JMIR Publications

ABSTRACT

Background:

Background:

Globally, mental health issues among children and adolescents have become increasingly prominent, evolving into a significant public health challenge. Exergaming, as a novel intervention modality that integrates physical activity with digital technology, has been recognized for its potential value in improving mental health in recent years. However, existing research has predominantly focused on isolated cognitive indicators, lacking a systematic integration of multidimensional mental health outcomes, while the dose-response relationship remains poorly defined. This study aims to systematically evaluate the impact of exergaming on the mental health of children and adolescents through a three-level meta-analysis, while exploring potential moderators and dose-response relationships.

Objective:

Objective:

To evaluate the effects of exergaming on mental health in children and adolescents and examine the dose–response relationship.

Methods:

Methods:

This study followed PRISMA guidelines and conducted a systematic literature search in PubMed, Web of Science, Embase, Cochrane Library, and ProQuest databases (up to March 2026). Hedges’ g was employed as the effect size metric. A three-level random-effects model was constructed using the metafor package in R, supplemented by moderator analyses and meta-regressions to further investigate potential influencing factors.

Results:

Results:

A total of 24 studies from 9 countries involving 1,800 children and adolescents (aged 4.72–17 years) were included. Meta-analysis results indicated that exergaming significantly promoted the overall level of mental health in children and adolescents (g = 0.31, p < 0.001). Regarding different dimensions, cognitive function showed significant improvement (g = 0.38, p < 0.001); while internalizing symptoms were marginally significant overall (g = 0.40, p = 0.053), the sub-component of anxiety exhibited significant improvement (g = 0.69, p < 0.001). Self-efficacy was marginally significant (g = 0.26, p = 0.068), whereas no significant improvements were observed for self-esteem or peer and social support. Moderator analysis revealed that population type, control group type, and study design significantly influenced intervention efficacy. Specifically, the effect size for left-behind children was significantly higher than that for typically developing populations (g = 0.72). Compared to cognitive training and educational games, the passive control group yielded a larger effect size (g = 0.44). Additionally, randomized controlled trials showed significantly higher effect sizes than quasi-experimental designs (g = 0.40). Meta-regression results demonstrated a significant positive relationship between training sessions and intervention efficacy (β = 0.0072, p = 0.019), indicating that effects increased with session frequency, whereas training duration did not reach statistical significance.

Conclusions:

Conclusions:

Exergaming can effectively promote mental health in children and adolescents, particularly demonstrating stable positive effects on cognitive function and anxiety symptoms. Intervention efficacy is influenced by population characteristics and study design, exhibiting a clear "cumulative effect," where increasing the number of training sessions helps enhance the intervention's impact. Clinical Trial: Trial Registration: PROSPERO CRD420261486172; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251163791