Potential vs Actual Benefits of Exergames

The study by Bailey and McInnis demonstrated that a wide variety of exergames spurred adolescents to physical activity of at least moderate intensity (>3 times the resting energy expenditure), and most games spurred activity of vigorous intensity (>6 times the resting energy expenditure). The vigorous-intensity activity spurred by use of some of these games is notable because it seems to have more protective effects against obesity than moderate-intensity activity.¹ We can conclude that a wide array of exergames on different video game systems have the potential to increase physical activity and energy expenditure, especially considering how many adolescents are likely to have the equipment at home.

Findings that type of game and level of play have important effects on physical-activity intensity level could be translated into game designs that stimulate players to move up the levels and that concentrate technology innovations to increase enjoyment of games that require higher-intensity activity. Complementary interventions at school or through health care settings could promote use of such games.

A major contribution of the study was assessment of enjoyment of the games. The finding that boys enjoyed boxing more and girls enjoyed dancing more may not be surprising, but it indicates the importance of designing games to appeal to both genders. By assessing enjoyment and preferences, it should be possible to design games to appeal to specific age, cultural, and weight-status groups.

Perhaps the most surprising result was that overweight and obese adolescents enjoyed exergames more than their healthy-weight counterparts, although most of the enjoyment difference was attributable to 1 game. Such a result suggests that exergames may be an attractive mode of activity for overweight and obese adolescents. Further studies are needed to evaluate the use of exergames as part of multicomponent weight-control programs for adolescents.

Exergames can act as a positive force for health if they are used in addition to other types of exercise. However, they could yield negative outcomes if the lure of technology leads us to neglect the numerous other options for adolescent physical activity.

The findings by Bailey and McInnis show how much physical activity exergames have the potential to yield. The next question is how much activity they actually yield. The effect on energy expenditure and health outcomes is determined by the frequency, intensity, duration, and types of games used in everyday life. Findings to date regarding this topic indicate that regardless of how frequently adolescents play the games when they first obtain them, use typically declines within a few weeks or months. For example, Madsen and colleagues² reported that only 12 of 30 obese children prescribed to use exergames played them at least weekly for the first 3 months, and during the following 3 months, only 2 obese children did so. This decline occurred despite regular phone calls from clinic staff to encourage use. A review also commented on the decline in use and the need for more studies of actual use patterns.³ Most studies of exergames in field settings have prescribed or recommended their use, and unprompted use over time by regular purchasers of games is not known.

The apparent short-term use problem presents a possibility for interventions to promote regular and extended use, whether at home, in school, or at a health club. One study with encouraging results compared assigned home use to home use plus a weekly supervised multiplayer session at a sports center.⁴ Youth assigned to the multiplayer sessions used the exergames more frequently overall and were much less likely to drop out of the study. This study confirms the problem of short-term unsupervised use but suggests ways to motivate youth to continue to use and enjoy exergames.

At this time, the solution to the problem of adolescent physical inactivity offered by exergames appears to be limited, but the use of such games is an approach that should be encouraged, improved, and expanded. However, we should not be overly enthusiastic about the potential for technology to reintegrate physical activity into adolescents' lives. Let us not forget that for the millennia during which adolescents likely were very physically active on a daily basis, they were probably doing so outdoors. Modern society has created many barriers to the inclination of adolescents to spend time outdoors, such as the lure and heavy promotion of television, the Internet, and sedentary video games, disparities in access to parks and their programs, schools closed to afterschool use, automobile traffic hazards, and fear of crime.^{5 - 7} Evidence exists that spending time outdoors is the strongest correlate of physical activity among preschool-aged children,⁸ although this topic has not been well studied with adolescents. It is likely that increasing adolescents' access to outdoor places and programs that support physical activity will have a much larger effect on energy expenditure and health than will exergames. That is not to say we should ignore the potential of exergames. They can contribute to daily physical activity, their purchase encourages the electronics industry to invest more heavily in innovation and promotion of such games, and they could help keep adolescents fit enough to enjoy doing other forms of physical activity. We need to pursue every avenue for getting adolescents active and not place all our hopes on any single option.

Now that we know exergames can spur high-intensity physical activity, a key research topic is to directly compare exergames to other physical-activity options. The main outcomes of interest are total physical activity and energy expenditure during weeks and months. Other research topics are how to promote extensive long-term use of exergames, how to integrate exergaming within comprehensive physical-activity promotion efforts, and how to make effective exergames accessible to economically disadvantaged adolescents who have limited access to other physical-activity options.