# Exercise as it relates to Disease/Exergames - Can they improve the health of children?

This is an analysis of the journal article “Do exergames allow children to achieve physical activity intensity commensurate with national guidelines?” by Perron, Graham, Feldman, Moffett and Hall (2011).

## What is the background to the research?

Obesity is currently the second leading cause of preventable disease and death in the United States of America. Between 2011-2014, more than 17% of youth aged 2–19 years old were classified as being obese in America. Physical activity can benefit the health of an individual in a number of ways, some of these including: a decreased risk of cardiovascular disease; a decreased risk of diabetes; a decreased risk of depression; a decrease in fat mass; and an increase in cardiorespiratory functioning. The Centre for Disease Control and Prevention (CDC) has developed a set of guidelines, which states the minimal amount of exercise that is required to maintain a healthy state. These physical activity guidelines state that an individual between the ages of 6-17 must complete a minimum of 60 minutes of moderate-intensity aerobic exercise per day. Research has shown, however, that less than 30% of children within this age group actually adhere to this recommendation, with the majority of youth spending more than 3 hours per day in ‘screen time’ (i.e. watching TV). In a study of 548 school students, in 2006, researchers found that each hour increase in ‘screen time’ was associated with an additional 167kcal consumed per day. Therefore, it may be suggested that ‘screen time’ contributes to the obesity epidemic through both the sedentary nature of the activity and through an associated increase in energy intake. Due to the extremely high volume of time many children spend in ‘screen time’, it is highly unlikely that eliminating time spent watching television and playing video games would be an easy task. For this reason, exergames may provide a potential solution to this problem. Exergames are types of video games that require a player to be more physically active than in traditional video game play. This study measured a number of physiological responses elicited by two exergames (Wii Fit and EA SPORTS Active) and analysed these responses to determine whether they were commensurate with the national physical activity guidelines.

## Where is this research from?

This study was conducted by members of the Department of Exercise Science at Elon University, North Carolina, United States of America. The article was originally published in the International Journal of Exercise Science in October, 2011.

## What kind of research was this?

This type of study was both quantitative and comparative in nature and had a similar design to that of a randomised controlled trial. The random allocation of participants to the two groups helps to reduce any bias that may exist.

## What did the research involve?

The study consisted of thirty participants (19 males and 11 females) with a mean age of 9.4±1.8 years. The “control” for this experiment was comprised of pre-determined values for Percentage of Heart Rate Maximum (%HRM) and Rating of Perceived Exertion (RPE), outlined by the Centre for Disease Control and Prevention’s physical activity guidelines. The participants were randomly divided into two groups of equal numbers. The first group participated in the Wii Fit game and the second group participated in the EA SPORTS Active game. Both of these games are designed for the Nintendo Wii game console. Baseline measurements of height, weight and resting heart rate were recorded. After instructions for each specific game session were given, the subjects participated in their respective games for approximately 25 minutes. Heart rate (measured using a heart rate monitor) and RPE (measured using the OMNI scale) were recorded during the activity.

## What were the basic results?

| | Wii Fit | EASPORTS ACTIVE |
| HR (bpm) | 136.5 ± 9.6 | 144.0 ± 8.0 |
| RPE (0-10) | 4.0 ± 2.8 | 4.5 ± 2.6 |

## How did the researchers interpret the results?

The researchers have determined that exergames are a viable means of physical activity for children to undertake in order to obtain a level of exercise intensity commensurate with the national guidelines set out by the CDC. The main evidence to support this notion is the fact that the requirements of the exergames elicited a heart rate response of approximately 66.5% of the sample population’s Age Predicted Heart Rate Maximum (APHRM). This percentage falls into the ‘50-70%HRmax’ range for exercise of a ‘moderate-intensity’, as outlined by the CDC. However, the mean RPE of the two exergames was 4.25, which falls below the required range for exercise to be considered moderate in intensity (5.0-6.0). In support of their argument, the researchers outlined a number of previous experiments that also found evidence that participation in exergames stimulates a physiological response similar to common types of exercise considered to be moderate in intensity.

## What conclusions should be taken away from this research?

Despite the outcomes of the study, there are a number of limitations associated with the design of this experiment that could potentially hinder the validity of the results collected. The small sample size and the lack of repetitions of the test may contribute to an inaccurate representation of the population and a decrease in the accuracy of the results. However, as previous research has highlighted, it is relatively clear that exergames elicit a physiological response that is great enough to be classed as ‘moderate-intensity’ physical activity. This study has identified the need for further research to test the long-term effect of exergames and to determine if they have the potential for children to enjoy ‘screen time’ in a healthy and active manner.

## Practical Advice

Although this study has highlighted exergames as being a ‘moderate-intensity’ form of exercise, the extent to which they may benefit our health and cardiovascular fitness, particularly in the long-term, is still unclear. Therefore, it may be wise to encourage children to regularly participate in other forms of exercise, such as walking, running and sports, of which are low in cost and have numerous physiological benefits, and to encourage parents to engage their children in exergames as an active alternative to regular sedentary ‘screen time’.

## Further reading

American College of Sports Medicine: Exergaming Brochure https://www.acsm.org/docs/brochures/exergaming.pdf
Exergaming Australia: http://exergamingaustralia.com/
Exergames for Physical Education Courses: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339488/