JMIR Publications

ABSTRACT

Background:

Research on digital games designed to increase physical activity (PA), also known as exergames or active video games (AVGs), has proliferated over the past two decades. As a result, reviews of this literature rapidly become outdated, revealing the need for updated, high-quality reviews that identify overarching insights.

Objective:

For public health, especially needed are insights into when and why longitudinal AVG interventions are more or less successful for sustained increases in PA.

Methods:

Six databases (PubMed, PsycINFO, Sport Discus, MEDLINE, Web of Science, and Google Scholar) were reviewed by December 31, 2020. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, randomized controlled trials had to prominently (>50% of intervention) feature AVG technology, involve repeated AVG exposure, and target changes in PA behavior. Experimental designs must include ≥2 within- or between-subject conditions with ≥10 participants per condition.

Results:

A total of 25 studies published in English between 1996 and 2020 were identified, with 19 providing sufficient data for inclusion in the meta-analysis. The findings indicated that AVG interventions had a moderate positive effect, increasing overall PA (Hedges’ g = 0.525; 95% CI = 0.322 – 0.728). This analysis showed substantial heterogeneity (I2 = 87.7%, Q = 154.1). The main findings were consistent across all of the sub-group analyses. The comparison between PA Assessment Type groups showed a moderate effect for Objective measures (Hedges’ g = 0.586; 95% CI = 0.321 – 0.852), and a small effect for Subjective measures (Hedges’ g = 0.301; 95% CI = 0.049 – 0.554), but no significant difference between the groups (p = 0.128). The platform subgroup analysis indicated a moderate effect for the stepping devices (Hedges’ g = 0.303; 95% CI = 0.110 – 0.496); for the Combination of handheld and body sensing devices (Hedges’ g = 0.512; 95% CI = 0.288 – 0.736); and Other devices (Hedges’ g = 0.694; 95% CI = 0.350 – 1.039). The Type of Control Group showed a wide range of effects sizes, ranging from a small effect (Hedges’ g = 0.370; 95% CI = 0.212 – 0.527) for Passive Control Group (nothing) to a moderate effect size for Conventional PA Intervention Group (Hedges’ g = 0.693; 95% CI = 0.107 – 1.279), and ultimately to a large effect for Sedentary Game as control groups (Hedges’ g = 0.932; 95% CI = 0.043 – 1.821). There was no significant difference among the groups (P = 0.291).

Conclusions:

AVGs represent a promising tool for PA promotion among both the general population and clinical subpopulations. However, significant variability in AVG quality, study design, and impact were also detected. Suggestions for improving AVG interventions and related research will be discussed. Clinical Trial: PROSPERO: CRD42020204191