Impact of Exergaming on Children's Motor Skill Competence and Health-Related Fitness: A Quasi-Experimental Study

Effects of exergames on student physical education learning in the context of the artificial intelligence era: a meta-analysis

Whether the application of exergames in physical education (PE) courses can significantly improve student performance in PE learning is still controversial. This review explores the promoting effect of exergames on student PE learning and the conditions in which the effect of exergames can be maximized. Based on the PICOS method, two researchers independently searched the ProQuest database, EBSCO database, Web of Science (WoS) database, PubMed database, Chinese National Knowledge Infrastructure (CNKI) database, Wanfang database, and VIP database, evaluated the literature quality using the Cochrane system evaluation manual, and performed a meta-analysis of the included literature. A total of 16 randomized controlled trials involving 2962 subjects were included in this study. The meta-analysis showed that exergames effectively improved student performance in PE learning (SMD = 0.45, 95% CI: 0.27-0.63, P < 0.00001). Subgroup analysis indicated that better results could be achieved when exergames were introduced in small kindergarten classes and continued for 1-2 months.

Effects of exergaming on executive functions of children: a systematic review and meta-analysis from 2010 to 2023

BACKGROUND

Executive function plays a crucial role in children's cognitive development, academic performance, as well as their physical and mental health. This study aims to assess the impact of exergaming on executive functions in pediatric populations.

METHODS

The criteria of inclusion were randomized controlled trials of exergaming intervention and evaluation of executive function in children aged 4-12 years. A meta-analysis was performed in databases of China National Knowledge Infrastructure (in Chinese), Wan Fang (in Chinese), Web of Science, Embase, and PubMed, from January 2010 to February 2023, following the PRISMA guidelines. Risk of bias was assessed by the Jadad scale, the Cochrane risk of bias assessment tool, funnel plot, and regression-based Egger test. The Review Manager 5.3 was used to analyze the included articles using a random-effects model, and the effects were calculated as standardized mean difference (SMD).

RESULTS

Eleven experimental studies with children (n = 508) were included. Exergaming was found to have a positive impact on children's cognitive flexibility (SMD = 0.34, 95%CI [0.17,0.52], P < 0.01), inhibitory control (SMD = 0.57, 95%CI [0.31,0.83], P < 0.01), and working memory (SMD = 0.26, 95%CI [0.02,0.51], P < 0.05). The publication bias were observed.

CONCLUSIONS

Exergaming has the potential to improve executive functions in children. More studies with rigorous designs are warranted to explore the specific effects of exergaming intervention. This study was registered on the PROSPERO (CRD42023401526).

Strategies to Improve Physical Activity and Nutrition Behaviours in Children and Adolescents: A Review

Despite widespread acknowledgement of the multifarious health benefits of physical activity (PA), including prevention and control of obesity, an overwhelming majority of children and adolescents are not sufficiently active to realise such benefits. Concurrently, young people are significantly impacted by the rapid global rise of sedentarism, and suboptimal dietary patterns during key phases of development. Regrettably, the cumulative effects of unhealthy behaviours during the growing years predisposes young people to the early stages of several chronic conditions, including obesity. Clear and consistent approaches are urgently needed to improve eating and activity behaviours of children and adolescents. Based on existing evidence of "best bets" to prevent and control obesity and its comorbidities, we present a set of non-negotiable strategies as a 'road map' to achieving prevention and improving the health of children and adolescents.

Comparative effectiveness of school-based exercise interventions on physical fitness in children and adolescents: a systematic review and network meta-analysis

Background

Schools provide a favorable setting for health education, however, the most effective school-based exercise mode for improving physical fitness remains unclear. This network meta-analysis was designed to assess and rank the comparative efficacy of six exercise modalities on physical fitness indicators in a school-based setting.

Methods

An online search of the Web of Science, PubMed, SPORTDiscus, and Scopus databases was conducted. Randomized and quasi-randomized controlled trials were considered. Outcomes included measures of anthropometry and body composition, muscular fitness, and cardiorespiratory fitness. Data were pooled with a random effects model using the frequentist framework.

Results

A total of 66 studies with 8,578 participants (48% girls) were included. High-intensity interval training was the most effective intervention reducing body mass index (mean difference (MD) = -0.60 kg·m^-2, 95% confidence interval (95%CI) = -1.04 to -0.15, p = 0.009), elevating VO_2max (MD = 3.59 mL·kg^-1·min^-1, 95% CI = 2.45 to 4.74, p < 0.001), and 20-meter sprint performance (MD = -0.35 s, 95% CI = -0.55 to -0.14, p = 0.001). Aerobic training had the highest probability of reducing waist circumference (standardized mean difference (SMD) = -0.60, 95% CI = -0.88 to -0.32, p < 0.001). Active video games emerged as a promising modality for improving countermovement jump (MD = 2.43 cm, 95% CI = 0.06 to 4.80, p = 0.041) and shuttle running performance (SMD = 0.86, 95% CI = 0.29 to 1.43, p = 0.003). Strength training was the best exercise mode for improving standing long jump performance (SMD = 1.03, 95% CI = 0.07 to 1.98, p = 0.035) while combined training was rated the first for decreasing body fat percent (MD = -2.56%, 95% CI = -4.73 to -0.40, p = 0.022) and increasing push-up repetitions (SMD = 3.59, 95% CI = 0.81 to 6.37, p = 0.012).

Conclusion

School-based exercise interventions have multiple effects on physical fitness. The findings of this study will help to inform physical education teachers and coaches how best to deliver exercise programs in a school setting. Since the study was limited by the original research, the conclusions will require further verification using high-quality randomized controlled trials.

Systematic Review Registration

PROSPERO, Identifier: CRD42023401963.

Evaluating Changes in Perceived Enjoyment throughout a 12-Week School-Based Exergaming Intervention

This study assessed whether a high-intensity exergame represents an enjoyable training tool for children in the elementary school setting. Furthermore, it evaluated whether gender, body mass index (BMI), waist-to-height ratio (WHtR), fitness level, weekly physical activity level, and general interest in sports moderate perceived enjoyment during the 12-week intervention. Thirty fifth- and sixth-grade students (10.5 ± 0.7 years; 50% girls) participated in this study. During baseline assessments, anthropometric measurements and a shuttle run test were conducted. Throughout the intervention period, the students participated in 15−20-min exergaming sessions (ES) in the ExerCube twice a week during school hours. Enjoyment was assessed after an ES in weeks 2 and 12. Additionally, enjoyment was evaluated after a physical education (PE) class in week 2. The results reveal no significant changes in enjoyment (p = 0.164) over time. The modest changes over time were significantly affected by BMI (p = 0.027), WHtR (p = 0.007), and weekly activity level (p = 0.016). Compared to the PE class, enjoyment was significantly higher during the ES (p < 0.001). None of the covariates showed a significant effect. Mean HR during the ES reached 87.1 ± 1.9% of students’ individual maximum HR. In conclusion, the ExerCube provides a promising tool for schools to promote enjoyable moderate-to-vigorous physical activity.

A Skill Acquisition Perspective on the Impact of Exergaming Technology on Foundational Movement Skill Development in Children 3-12 Years: A Systematic Review and Meta-analysis

BACKGROUND

Sedentary, digital screen time in children represents a major concern due to its detrimental effect on children's development. Nowadays, however, advances in technology allow children to actively interact with a digital screen using their whole body (e.g., exergaming), providing potential for movement learning. Exergaming technology may prove valuable in supporting children's development of foundational movement skills (FMS).

OBJECTIVE

To examine the impact of exergaming technology on the development of FMS in children 3-12 years through a skill acquisition lens.

METHODS

Systematic review and meta-analysis were conducted following the PRISMA guidelines. Web of Science, PubMed, PsycINFO and SPORTDiscus databases were searched between 2007 and 2022. Studies were eligible if they conducted an exergaming intervention to improve FMS in typically developing children aged three to twelve with a control group, using a baseline and post-intervention assessment design. FMS outcomes were pooled with a random effects model.

RESULTS

Nine trials (4 RCTs, 2 cluster RCTs and 3 non-randomized trials) of varying methodological quality (2 had low, 6 had some concerns, and 1 had a high risk of bias) were included, with a total of 783 participants. FMS outcome measures across studies comprised object control skills, locomotor skills, coordination, agility, balance and balance-related skills. The meta-analysis included showed a small positive effect in favor of the exergaming intervention (r = 0.24 [95% confidence interval: 0.11-0.36]).

CONCLUSION

Our results indicate that screen-based technology that requires an active engagement of the child can promote the development of FMS. Considering that FMS are the foundation of a child's physical, mental, health and academic development, this finding could lead to a reshaping of the perception of digital screen-based technology and the role this should play in children's lives. We speculate that the observed benefits most likely depend upon the quality of information-movement coupling specificity and the motor learning strategies built into the exergame and/or the intervention design. We do not believe this is dependent on the type of FMS being performed or the amount of practice. We recommend therefore that future research should examine how practitioners (school teachers, coaches and parents) can facilitate the interaction between a child and exergaming technology.

Comparative Effectiveness of Physical Activity Intervention Programs on Motor Skills in Children and Adolescents: A Systematic Review and Network Meta-Analysis

Objective: To evaluate how different physical activity (PA) interventions (traditional, exergaming, and teacher/parent education) impacted children's motor skills (object control, locomotor, and gross motor). Design: Systematic review and network meta-analysis. Data sources: PubMed, Medline, Scopus, Web of Science, EMBASE, and PsycINFO. Eligibility criteria: (1) Participants comprised 1708 children 3-12 years; (2) PA or exercise-based interventions were investigated; (3) only studies using a Test of Gross Motor Skills assessment were included; (4) RCT were chosen as the study design to assess the impact of PA interventions on children's motor skills; and (5) culture-based PA studies with English language only were included. Data were analyzed using a Bayesian network meta-analysis. Results: The results were reported as standardized mean differences (SMDs) with associated 95% credible intervals (CrIs). For object control, aerobic intervention (SMD 6.90, 95% Crl 1.39 to 13.50); for locomotor, exergaming intervention (SMD 12.50, 95% Crl 0.28 to 24.50); and for gross motor, aerobic intervention (SMD 7.49, 95% Crl 0.11 to 15.70) were the most effective treatments. Conclusion: Children's FMSs have been improved through different PA interventions. Among them, aerobic interventions seem to be the most effective intervention in enhancing object control skills and overall gross motor skills.

The Effects of Exergames on Physical and Psychological Health in Young Adults

Objective: This study aims to examine the effects of Kinect-based exergaming on physical (balance and reaction time) and psychosocial health factors (mental well-being and subjective happiness level) in young adults. Materials and Methods: A total of 22 men aged between 18 and 40, who play sedentary videogames at least once a week, were randomly divided into 2 groups to participate in either a Kinect-based exergame program (experimental group, n = 11) or to continue playing sedentary videogames without making any changes (control group, n = 11). The Kinect-based exergame program, including three exergames (Kinect Adventure: Reflex Ridge, Dance Central 3, Kinect Sports: Volleyball), was implemented with the experimental group for 5 weeks, three times a week, and 45 minutes per session. Balance and reaction time were assessed using SportKAT® 4000 Kinesthetic Ability Trainer and FitLight Trainer™ devices, respectively. To measure mental well-being and subjective happiness level, scales with proven psychometric qualities, whose validity and reliability studies were conducted, were used. Results: Results of the study showed statistically significant improvement for the experimental group on the measures of reaction time [t(10) = -4.69, P = 0.001], subjective happiness [t(10) = 8.94, P = 0.000], and mental well-being [t(10) = 4.62, P = 0.001]. In addition, the difference between the groups in reaction time [t(20) = 1.66, P = 0.01], right leg static balance [t(20) = -2.96, P = 0.008], mental well-being [t(20) = 2.77, P = 0.012], and subjective happiness levels (U = 0.50, P = 0.000) was found to be statistically significant in favor of the experimental group. Conclusion: The findings suggest that Kinect-based exergaming positively supports adults' reaction time, mental well-being, and subjective happiness.

Digital technology in physical education: a systematic review of research from 2009 to 2020

Digital media is currently one of the defining topics in discussions about schools and teaching. In this context, there has been a wide range of research in physical education (PE) in areas such as health, gamification, and wearable technologies. This raises the question of the goals pursued by empirical studies regarding the use of digital media in PE. The present systematic review provides an overview of the state of research in English and German on the use of digital media in PE. To this end, the included studies were those published between 2009 and 2020 in journals or edited volumes or as dissertations. They were found in relevant databases, selected based on criterion-guided screening, and transferred to the synthesis. Overall, this systematic review presents the possibilities and limitations of digital media in PE and highlights the goals regarding the use of digital media in PE that are pursued by empirical studies in the categories of physical, cognitive, social, affective, and school framework conditions. While benefits from the usage of digital media in PE—such as in terms of motivation or improving sport-specific motor capabilities and skills—were identified, barriers regarding the preparation of PE teachers were also found. More specifically, the benefits of using digital media to achieve PE-related goals were in the foreground in many of the selected studies. However, only a few specifically addressed learning via media, including topics such as data protection and the effect that viewing images has on students’ self-concepts.

Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial

This study aimed to investigate the effects of a school-based exergame intervention on anthropometric parameters and physical fitness. Fifty-eight students (10.4 ± 0.8 years; 48% girls) were randomized into an intervention (IG) and a control (CG) group. Both groups participated in regular physical education classes during the three-month intervention period. The IG additionally received a 20-minute exergame intervention twice per week. At baseline and following the intervention period, body mass index (BMI) and waist-to-height ratio (WHtR) were assessed. Furthermore, a sprint test (ST), a countermovement jump test (CMJ), and a shuttle run test (SRT) were performed. Due to prescribed quarantine measures, only 34 students (18 IG; 16 CG) were included in the final analysis. A significant group−time interaction was determined in CMJ performance (p < 0.001; η2 = 0.403), with a significant increase (+2.6 ± 2.4 cm; p < 0.001; η2 = 0.315) in the IG and a significant decrease (−2.0 ± 3.1 cm; p = 0.009; η2 = 0.190) in the CG. Furthermore, ST performance significantly improved in the IG (−0.03 ± 0.08 s; p = 0.012; η2 = 0.180) but not in the CG (0.13 ± 0.16 s; p = 0.460; η2 = 0.017), revealing significant interaction effects (p = 0.02; η2 = 0.157). Significant group−time interaction was observed for the SRT (p = 0.046; η2 = 0.122), with a significant increase (+87.8 ± 98.9 m; p = 0.028; η2 = 0.147) in the IG and no changes (−29.4 ± 219.7 m; p = 0.485; η2 = 0.016) in the CG. Concerning BMI (p = 0.157; η2 = 0.063) and WHtR (p = 0.063; η2 = 0.114), no significant interaction effects were detected. School-based exergaming is a suitable tool to influence students’ physical fitness positively.

The use of digital technology to improve and monitor handwashing among children 12 years or younger in educational settings: a scoping review

Our scoping review aimed to identify and describe the application of digital technology in hand hygiene research among children in educational settings. We searched for articles in PubMed, IEEE Xplore, and Web of Science. Original hand hygiene research with a form of digital technology used among children ≤12 years in educational settings was eligible for inclusion. Twelve studies met the eligibility criteria and the data were extracted by two teams of independent co-authors for narrative synthesis. Ten studies used digital technology as an intervention tool and two for monitoring purposes. Three main digital technologies were identified including computer games (n = 2), videos (n = 8), and video cameras (n = 2). Digital technologies found in our scoping review were reported to be effective in hand hygiene studies over short temporal periods especially when used in combination with other measures. Future research may demonstrate the effectiveness of digital technology in helping children develop sustainable handwashing behaviors.

The Effect of an Intervention with Active Video Games Combined with Multicomponent Exercise on Cardiorespiratory fitness in Children with Overweight and Obesity: A Randomized Controlled Trial. (Preprint)

Background

Childhood overweight and obesity have become major global health problems and are negatively related with the cardiorespiratory fitness (CRF) level in school children and adolescents. Exercise, specifically multicomponent training, is effective for CRF improvement, but the main challenge is to ensure adherence to exercise in children with overweight and obesity. Therefore, new ways of exercising that are more attractive and motivational for this population are needed and playing or training with active video games (AVGs) has been proposed as an effective alternative because they require full-body movement and therefore increase energy expenditure.

Objective

The main aim of this study was to investigate the effects of an AVG intervention combined with multicomponent training on CRF at maximal and submaximal intensities in children with overweight or obesity.

Methods

We recruited 28 children (13 girls and 15 boys) aged 9 to 11 years with overweight or obesity from medical centers and divided them into 2 groups, an intervention group (n=20) that participated in a 5-month supervised AVG exercise program combined with multicomponent exercise, and a control group (n=8) that continued daily activities without modification. A maximal stress test to measure CRF using a walking-graded protocol with respiratory gas exchange was performed by the participants.

Results

The AVG group showed a significant decrease in heart rate and oxygen uptake for the same intensities in the submaximal stages of the maximal treadmill test, as well as a lower oxygen uptake percentage according to the individual maximal oxygen uptake, whereas the control group did not show overall changes. No change in the peak oxygen uptake (VO_2peak) was found.

Conclusions

A 5-month AVG intervention combined with multicomponent exercise had positive effects on CRF at submaximal intensity, showing a lower heart rate and oxygen uptake at the same intensities and displaying a lower oxygen uptake percentage according to the individual (VO_2peak). Greater benefits were found in children with the highest fat percentage.

Trial Registration

ClinicalTrials.gov NCT04418713; https://clinicaltrials.gov/show/NCT04418713

It's Not Just What You Do but the Way You Do It: A Systematic Review of Process Evaluation of Interventions to Improve Gross Motor Competence

BACKGROUND

Motor competence is an important predictor of health behaviours. However, levels of motor competence are low in children and adolescents. Many interventions have improved motor competence, yet intervention effects were highly variable. Potential causes of such variations are not fully understood. Process evaluation can assist with the understanding of why an intervention worked or not, but its application and reporting in motor competence interventions has received little attention.

OBJECTIVES

The primary aim of this review was to investigate whether process evaluations have been reported in interventions to improve motor competence and, if reported, which process evaluation measures have been used. A secondary aim was to explore the association of intervention characteristics and process evaluation findings (outcomes of process evaluation measures) with intervention outcomes, in a search for what process evaluation measures may impact on intervention functioning and outcomes.

METHODS

The process of conducting and reporting this review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered with PROSPERO (CRD42019124412). A systematic search of seven electronic databases (i.e. MEDLINE [via EBSCOhost], Cochrane Central Register of Controlled Trials [CENTRAL], CINAHL, Academic Search Complete, Education Database, SPORTDiscus and Scopus) was conducted with no date restrictions. Eligibility criteria included the following: (1) a study sample of typically developing children and adolescents aged 5-18 years, (2) an intervention aimed to improve motor competence, (3) an intervention included a control group, (4) a report of motor competence outcome at both pre- and post-intervention. Only original articles published in English in peer-reviewed journals were considered. Process evaluation measures and findings were extracted using the UK Medical Research Council's process evaluation framework in order to provide overarching descriptions on the implementation, mechanism of change and context of interventions. Univariable meta-regressions were performed to ascertain whether selected study-level covariates moderated the improvement in motor competence outcomes in interventions.

RESULTS

The search identified 60 intervention studies. Only 30 studies (50%) reported process evaluation measures. No studies reported (or employed) theoretical frameworks to guide process evaluation. Process evaluation measures relating to implementation were most commonly reported, with the most prevalent aspect being fidelity. This was followed by reporting on measures relating to mechanism of change and context of the intervention. Meta-analysis results suggested intervention duration, dose, inclusion of process evaluation aim, provision of lesson plans, sample size and sex as potential moderators.

CONCLUSIONS

Reporting of process evaluation measures may help build our understanding of the optimal characteristics of motor competence interventions. However, process evaluation is under-used and/or under-reported. This review serves as a call for more process evaluations and better reporting in motor competence interventions.

The Effects of Active Video Games on Health-Related Physical Fitness and Motor Competence in Children and Adolescents with Healthy Weight: A Systematic Review and Meta-Analysis

(1) Background: Poor levels of physical fitness and motor skills are problems for today's children. Active video games (AVG) could be an attractive strategy to help address them. The aim was to investigate the effects of AVG on health-related physical fitness and motor competence in children and adolescents with healthy weight. (2) Methods: Randomized and non-randomized controlled trials investigating the effects of AVG programs on health-related physical fitness and motor competence were included. Two different quality assessment tools were used to measure the risk of bias. Twenty articles met the inclusion criteria and the variables of interest were body mass index (BMI), body fat, cardiorespiratory fitness (CRF), muscular fitness and motor competence. (3) Results: AVG interventions seem to have benefits in BMI when lasting longer than 18 weeks (SMD, -0.590; 95% IC, -1.071, -0.108) and in CRF (SMD, 0.438; 95% IC, 0.022, 0.855). AVG seems to be a promising tool to improve muscular fitness and motor competence but the effects are still unclear due to the lack of evidence. (4) Conclusions: AVG seem to be an effective tool for improving some components of health-related physical fitness and motor competence in healthy-weight children and adolescents, but the effect on some fitness components needs further research. Therefore, AVG may be included as a strategy to improve health.

The Effects of Physical Activity and Exergaming on Motor Skills and Executive Functions in Children with Autism Spectrum Disorder

Objective: This study aims at investigating the effects of two types of interventions, Sports, Play and Active Recreation for Kids (SPARK) and exergaming (Kinect), on motor skills (MS) and executive functions (EF) in children with autism spectrum disorder (ASD). Materials and Methods: Sixty children, aged 6-10 years were randomly assigned to SPARK (n = 20), Kinect (n = 20), or a control group (n = 20). Children's MS and EF were assessed before and after the intervention. The SPARK and Kinect groups participated in an 8-week intervention; the control group received treatment as usual. Intention-to-treat repeated-measures ANOVA was used to examine the effects of the intervention. Results: For MS, a significant group X time interaction was observed for aiming and catching skills [F(2, 53) = 4.12, P < 0.05]; the SPARK group improved significantly from pre- to post-test compared with the other groups. For EF, a main effect of group was found for correct responses [F(2, 53) = 5.43, P < 0.01]. The Kinect group showed more correct responses than the SPARK and control groups. A main effect of time was significant for conceptual responses [F(1, 53) = 10.61, P < 0.01] and perseverative errors [F(1, 53) = 14.31, P < 0.01]. Conclusion: This study suggests that structured physical activity (PA) interventions that target specific MS improve motor function in children with ASD and exergaming could be effective for improving EF. Future research is needed to untangle the interaction between the type of exercise, traditional PA versus exergaming, and the dose associated with improvements in MS and EF in children with ASD.

Home-Based Exergaming on Preschoolers' Energy Expenditure, Cardiovascular Fitness, Body Mass Index and Cognitive Flexibility: A Randomized Controlled Trial

PURPOSE

The effects of exergaming-based physical activity (PA) interventions on preschoolers' health outcomes and cognition remain largely unexplored. Therefore, we conducted a randomized controlled trial to discern the effectiveness of a home-based educational exergaming intervention on preschoolers' energy expenditure, fitness, body mass index, and cognition.

METHODS

Participants were 32 preschoolers (16 girls; 59.4% Asian; M_age = 4.72, SD = ±0.73) recruited from the Twin Cities area in Minnesota. During baseline testing, we measured preschooler's daily energy expenditure (EE), cardiovascular fitness, body mass index, and cognitive flexibility using validated instruments. Participants were then randomly assigned to one of two conditions: (1) the exergaming intervention condition; or (2) control condition. The intervention program requested children participate in home-based educational exergaming using the LeapTV gaming console for at least 30 min/session 5 times/week. The control condition asked children to maintain regular PA patterns without any exergaming gameplay. Each condition lasted 12 weeks. We conducted identical outcome assessments for all children at baseline and post-intervention.

RESULTS

Analysis of covariance with repeated measures yielded significant time x group interaction effects for cognitive flexibility, Wilks' Lambda = 0.81, F(1, 29) = 6.98, p = 0.01, η² = 0.19, suggesting children in the exergaming group demonstrated significantly greater increases in cognitive flexibility as compared to those in the control group over time. There were no significant differences for time x group changes between the two groups for EE, Wilks' Lambda = 0.92, F(1, 29) = 2.29, p = 0.14, η² = 0.08; cardiovascular fitness, Wilks' Lambda = 0.96, F(1, 29) = 1.07, p = 0.31, η² = 0.04; and BMI, Wilks' Lambda = 0.99, F(1, 29) = 0.05, p = 0.82, η² = 0.01. However, our data did suggest a marginal effect of time for EE, Wilks' Lambda = 0.89, F(1, 29) = 3.26, p = 0.08, η² = 0.08, indicating that children's daily EE increased from baseline to post-intervention.

CONCLUSIONS

Home-based educational exergaming may positively impact cognitive flexibility in preschoolers. Studies with larger sample sizes in multiple geographic locations are needed, with our study suggesting a longer intervention period might also be warranted.

Effects of Active Video Games on Children's Psychosocial Beliefs and School Day Energy Expenditure

Purpose: Examine the effects of active video games (AVGs) on children's school-day energy expenditure (EE) and physical activity (PA)-related self-efficacy, social support, and outcome expectancy over 9 months. Method: Participants were 81 fourth grade students ( X ¯ age = 9.23 years, SD = 0.62; 39 girls) from two urban Minnesota elementary schools. A once-weekly 50 min AVG intervention was implemented in the intervention school for 9 months in 2014-2015 while the control school continued regular recess. Children's school-day EE (daily caloric expenditure) and mean daily metabolic equivalent (MET) values were estimated via accelerometry whereas self-efficacy, social support, and outcome expectancy were assessed with psychometrically-validated questionnaires. All measures were completed at baseline and at the 4th and 9th months. Results: We observed significant interaction effects for daily caloric expenditure, F(1, 58) = 15.8, p < 0.01, mean daily MET values, F(1, 58) = 11.3, p < 0.01, and outcome expectancy, F(1, 58) = 4.5, p < 0.05. Specifically, intervention children had greater increases in daily caloric expenditure (91 kilocalorie/day post-intervention group difference), with control children decreasing daily caloric expenditure over time. We observed identical trends for mean daily MET values (0.35 METs/day post-intervention group difference). Interestingly, we observed outcome expectancy to increase in the control children, but decrease among intervention children, at post-intervention (1.35 group difference). Finally, we observed a marginally significant interaction effect for social support, F(1, 58) = 3.104, p = 0.08, with an increase and decrease seen in the intervention and control children, respectively. We observed no interaction or main effects for self-efficacy. Discussion: Observations suggested an AVG intervention contributed to longitudinal increases in school-day EE and social support compared to the control condition. Future research should examine how self-efficacy and outcome expectancy might be promoted during school-based AVG interventions.

Effects of Exergaming on Preschoolers' Executive Functions and Perceived Competence: A Pilot Randomized Trial

Purpose: This study aimed to evaluate the effects of a child-centered exergaming program and a traditional teacher-led physical activity (PA) program on preschoolers’ executive functions and perceived competence. Methods: Sixty children aged 4–5 years from an urban childcare center in China completed an 8-week exergaming/traditional PA intervention. After baseline measurements of executive functions and perceived competence (i.e., perceived physical competence and social acceptance), children were randomly assigned to either an exergaming group or traditional PA group (30 children per group). Exergaming and traditional PA programs were offered 20 min/session by trained instructors for 8 weeks. Post-intervention measures were identical to baseline measures. Results: In general, children’s executive functions, perceived physical competence, and perceived social acceptance were enhanced over time. Analysis of variance revealed significant time by group interaction effects for executive functions, F(1, 58) = 12.01, p = 0.01, and perceived social acceptance, F(1, 58) = 6.04, p = 0.02, indicating that the exergaming intervention group displayed significantly greater increases in executive functions and perceived social acceptance in comparison with traditional PA children. In addition, children’s executive functions and perceived physical and social competence significantly improved from baseline to post-intervention. However, there was no significant difference in the increase of children’s perceived physical competence across groups over time. Conclusion: The results suggested exergaming to be beneficial in enhancing young children’s executive functions and perceived social acceptance compared to the traditional PA program. More diverse samples with a longer intervention duration in preschool children in urban areas are warranted.

Exergaming for Children and Adolescents: Strengths, Weaknesses, Opportunities and Threats

Exergaming, or active video gaming, has become an emerging trend in fitness, education and health sectors. It is defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). Since exergaming is becoming more popular, claims have been made on the usefulness of exergaming. It has, for example, been entitled as being "the future of fitness" by the American College of Sports Medicine, promoting PA and health in children and adolescents. However, research also suggests that long-term engagement in exergaming is difficult to achieve, and there is a noticeable reservation towards exergaming by parents, teachers and caregivers. To provide an overview and to outline the future directions of exergaming, the aim of this review was to critically illustrate the strengths, weaknesses, opportunities and threats of exergaming to promote PA and health in children and youth. The available evidence indicates that exergaming has the potential to improve health via an increase in PA. However, it seems that this potential is frequently underexploited, and further developments such as customized exergames are needed.