title: Effects of active video games on body composition: a randomized controlled trial. Effects of a pediatric weight management program with and without active video games a randomized trial. Competitive versus cooperative exergame play for African American adolescents' executive function skills: short-term effects in a long-term training intervention. Creating action plans in a serious video game increases and maintains child fruit-vegetable intake: a randomized controlled trial Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes in Children? Exergaming for Health Effects of Behavioral Contingencies on Adolescent Active Videogame Play and Overall Activity: A Randomized Trial. Squire's Quest! Dietary outcome evaluation of a multimedia game. Active video games and energy balance in male adolescents: a randomized crossover trial.
abstract: BACKGROUND Sedentary activities such as video gaming are independently associated with obesity .  Active video games , in which players physically interact with images on screen , may help increase physical activity and improve body composition . OBJECTIVE The aim of this study was to evaluate the effect of active video games over a 6-mo period on weight , body composition , physical activity , and physical fitness . DESIGN We conducted a 2-arm , parallel , r and omized controlled trial in Auckl and , New Zeal and . A total of 322 overweight and obese children aged 10 - 14 y , who were current users of sedentary video games , were r and omly assigned at a 1:1 ratio to receive either an active video game up grade package ( intervention , n = 160 ) or to have no change ( control group , n = 162 ) . The primary outcome was the change from baseline in body mass index ( BMI ; in kg/m(2 ) ) . Secondary outcomes were changes in percentage body fat , physical activity , cardiorespiratory fitness , video game play , and food snacking . RESULTS At 24 wk , the treatment effect on BMI ( -0.24 ; 95 % CI : -0.44 , -0.05 ; P = 0.02 ) favored the intervention group . The change ( ±SE ) in BMI from baseline increased in the control group ( 0.34 ± 0.08 ) but remained the same in the intervention group ( 0.09 ± 0.08 ) . There was also evidence of a reduction in body fat in the intervention group ( -0.83 % ; 95 % CI : -1.54 % , -0.12 % ; P = 0.02 ) . The change in daily time spent playing active video games at 24 wk increased ( 10.03 min ; 95 % CI : 6.26 , 13.81 min ; P < 0.0001 ) with the intervention accompanied by a reduction in the change in daily time spent playing nonactive video games ( -9.39 min ; 95 % CI : -19.38 , 0.59 min ; P = 0.06 ) . CONCLUSION An active video game intervention has a small but definite effect on BMI and body composition in overweight and obese children . This trial was registered in the Australian New Zeal and Clinical Trials Registry at http://www.anzctr.org.au/ as ACTRN12607000632493 IMPORTANCE Active video games may offer an effective strategy to increase physical activity in overweight and obese children . However , the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown . OBJECTIVE To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence -based weight management program delivered in the community . DESIGN , SETTING , AND PARTICIPANTS Group-r and omized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts , Rhode Isl and , and Texas . Seventy-five overweight or obese children ( 41 girls [ 55 % ] , 34 whites [ 45 % ] , 20 Hispanics [ 27 % ] , and 17 blacks [ 23 % ] ) enrolled in a community-based pediatric weight management program . Mean ( SD ) age of the participants was 10.0 ( 1.7 ) years ; body mass index ( BMI ) z score , 2.15 ( 0.40 ) ; and percentage overweight from the median BMI for age and sex , 64.3 % ( 19.9 % ) . INTERVENTIONS All participants received a comprehensive family-based pediatric weight management program  ( JOIN for ME ) . Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program . Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program . MAIN OUTCOMES AND MEASURES Objective ly measured daily moderate-to-vigorous and vigorous physical activity , percentage overweight , and BMI z score . RESULTS Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous ( mean [ SD ] , 7.4 [ 2.7 ] min/d ) and vigorous ( 2.8 [ 0.9 ] min/d ) physical activity at week 16 ( P < .05 ) . In the program-only group , a decline or no change was observed in the moderate-to-vigorous ( mean [ SD ] net difference , 8.0 [ 3.8 ] min/d ; P = .04 ) and vigorous ( 3.1 [ 1.3 ] min/d ; P = .02 ) physical activity . Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16 . However , the program and active gaming group exhibited significantly greater reductions in percentage overweight ( mean [ SD ] , -10.9%[1.6 % ] vs -5.5%[1.5 % ] ; P = .02 ) and BMI z score ( -0.25 [ 0.03 ] vs -0.11 [ 0.03 ] ; P < .001 ) . CONCLUSIONS AND RELEVANCE Incorporating active video gaming into an evidence -based pediatric weight management program has positive effects on physical activity and relative weight . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01757925 Exergames are videogames that require gross motor activity , thereby combining gaming with physical activity . This study examined the role of competitive versus cooperative exergame play on short-term changes in executive function skills , following a 10-week exergame training intervention .  Fifty-four low-income overweight and obese African American adolescents were r and omly assigned to a competitive exergame condition , a cooperative exergame condition , or a no-play control group . Youths in the competitive exergame condition improved in executive function skills more than did those in the cooperative exergame condition and the no-play control group . Weight loss during the intervention was also significantly positively correlated with improved executive function skills . The findings link competitive exergame play to beneficial cognitive outcomes for at-risk ethnic minority adolescents Background Child fruit and vegetable intake is below recommended levels , increasing risk for chronic disease . Interventions to influence fruit and vegetable intake among youth have had mixed effects . Innovative , theory-driven interventions are needed . Goal setting , enhanced by implementation intentions ( i.e. , plans tightly connected to a behavioral goal ) , may offer a solution . Action plans state “ how ” a goal will be achieved , while coping plans identify a potential barrier and corresponding solution . The research reported here evaluated the short- and long-term effects of goal setting enhanced with implementation intentions on child fruit and vegetable intake in a 10-episode , theoretically-grounded serious videogame promoting fruit and vegetables . This is one of the first studies to test the efficacy of implementation intentions on the dietary intake of healthy children . Methods A four-group r and omized design with three data collection periods ( baseline , immediate post-intervention , 3 months post-intervention ) was employed . Groups varied on whether children created an implementation intention ( none , action , coping , both ) as part of goal setting . Participants were 4th and 5th grade children ( ~9 - 11 years old ) and one parent . An a priori power analysis indicated this would provide > 80 % power to detect a small effect ( Cohen ’s d = 0.17 ) . Children played a 10-episode online videogame ; parents received 10 electronic newsletters and access to a parent-only website . The primary outcome was child fruit and vegetable intake , assessed via three , dietitian-assisted telephone recalls at each data collection period . The primary analysis was conducted using a repeated measures analysis of covariance with a mixed model procedure . Secondary analyses examined intervention effects on fruit and vegetables separately . Results Four hundred parent/child dyads were recruited . A significant group-by-time interaction for fruit and vegetable intake ( p < 0.001 ) was found in only the Action group , which had significant increases in fruit and vegetable intake at post 1 ( p < 0.0001 ) and post 2 ( p < 0.0001 ) . No other significant interactions were observed ; however , there were significant time effects for fruit ( p < 0.0001 ) . Conclusions Action intentions may be an important component of successful interventions to increase and maintain fruit and vegetable intake in pre-adolescent children .  Videogames promoting healthy diets offer an effective vehicle for delivering behavior change interventions to children . Trial registration Clinical Trials.gov NCT01004094 Physical inactivity among children is a serious public health problem . It has been suggested that high levels of screen time are contributory factors that encourage sedentary lifestyles in young people . As physical inactivity and obesity levels continue to rise in young people , it has been proposed that new-generation active computer- and video-console games ( otherwise known as “ exergaming ” ) may offer the opportunity to contribute to young people 's energy expenditure during their free time . Although studies have produced some encouraging results regarding the energy costs involved in playing active video-console games , the energy costs of playing the authentic versions of activity-based video games are substantially larger , highlighting that active gaming is no substitute for real sports and activities . A small number of exergaming activities engage children in moderate-intensity activity , but most do not . Only 3 very small trials have considered the effects of exergaming on physical activity levels and /or other health outcomes in children . Evidence from these trials has been mixed ; positive trends for improvements in some health outcomes in the intervention groups were noted in 2 trials . No adequately powered r and omized , controlled trial has been published to date , and no trial has assessed the long-term impact of exergaming on children 's health . We now need high- quality r and omized , controlled trials to evaluate the effectiveness and sustainability of exergaming  , as well as its clinical relevance ; until such studies take place , we should remain cautious about its ability to positively affect children 's health Objective . To evaluate the efficacy and feasibility of a multifaceted , community-based weight intervention program for children using exergaming technology ( activity-promoting video gaming ) .  Design and Methods . This is a prospect i ve observational pilot study . Forty-eight children , between the ages of 8 and 16 years , who are overweight or obese , enrolled in Exergaming for Health , a multidisciplinary weight management program , which used active video gaming . Primary outcome measures were change in body mass index ( BMI ) z scores . Results . Most children ( n = 40 , 83 % ) completed the program and participated in outcome evaluations . The average BMI change was −0.48 kg/m2 ( SD = 0.93 ) , P < .002 ( BMI z-score change was −0.072 , SD = 0.14 , P < .0001 ) . The average Global Self-Worth score improved , screen time and soda intake reduced , and exercise hours per week increased . Conclusions . The Exergaming for Health program may be an effective weight management intervention that is feasible with high participation rates . A larger r and omized controlled trial is needed to confirm these results OBJECTIVE This study evaluated the effect of four active videogames ( AVGs ) varying in behavioral contingencies ( behavior-consequence relations ) on  adolescent AVG play and overall activity levels over 4 weeks . MATERIAL S AND METHODS Each AVG , manufactured by SSD/Xavix ( ® ) ( Shiseido Co. of Japan , Tokyo , Japan ) , was coded and scored for the number of positive and aversive behavioral contingencies within the games . " Bowling " and " Tennis " were classified as having " higher contingency scores , " and " Boxing " and aerobic fitness training were classified as having " lower contingency scores . " Adolescents ( n=63 ; 11 - 15 years old ; 62 % male ; 38 % Hispanic ; 44 % overweight or obese ) were r and omized to play one of the four AVGs at home and recorded game play sessions in a paper log . Baseline and week 4 assessment s were completed at home ; week 1 , 2 , and 3 assessment s were completed by telephone . Accelerometers were worn during baseline and weeks 1 and 4 . RESULTS Accelerometer-measured sedentary and light activity hours/day were stable over time , whereas moderate-vigorous physical activity minutes/day increased in the higher contingency group and decreased in the lower contingency group ( interaction effect , 6.43 , P=0.024 ) . Reported game play minutes decreased in both groups from week 1 to week 4 ( -29.42 minutes , P=0.001 ) . DISCUSSION There was some support for the hypothesis that AVGs with more behavioral contingencies , compared with AVGs with fewer behavioral contingencies , result in more physical activity . However , overall AVG play decreased substantially after the first week . Further study is needed to better underst and how behavioral contingencies can be used in AVGs to enhance their potential to provide health benefits to game players BACKGROUND Fruit , juice , and vegetable  ( FJV ) consumption among children is low . Innovative programs are needed to enable children to increase FJV intake . Psychoeducational multimedia permits the delivery of interventions as design ed and capitalizes on known behavior change principles . DESIGN Elementary school was the unit of recruitment , assignment , and analysis . Twenty-six elementary schools were pair matched on size and percentage of free or reduced-price lunch , and r and omly assigned to treatment or control groups . Data were collected just before and just after the program . SETTING / PARTICIPANTS All fourth- grade students in participating elementary schools were invited to participate . Data were collected on 1578 students . MAIN OUTCOME Servings of fruit , 100 % juice , and vegetables consumed . INTERVENTION Squire 's Quest ! is a ten-session , psychoeducational , multimedia game delivered over 5 weeks , with each session lasting about 25 minutes . Based on social cognitive theory , educational activities attempted to increase preferences for FJV through multiple exposures and associating fun with their consumption , increase asking behaviors for FJV at home and while eating out , and increase skills in FJV preparation through making virtual recipes . MEASURES Four days of dietary intake were assessed before and after the intervention . Assessment was made by the Food Intake Recording Software System ( FIRSSt ) , which conducts a multiple pass , 24-hour dietary intake interview directly with the children . RESULTS Children participating in Squire 's Quest ! increased their FJV consumption by 1.0 servings more than the children not receiving the program . CONCLUSIONS Psychoeducational multimedia games have the potential to substantially change dietary behavior . More research is warranted BACKGROUND Active video games ( AVGs ) have been shown to acutely increase energy expenditure when compared with seated video games ; however , the influence of AVGs on compensatory adjustments in energy intake and expenditure is largely unknown . OBJECTIVE The aim was to examine the acute effects of AVGs on energy intake and expenditure . DESIGN With the use of a r and omized crossover design , 26 male adolescents ( mean ± SD age : 14.5 ± 1.4 y ) completed three 1-h experimental conditions : resting control , seated video game play ( Xbox 360 ; Microsoft ) , and AVG play ( Kinect Adventures on Xbox 360 ) followed by an ad libitum lunch . A vali date d food menu was used to assess food intake immediately after the conditions and for the remainder of the day , and a dietary record was used for the subsequent 3-d period . Energy expenditure was measured by using portable indirect calorimetry throughout each experimental condition , and an accelerometer was used to assess the subsequent 3-d period . Appetite sensations were assessed by using visual analog scales at different time points during the testing day . The primary outcomes were acute ( immediately after the conditions and 24-h ) and short-term ( 3-d ) energy intake and expenditure . RESULTS Energy expenditure was significantly higher ( ~145 % ; P < 0.001 ) during the AVG condition than during the resting control and seated video game conditions ; however , no significant differences in energy expenditure were observed 24 h ( ~6 % ; P > 0.49 ) and 3 d after the experimental conditions ( ~3 % ; P > 0.82 ) . No significant differences were observed in absolute energy intake immediately after the conditions ( ~2 % ; P > 0.94 ) or in absolute energy intake 24 h ( ~5 % ; P > 0.63 ) and 3 d ( ~9 % ; P > 0.53 ) after the experimental conditions . Finally , appetite sensations were similar between conditions at all time points ( P > 0.05 ) . CONCLUSIONS The increase in energy expenditure promoted by a single session of Kinect AVG play is not associated with increased food intake but is compensated for after the intervention , result ing in no measurable change in energy balance after 24 h. These results suggest that the potential of Kinect to reduce the energy gap underlying weight gain is offset within 24 h in male adolescents . This trial was registered at clinical trials.gov as NCT01655901
target: Reflecting public health interest in the potential of exergames to encourage PA , many review s of this literature have appeared.18 - 20 Some review s have been sympathetic,21,22 whereas others have been critical.23,24 A reasonably balanced assessment revealed that , in research laboratories , exergames could provide an intense workout that included moderate-to-vigorous PA  , but under less-supervised circumstances , children tended not to get much activity18 and their interest in the activity waned over 1 week or less .
background: Video games , the most commonly enjoyed medium by this generation of children , generates more money than Hollywood productions .
  Forty percent of these studies influenced obesity or obesogenic behavior in the desired directions.12 A roundtable discussion of investigators of G4H and obesity indicated substantial potential for video games to reduce child obesity , but emphasized the need for games to be fun , not just health promoting.13 Some of the obesity-related studies used games specially design ed to target diet and /or PA change outside the games.14 - 17 " Squire 's Quest ! , "