JMIR Publications

ABSTRACT

Background:

Exergaming, or active video gaming, is increasingly used to make physical activity more engaging for children and adolescents. Existing reviews mainly examined physical activity, fitness, obesity, or broad cardiometabolic outcomes, leaving its specific effects on glucose and lipid metabolism uncertain.

Objective:

This systematic review and meta-analysis evaluated the effects of exergaming on glucose and lipid metabolism in children and adolescents and explored potential moderators.

Methods:

Following PRISMA 2020, we searched PubMed, Embase, Scopus, Web of Science, the Psychology and Behavioral Sciences Collection, and CENTRAL from inception to April 27, 2026. Eligible studies were peer-reviewed controlled interventions in participants aged 18 years or younger that compared exergaming or active video game-based exercise with usual care, no intervention, sedentary gaming, seated rest, or other non-exergaming controls. Outcomes were glucose, insulin, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Hedges g was pooled using Hartung-Knapp-Sidik-Jonkman-adjusted random-effects models. We reported 95% CIs, heterogeneity, and 95% prediction intervals (PIs), explored moderators using subgroup analysis and meta-regression, assessed risk of bias with RoB 2 and ROBINS-I, and rated certainty using GRADE.

Results:

Ten intervention studies involving 732 participants were included. Exergaming showed no significant pooled effects on glucose (9 studies, 528 participants; g=-0.16, 95% CI -0.57 to 0.24; P=.381; I²=65%; 95% PI -1.12 to 0.79), insulin (5 studies, 308 participants; g=-0.06, 95% CI -0.35 to 0.23; P=.584; I²=0%; 95% PI -0.39 to 0.27), TC (9 studies, 510 participants; g=-0.39, 95% CI -1.11 to 0.33; P=.250; I²=77%; 95% PI -1.70 to 0.93), TG (9 studies, 510 participants; g=-0.17, 95% CI -0.50 to 0.17; P=.292; I²=49%; 95% PI -0.88 to 0.55), or HDL-C (9 studies, 510 participants; g=0.14, 95% CI -0.06 to 0.34; P=.148; I²=0%; 95% PI -0.07 to 0.35). LDL-C showed a small favorable average reduction (9 studies, 510 participants; g=-0.29, 95% CI -0.55 to -0.04; P=.028; I²=23%; 95% PI -0.73 to 0.14), but the PI crossed the null. Subgroup signals for glucose by sex and intervention type were exploratory. Meta-regression found no significant moderators. Most studies had risk-of-bias concerns, and GRADE certainty was low for all outcomes.

Conclusions:

Exergaming may be associated with a modest average reduction in LDL-C, but low-certainty evidence and a PI crossing the null limit confidence that this effect will be reproduced across settings. Effects on glucose, insulin, TC, TG, and HDL-C remain inconclusive. Larger preregistered trials with standardized dosing and longer follow-up are needed. Clinical Trial: OSF Registries 10.17605/OSF.IO/64FUS.