Energy Cost and Enjoyment of Active Videogames in Children and Teens: Xbox 360 Kinect

Active Virtual Reality Games: Comparing Energy Expenditure, Game Experience, and Cybersickness to Traditional Gaming and Exercise in Youth Aged 8-12

Objective: The purpose of this study was to (1) quantify the oxygen consumption (VO2) and heart rate (HR) of virtual reality (VR) exergaming in youth, (2) compare the physical activity intensity of VR gaming to moderate-intensity thresholds, and (3) quantify the game experience and cybersickness of VR gaming, compared with traditional gaming. Material and Methods: Youth (N = 28; age, 9.4 ± 1.2 years) completed 10-minute conditions: seated rest, seated videogame Katamari Forever (SVG-KF), treadmill walking (TW) (5.6 km/h, 0% grade), and VR exergames Beat Saber (BS) and Thrill of the Fight (TOF) while VO2 and HR were collected. Game experience and Child Simulator Sickness Questionnaires were collected after gameplay. Results: VO2 and HR for BS (9.1 ± 3.0 mL/kg/min and 119 ± 15 bpm), TW (17.1 ± 2.4 mL/kg/min and 135 ± 15 bpm), and TOF (16.9 ± 5.4 mL/kg/min and 145 ± 19 bpm) were significantly higher than that at rest (4.2 ± 1.5 mL/kg/min and 94 ± 12 bpm) and for SVG-KF (4.3 ± 1.3 mL/kg/min and 94 ± 12 bpm). BS was light-to-moderate, whereas TW and TOF were of moderate intensity based on HR and metabolic equivalents (METs). For game experience, SVG-KF (1.6 ± 1.6) was less challenging than BS (3.3 ± 1.0) and TOF (3.1 ± 1.1). BS was more visually satisfying (3.5 ± 0.7 vs 2.7 ± 0.9) and required more concentration than SVG-KF (3.6 ± 0.7 vs 3.1 ± 1.1). TOF (3.4 ± 0.8) was more fun than SVG-KF (2.8 ± 0.7). Two youths (7%) experienced cybersickness symptoms, but neither requested to stop play. Oculomotor symptoms (0.6 ± 0.9), although minimal, were significantly greater than nausea (0.2 ± 0.5) and disorientation (0.3 ± 0.6) in both games. Conclusions: VR exergames provided light- to moderate-intensity exercise, challenge, visual stimulation, attention, and fun with minimal cybersickness symptoms, compared with conventional gameplay in youth.

Alternative Model for Physical Activity: Active Video Games Lead to High Physiological Responses

Purpose: This study aimed to i) investigate the physiological and perceptual responses to two different active video games (AVGs), ii) compare the physiological and perceptual responses to AVGs with those encountered during classic exercise and daily sedentary routines, and iii) compare the examined variables between the sexes. Methods: Forty-three (n = 22 male, n = 21 female) volunteers participated in the study and were tested in five different conditions (resting, watching television (TV), brisk walking, AVG dancing, and AVG fighting). Oxygen consumption (VO₂) and heart rate (HR) were measured continuously, whereas energy expenditure (EE) and metabolic equivalent (MET) were calculated. Rating of perceived exertion (RPE) and enjoyment scores were recorded. Results: AVG dancing and AVG fighting significantly increased VO₂, MET, EE, and HR compared with brisk walking, resting, and watching TV. Comparing with brisk walking the AVG dancing yielded similar RPE and higher enjoyment scores. However, the highest physiological responses, RPE, and enjoyment scores were obtained during AVG fighting. There were significant sex x condition interactions for VO₂, MET, EE, and HR. VO₂, MET, and EE were significantly higher in males for all conditions, whereas HR was significantly higher in females. The mean EE values during AVG fighting and AVG dancing were 13.12 ± 2.2 kcal.min^-1 and 9.69 ± 2.0 kcal.min^-1, respectively in males, and 9.31 ± 1.9 kcal.min^-1 and 7.07 ± 1.3 kcal.min^-1, respectively in females. Conclusions: AVG dancing (MET >7) and AVG fighting (MET >9) are enjoyable, vigorous physical activities that can be recommended as an alternative home-based physical activity.

Assessment of Active Video Games' Energy Expenditure in Children with Overweight and Obesity and Differences by Gender

(1) Background: Childhood obesity has become a main global health problem and active video games (AVG) could be used to increase energy expenditure. The aim of this study was to investigate the energy expenditure during an AVG intervention combined with exercise, differentiating by gender. (2) Methods: A total of 45 children with overweight or obesity (19 girls) performed an AVG intervention combined with exercise. The AVG used were the Xbox Kinect, Nintendo Wii, dance mats, BKOOL cycling simulator, and Nintendo Switch. The energy expenditure was estimated from the heart rate recorded during the sessions and the data from the individual maximal tests. (3) Results: The mean energy expenditure was 315.1 kilocalories in a one-hour session. Participants spent the most energy on BKOOL, followed by Ring Fit Adventures, Dance Mats, Xbox Kinect, and the Nintendo Wii, with significant differences between BKOOL and the Nintendo Wii. Significant differences between boys and girls were found, but were partially due to the difference in weight, VO2max, and fat-free mass. (4) Conclusions: The energy expenditure with AVG combined with multi-component exercise was 5.68 kcal/min in boys and 4.66 kcal/min in girls with overweight and obesity. AVG could be an effective strategy to increase energy expenditure in children and adolescents with overweight and obesity.

Active Video Games Versus Traditional Exercises: Energy Expenditure and Blood Lactate Responses

Purpose: The current study aimed to investigate the exercise intensity and exercise characteristics of active video games (AVGs) by measuring various physiological responses, and to test whether AVGs can be used in components of training in sports branches. Methods: Twenty-two male athletes with good aerobic fitness level (age = 20.6 ± 2.2 years; maximum oxygen consumption (VO₂max) = 52.2 ± 3.5 ml.kg^-1.min^-1) visited the laboratory three times (D1, D2, and D3). After taking measurements during rest, the VO₂max was assessed (D1). Traditional brisk walking and running exercises were performed consecutively (D2), and AVGs-dancing and fighting-were performed at random (D3); each exercise session lasted 20 minutes, and for each experiment session oxygen consumption (VO₂), heart rate (HR) were recorded, VO₂max%, metabolic equivalent (MET), and energy expenditure (EE) were calculated. Results: No significant differences were found between AVG-dancing and brisk walking (p > .05) for VO₂ (25.96 ± 3.3 vs. 24.39 ± 2.3 ml.kg^-1.min^-1), HR (137.02 ± 20.15 vs. 125.61 ± 6.49 beats.min^-1) VO₂max% (49.99 ± 7.00 vs. 46.84 ± 4.06), MET (7.49 ± 0.94 vs. 6.96 ± 0.65), and EE (181.19 ± 27.65 vs. 171.21 ± 22.51 Kcal). Additionally, no significant differences were found between AVG-fighting and running (p > .05) for VO₂ (33.96 ± 5.88 vs. 33.13 ± 2.52 ml.kg^-1.min^-1), HR (155.66 ± 15.05 vs. 153.30 ± 6.83 beats.min^-1), VO₂max% (65.05 ± 9.76 vs. 63.60 ± 3.51), MET (9.70 ± 1.68 vs. 9.47 ± 0.72), and EE (236.75 ± 37.20 vs. 232.70 ± 27.06). Conclusions: AVG-dancing and fighting were defined as moderate (MET>7) and high (MET>9) intensity intermittent exercises, respectively. Consequently, AVGs can be a part of training for athletes; as a block, modified block or a traditional training cycle involving enjoyable alternative exercises, especially when the appropriate AVGs are chosen.

Design Features Associated with User Engagement in Digital Games for Healthy Lifestyle Promotion in Youth: A Systematic Review of Qualitative and Quantitative Studies

User engagement in digital (serious) games may be important to increase their effectiveness. Insights into how to create engaging games for healthy lifestyle promotion are needed, as despite their potential, not all digital (serious) games are highly engaging. This study systematically reviewed game features that were associated with higher user engagement among youth. A systematic search was conducted in PubMed, Web of Science, CINAHL, and PsycARTICLES databases. Qualitative and quantitative studies were included, if they documented game features associated with youth engagement. Coding of game features was performed using the mechanics-dynamics-aesthetics (MDA) framework. A total of 60 studies met the inclusion criteria and were included in the registered systematic review (No. CRD42018099487). Results showed that various game features were associated with user engagement in digital (serious) games: an attractive storyline, adaptable to gender and age, including diverse (antagonist) characters the user may identify with, high-end realistic graphics, well-defined instructions, which can be skipped, in combination with clear feedback and a balance of educational and fun content. This review underpinned the relevance of investigating engaging game features specifically for youth, as deviations were found with characteristics that are engaging for other populations.

Evaluation of the exercise intensity generated by active video gaming in patients with cystic fibrosis and healthy individuals

BACKGROUND

Adherence of patients with cystic fibrosis (CF) to exercise is challenging. Here we compared the physiological responses during the use of interactive video games (VG) with the cardiopulmonary exercise test (CPET) in healthy and CF subjects.

METHODS

Cross-sectional study including CF and healthy (CON) subjects older than 6 years. Individuals were evaluated in two visits. At visit one, anthropometric measures, spirometry and CPET were performed. In the second visit, a physical activity questionnaire was applied and gas analyses performed during the use (10 min) of both Nintendo Wii (Wii Fit Plus: (1) Obstacle Course, (2) Rhythm Boxing and (3) Free Run) and Xbox One (Just Dance 2015: (1) Love Me Again, (2) Summer and (3) Happy).

RESULTS

Twenty-five CON and 30 CF patients were included. The mean FEV₁ (%) was significantly lower in the CF group compared to CON. There were no differences between groups at peak exercise (CPET) for heart rate (HR), oxygen consumption (VO₂) and minute ventilation (V_E). In the CON group, games 2 and 3 (Xbox) and game 3 (Nintendo) increased HR to values similar to the anaerobic threshold (AT), while for the CF group this occurred for games 2 (Xbox) and 3 (Nintendo). As for VO₂ and V_E, both groups obtained similar responses as compared to AT values in games 2 (Xbox) and 3 (Nintendo).

CONCLUSION

The use of VG generated a cardiorespiratory response similar to AT levels found during CPET, indicating that it may be an alternative for exercise training of CF individuals.

Does Wearing a Portable Metabolic Unit Affect Youth's Physical Activity or Enjoyment During Physically Active Games or Video Games?

Portable metabolic units (PMUs) are used to assess energy expenditure, with the assumption that physical activity level and enjoyment are unaffected due to the light weight and small size.

PURPOSE

To assess differences in physical activity level and enjoyment while wearing and not wearing a PMU.

METHOD

Youth (8-17 y; N = 73) played children's games or active video games while wearing and not wearing a PMU (crossover design). Participants wore an accelerometer and heart rate monitor and responded to questions about enjoyment on a facial affective scale. A repeated-measures analysis of variance was used to determine if accelerometer measures, heart rate, or enjoyment differed between conditions overall and by sex and weight status.

RESULTS

Steps per minute were lower while wearing the PMU than not wearing the PMU (40 vs 44, P = .03). There was an interaction between PMU condition and weight status for enjoyment (P = .01), with overweight participants reporting less enjoyment when wearing the PMU compared with not wearing the PMU (72 vs 75 out of 100). Heart rate, vector magnitude, and counts per minute were not different.

CONCLUSION

There may be psychosocial effects of wearing the PMU, specifically in overweight participants. Activity level was minimally affected, but the practical significance for research is still unknown.

The Effect of Body Mass Index on Acute Cardiometabolic Responses to Graded Exercise Testing in Children: A Narrative Review

Although the beneficial role of exercise for health is widely recognized, it is not clear to what extent the acute physiological responses (e.g., heart rate (HR) and oxygen uptake (VO₂)) to a graded exercise test are influenced by nutritional status (i.e., overweight vs. normal-weight). Therefore, the main objectives of the present narrative review were to examine the effect of nutritional status on acute HR, and VO₂ responses of children to exercise testing. For this purpose, we examined existing literature using PubMed, ISI, Scopus, and Google Scholar search engines. Compared with their normal-body mass index (BMI) peers, a trend of higher HRrest, higher HR during submaximal exercise testing, and lower HRmax was observed among overweight and obese children (according to BMI). Independent from exercise mode (walking, running, cycling, or stepping), exercise testing was metabolically more demanding (i.e., higher VO₂) for obese and overweight children than for their normal-weight peers. Considering these cardiometabolic differences according to BMI in children might help exercise specialists to evaluate the outcome of a graded exercise test (GXT) (e.g., VO2max, HRmax) and to prescribe optimal exercise intensity in the context of development of exercise programs for the management of body mass.

Comparison of Accelerometer-Based Cut-Points for Children's Physical Activity: Counts vs. Steps

Background: Accelerometers measure complex movements of children’s free play moderate-vigorous physical activity (MVPA), including step and non-step movements. Current accelerometer technology has introduced algorithms to measure steps, along with counts. Precise interpretation of accelerometer-based cadence (steps/min) cut-points is necessary for accurately measuring and tracking children’s MVPA. The purpose of this study was to assess the relationships and agreement between accelerometer-based cut-points (cadence and counts/min) to estimate children’s MVPA compared to measured values. Methods: Forty children (8–12 years; 25 boys) played 6–10 games while wearing a portable metabolic analyzer and GT3X⁺ to measure and estimate MVPA, respectively. Correlation, kappa, sensitivity, and specificity assessed the relationships and agreement between measured and estimated MVPA. Results: Games elicited, on average, 6.3 ± 1.6 METs, 64.5 ± 24.7 steps/min, and 3318 ± 1262 vertical (V) and 5350 ± 1547 vector-magnitude (VM) counts/min. The relationship between measured and estimated MVPA intensity was higher for cadence (r = 0.50) than V and VM counts/min (r = 0.38 for both). Agreement using V and VM counts/min for measuring PA intensity varied by cut-points (range: 6.8% (κ = −0.02) to 97.6% (κ = 0.49)), while agreement was low using cadence cut-points (range: 4.0% (κ = 0.0009) to 11.3% (κ = 0.001)). Conclusion: While measured and estimated values were well correlated, using cadence tended to misclassify children’s free-play MVPA.

Effects of Active Videogame and Sports, Play, and Active Recreation for Kids Physical Education on Children's Health-Related Fitness and Enjoyment

OBJECTIVE

The purpose of the study was to compare the effects of a Kinect active videogame (AVG) and the Sports, Play, and Active Recreation for Kids (SPARK) intervention in improving children's health-related fitness and physical activity (PA) enjoyment.

MATERIALS AND METHODS

A total of 65 students from both third and fourth grade in a rural elementary school participated in the study. The third graders (N = 29, mean age = 9.1 years, 10 boys, mean body mass index [BMI] = 20.1) were assigned to a SPARK physical education group, while the fourth graders (N = 36, mean age = 10.2 years, 15 boys, mean BMI = 20.3) were enrolled in the Kinect AVG group. The intervention lasted for 6 weeks, with each week including three practice sessions (∼40 minutes per session). All participants were measured on their health-related fitness by testing their performance in the 15-m Progressive Aerobic Cardiovascular Endurance Run (PACER), curl-ups, and push-ups both before and after the interventions. Participants' PA enjoyment was measured immediately after the first and last session's practice. Various ANCOVA tests were conducted to analyze the intervention effects on the changes of health-related fitness performances and enjoyment while controlling for baseline values, gender, and BMI. Various MANOVA tests were used to examine the intervention effects on PA levels during three practice sessions.

RESULTS

Participants in AVG group had greater improvement in 15-m PACER test (P < 0.001), as well as PA enjoyment (P < 0.05), than those in SPARK group. The AVG group generated higher light PA and lower sedentary time for three (P < 0.05 to P < 0.001) and two sessions (P < 0.05 and P < 0.001), respectively. In addition, the AVG group accumulated higher moderate-to-vigorous physical activity (MVPA) for the first session (P < 0.01), while the SPARK group generated higher MVPA for the third session (P < 0.001). No MVPA difference was found between groups for another session.

CONCLUSION

A 6-week (40 minutes × 3 times/week) program using AVG could be an effective strategy in improving children's cardiorespiratory fitness while maintaining PA enjoyment.

Effect of Prior Game Experience on Energy Expenditure During Xbox Kinect in Children and Teens

OBJECTIVE

To examine the effect of game-specific and overall Kinect experience and overall gaming habits on energy expenditure (EE) and enjoyment of children and adolescents (8-17 years) while playing Xbox^® Kinect exergames.

MATERIALS AND METHODS

Participants (N = 55) played four active videogames for 6-10 minutes. Height, weight, and resting metabolic rate were measured and participants completed a survey on gaming habits and previous experience. Habit (none, low, moderate, or high) was based on the number of game systems at home, frequency, and duration of game play. Game-specific experience was classified as either inexperienced or experienced. A composite score was created for how much experience they had with each game, classified as none, low, or high. The participant wore a portable metabolic analyzer (total and physical activity energy expenditure [PAEE]), heart rate (HR) monitor, and accelerometer (waist, counts/min). Enjoyment was measured after each game using a three-item face scale. Bonferroni-adjusted three-way ANOVA assessed PAEE, intensity, and enjoyment across overall and game-specific experience and habits (P < 0.05).

RESULTS

Intensity, PAEE, and HR were greater in experienced versus inexperienced players (5.1 ± 0.2 vs. 4.4 ± 0.2 metabolic equivalents [METs]; 4.1 ± 0.2 vs. 3.3 ± 0.2 kcal/min; 138 ± 2.5 vs. 130 ± 1.9 bpm). Higher game-specific experience levels elicited greater counts/min compared with no experience. Moderate gaming habits elicited greater PAEE and METs than low gaming habits. Enjoyment was equal in all groups.

CONCLUSION

Participants with more game-specific Kinect experience or overall gaming habits elicited greater PA energy and intensity. This study supports that children and adolescents can play Xbox Kinect without decrements in PAEE or enjoyment.