# Exercise as it relates to Disease/Physically interactive video games vs sedentary alternative in children

This is a critique of the article "Motivation and Physiologic Responses of Playing a Physically Interactive Video Game Relative to a Sedentary Alternative in Children".

## What is the background to this research?

Children are spending an increased amount of time playing video games and watching television, this has been found to be linked to a decrease in physical activity levels and increased risk of weight gain in children. If an alternative and more interactive video game is an option then it might be helpful in encouraging children to be more active whilst playing video games, however there is little research conducted on the physiologic cost of physically interactive Nintendo Wii games or the relative reinforcing value of the Wii versus a sedentary game.
The reason for this research was
* measure the energy expenditure of interactive video games relative to sedentary video games and physical activity (treadmill walking)
* which type of video game, lean or obese children were more likely to play
* to see whether including Wii play in physical activity interventions would be successful

## Where is the research from?

The research was conducted at Kent State University which has its own division of Research and Sponsored Programs, Jacob Barkley currently works there as an associate professor. He has been involved in over 150 research items, and has expertise in physical activity, obesity, peer/social influence and Exergames (e.g. Nintendo Wii).
Amanda Penko has thirteen research items published, but out of those thirteen there is only one other that is related to physiologic responses in interactive video games. There are no sponsorship links in the article.

## What kind of research was this?

This is a research study which was conducted on 11 lean and 13 overweight/obese 8 to 12 yr old.
The article has thirty-eight references consisting of -
* systematic reviews
* guidelines
* randomised control trials
* analysis's
Majority of articles were published from the year 2000 to the current date, only three were published before the 1990s and could be considered outdated evidence. This altogether would provide a consistent level of evidence for the article.

## What did the research involve?

The 24 participants were first measured for height and weight, they then completed four activities including resting, treadmill walking, playing a sedentary video game, and playing a physically interactive video game (Wii sports boxing). Heart rate and VO$_2$ were measured throughout the activities. The children were then asked at the end how much they enjoyed the games and how hard they perceived the activity to physically be.
I think the physiological testing was the best approach for finding which activity had the most energy expenditure. For the relative reinforcing value it would've been easier to just release a survey asking children about what video games they played and preferred. This would've also been a more reliable source than 24 participants.
There were a few limitations to this study such as,
- RRV which is quite a complicated factor in determining how likely someone is to keep playing a game. There are a lot of other factors that affect children playing a certain game.
- The sample size was very small and only included 8-10yr olds whereas teenagers would be a larger population playing video games.
- The participant recruitment was just from Kent University databases that they had already been on which could potentially be biased.
- The research only evaluated a single Wii game and a single SVG.

## What were the basic results?

Results concluded that Heart Rate and VO$_2$ incrementally increased from resting to the largest increase which was Wii Sports Boxing Condition. Liking was significantly greater for Nintendo Wii than all other activities. Lean children displayed a greater peak responding for access to Wii relative to the SVG whereas overweight/obese children did not.
A statistical analysis was conducted on the primary outcome measures of the study. BMI was used to determine whether children were considered lean, overweight or obese. ANOVA was used to assess physical characteristics (age, height, weight, BMI percentile), gender and weight category. Chi-squared analysis, T tests, and paired-samples T test were also used to interpret the difference between the conditions and measures.
Whilst they state that heart rate and VO$_2$ increases greatly in the Wii video game, it is then later stated that it would be considered moderate physical activity but would not be great enough to alter cardio-respiratory fitness. Wii received a higher liking and RRV than what the SVG scored, but they stated that kids would still be motivated to play the Wii and SVG the same amount in a living setting.
Physiologic and perceptual effects of participating in the resting, sedentary video game, treadmill walking, and Wii Sports Boxing conditions :
| Variable | Resting$^a$ | Sedentary video game | Treadmill walking (67.1 mmin$^{-1}$ | Wii Sports Boxing |
| VO$_2$ (ml kg$^{-1}$min$^{-1}$) | 5.1 ±1.2 | 5.4 ±1.2 | 10.2 ±2.4 | 11.7 ±3.4 |
| Heart rate (beats min$^{-1}$) | 84.4 ±10.4 | 91.1 ±11.0 | 105.9 ±12.7 | 121.4 ±20.3 |
| Liking (cm) | - | 6.9 ±2.6 | 6.0 ±3.1 | 8.5 ±1.8 |
| RPE | - | 1.7 ±1.5 | 2.7 ±2.4 | 3.4 ±2.5 |

## What conclusions can we take from this research?

We can conclude that Wii games increase physiological responses greater than what SVG and treadmill walking does, but only the lean children favoured the Wii game and were more likely to pick it over the SVG. This changed with overweight/obese children who were just as likely to play the SVG game as the Wii game. The Wii game however would not be recommended over outside physical activity.
Whilst the Wii game is better for children to play than the SVG it does not make the child active enough to actually affect their cardiorespiratory fitness and other physiological factors. This could mean they are still at the same risk as the children who just play SVG. Further research would be required on teenagers and long term studies to determine how much playing an interactive video game compared to sedentary video games would decrease risks of chronic diseases and co-morbidities.
Other studies also found that active video games elicited a greater energy expenditure than what sedentary video games did, and was similar in intensity to moderate intensity physical activities.

## Practical advice

This research could provide children who enjoy playing video games over organised physical activity another alternative. Traditional physical activity may always have the greatest benefits involved but the suggested MET level associated with the Wii sports boxing would at least contribute to moderate physical activity. It could also change physical activity guidelines, different games could be classified as moderate or low activity and be counted as minutes contributing to physical activity.
Active video games should be seen as more of a way to break up sedentary time. More information would be required to see the frequency and duration required for active video games before it starts reducing risks of obesity and chronic diseases.
Currently the Wii has been discontinued so another console that provides active video games would need to be assessed again before it can be determined whether the newer video games would be as good as the Wii games study found.
Parents still need to be aware that video game addiction is a possibility, children can play video games too much even if they are active video games.
Further readings involving video games, physical activity and healthy gaming can be found below in related readings.

## Related reading

* Physiologic Responses, Liking and Motivation for Playing the Same Video Game on an Active Versus a Traditional, Non-Active Gaming System: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738972/
* Comparison between Nintendo Wii Fit aerobics and traditional aerobic exercise in sedentary young adults: https://www.ncbi.nlm.nih.gov/pubmed/22446674
* Replacing Non-Active Video Gaming by Active Video Gaming to Prevent Excessive Weight Gain in Adolescents: https://www.researchgate.net/publication/279991584_Replacing_Non-Active_Video_Gaming_by_Active_Video_Gaming_to_Prevent_Excessive_Weight_Gain_in_Adolescents
* Active video games: Are they an effective approach to reducing sedentary time and increasing physical activity in children: https://doi.org/10.1016/j.jsams.2014.11.292
* Could Video Games Replace Sport?: http://this.deakin.edu.au/lifestyle/could-active-video-games-really-replace-real-sports
* Video Games Can't Replace Physical Activity: https://activeforlife.com/video-games-cant-replace-real-activity/
* Healthy Video Gaming for Children: http://raisingchildren.net.au/articles/healthy_video_gaming.html

## References

* ↑ Amanda L. Penko, Jacob E. Barkley; Motivation and Physiologic Responses of Playing a Physically Interactive Video Game Relative to a Sedentary Alternative in Children, Annals of Behavioral Medicine, Volume 39, Issue 2, 1 May 2010, Pages 162–169, https://doi.org/10.1007/s12160-010-9164-x
* ↑ Epstein LH, Roemmich JN, Robinson JL, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008; 162(3): 239–245.
* 1 2 Rosiek, A., Frąckowiak Maciejewska, N., Leksowski, K., Rosiek-Kryszewska, A., & Leksowski, Ł. (2015). Effect of Television on Obesity and Excess of Weight and Consequences of Health. International Journal of Environmental Research and Public Health, 12(8), 9408–9426. http://doi.org/10.3390/ijerph120809408
* ↑ Louise F, Ralph M. Use of Active Video Games to Increase Physical Activity in Children: A (Virtual) Reality? 2010, Pediatric exercise science. 22. 7-20. 10.1123/pes.22.1.7.
* ↑ Taylor LM, Ngaire K,Tara F,Ralph M. Active Video Games for Improving Physical Performance Measures in Older People: A Meta-analysis. Journal of Geriatric Physical Therapy: June 2018, 41(2) 108–123. doi: 10.1519/JPT.0000000000000078
* ↑ Roberts JD, Rodkey L, Ray R, Knight B, Saelens BE. Electronic media time and sedentary behaviors in children: Findings from the Built Environment and Active Play Study in the Washington DC area. Preventive Medicine Reports. 2017;6:149-156. doi:10.1016/j.pmedr.2017.02.021.