Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 4, 2024
Date Accepted: May 31, 2025
Exergame-Based Behavior Change Interventions for Promoting Physical Activity: A Systematic Review and Meta-Analysis of Randomized Controlled Studies Incorporating Behavior Change Techniques
ABSTRACT
Background:
Physical inactivity is defined to be an activity level insufficient to meet recommendations. Exergame, which refers to a combination of exercise and video games, has the potential to promote physical activity (PA).
Objective:
A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to examine the effects of exergame-based interventions for promoting PA. Behavior change techniques (BCTs), the minimal, replicable components of an intervention, were also identified and discussed in this review.
Methods:
We searched for relevant RCTs across six databases from their inception to March 21, 2024. Meta-analyses using random-effects models assessed the effects on PA, moderate-to-vigorous PA (MVPA), light PA (LPA), moderate PA (MPA), vigorous PA (VPA), sedentary time (SED), step count, and body mass index (BMI). Subgroup analyses and meta-regression of PA were conducted to explore the influencing factors of exergame-based behavior change interventions. Review Manager software (version 5.3; Cochrane Collaboration) and Stata software (version 16; Statacorp) were used to analyze data.
Results:
Exergame-based behavior change interventions significantly increased PA [standard mean deviation (SMD) = 0.18, 95% CI 0.02 to 0.34], MVPA (SMD = 0.48, 95% CI 0.12 to 0.85), and step counts (SMD = 0.54, 95% CI 0.13 to 0.94). Furthermore, subgroup analyses showed that intervention implementer (research assistants vs. other implementers), game console (Xbox vs. play station vs. Nintendo Wii), game participation type (individual game vs. non-individual game), measurement method (subjective vs. objective), and the number of BCTs (<10 vs. ≥10) used significantly influenced the effectiveness of these interventions. Certain BCT categories (i.e., ‘4 shaping knowledge’, ‘6 comparison of behavior’, ’10 reward and threat’) were associated with better PA outcomes.
Conclusions:
Our review has demonstrated that exergame-based interventions are effective in promoting PA. Future trials are needed to further validate the insights proposed in our studies and assess the long-term effects on PA.
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