008;58
PubMed10.1186/1479-5868-5-8
Maloney  AEBethea  TCKelsey  KS  et al.  A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time. Obesity (Silver Spring) 2008;16 (9) 2074- 2080
PubMed
Paez  SMaloney  AKelsey  KWiesen  CRosenberg  A Parental and environmental factors associated with physical activity among children participating in an active video game. Pediatr Phys Ther 2009;21 (3) 245- 253
PubMed
Baquet  GVan Praagh  EBerthoin  S Endurance training and aerobic fitness in young people. Sports Med 2003;33 (15) 1127- 1143
PubMed
Bar-Or  O Pediatric Sports Medicine for the Practitioner: From Physiological Principles to Clinical Applications.  New York, NY Springer-Verlag New York Inc1983;
Hillier  A Childhood overweight and the built environment: making technology part of the solution rather than part of the problem. Ann Am Acad Pol Soc Sci 2008;61556- 82
Zabinski  MFSaelens  BEStein  RIHayden-Wade  HAWilfley  DE Overweight children's barriers to and support for physical activity. Obes Res 2003;11 (2) 238- 246
PubMed
Nett  MPCollins  MSSperling  JW Magnetic resonance imaging of acute “wiiitis” of the upper extremity. Skeletal Radiol 2008;37 (5) 481- 483
PubMed
Bonis  J Acute Wiiitis. N Engl J Med 2007;356 (23) 2431- 2432
PubMed
Robinson  RJBarron  DAGrainger  AJVenkatesh  R Wii knee. Emerg Radiol 2008;15 (4) 255- 257
PubMed
Buttussi  FChittaro  LRanon  RVerona  A Adaptation of graphics and gameplay in fitness games by exploiting motion and physiological sensors. Lect Notes Comput Sci 2007;456985- 96
Sinclair  JHingston  PMasek  MNosaka  K Using a virtual body to aid in exergaming system development. IEEE Comput Graph Appl 2009;29 (2) 39- 48
PubMed
Hamilton  MTHamilton  DGZderic  TW Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes 2007;56 (11) 2655- 2667
PubMed
Pate  RR Physically active video gaming: an effective strategy for obesity prevention? Arch Pediatr Adolesc Med 2008;162 (9) 895- 896
PubMed
Wilson  PMMack  DEGrattan  KP Understanding motivation for exercise: a self-determination theory perspective. Can Psychol 2008;49 (3, special issue) 250- 256
Epstein  LH Integrating theoretical approaches to promote physical activity. Am J Prev Med 1998;15 (4) 257- 265
PubMed
Mueller  FStevens  GThorogood  AO’Brien  SWulf  V Sports over a distance. Pers Ubiquitous Comput 2007;11 (8) 633- 645
Borja  RR Dance video games hit the floor in schools. Educ Week 2006;25 (22) 1- 2
Rimmer  JHRowland  JLYamaki  K Obesity and secondary conditions in adolescents with disabilities: addressing the needs of an underserved population. J Adolesc Health 2007;41 (3) 224- 229
PubMed
Jannink  MJvan der Wilden  GJNavis  DWVisser  GGussinklo  JIjzerman  M A low-cost video game applied for training of upper extremity function in children with cerebral palsy: a pilot study. Cyberpsychol Behav 2008;11 (1) 27- 32
PubMed
Deutsch  JEBorbely  MFiller  JHuhn  KGuarrera-Bowlby  P Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Phys Ther 2008;88 (10) 1196- 1207
PubMed
Yavuzer  GSenel  AAtay  MBStam  HJ “PlayStation EyeToy Games” improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. Eur J Phys Rehabil Med 2008;44 (3) 237- 244
PubMed
Haik  JTessone  ANota  A  et al.  The use of video capture virtual reality in burn rehabilitation: the possibilities. J Burn Care Res 2006;27 (2) 195- 197
PubMed
O’Connor  TJCooper  RAFitzgerald  SG  et al.  Evaluation of a manual wheelchair interface to computer games. Neurorehabil Neural Repair 2000;14 (1) 21- 31
PubMed
Widman  LMMcDonald  CMAbresch  RT Effectiveness of an upper extremity exercise device integrated with computer gaming for aerobic training in adolescents with spinal cord dysfunction. J Spinal Cord Med 2006;29 (4) 363- 370
PubMed
Li  WLam-Damji  SChau  TFehlings  D The development of a home-based virtual reality therapy system to promote upper extremity movement for children with hemiplegic cerebral palsy. Technol Disabil 2009;21 (3) 107- 11310.3233/TAD-2009-0277
Yalon-Chamovitz  SWeiss  PL Virtual reality as a leisure activity for young adults with physical and intellectual disabilities. Res Dev Disabil 2008;29 (3) 273- 287
PubMed
Martin Ginis  KALatimer  AEBuchholz  AC  et al.  Establishing evidence-based physical activity guidelines: methods for the Study of Health and Activity in People With Spinal Cord Injury (SHAPE SCI). Spinal Cord 2008;46 (3) 216- 221
PubMed

Figures

Place holder to copy figure label and caption
Figure.

Flowchart documenting the article selection process. AVG indicates active video game.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Summary of Studies That Explored Energy Expenditure During AVG Playa
Table Graphic Jump LocationTable 2. Summary of Heart Rates and Energy Expenditures During AVG Play
Table Graphic Jump LocationTable 3. Summary of Studies That Explored the Potential of AVGs for Physical Activity Promotion in the Home

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Verhagen  APde Vet  HCde Bie  RABoers  Mvan den Brandt  PA The art of quality assessment of RCTs included in systematic reviews. J Clin Epidemiol 2001;54 (7) 651- 654
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PubMed
Warburton  DERSarkany  DJohnson  M  et al.  Metabolic requirements of interactive video game cycling. Med Sci Sports Exerc 2009;41 (4) 920- 926
PubMed
Warburton  DERBredin  SSDHorita  LTL  et al.  The health benefits of interactive video game exercise. Appl Physiol Nutr Metab 2007;32 (4) 655- 663
PubMed
Sell  KLillie  TTaylor  J Energy expenditure during physically interactive video game playing in male college students with different playing experience. J Am Coll Health 2008;56 (5) 505- 511
PubMed
Siegel  SRHaddock  BLDubois  AWilkin  DL Active video/arcade games (exergaming) and energy expenditure in college students. Int J Exerc Sci 2009;2 (3) 165- 174
PubMed
Miyachi  MYamamoto  KOhkawara  KTanaka  S METs in adults while playing active video games: a metabolic chamber study [published online ahead of print December 9, 2009]. Med Sci Sports Exerc 10.1249/MSS.0b013e3181c51c78
Inzitari  MGreenlee  AHess  RPerera  SStudenski  SA Attitudes of postmenopausal women toward interactive video dance for exercise. J Womens Health (Larchmt) 2009;18 (8) 1239- 1243
PubMed
Leatherdale  STWoodruff  SJManske  SR Energy expenditure while playing active and inactive video games. Am J Health Behav 2010;34 (1) 31- 35
PubMed
Graf  DLPratt  LVHester  CNShort  KR Playing active video games increases energy expenditure in children. Pediatrics 2009;124 (2) 534- 540
PubMed
Haddock  BLSiegel  SRWikin  LD The addition of a video game to stationary cycling: the impact on energy expenditure in overweight children. Open Sports Sci J 2009;242- 46
PubMed
Lanningham-Foster  LFoster  RCMcCrady  SKJensen  TBMitre  NLevine  JA Activity-promoting video games and increased energy expenditure. J Pediatr 2009;154 (6) 819- 823
PubMed
Graves  LEFRidgers  NDStratton  G The contribution of upper limb and total body movement to adolescents' energy expenditure whilst playing Nintendo Wii. Eur J Appl Physiol 2008;104 (4) 617- 623
PubMed
Graves  LStratton  GRidgers  NDCable  NT Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study. BMJ 2007;335 (7633) 1282- 1284
PubMed
Maddison  RMhurchu  CNJull  AJiang  YPrapavessis  HRodgers  A Energy expended playing video console games: an opportunity to increase children's physical activity? Pediatr Exerc Sci 2007;19 (3) 334- 343
PubMed
Straker  LAbbott  R Effect of screen-based media on energy expenditure and heart rate in 9- to 12-year-old children. Pediatr Exerc Sci 2007;19 (4) 459- 471
PubMed
Lanningham-Foster  LJensen  TBFoster  RC  et al.  Energy expenditure of sedentary screen time compared with active screen time for children. Pediatrics 2006;118 (6) e1831- e1835
PubMed10.1542/peds.2006-1087
Unnithan  VBHouser  WFernhall  B Evaluation of the energy cost of playing a dance simulation video game in overweight and non-overweight children and adolescents. Int J Sports Med 2006;27 (10) 804- 809
PubMed
Tan  BAziz  ARChua  KTeh  KC Aerobic demands of the dance simulation game. Int J Sports Med 2002;23 (2) 125- 129
PubMed
Madsen  KAYen  SWlasiuk  LNewman  TBLustig  R Feasibility of a dance videogame to promote weight loss among overweight children and adolescents. Arch Pediatr Adolesc Med 2007;161 (1) 105- 107
PubMed
Chin A Paw  MJMJacobs  WMVaessen  EPGTitze  Svan Mechelen  W The motivation of children to play an active video game. J Sci Med Sport 2008;11 (2) 163- 166
PubMed
McDougall  JDuncan  MJ Children, video games and physical activity: an exploratory study. Int J Disabil Hum Dev 2008;7 (1) 89- 94
Ni Mhurchu  CMaddison  RJiang  YJull  APrapavessis  HRodgers  A Couch potatoes to jumping beans: a pilot study of the effect of active video games on physical activity in children. Int J Behav Nutr Phys Act 2008;58
PubMed10.1186/1479-5868-5-8
Maloney  AEBethea  TCKelsey  KS  et al.  A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time. Obesity (Silver Spring) 2008;16 (9) 2074- 2080
PubMed
Paez  SMaloney  AKelsey  KWiesen  CRosenberg  A Parental and environmental factors associated with physical activity among children participating in an active video game. Pediatr Phys Ther 2009;21 (3) 245- 253
PubMed
Baquet  GVan Praagh  EBerthoin  S Endurance training and aerobic fitness in young people. Sports Med 2003;33 (15) 1127- 1143
PubMed
Bar-Or  O Pediatric Sports Medicine for the Practitioner: From Physiological Principles to Clinical Applications.  New York, NY Springer-Verlag New York Inc1983;
Hillier  A Childhood overweight and the built environment: making technology part of the solution rather than part of the problem. Ann Am Acad Pol Soc Sci 2008;61556- 82
Zabinski  MFSaelens  BEStein  RIHayden-Wade  HAWilfley  DE Overweight children's barriers to and support for physical activity. Obes Res 2003;11 (2) 238- 246
PubMed
Nett  MPCollins  MSSperling  JW Magnetic resonance imaging of acute “wiiitis” of the upper extremity. Skeletal Radiol 2008;37 (5) 481- 483
PubMed
Bonis  J Acute Wiiitis. N Engl J Med 2007;356 (23) 2431- 2432
PubMed
Robinson  RJBarron  DAGrainger  AJVenkatesh  R Wii knee. Emerg Radiol 2008;15 (4) 255- 257
PubMed
Buttussi  FChittaro  LRanon  RVerona  A Adaptation of graphics and gameplay in fitness games by exploiting motion and physiological sensors. Lect Notes Comput Sci 2007;456985- 96
Sinclair  JHingston  PMasek  MNosaka  K Using a virtual body to aid in exergaming system development. IEEE Comput Graph Appl 2009;29 (2) 39- 48
PubMed
Hamilton  MTHamilton  DGZderic  TW Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes 2007;56 (11) 2655- 2667
PubMed
Pate  RR Physically active video gaming: an effective strategy for obesity prevention? Arch Pediatr Adolesc Med 2008;162 (9) 895- 896
PubMed
Wilson  PMMack  DEGrattan  KP Understanding motivation for exercise: a self-determination theory perspective. Can Psychol 2008;49 (3, special issue) 250- 256
Epstein  LH Integrating theoretical approaches to promote physical activity. Am J Prev Med 1998;15 (4) 257- 265
PubMed
Mueller  FStevens  GThorogood  AO’Brien  SWulf  V Sports over a distance. Pers Ubiquitous Comput 2007;11 (8) 633- 645
Borja  RR Dance video games hit the floor in schools. Educ Week 2006;25 (22) 1- 2
Rimmer  JHRowland  JLYamaki  K Obesity and secondary conditions in adolescents with disabilities: addressing the needs of an underserved population. J Adolesc Health 2007;41 (3) 224- 229
PubMed
Jannink  MJvan der Wilden  GJNavis  DWVisser  GGussinklo  JIjzerman  M A low-cost video game applied for training of upper extremity function in children with cerebral palsy: a pilot study. Cyberpsychol Behav 2008;11 (1) 27- 32
PubMed
Deutsch  JEBorbely  MFiller  JHuhn  KGuarrera-Bowlby  P Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Phys Ther 2008;88 (10) 1196- 1207
PubMed
Yavuzer  GSenel  AAtay  MBStam  HJ “PlayStation EyeToy Games” improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. Eur J Phys Rehabil Med 2008;44 (3) 237- 244
PubMed
Haik  JTessone  ANota  A  et al.  The use of video capture virtual reality in burn rehabilitation: the possibilities. J Burn Care Res 2006;27 (2) 195- 197
PubMed
O’Connor  TJCooper  RAFitzgerald  SG  et al.  Evaluation of a manual wheelchair interface to computer games. Neurorehabil Neural Repair 2000;14 (1) 21- 31
PubMed
Widman  LMMcDonald  CMAbresch  RT Effectiveness of an upper extremity exercise device integrated with computer gaming for aerobic training in adolescents with spinal cord dysfunction. J Spinal Cord Med 2006;29 (4) 363- 370
PubMed
Li  WLam-Damji  SChau  TFehlings  D The development of a home-based virtual reality therapy system to promote upper extremity movement for children with hemiplegic cerebral palsy. Technol Disabil 2009;21 (3) 107- 11310.3233/TAD-2009-0277
Yalon-Chamovitz  SWeiss  PL Virtual reality as a leisure activity for young adults with physical and intellectual disabilities. Res Dev Disabil 2008;29 (3) 273- 287
PubMed
Martin Ginis  KALatimer  AEBuchholz  AC  et al.  Establishing evidence-based physical activity guidelines: methods for the Study of Health and Activity in People With Spinal Cord Injury (SHAPE SCI). Spinal Cord 2008;46 (3) 216- 221
PubMed

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