Do active video games make kids more active?

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Musu tired of playing Wii fit

Today’s post comes from friend and colleague Allana Leblanc, who recently published a systematic review examining whether active video games were associated with health benefits in children.  The paper was published in PLOS ONE (the same folks who host our blog), and can be read in its entirety here.  You can find out more about Allana at the bottom of this post.

Background

It is well documented that children and youth around the world do not meet current physical activity guidelines, and spend the majority of their day engaged in sedentary pursuits.  It is also well understood that poor lifestyle habits formed in childhood (like low levels of physical activity, and high sedentarism) are likely to follow an individual into adulthood and put them at a higher risk for numerous health problems (Type 2 diabetes! Heart disease! Poor mental health!).

Since thus far, researchers have had little success in dramatically increasing population level physical activity, they’ve turned to other (more sneaky) methods to get people more active. One such intervention is the use of active video games (AVGs), or screen-based activities that require increased PA to play the game compared to conventional sedentary, or passive, video games (you can see the definitions we used for each of these terms in Table 1).  These have been around for a little while now (remember the Power Pad?), but really came into the spotlight with gaming giants like Nintendo and Microsoft developing active video game consoles.

Table 1: Relevant definitions

Passive video game An electronic or computerized game played seated by manipulating images on a video display or television screen, using a conventional gamepad controller (e.g. a conventional hand-held game). 
Active video game A video game that requires physical activity beyond that of a passive game (i.e. conventional hand-held games). Active video games rely on technology that tracks body movement or reaction for the game to progress.
Traditional physical activity Any bodily movement produced by skeletal muscles that requires energy expenditure without the use of an electronic gaming system or display device.

As with other public health interventions, it’s important to determine if these active video games are actually effective in increasing health or physical activity levels.  So we set out to do a systematic review to determine the relationship between active video games and health in children and youth.  Specifically,

The objective of this systematic review is to present current evidence on the relationship between AVGs and several health and behavioural indicators in children and youth aged 0-17 years.

What we did

To determine what studies have been done, we did a comprehensive search of five different academic databases (you can see more details on this in the full article) looking for any study that examined the relationship between active video games, and a pre-determined health or behaviour indicator (these are all listed in Table 2, which is available here).

To guide our review, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, which is basically the international gold standard to guide systematic reviews.  This ensures that as many decisions as possible are made a-priori to minimize any bias the authors may have.

What we found

After de-duplication, we ended up retrieving 1,243 articles related to active video games and health in children and youth.  Of these, 51 studies (represented in 52 papers) met our inclusion criteria and were included in the final systematic review.  See Figure 1 (see below, and available in full size here) for the PRISMA flow diagram for study inclusion and exclusion.

PRISMA flow diagram. From Leblanc et al., 2013.

The health and behaviour indicators represented in the included studies were energy expenditure (n=35), adherence and appeal (n=18), opportunity cost (n=2), adiposity (n=9), cardiometabolic health indicators (n=3), energy intake (n=2), and learning and rehabilitation (n=9). We didn’t identify any studies looking at the relationship between active video games and adaptation, or evolution of video games (**idea for your next grant perhaps?! **).  Many of the included studies looked at more than one indicator, and were presented as such in the manuscript. Because studies used such different methods (e.g., brand of gaming consoles, game type, playing time), we weren’t able to conduct a meta-analysis, therefore a qualitative synthesis was conducted for all included studies.

What we concluded

From the paper:

While controlled laboratory studies clearly demonstrate that a motivated player can obtain some light- to moderate-intensity PA from most AVGs, the findings are inconsistent about whether, or the circumstances under which, having an AVG results in sustained PA behaviour change, or for how long the behaviour change persists. Some of these games offer nuances on game play that could be related to increased PA or decreased sedentary behaviour. AVG technology is innovating at a rate that outpaces the related research. Higher quality research is needed that tests conceptual models of how different AVGs may relate to the initiation and maintenance of increased PA or decreased sedentary behaviour and understand their effects on health outcomes to resolve these inconsistencies.

Where we go from here

Other reviews in this area have shown similar results to ours in that some AVGs are able to acutely increase light- to moderate-intensity PA in some children and youth but unable to elicit PA of high enough intensity, or volume to enable children to meet physical activity guidelines. More high quality, robustly designed and well powered studies are needed comparing AVGs to traditional PA (not just to rest or other sedentary games); comparing different types of video game consoles; measuring energy intake while playing AVGs (compared to a variety of both active and sedentary behaviours); assessing AVG use in limited areas that may be unsafe; assessing the ability of AVGs to displace sedentary time; examining the opportunity cost of AVGs (i.e., both time and financial considerations); and assessing behavioural compensation throughout the entire day.

Further, as Travis mentioned in an earlier post, Active Healthy Kids Canada (who helped fund this work), released a position stand on active video games back in November.  The position stand, as well as supporting material, can be accessed here.

In my opinion (full disclosure, I’m not a fan of video games/active video games/television etc.), as of right now, I don’t think active video games are the panacea for childhood inactivity/sedentarism. Yes they can be super fun, and yes mastering Dance Dance Revolution is an awesome party trick, but, in my opinion, they don’t provide enough sustained activity, and we shouldn’t view them as a replacement for more traditional sports/activities.  Further, what kind of life skill are you teaching your children when they can master the wrist flick needed in Wii tennis? Amirite?!

Allana Leblanc, MSc, CEP

About the Author: Allana LeBlanc is a Clinical Exercise Specialist, a Certified Exercise Physiologist, a Physical Activity in Health Specialist and a PhD student in Population Health at the University of Ottawa.  She is the lead author on the systematic review on active video games and health in children and youth, and a frequent guest poster at Obesity Panacea.  You can find a list of all her guest posts here.

 

References:

  1. WHO. (2010) Global recommendations on physical activity for health. Geneva: World Health Organization.
  2. Hallal PC, Anderson LB, Bull FC, Guthold R, Haskell W, et al. (2012)  Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet  S20-30
  3. Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, et al. (2011)  Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act  8:98.
  4. Peng W, Lin JH, Crouse J. (2011) Is playing exergames really exercising? A meta-analysis of energy expenditure in active video games. Cyberpsychol Behav Soc Netw 14:681-8.
  5. Peng W, Crouse JC, Lin JH. (2013) Using active video games for physical activity promotion: a systematic review of the current state of research. Health Educ Behav 40:171-92.
  6. Daley AJ. (2009) Can exergaming contribute to improving physical activity levels and health outcomes in children? Pediatrics 124.
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