Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: The electronic games to aid motivation to exercise (eGAME) study The effect of active video games by ethnicity, sex and fitness: subgroup analysis from a randomised controlled trial Tipping the balance: use of advergames to promote consumption of nutritious foods and beverages by low-income African American children. Overweight and obesity related to activities in Portuguese children, 7-9 years. Video game playing increases food intake in adolescents: a randomized crossover study. Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes in Children? Squire's Quest! Dietary outcome evaluation of a multimedia game. Management of chronic pediatric diseases with interactive health games: theory and research findings. KidWAVE: Get Healthy Game--promoting a more healthful lifestyle in overweight children. Effects of active video games on body composition: a randomized controlled trial. Design and Evaluation of a Computer Game to Promote a Healthy Diet for Young Adults The Fun Families Study: intervention to reduce children's TV viewing. Effects of interactive video game cycling on overweight and obese adolescent health. Impact of an Active Video Game on Healthy Children’s Physical Activity Videogames and Health Improvement: A Literature Review of Randomized Controlled Trials. Investigating the obesogenic effects of marketing snacks with toys: an experimental study in Latin America The effect of active video gaming on children's physical activity, behavior preferences and body composition.
Background Childhood obesity has reached epidemic proportions in developed countries . Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity . Active video games , where players physically interact with images onscreen , may have utility as a novel intervention to increase physical activity and improve body composition in children . The aim of the Electronic Games to Aid Motivation to Exercise ( eGAME ) study is to determine the effects of an active video game intervention over 6 months on : body mass index ( BMI ) , percent body fat , waist circumference , cardio-respiratory fitness , and physical activity levels in overweight children . Methods / Design Three hundred and thirty participants aged 10–14 years will be r and omized to receive either an  active video game up grade package  or to a control group ( no intervention ) .  Discussion An overview of the eGAME study is presented , providing an example of a large , pragmatic r and omized controlled trial in a community setting . Reflection is offered on key issues encountered during the course of the study . In particular , investigation into the feasibility of the proposed intervention , as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial . Trial registration Australian New Zeal and Clinical Trials Registry Background The prevention and treatment of childhood obesity is a key public health challenge . However , certain groups within population s have markedly different risk profiles for obesity and related health behaviours . Well- design ed subgroup analysis can identify potential differential effects of obesity interventions , which may be important for reducing health inequalities . The study aim was to evaluate the consistency of the effects of active video games across important subgroups in a r and omised controlled trial ( RCT ) . Findings A two-arm , parallel RCT was conducted in overweight or obese children ( n = 322 ; aged 10–14 years ) to determine the effect of active video games on body composition . Statistically significant overall treatment effects favouring the intervention group were found for body mass index , body mass index z-score and percentage body fat at 24 weeks . For these outcomes , pre-specified subgroup analyses were conducted among important baseline demographic ( ethnicity , sex ) and prognostic ( cardiovascular fitness ) groups . No statistically significant interaction effects were found between the treatment and subgroup terms in the main regression model ( p = 0.36 to 0.93 ) , indicating a consistent treatment effect across these groups . Conclusions Preliminary evidence suggests an active video games intervention had a consistent positive effect on body composition among important subgroups . This may support the use of these games as a pragmatic public health intervention to displace sedentary behaviour with physical activity in young people OBJECTIVE To examine how advergames , which are online computer games developed to market a product , affect consumption of healthier and less healthy snacks by low-income African American children . DESIGN Cross-sectional , between-subjects examination of an advergame in which children were rewarded for having their computer character consume healthier or less healthy foods and beverages . Children were r and omly assigned to 1 of the following 3 conditions : ( 1 ) the healthier advergame condition , ( 2 ) the less healthy advergame condition , or ( 3 ) the control condition . SETTING Urban public elementary schools . PARTICIPANTS Thirty low-income , African American children aged 9 to 10 years . Main Exposure Children in the treatment conditions played a less healthy or a healthier version of an advergame 2 times before choosing and eating a snack and completing the experimental measures . Children in the control group chose and ate a snack before playing the game and completing the measures . MAIN OUTCOME MEASURES The number of healthier snack items children selected and ate and how much children liked the game . RESULTS Children who played the healthier version of the advergame selected and ate significantly more healthy snacks than did those who played the less healthy version . Children reported liking the advergame . CONCLUSIONS Findings suggest that concerns about online advergames that market unhealthy foods are justified . However , advergames may also be used to promote healthier foods and beverages . This kind of social marketing approach could tip the scales toward the selection of higher- quality snacks , thereby helping to curb the obesity epidemic BACKGROUND The purpose of the study was to explore the association among the following variables : physical activity , TV , videogames , and obesity . The study included a Portuguese r and om nationally representative sample of 3365 children ( 1610 girls and 1755 boys ) 7 - 9 year olds . METHODS A general question naire was completed by the parents of participating children to provide information about the hours spent per week watching television , computer use and electronic games , and the participation in physical education .  Overweight and obesity were calculated by using the body mass index ( BMI ) assessment and the cut-off points for overweight ( 25 kg/m(2 ) ) and obesity ( 30 kg/m(2 ) ) . RESULTS The data from the association between BMI and the independent variables ( analysis of variance ) were only significant for time playing electronic games for boys and girls ( P < 0.001 ; P < 0.029 ) . The association between hours of watching TV and BMI was significant only for boys ( P < 0.016 ) . The results from the logistic regression were only significant for electronic games both for boys and girls ( P < 0.000 ; P < 0.000 ) . CONCLUSIONS The results of this study suggest that the time spent playing electronic games is associated with obesity . Reducing childhood obesity calls for the reduction in sedentary behaviours , and the promotion of a more active lifestyle BACKGROUND Video game playing has been linked to obesity in many observational studies . However , the influence of this sedentary activity on food intake is unknown . OBJECTIVE The objective was to examine the acute effects of sedentary video game play on various components of energy balance . DESIGN With the use of a r and omized crossover design , 22 healthy , normal-weight , male adolescents ( mean ± SD age : 16.7 ± 1.1 y ) completed two 1-h experimental conditions , namely video game play and rest in a sitting position , followed by an ad libitum lunch . The endpoints were spontaneous food intake , energy expenditure , stress markers , appetite sensations , and profiles of appetite-related hormones . RESULTS Heart rate , systolic and diastolic blood pressures , sympathetic tone , and mental workload were significantly higher during the video game play condition than during the resting condition ( P < 0.05 ) . Although energy expenditure was significantly higher during video game play than during rest ( mean increase over resting : 89 kJ ; P < 0.01 ) , ad libitum energy intake  after video game play exceeded that measured after rest by 335 kJ ( P < 0.05 ) . A daily energy surplus of 682 kJ ( 163 kcal ) over resting ( P < 0.01 ) was observed in the video game play condition . The increase in food intake  associated with video game play was observed without increased sensations of hunger and was not compensated for during the rest of the day . Finally , the profiles of glucose , insulin , cortisol , and ghrelin did not suggest an up-regulation of appetite during the video game play condition . CONCLUSION A single session of video game play in healthy male adolescents is associated with an increased food intake , regardless of appetite sensations . The trial was registered at clinical trials.gov as NCT01013246 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 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 In r and omized clinical trials , children and adolescents improved their self care and reduced their emergency clinical utilization after playing health education and disease management video games . A diabetes game reduced diabetes-related urgent and emergency visits by 77 percent after diabetic youngsters had the game at home for six months , compared to no reduction in clinical utilization in a control group of diabetic youngsters who took home an entertainment video game that had no health content . Positive impacts were also found in clinical trials of games for asthma self-management and smoking prevention Lifestyle , in relation to the prevalence of overweight in children , is a public health concern . Behavioral change constructs , such as goal setting , selfefficacy , and readiness for change , need to be applied to the development of educational material s to address obesity in children .  Educational games can promote goal setting , enhance motivation , and build self-efficacy in overweight preadolescents . The United States Department of Agriculture provides interactive MyPyramid for Kids material s for children aged 6 - 11 years on its Web site , but these material s do not address the children ’s readiness to make changes or self-efficacy in promoting intake goals . The authors adapted components from the Weight , Activity , Variety , and Excess ( WAVE ) Pocket Card and Screeners to develop a gamelike tool for introducing goal setting to overweight children entering a weight-management program . The goal was to enhance motivation before introducing the MyPyramid recommendations 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 This article reports the development and evaluation of a computer game ( RightWay Café ) as a special medium to promote a healthy diet for young adults . Structural features of computer games , such as interactive tailoring , role playing , the element of fun , and narrative , were operationalized in the RightWay Café game to afford behavior rehearsal in a safe and entertaining way . Theories such as the health belief model , social cognitive theory , and theory of reasoned action guided the content design of the game to influence mediators of behavior change , including self-efficacy , perceived benefits , perceived barriers , and behavior change intention . A r and omized controlled evaluation study with pretest , posttest , and follow-up design demonstrated that this game was effective in teaching nutrition and weight management knowledge and increasing people 's self-efficacy and perceived benefits of healthy eating , as well as their intention to be on a healthy diet . Limited long-term effects were also found : participants in the game-playing group had greater self-efficacy than participants in the control group after 1 month . This study vali date s the computer game – based approach to health promotion for young adults . Limitations and implication s are also discussed Media consumption may contribute to  childhood obesity . This study developed and evaluated a theory-based , parent-focused intervention to reduce television and other media consumption to prevent and reduce childhood obesity .  Families ( n = 202 ) with children ages 6 - 9 were recruited from a large , urban multiethnic population into a r and omized controlled trial ( 101 families into the intervention group and 101 into the  control group ) , and were followed for 6 months . The intervention consisted of a 2-hour workshop and six bimonthly newsletters . Behavioral objectives included : ( i ) reduce TV watching ; ( ii ) turn off TV when nobody is watching ; ( iii ) no TV with meals ;  ( iv ) no TV in the child 's bedroom ; and ( v ) engage in fun non-media related activities .  Parents were 89 % female , 44 % white , 28 % African American , 17 % Latino , and 11 % Asian , mean age 40 years ( s.d . = 7.5 ) ; 72 % were married . Children were 49 % female , mean age 8 years ( s.d . = 0.95 ) . Sixty-five percent of households had three or more TVs and video game players ; 37 % had at least one h and held video game , and 53 % had three or more computers . Average children 's weekday media exposure was 6.1 hours . At 6 months follow-up , the intervention group was less likely to report the TV being on when nobody was watching ( adjusted odds ratio ( AOR ) = 0.23 , P < 0.05 ) , less likely to report eating snacks while watching TV ( AOR = 0.47 , P < 0.05 ) , and less likely to have a TV in the child 's bedroom ( AOR = 0.23 , P < 0.01 ) . There was a trend toward reducing actual media consumption but these outcomes did not reach statistical significance . Effective strategies to reduce children 's TV viewing were identified The purpose of this study was to examine the efficacy of interactive video game stationary cycling ( GameBike ) in comparison with stationary cycling to music on adherence , energy expenditure measures , submaximal aerobic fitness , body composition , and cardiovascular disease risk markers in overweight and obese adolescents , using a r and omized controlled trial design . Thirty overweight ( with at least 1 metabolic complication ) or obese adolescents aged 12 - 17 years were stratified by gender and r and omized to video game or music condition , with 4 participants ( 2 per group ) failing to complete the twice weekly 60 min sessions of the 10-week trial . The music group had a higher rate of attendance compared with the video game group ( 92 % vs. 86 % , p < 0.05 ) . Time spent in minutes per session at vigorous intensity ( 80%-100 % of predicted peak heart rate ) ( 24.9 ± 20 min vs. 13.7 ± 12.8 min , p < 0.05 ) and average distance ( km ) pedaled per session ( 12.5 ± 2.8 km vs. 10.2 ± 2.2 km , p < 0.05 ) also favoured the music group . However , both interventions produced significant improvements in submaximal indicators of aerobic fitness as measured by a grade d cycle ergometer protocol . Also , when collapsed , the exercise modalities reduced body fat percentage and total cholesterol . The present study indicates that cycling to music was just as effective  as stationary cycling while playing video games at improving fitness , body composition , and cholesterol profiles in overweight and obese teens , and result ed in increased attendance , vigorous intensity of physical activity , and distance pedaled . Therefore , our data support the superiority of cycling to music and indicate investing in the more expensive GameBike may not be worth the cost OBJECTIVE : This naturalistic study tests whether children receiving a new ( to them ) active video game  spontaneously engage in more physical activity than those receiving an inactive video game  , and whether the effect would be greater among children in unsafe neighborhoods , who might not be allowed to play outside . METHODS : Participants were children 9 to 12 years of age , with a BMI > 50th percentile , but < 99th percentile ; none of these children a medical condition that would preclude physical activity or playing video games . A r and omized clinical trial assigned children to receiving 2 active or 2 inactive video games , the peripherals necessary to run the games , and a Wii console .  Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment . Neighborhood safety was assessed with a 12 item vali date d question naire . RESULTS : There was no evidence that children receiving the active video games were more active in general , or at anytime , than children receiving the inactive video games . The outcomes were not moderated by parent perceived neighborhood safety , child BMI z score , or other demographic characteristics . CONCLUSIONS : These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children OBJECTIVE There are potential benefits of playing videogames for health improvement such as increasing knowledge about health-related issues by playing educational games and fighting a sedentary lifestyle by playing exergames . The number of systematic review articles about " videogames " and " health improvement " is limited . Therefore , the purpose of this study is to review those r and omized controlled trials ( RCTs ) with the topic of " videogames " and " health improvement . " MATERIAL S AND METHODS Several electronic data bases were search ed for RCTs testing  videogames on health outcomes that were published in English between January 2000 and April 2012 . RESULTS Forty-five articles met the eligibility criteria and were categorized into five groups : ( 1 ) videogames and patient pain and stress reduction ( nine articles ) , ( 2 ) videogames and  patient behavioral change  ( 19 articles ) , ( 3 ) videogames and patient rehabilitation  ( eight articles ) , ( 4 ) videogames as diagnostic tools ( three articles ) , and ( 5 ) videogames and cognitive ability ( six articles ) . CONCLUSIONS Most of the articles have shown promising results in using videogames within various fields of healthcare . Although exergames are the most prominent choice regarding health improvement , videogames have the potential to be used as a pain management tool , diagnostic tool , or educational tool . They also can be used as a facilitator in physical rehabilitation or cognitive loss prevention . More RCTs are needed to fully uncover the benefits of using videogames for improving patients ' health Background The inclusion of toys in food packages is a common marketing practice , and it is suspected of promoting obesogenic behaviours . This study aim ed to determine whether toys packaged with food are indeed increasing the amount of food eaten by children , and if this effect is enhanced by contemporary exposure to TV and /or advertising . Methods A total of 600 children ( balanced according to gender and age groups , 3–6 and 7–10 years old ) were r and omized in three school facilities in Argentina , Brazil and Mexico and exposed to food ( snacks ) alone or food associated with toys in an experimental setting . All of the children received the same meal at lunchtime . The products were packages in which chocolate was associated with toys in an egg-shaped container partially filled by chocolate . The children were asked to eat ad libitum for 20 minutes during the afternoon break . In addition , the children were r and omized into two groups and either shown or not shown a movie cartoon , with three different levels of exposure to commercials in the TV viewing condition ( 1 , 2 or 3 advertisements ) . Results No significant differences emerged between the “ toys ” and “ no toys ” groups even after taking into account exposure to TV , commercials and other confounding factors . Conclusions The inclusion of toys in food packages was not shown per se to lead to an increase in the caloric intake of children Active video game interventions typically provide children a single game that may become unappealing . A peripheral device ( jOG ) encourages step-powered gaming on multiple games . This trial evaluated the effect of jOG on children 's objective ly measured PA , body fat and self-reported behaviors . 42 of 58 eligible children ( 8 - 10 y ) r and omly assigned to an intervention ( jOG ) or control ( CON ) completed the trial . Intervention children received two jOG devices for home use . Analyses of covariance compared the intervention effect at 6 and 12 weeks from baseline . No differences were found between groups for counts per minute ( CPM ; primary outcome ) at 6 and 12 weeks ( p > .05 ) . Active video gaming increased ( adjusted change 0.95 ( 95 % CI 0.25 , 1.65 ) h·d⁻¹ , p < .01 ) and sedentary video gaming decreased ( -0.34 ( -1.24 , 0.56 ) h·d⁻¹ , p > .05 ) at 6 weeks relative to CON . No body fat changes were observed between groups . Targeted changes in video game use did not positively affect PA . Larger trials are needed to verify the impact of active video games on children 's PA and health
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 .
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 ! , "