# Exercise as it relates to Disease/Does playing active video games increase energy expenditure in children?

This page reviews and critiques the article: Does playing active video games increase energy expenditure in children.

## What is the background to this research?

With a population that is becoming increasingly sedentary and obese, many would say that technological advances have a big role to play in this issue. Exercise is an important part of life and is one of the best, healthiest solutions (alongside a healthy diet) for keeping healthy. Video games have become a massive part of children's lives in the last couple of decades and is often seen as an unhealthy habit. This is believed to be an unhealthy habit due to the long hours children tend to sit and play for. To combat the issue of sedentary behaviour while video gaming, companies like Nintendo have introduced 'active video gaming' where the game requires the player to physically move around while playing the game. Although this might sound like a good solution, do these active video games really have a lasting impact? There are a many articles and studies that have been produced exploring this issue, many of which come to the conclusion that active video gaming is a solution to combat sedentary behaviour.
The article chosen for this particular review explores the extent and effect that active video gaming has on children's daily energy expenditure. Studies like these are important as it helps prove whether active video games are truly good alternatives compared to normal video games. This kind of information would be useful and informative for the parenting population, who have concerns for their child's wellbeing and health.

## Where is the research from?

This article was added to the Official Journal of the American Academy of Pediatrics in 2009. This journal has be published continuously since 1948. The article and research was conducted at the University of Oklahoma and published on July 13, 2009. Although it was conducted in the United States of America, the research is still relevant in Australia.
All co-authors from this study have had contributions to other peer-reviewed articles and studies. All co-authors bar Diana L. Graf, have contributions to other studies either relating to this article or in the field of pediatrics. Since all co-authors are experienced and have contributed to other research, this improves the reliability of this article.
Bias and conflict of interest is unlikely from all of these co-authors as they do not benefit from the study in any way other than the experience gained by conducting and publishing the study.

## What kind of research was this?

This researchers used a randomised crossover trial (RCT) for this study. For this type of experiment, an RCT is suitable as it is a controlled study and provides the researchers with the ability to incorporate a repeated measures design. This works well for this particular study as the researchers need to compare numbers of different variables produced by the same subject. An observational study would not be appropriate for this kind of study as the researchers need to control some variables in order to gather and find differences in the results. A meta-analysis study could benefit the level of evidence for this type of research. By comparing multiple studies that address the same question, it could add a high level of evidence supporting the research that it is intending to show. However if there is conflicting evidence in the articles used, this could decrease the level of evidence for the intended result.

## What did the research involve?
#### Method

14 boys and 9 girls aged 11–13 years old, with a BMI at 3-98th percentile for age and gender were used for this study. Energy expenditure, heart rate, step rate, and perceived exertion were all measured while performing different activities. The activities were watching television at rest, playing Dance Dance Revolution (DDR) at 2 skill levels, playing Wii bowling and boxing, and walking at 2.6, 4.2, and 5.7 km/hr on a treadmill. Arterial elasticity was also measured before and after each activity.

#### Approach and limitations

The research approach was appropriate for the study and all variables measured were suitable to determine the energy expenditure for each activity. The study may lack validity as the sample size used was small. Only using a total of 23 children could affect the validity of the study as it may not reflect the general population.

## What were the basic results?
#### Important findings

* Energy expenditure while participating in active video gaming or walking increased 2-to-3 times, compared with watching television at rest.
* The highest rates of energy expenditure, heart rate, and perceived exertion were found during Wii boxing, DDR level 2, and at highest walking rate of 5.7 km/hr on the treadmill.
* Wii bowling and beginner level DDR had a 2x increase in energy expenditure compared to television watching at rest.

#### Researcher's interpretation of results

The researchers came to the conclusion that energy expenditure during active video gaming is comparable to light-moderate intensity walking. This was then extended to say that children who spend long periods of time playing video games, would benefit from playing physically active games as they are a safe, fun, and valuable means of promoting energy expenditure.

## What conclusions can we take from this research?

The conclusion that active video games increase energy expenditure compared to watching television at rest is a fair statement. However the article only compares active video games to treadmill walking, which considering exercise standards, isn't a very good example of the level of exercise that children should be getting everyday. This article could be misleading in the way that people reading could think they are promoting active video gaming as a complete alternative to genuine exercise.

#### Comparison to other research in this area

Other articles and research in this area found similar results to the article being critiqued. In the years 2008 and 2013 studies using the similar research methods to the study being critiqued, found very similar results. Furthermore, in 2011 Wei Peng and others produced a meta-analysis of the energy expenditure during active video games. The meta-analysis put together multiple studies adding up to a total of 354 participants. The researchers found that energy expenditure during active gaming can be the same as during light-moderate intensity exercise.

## Practical advice
#### Implications of this research study

* Small sample size means that the study may not be relevant to the wider population.
* Exercise on a treadmill is not an everyday exercise which most children undertake on a day to day basis.
* Researchers conclude that playing physically active games are a safe, fun and valuable means of promoting energy expenditure. However they failed to provide that active video games must not be used as a genuine substitute for exercise. An article by Susan E. Klepper about the benefits of exercise and physical activity for children highlights the reason that genuine physical activity is so important for the development and wellbeing of children.

#### Conclusion

Active video games are a better option for energy expenditure than video gaming or watching television at rest. However, active video gaming should not completely replace genuine exercise.

## Further information/resources

For further reading on the effects of active video gaming on energy expenditure in children, please click the links below:
* Is Playing Exergames Really Exercising? A Meta-Analysis of Energy Expenditure in Active Video Games.
* Energy Expenditure and Cardiovascular Responses to Seated and Active Gaming in Children.
* Activity promoting games and increased energy expenditure.
* Couch potatoes to jumping beans: A pilot study of the effect of active video games on physical activity in children

## References

* 1 2 3 4 5 6 7 8 Graf, D. L., Pratt, L. V., Hester, C. N., & Short, K. R. (2009). Playing active video games increases energy expenditure in children. Pediatrics, 124(2), 534-540.
* ↑ Owen, N., Sparling, P. B., Healy, G. N., Dunstan, D. W., & Matthews, C. E. (2010, December). Sedentary behavior: emerging evidence for a new health risk. In Mayo Clinic Proceedings (Vol. 85, No. 12, pp. 1138-1141). Elsevier.
* ↑ Zelasko, C. J. (1995). Exercise for weight loss: what are the facts?. Journal of the American dietetic association, 95(12), 1414-1417.
* 1 2 Vandewater, E. A., Shim, M. S., & Caplovitz, A. G. (2004). Linking obesity and activity level with children's television and video game use. Journal of adolescence, 27(1), 71-85. Chicago
* 1 2 Peng, W., Crouse, J. C., & Lin, J. H. (2013). Using active video games for physical activity promotion: a systematic review of the current state of research. Health education & behavior, 40(2), 171-192.
* 1 2 Mellecker, R. R., & McManus, A. M. (2008). Energy expenditure and cardiovascular responses to seated and active gaming in children. Archives of pediatrics & adolescent medicine, 162(9), 886-891.
* 1 2 3 Peng, W., Lin, J. H., & Crouse, J. (2011). Is playing exergames really exercising? A meta-analysis of energy expenditure in active video games. Cyberpsychology, Behavior, and Social Networking, 14(11), 681-688.
* 1 2 Klepper, S. E. (2003). Exercise and fitness in children with arthritis: evidence of benefits for exercise and physical activity. Arthritis Care & Research, 49(3), 435-443.