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.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/383491/pra05001_664_672.pdf

Active video games to promote physical activity in children and youth: a systematic review.

Active Video Games to Promote Physical Activity in Children and Youth

Background: Physical activity helps people maintain a healthy weight and reduces the risk for several chronic diseases. Although this knowledge is widely recognized, adults and children in many countries around the world do not get recommended amounts of physical activity. Although many interventions are found to be ineffective at increasing physical activity or reaching inactive populations, there have been anecdotal reports of increased physical activity due to novel mobile games that embed game play in the physical world. The most recent and salient example of such a game is Pokemon Go, which has reportedly reached tens of millions of users in the United States and worldwide. Objective: The objective of this study was to quantify the impact of Pokemon Go on physical activity. Methods: We study the effect of Pokemon Go on physical activity through a combination of signals from large-scale corpora of wearable sensor data and search engine logs for 32,000 Microsoft Band users over a period of 3 months. Pokemon Go players are identified through search engine queries and physical activity is measured through accelerometers. Results: We find that Pokemon Go leads to significant increases in physical activity over a period of 30 days, with particularly engaged users (ie, those making multiple search queries for details about game usage) increasing their activity by 1473 steps a day on average, a more than 25% increase compared with their prior activity level (P<.001). In the short time span of the study, we estimate that Pokemon Go has added a total of 144 billion steps to US physical activity. Furthermore, Pokemon Go has been able to increase physical activity across men and women of all ages, weight status, and prior activity levels showing this form of game leads to increases in physical activity with significant implications for public health. In particular, we find that Pokemon Go is able to reach low activity populations, whereas all 4 leading mobile health apps studied in this work largely draw from an already very active population. Conclusions: Mobile apps combining game play with physical activity lead to substantial short-term activity increases and, in contrast to many existing interventions and mobile health apps, have the potential to reach activity-poor populations. Future studies are needed to investigate potential long-term effects of these applications. [J Med Internet Res 2016;18(12):e315]

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Influence of Pokémon Go on Physical Activity: Study and Implications

This article reports a meta-analysis of energy expenditure (EE) of playing active video games (AVGs). In particular, heart rate (HR), oxygen consumption (VO2), and EE were assessed and three moderators for the effects of AVGs—types of AVG, player age, and player weight status—were analyzed. The results show that playing AVGs significantly increased HR, VO2, and EE from resting. The effect sizes of playing AVGs on HR, VO2, and EE were similar to traditional physical activities. AVG type and player age were significant modera-tors for the effects of AVGs. The finding suggests that AVGs are effective technologies that may facilitate light- to moderate-intensity physical activity promotion.

Is Playing Exergames Really Exercising? A Meta-Analysis of Energy Expenditure in Active Video Games

Digital games combining exercise with game play, known as exergames, can improve youths' health status and provide social and academic benefits. Exergame play increases caloric expenditure, heart rate, and coordination. Psychosocial and cognitive impacts of exergame play may include increased self-esteem, social interaction, motivation, attention, and visual-spatial skills. This article summarizes the literature on exergames, with a special emphasis on physical education courses and the potential of exergames to improve students' physical health, as well as transfer effects that may benefit related physical, social, and academic outcomes.

/pdf/exergames-for-physical-education-courses-physical-social-and-1qqq2fvub1.pdf

Exergames for Physical Education Courses: Physical, Social, and Cognitive Benefits

Exergaming is the use of video games in an exercise activity. In this paper we consider game design for successful exergames. To do this, we review the history of exergaming and the current state of research in this field. We find that there exists some research aimed at evaluating the physical and health characteristics of exergames, but research on how to design exercise games is still in the early stages. From an analysis of this information, and drawing on established principles from sports science for the prescription of exercise programs, we then attempt to identify success factors to guide designers of exergaming systems.

Considerations for the design of exergames

Exergaming, the merger of exercise and video games, tries to use the engaging experience of playing a video game to help people achieve their exercise requirements. To guide the design of such games the dual flow model, an extension of the theory of flow to both mental and physical experience, has been proposed. This paper presents the development of an exergame system designed to demonstrate the validity of the dual flow model, along with initial results from a pilot trial. The results show that such a game system can be used to deliver the required exercise across a range of participants.

Exergame development using the dual flow model

In this paper, we report on an experimental study in which we investigated the use of feedback mechanisms in exergames. We based the study around the Dual Flow model for exergame design, using biophysical feedback to control exercise intensity, and player performance feedback to control gameplay challenge. We found good success in controlling exercise intensity to achieve an effective workout, while controlling gameplay challenge to improve enjoyment and attractiveness was problematic. We offer some possible reasons for this, suggesting the need for further investigation.

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Testing an exergame for effectiveness and attractiveness

A framework for simulating physiological responses to exercise lets exergame developers more efficiently test their games during development. An example implementation combines software that simulates heart-rate responses with a custom hardware setup. Simulated heart-rate responses closely match the real physiological responses, demonstrating the approach's validity and potential.

Using a Virtual Body to Aid in Exergaming System Development

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Jeff Sinclair

Papers

Considerations for the design of exergames

Exergame development using the dual flow model

Testing an exergame for effectiveness and attractiveness

Using a Virtual Body to Aid in Exergaming System Development

Feedback control for exergames