JMIR Publications

ABSTRACT

Background:

Cardiometabolic risk factors that emerge during childhood and adolescence can track into adulthood and increase the risk of cardiovascular disease. Although traditional physical activity can improve cardiovascular health, it may lack appeal and fail to promote regular participation among children and adolescents. Active video games combine physical activity with video games enjoyment and may increase engagement in exercise among this population.

Objective:

To evaluate the effects of active video games on cardiometabolic health in children and adolescents and to explore potential moderators of these effects.

Methods:

PubMed, Web of Science, the Cochrane Library, and Embase were searched from database inception to March 2026. Eligibility criteria were established according to the PICOS framework. Randomized controlled trials involving children and adolescents aged 4 to 18 years were included if they examined active video games or virtual reality-based exergames compared with no intervention, sedentary video game controls, or habitual physical activity. Outcomes included body mass index (BMI), low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglycerides (TG), heart rate (HR), and glucose. Subgroup analyses were conducted according to gender, intervention type, and weight status to explore potential sources of heterogeneity. A random-effects model was used to pool effect sizes with 95% confidence intervals. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Sensitivity analyses were performed to evaluate the robustness of the findings, and publication bias was examined using funnel plots combined with Egger’s test. A comprehensive assessment of evidence quality will be conducted using the GRADE system.

Results:

Nine RCTs involving 867 participants were included. active video games produced significant reductions in BMI (Hedges’ g = −0.24, 95% CI [−0.39, −0.09], P=.002) and LDL (Hedges’ g = −0.50, 95% CI [−0.76, −0.23], P<.001). Subgroup analysis shows that the beneficial effects on BMI were primarily observed in the overweight subgroup (Hedges’ g = −0.31), although the between-subgroup difference was not statistically significant. No significant effects were observed for HDL, SBP, DBP, TC, TG, HR, or glucose.

Conclusions:

Active video games may reduce BMI and LDL in children and adolescents, but no significant effects were observed for HDL, SBP, DBP, TC, TG, HR, or glucose. These findings should be interpreted with caution given the low to very low certainty of the overall evidence. Further high-quality RCTs are needed to confirm these findings. Clinical Trial: PROSPERO CRD420261303390; https://www.crd.york.ac.uk/PROSPERO/myprospero