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

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 (< or = 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.