Exploring Energy Expenditure and Body Movement of Exergaming in Children of Different Weight Status

Efficacy of exergaming dance and aerobic dance on young adults' enjoyment, situational motivation, self-efficacy, and steps

Introduction

This study explored differences in young adults' enjoyment, situational motivation, self-efficacy, and physical activity between two content-identical exercise formats: exergaming aerobic dance and traditional aerobic dance.

Methods

A total of 40 young adults (20 females; Mage = 20.38) from a Chinese university participated in two separate 12-min dance sessions: (1) a non-stop exergaming aerobic dance using the Xbox 360, Kinect Just Dance and (2) a traditional aerobic dance led by an experienced instructor. Psychological measures of self-efficacy, enjoyment, and situational motivation (including intrinsic motivation, identified regulation, external regulation, and amotivation) were assessed using validated questionnaires after each session. Physical activity levels were measured using a research-grade pedometer to track steps. A repeated-measures MANOVA compared the outcomes between the two dance modalities.

Results

Statistically significant differences were observed between the two dance sessions for the overall model (p < 0.05). Participants reported higher enjoyment during the exergaming dance session compared to the traditional aerobic dance [F (1,39) = 3.59, p = 0.05, η2 = 0.07]. Intrinsic motivation were significantly higher for exergaming dance than for the traditional format [F (1,39) = 3.83, p < 0.05, η2 = 0.09]. However, participants achieved significantly more steps per minute in the traditional aerobic dance compared to the exergaming session [F (1,39) = 39.79, p < 0.01, η2 = 0.51]. No other significant differences were found for the remaining outcomes.

Discussion

These findings suggest that exergaming dance may enhance perceived enjoyment and intrinsic motivation, leading to more time spent on exercise or physical activity, though it results in fewer steps per minute than traditional aerobic dance. These results are practically relevant for promoting long-term physical activity through game-like exercises, as higher enjoyment and motivation play a crucial role in maintaining physical activity.

Acute effects of exergaming on young adults' energy expenditure, enjoyment, and self-efficacy

This study investigated the effects of a dance-based exergaming on Chinese college students' energy expenditure, self-efficacy, and enjoyment in comparison with the traditional aerobic dance exercise. Forty young adults (33 females; Mage = 21.55 years, SD = 2.06) completed two separate 20 min exercise sessions with 10 min intervals on the same day: (1) Xbox 360 Kinect Just Dance exergaming session; and (2) a traditional instructor-led aerobic dance exercise session. Participants' energy expenditure (Kcal/session) was measured by the ActiGraph GT9X Link accelerometers, and their perceived self-efficacy and enjoyment were assessed via validated surveys following each session. Dependent t-test indicated significant differences in participants' enjoyment (t = -1.83, p = 0.04). Specifically, participants in the dance-based exergaming session reported a higher level of enjoyment (M = 3.96, SD = 0.65) as compared to the aerobic dance session (M = 3.61, SD = 0.54). However, there was no significant difference in energy expenditure and self-efficacy between the two sessions. Findings suggest that college students had comparable energy expenditure as the traditional aerobic dance session while experiencing more fun and enjoyment. This suggests that exergaming can be a fun exercise alternative for promoting physical activity among young adults.

Exergames to Limit Weight Gain and to Fight Sedentarism in Children and Adolescents with Obesity

Exergames are defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). The players interact with the game through whole-body movements improving energy expenditure. Exergames may be effective in improving physical and psychological aspects of children and adolescents with obesity. In this narrative review, we synthesized the current evidence regarding the role of exergames in modifying body composition and weight and in promoting changes in sedentary behavior to define the benefits of active video games as useful tools for fighting sedentarism and to outline the future directions of exergaming as a supplementation exercise rather than a replacement in educational programs for pediatric obesity. Data from the literature indicate that exergames may offer an interesting impact on childhood obesity and may be considered a potential strategy for controlling weight gain and body composition, promote PA, and decrease time spent on sedentary behavior in children and adolescents with obesity. However, exergame use also has some limits, such as children's poor self-regulation and poor structuring of exergame use. Therefore, a prudent approach should be maintained, and additional high-quality research is needed to determine if exergames can be effectively used in the treatment of childhood obesity and if new digital media, as a supplementation of exercise rather than a replacement, could be considered to combat sedentary behavior in educational programs for pediatric obesity prevention.

How much did it cost to develop and implement an eHealth intervention for a minority children population that overlapped with the COVID-19 pandemic?

BACKGROUND

eHealth interventions using active video games (AVGs) offer an alternative method to help children exercise, especially during a pandemic where options are limited. There is limited data on costs associated with developing and implementing such interventions.

OBJECTIVES

We quantified the costs of delivering an eHealth RCT intervention among minority children during COVID-19.

METHODS

We categorized the total trial cost into five subcategories: intervention material development, advertising and recruitment, intervention delivery, personnel salaries, and COVID-19-related equipment costs.

RESULTS

The total RCT cost was $1,927,807 (Direct: $1,227,903; Indirect: $699,904) with three visits required for each participant. The average cost per participant completing the RCT (79 participants/237 visits) was $24,403 (Direct: $15,543; Indirect: $8860). Due to no-shows and cancellations (198 visits) and dropouts before study completion (61 visits; 56 participants), 496 visits had to be scheduled to ensure complete data collection on 79 participants. If all 496 visits were from participants completing the three-visit protocol, that would correspond to 165 participants, bringing the average cost per participant down to $11,684 (Direct: $7442; Indirect: $4242). Of the subcategories, intervention material development accounted for the largest portion, followed by personnel salaries. While the direct COVID-19-specific cost constituted <1% of the entire budget, the indirect effects were much larger and significantly impacted the trial.

CONCLUSION

RCTs typically involve significant resources, even more so during a pandemic. Future eHealth intervention investigators should budget and plan accordingly to prepare for unexpected costs such as recruitment challenges to increase flexibility while maximizing the intervention efficacy.

The effect of narrative element incorporation on physical activity and game experience in active and sedentary virtual reality games

Narratives are pervasive in video games and have been found to increase physical activity in active video games. However, the effect of incorporating narrative elements has seldom been examined in fully immersive virtual reality games. We investigated the effect of narrative element incorporation (between-subject: narrative vs. no narrative) in active virtual reality and sedentary virtual reality games (within-subject) and examined between- and within-subject effects on physical activity behavior, game experience, and physical activity engagement. We randomized 36 sedentary college students to either the narrative or the non-narrative group. All participants played an active virtual reality and a sedentary virtual reality game in counter-balanced order. Before each game session, they either watched a 5-min narrative video (narrative) or directly played the original virtual reality games without narratives (non-narrative). We collected participants' physical activity data using wrist-worn accelerometers; we obtained their game experience and physical activity engagement via questionnaires. The narrative group spent a greater proportion of time in moderate-to-vigorous physical activity (%) and had less non-movement time during the active virtual reality gameplay than the non-narrative group (all p values < .05). The active virtual reality sessions induced a greater positive affect and greater physical activity engagement ratings than the sedentary virtual reality sessions. The incorporation of narrative elements in active virtual reality increased the relative time spent in moderate-to-vigorous physical activity and reduced non-movement time, compared to the non-narrative group. Active virtual reality encouraged more activity by participants and offered them a more enjoyable gaming experience in which they engaged more. Active virtual reality is a feasible physical activity promotion option among sedentary adults; the incorporation of narrative elements in active virtual reality helps increase relative moderate-to-vigorous physical activity and should be further explored for its efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00754-7.

The influence of active video game play upon physical activity and screen-based activities in sedentary children

Background

Few children meet physical activity recommendations, partly due to the prevalence of screen-based sedentary activities. Active video game (AVG) play produces light to moderate physical activity. Yet, providing children access to AVG does not increase physical activity, possibly because children who play AVG may also tend towards sedentary screen-based activities. How multiple days of AVG play influences children’s choice of other activities is not yet known.

Purpose

To examine how AVG influences children’s physical activity, sedentary screen-based activities, and other alternative activities.

Methods

Sedentary children (N = 49) played AVG 3 times/week and sedentary video games (SVG) ad libitum for 6 weeks, followed by 4 weeks of ad libitum play of both AVG and SVG. Participants wore an activity monitor for 7 days and completed a 24-hour activity recall on 4 randomly selected days at baseline, week 6, and week 10.

Results

AVG play increased during the intervention (p < 0.01). Light activity and SVG play both decreased baseline to 10 weeks (p = 0.006) and 6 to 10 weeks (p = 0.017). Non-SVG sedentary behavior increased from baseline to 10 weeks (p = 0.005) and 6 to 10 weeks (p = 0.007). Changes over time were not observed in physical activity, or recall-measured active play, social activities, other hobbies, television or computer/phone use.

Conclusion

AVG play did not change children’s objectively-measured physical activity or subjectively measured active play. SVG time was substituted with other sedentary behaviors. AVG did not increase time engaged in SVG or screen-based devices.

Active video games in fully immersive virtual reality elicit moderate-to-vigorous physical activity and improve cognitive performance in sedentary college students

BACKGROUND

Active video games are a new method for increasing physical activity (PA). Fully immersive virtual reality (VR) is a hardware device on which an active video game can run. Active (video games in) VR (AVR), might increase immersion, game engagement, and moderate-to-vigorous PA (MVPA), thereby yielding greater exercise-related benefits, e.g., cognitive performance.

METHODS

We examined the induction of MVPA via an AVR and a sedentary VR (SVR) as well as the effects of VR play on cognitive performance, which was monitored using 2 different methods. Each of 29 sedentary college students attended three 20-min laboratory sessions (AVR, SVR, or control) in a randomized order; during the control session, they sat quietly doing nothing. A fully immersive headset was used for the 2 video game sessions. We monitored and computed participants' PA using hip-worn accelerometers (wGT3x-bt; ActiGraph, Pensacola, FL, USA) and a heart rate band (Polar H7; Polar, Kempele, Finland). After each session, the participants completed a mnemonic similarity test (MST) to measure recognition memory. They also filled out a motion sickness questionnaire and an abbreviated game experience questionnaire.

RESULTS

The AVR session induced a significantly greater heart rate and more time spent in MVPA than did either of the other 2 sessions regardless of the PA monitoring method. AVR elicited greater game experience questionnaire-assessed sensory and imaginative immersion, challenge, and positive affect than did SVR. The mnemonic similarity test recognition score was marginally higher post-AVR session than it was post-SVR session.

CONCLUSION

AVR elicited MVPA without a significant increase in motion sickness and induced a better game experience and better borderline cognitive performance than did SVR.

What Type of Body Shape Moves Children? An Experimental Exploration of the Impact of Narrative Cartoon Character Body Shape on Children's Narrative Engagement, Wishful Identification, and Exercise Motivation

BACKGROUND

The incorporation of narratives helps to enhance children's engagement in active video games (AVGs), thus increasing moderate-to-vigorous physical activity (MVPA). Specific narrative elements, such as the visual representation of the characters' body shape, have been rarely manipulated to explore their role in modulating children's narrative engagement (NE) and exercise motivation.

OBJECTIVE

To investigate the effects of character body shape manipulation (overweight/obese, average, or athletic slim) on children's narrative immersion (NI), NE, wishful identification (WI), as well as their mediating effect on AVG and PA motivation.

METHODS

Children ages 8-12 years old (N = 87) were randomly assigned to watch a 15-min animated video (designed for an existing AVG) in which the main characters had an overweight/obese, or average∗, or athletic slim body shape (all other elements were identical). Children's NI, NE, WI, and AVG and physical activity (PA) motivation were then assessed.

RESULTS

Controlling for social desirability, the analysis indicated that participants with a BMI of greater than the 75th percentile had a significantly higher NI, NE, WI, and PA motivation when video characters were set to the overweight/obese condition, than they did for video characters set to the average or athletic slim conditions. On the other hand, children of equal or less than the 75th percentile exposed to the average character body condition had a greater NE, WI, and PA motivation than overweight/obese or athletic slim conditions. A mediation analysis with structural equation modeling indicated that NE mediated the effect between character body shape and AVG and PA motivation.

CONCLUSION

Narrative cartoon characters that mirror the target participant's body shape can increase NE, which in turn mediates AVG and PA motivation. Content producers should identify optimal strategies in character body shape design to encourage children of different weight status to participate in PA with engaging stories to maximize health narratives' persuasive potentials.∗The term average in this sense is not in reference to the national average body weight, but rather an average of the body weights represented in conditions A and C.

Improving Serious Games to Tackle Childhood Obesity

Childhood obesity has become a global public health issue. Today, there are opportunities to promote health through technological devices such as serious games. Despite the major advancement of this field of research, the use of serious games as a validated intervention in clinical practice requires further clarifications on some methodological aspects. In this perspective article, we report the pros and cons of existing serious games. Besides, we attempt to propose a new methodology of design of a serious game that could help to cope with childhood obesity. The proposed idea consists of a serious game in virtual reality based on enjoyment, movement, education, and executive functioning (EF) training. Longitudinal studies and solid research protocol would certainly ensure consistency and aid interpretation.

Comparison of Inhibitory Control After Acute Bouts of Exergaming Between Children with Obesity and Their Normal-Weight Peers

Objective: The benefits of exergaming on executive function in children have been increasingly reported; however, weight-dependent effects of exergames on executive function, and inhibitory control in particular, remain poorly understood. We examined performance on an inhibitory control task at baseline and following acute bouts of exergaming in children who varied in weight status. Materials and Methods: Forty 8-12-year-old children with obesity (n = 20) and normal weight (n = 20) performed neutral, congruent, and incongruent conditions of a Victoria Stroop Test (VST) before and after exergames through an Xbox One in an elementary classroom. We measured time spent in moderate-to vigorous-intensity activity through ActiGraph accelerometers and recorded gameplay time. Results: At baseline, children with obesity relative to their normal-weight peers had significantly longer reaction times (P = 0.011), resulting in significantly longer completion time (P = 0.005) during incongruent trials requiring greater inhibitory control, and therefore had higher interference scores (P = 0.024). However, following acute bouts of exergames, children with obesity compared with their normal-weight counterparts significantly decreased completion time (P = 0.013), made fewer errors (P = 0.012) during incongruent trials, and subsequently had reduced interference effects (P = 0.037). Children with obesity and normal-weight children spent similar time (minutes) (7.8 vs. 8.6, P = 0.725) in moderate-to vigorous-intensity activity during similar gameplay time (8.7 vs. 10.5, P = 0.819). Conclusion: Our results suggest that greater, acute cognitive gains occur in children with obesity relative to normal-weight children following similar intensity and duration of exergames, which may be due to reduced inhibitory control capacity at baseline in childhood obesity.

Assessment of Active Video Games' Energy Expenditure in Children with Overweight and Obesity and Differences by Gender

(1) Background: Childhood obesity has become a main global health problem and active video games (AVG) could be used to increase energy expenditure. The aim of this study was to investigate the energy expenditure during an AVG intervention combined with exercise, differentiating by gender. (2) Methods: A total of 45 children with overweight or obesity (19 girls) performed an AVG intervention combined with exercise. The AVG used were the Xbox Kinect, Nintendo Wii, dance mats, BKOOL cycling simulator, and Nintendo Switch. The energy expenditure was estimated from the heart rate recorded during the sessions and the data from the individual maximal tests. (3) Results: The mean energy expenditure was 315.1 kilocalories in a one-hour session. Participants spent the most energy on BKOOL, followed by Ring Fit Adventures, Dance Mats, Xbox Kinect, and the Nintendo Wii, with significant differences between BKOOL and the Nintendo Wii. Significant differences between boys and girls were found, but were partially due to the difference in weight, VO2max, and fat-free mass. (4) Conclusions: The energy expenditure with AVG combined with multi-component exercise was 5.68 kcal/min in boys and 4.66 kcal/min in girls with overweight and obesity. AVG could be an effective strategy to increase energy expenditure in children and adolescents with overweight and obesity.

The impact of narratives and active video games on long-term moderate-to-vigorous physical activity: A randomized controlled trial protocol

BACKGROUND

Although physical activity (PA) has been shown in helping prevent and treat obesity, current PA interventions are still not effective in ameliorating the obesity epidemic. Additional forms of PA need to be investigated to improve PA engagement and outcomes. We hypothesize that pairing a narrative (i.e., story) with an active video game (AVG), a less traditional form of PA, will increase participant engagement in PA. This paper presents the rationale, implementation, and pilot results of a study assessing the effect of narrative's impact on PA and a series of other health outcomes.

OBJECTIVE

This paper presents the rationale, implementation, and pilot results of a study assessing the effect of narrative's impact on PA and a series of other health outcomes.

METHODS/DESIGN

The Active Video Game Study is a six-month randomized controlled single-blind trial projected to include 210 participants. The intervention strategy will pair a narrative to an active video game (AVG). Participants will be randomized into 3 groups: condition A [Narrative + AVG], condition B [AVG Only], and condition C [Control]. Participants will undergo three in-person data collection visits over the course of six months. Inclusion criteria are that children are between the ages of 8-12 and have a BMI ≥ 85%. The primary outcome is change in moderate to vigorous physical activity (MVPA). Secondary outcome measures include change in BMI percentile, fasting insulin and glucose, lipid panel, C-reactive protein, and cognitive function. A pilot trial of n = 6 was conducted to help develop procedures and address problems that could arise in the main trial.

DISCUSSION

Successful completion of this study will provide the empirical basis for novel intervention and design strategies to enhance the impact of AVGs on long-term MVPA.

The Effect of Narrative on Physical Activity via Immersion During Active Video Game Play in Children: Mediation Analysis

BACKGROUND

Active video games (AVGs) can increase physical activity (PA) and help produce higher physiological expenditure. Animated narrative videos (NVs) possess unique immersive and motivational properties. When added to AVGs, they have been found to increase moderate-to-vigorous physical activity (MVPA) as opposed to the original no video condition. However, there is no evidence of whether that was due to the NV or the addition of an animated video to an AVG.

OBJECTIVE

This study aimed to investigate the differential effect of adding an NV versus a nonnarrative video (NNV) to an AVG on PA parameters and physiological responses and to explore the mediating role of immersion.

METHODS

A total of 22 children aged 8 to 12 years were randomly assigned to the NV or NNV condition. They were instructed to play an AVG (on Xbox Kinect) for as long as they wanted. We used accelerometers to estimate the time spent (in minutes) in MVPA. Heart rate (HR) and rate of perceived exertion (RPE) were measured before, during, and after the AVG play session. The participants then reported their experience of narrative immersion via a questionnaire.

RESULTS

The NV group had significantly higher narrative immersion (mean 3.50, SD 0.55 vs mean 2.91, SD 0.59; P=.03) and MVPA (mean 19.46, SD 13.31 vs mean 7.85, SD 5.83; P=.02) than the NNV group. Narrative immersion was positively correlated with MVPA (r=0.52; P=.01) and average HR during AVG (r=0.43; P=.05). Mediation analysis indicated that narrative immersion mediated the effect of NV (NV vs NNV) on MVPA (direct effect: beta=7.51; P=.01). The indirect effect was that NV was positively correlated with the mediator variable narrative immersion (beta=.59; P=.03), which was itself marginally associated with MVPA (beta=6.95; P=.09); when narrative immersion was included in the model, the regression coefficient was attenuated.

CONCLUSIONS

AVG with added narratives elicits more narrative immersion, resulting in more minutes in MVPA. Narrative immersion served as a mediator between NV and MVPA via its elicitation of an elevated HR without increasing RPE. The inclusion of immersive narratives in AVG could be helpful for inducing MVPA, to enhance AVG engagement without additional exertion.

Using Narrative Game Design to Increase Children's Physical Activity: Exploratory Thematic Analysis

Background

Physical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children’s physical activity.

Objective

Little is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games.

Methods

In this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis.

Results

Findings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity.

Conclusions

This research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles.