Increased physical activity (PA) and reduced sedentary behavior among children and adolescents have been positively associated with improvements in physiological and cognitive outcomes, such as body composition, cardiorespiratory fitness, bone health, cognition, and academic achievement [1
]. Consequently, it is recommended that children and adolescents accumulate at least 60 minutes (min) of moderate-to-vigorous PA (MVPA) per day [2
]. However, a recent study’s observations among 6128 children aged 9–11 years from 12 countries suggested that only 44.1% of participants met the MVPA recommendation [3
]. Indeed, physical inactivity, along with dietary behaviors, has been highlighted as an important determinant of overweightness and obesity among children worldwide [4
]. Furthermore, evidence has suggested that physical inactivity and overweightness/obesity during childhood may track into later life [5
], leading to higher risks of many chronic diseases including stroke, type 2 diabetes, and heart disease [7
]. Thus, researchers have been investigating effective and novel methods of promoting PA among children.
Exergaming, a new generation of video games, requires players to physically interact with video games during gameplay through various arm, leg, or whole-body movements such as dancing, jogging, and kicking [8
]. Given the fact that children spend a large proportion of their time engaging in screen-based sedentary behavior [9
], exergaming’s physically active screen-based nature has been considered a promising way to promote PA levels in children and a feasible manner to facilitate population-level attenuation of the increasing obesity prevalence among children and adolescents [8
Over the past decade, the beneficial health effects of exergaming have been extensively examined by researchers. Previous studies have suggested that exergaming may improve children’s PA levels and attitudes [11
], energy expenditure [15
], and perceived motor skills [17
], and reduce sedentary screen time [18
] and waist circumference [20
] and improve body composition [21
]. However, whether exergaming is an effective approach to promote PA levels and help children meet the PA recommendations (i.e., 60 min of MVPA per day) is still unclear. One study indicated that children had marginally higher energy expenditure during exergaming gameplay than sedentary computer games, but that such gameplay was not enough to meet the PA recommendations for children [23
]. This observation was supported by subsequent reviews, which suggested that many exergames could not engage children in moderate-intensity PA [24
], with most exergames only eliciting light PA [25
]. Nevertheless, we cannot ignore exergaming’s potential role in facilitating PA and health promotion—particularly as increasing evidence has indicated that light PA (LPA) can confer health benefits [27
]. Undoubtedly, it is easier for previously inactive children to accumulate more daily PA time during LPA before progressing toward greater MVPA participation. Hence, exergaming studies must also quantify children’s LPA during exergaming instead of concentrating exclusively on MVPA.
As exergaming has also been posited as a potential approach to promote PA levels among both sexes, observations of exergaming’s effectiveness at promoting PA between boys and girls are relevant, but have been mixed thus far. Some studies have reported that girls were less physically active than boys during exergaming play [23
], while other studies did not observe a difference [29
]. Considering the inconsistency of the observations, the relatively small sample sizes of previous studies [23
], and the fact that girls are considered a high-priority group for PA promotion [31
], more investigation of exergaming’s ability to promote PA among both sexes is needed within larger and more diverse samples.
Therefore, the current study aims to: (1) quantify young children’s PA and sedentary behaviors during exergaming using accelerometry; and (2) examine the sex differences in PA and sedentary behaviors during exergaming play. Study observations may provide a rationale for using exergaming as a supplement for more traditional PA promotion (e.g., physical education) in community-based contexts (e.g., school-based exergaming programs), particularly among girls.
As exergaming may be a viable supplemental approach to promote children’s PA participation, it is important to objectively quantify children’s PA and sedentary behavior during exergaming gameplay. These observations indicated that regardless of sex, children spent more than 50% of exergaming session time participating in PA (MVPA and LPA).
Study observations suggest that exergaming may be able to supplement other PA promotion strategies among children (e.g., physical education, in-class activity breaks, etc.), particularly for programs with the objective to increase LPA among previously inactive children. Thus, despite the current study’s observation that the LPA percentage was greater than the MVPA percentage, reasons are present as to why exergaming may still be considered a potentially effective supplemental PA promotion strategy. First, the combined mean percentages for MVPA and LPA participation still accounted for more than 50% of each exergaming session. Although current recommendations stress that more than 50% of any PA session should be comprised of MVPA [37
], the potential health benefits derived from engaging in LPA are emerging. Indeed, there is increasing evidence suggesting that LPA is independently and positively associated with improved health outcomes in children and adolescents, including reduced total body fat mass [38
], some cardiometabolic risk factors [39
], and improved body bone health [40
], in addition to cognitive function improvements among boys [41
]. Indeed, evidence has suggested the effectiveness of regular PA for health benefits—benefits partially explained by the increased energy expenditure that any intensity of PA confers versus sedentary behavior [42
], but also because regular PA participation at any intensity (even LPA) results in improved cardiorespiratory health (e.g., increased arterial elasticity which lowers blood pressure, enhanced ability to deliver oxygen and other nutrients to muscles, etc.) [43
]. Finally, LPA plays an important role in contributing to the children’s daily total energy expenditure (LPA vs. MVPA: around to 26.6% vs. 25.1%) [44
]. Therefore, LPA promotion may still be considered an alternative strategy in improving health-related outcomes, particularly as children replace sedentary behavior with exergaming or similar technology-based programs. In fact, considering the potential effect of LPA on health-related outcomes, the updated youth PA guidelines for youth not only emphasize the importance of MVPA, but also highlight that several hours of LPA should be performed each day [2
Exergaming is also not constrained by seasonal weather conditions, meaning this PA modality could be used to supplement daily segments such as recess or physical education when adverse weather conditions prohibit outdoor PA engagement. Finally, exergaming may act as an alternative supplement to physical education and recess as studies have indicated exergaming to increase children’s PA-related intrinsic motivation [45
]—a psychosocial construct considered to be a crucial determinant in children’s long-term PA engagement [46
]. Thus, exergaming might be employed as a “stepping stone” to promote increased PA outside of exergaming sessions, as shown in previous literature [12
The current study also observed no sex differences in PA levels during exergaming gameplay. Recent studies on sex-related differences in daily PA levels noted that boys had higher PA and sedentary behaviors than girls—observations consistent across different countries such as the U.S. [49
] and China [9
]. However, exergaming gameplay did not appear to exhibit these trends. Our observations are consistent with the previous studies, indicating that there was no difference between boys and girls for total PA time [51
] or average metabolic equivalent (METs) during exergaming [52
]. These observations are promising as it indicates that health professionals may be able use exergaming as an appropriate PA promotion strategy for all children, regardless of sex. However, more investigations in larger samples akin to the sample in the present study are needed, as past investigations have reported sex differences for exergaming-related intrinsic motivation and enjoyment [52
]—constructs which were significantly related to PA levels [46
]. Nonetheless, the fact that exergaming developers strive to develop games which are appealing to both sexes may partially explain the current study’s observations.
A few study limitations need to be noted for future direction. First, all participants were part of a convenience sample recruited from a single school in Texas, which limits the generalizability of the study’s observations to other populations from other geographic locations. Second, it is realized that the implementation of an exergaming program (or similar programs) is contingent upon school resources, as the setup of the exergaming classroom within the study school cost approximately US$
3600. Notably, as the exergaming program was able to be implemented by one teacher coordinating up to 24 children playing on 12 different exergaming stations, this type of exergaming program does appear feasible to promote both LPA and MVPA among children. Fortunately, this configuration has been implemented in more than 750 public schools in the State of West Virginia for PA promotion [54
]. Third, while this study does highlight the feasibility of implementing an exergaming program for PA promotion, other technologies may also be used in future studies (e.g., mobile devices), given the everchanging nature of youths’ current technology interests. Finally, the current study did not include an analysis of children’s anthropometric, physiological, or psychosocial outcomes—important components of overall health and wellness, which should be investigated thoroughly and in a longitudinal manner during future school-based exergaming or technology-based programs.