# Exercise as it relates to Disease/Playing Exergames at School to Target Weight Loss in Adolescents

This fact sheet is an analysis of the journal article “Adolescent Exergame Play for Weight Loss and Psychosocial Improvement: A Controlled Physical Activity Intervention” by Staiano, Abraham and Calvert (2013). Statement: This has been created by [u3099939]

## What is the background to this research?

Obesity has been defined by the World Health Organisation (WHO) as abnormal or excessive fat accumulation that may impair health. The most commonly used measure is body mass index (BMI) which uses height and weight to classify adults into different categories of obesity. BMI can also be used to classify children and adolescents by referencing growth charts for certain age groups (see WHO charts for age groups 0-5 and 5-19). Obesity is becoming an increasing problem in Australia’s youth; data from 2012 estimated over 25% of children aged 5–17 were classified as overweight and obese. Childhood obesity is a strong predictor for being overweight in adulthood, which is associated with poor physical health, mental health and decreased quality of life.
Obesity is fundamentally caused by an energy imbalance where more calories are consumed than expended. In some cases there are medical, genetic or environmental factors contributing to obesity, but lifestyle factors such as diet and physical inactivity are more significant contributors. The current Australian Physical Activity Guidelines recommend that children aged between 5-17 should perform at least 60 minutes of moderate to vigorous physical activity every day. Despite this, the 2012 Australian Health Survey found that only 1 in 3 children undertook the recommended amount of physical activity, and the average time spent on screen based activities exceeded the recommended maximum of 2 hours. As technology advances it is becoming increasingly difficult to entertain children and young people without screens, however this developing technology has also allowed for products such as exergames. Exergame is a term used to describe a video game that incorporates physical activity and is reliant upon technology that tracks body motion or movement. There are a large variety of exergames available across several platforms that cater to a range of fitness levels and provide different types of exercise. Research has indicated that these games may be beneficial in improving fitness and adherence to exercise, but the required amount and type of exergaming is not yet clear.

## Where is the research from?

This research was conducted by Staiano, Abraham and Calvert at The Georgetown University, USA. All authors have previously contributed to a variety of research regarding children and health. Funding for this research was provided by the Robert Wood Johnson Foundation’s Pioneer Portfolio through a grant from its national program, ‘‘Health Games Research: Advancing Effectiveness of Interactive Games for Health’’. With contributions from a sponsor within the exergame industry, it would be beneficial to the organisation if the results demonstrated a positive correlation between exergames and weightloss.

## What kind of research was this?

This was a randomised controlled trial with two intervention groups and one control group. There was no blinding in place for this trial.

## What did the research involve?

The research involved recruitment of 54 adolescent overweight participants through word of mouth and referral from the wellness clinic of a public high school in Washington D.C. Participants were included if their BMI was at or above the 75th percentile for their age and gender. Incentives in the form of gift certificates were provided to encourage attendance. The participants were randomly allocated into three groups;
* competitive exergame: instructed to compete against their opponent and expend the most calories
* cooperative exergame: instructed to cooperate with their partner to earn the most points and expend the most calories as a team
* control conditions: instructed to continue usual daily activities as prior to the study
Those in exergame groups had access to the Nintendo Wii Active exergame 30-60 minutes for every school day during lunch or after school with supervision from an adult coordinator for 20 weeks. Each session included cardio, upper and lower body strength training, and sports games.
Outcome measures included:
| Physical | Psychosocial |
| Height | Self efficacy |
| Weight | Self esteem |
| | Peer Support |

## What were the basic results?

Physical:
* Control group gained weight
* Competitive exergame group maintained weight
* Cooperative exergame group lost weight
Psychosocial:
* Self efficacy of cooperative exergame group increased
Other:
* Despite incentives and access, adherence was poor across all groups with an average attendance of 26% (or 1 session per week)
In summary, participants exercising as a team had positive results of weight loss and an increase in self efficacy, while those exercising competitively achieved weight maintenance. Those in the control group demonstrated how, with no intervention, the issue of obesity worsens. These results are surprising considering the low levels of attendance, which suggests that with stricter adherence, more benefits may be seen.

## What are the limitations to this research?

The authors have used BMI and some psychosocial measures as an indicator of health, however these techniques do not detect other health improvements such as body composition, muscular strength and cardiovascular measures. There was also no measure of lifestyle factors before and after the study, so a range of other variables such as diet may have impacted upon the results. All study participants were attending the same school, which potentially limits the generalisability of the results.

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

While the results from this study suggest exergames may be useful in targeting weightloss, it is important to look at all the evidence in this area. A review of the current research has suggested that exergames may be a useful additional tool to encourage physical activity, but should not be the sole source of exercise and requires further investigation. To be a successful lifestyle change, exergames should be an addition to routine physical activity, as the amount of exercise generated from exergame play does not meet the recommended activity levels for children and adolescents.

## Further Information

For further information regarding physical activity in adolescents and exergames, please click on the links below:
* Physical Activity guidelines for children and adolescents
* Current activity levels in Australian youth
* Exergaming Australia

## References

* 1 2 Staiano, A., Abraham, A., & Calvert, S. (2013). Adolescent Exergame Play for Weight Loss and Psychosocial Improvement: A Controlled Physical Activity Intervention. Obesity, 21(3), 598-601. http://dx.doi.org/10.1002/oby.20282
* ↑ World Health Organisation. (2016). Obesity and overweight. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/
* ↑ Australian Bureau of Statistics. (2013). Australian Health Survey: Updated Results 2011-2012. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/33C64022ABB5ECD5CA257B8200179437?opendocument
* ↑ Field, A., Cook, N., & Gillman, M. (2005). Weight Status in Childhood as a Predictor of Becoming Overweight or Hypertensive in Early Adulthood. Obesity Research, 13(1), 163-169. http://dx.doi.org/10.1038/oby.2005.21
* ↑ Nigatu, Y., Reijneveld, S., de Jonge, P., van Rossum, E., & Bültmann, U. (2016). The Combined Effects of Obesity, Abdominal Obesity and Major Depression/Anxiety on Health-Related Quality of Life: the LifeLines Cohort Study. PLOS ONE, 11(2). http://dx.doi.org/10.1371/journal.pone.0148871
* ↑ Williams, E., Mesidor, M., Winters, K., Dubbert, P., & Wyatt, S. (2015). Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem. Current Obesity Reports, 4(3), 363-370. http://dx.doi.org/10.1007/s13679-015-0169-4
* 1 2 Department of Health. (2016). Australia's Physical Activity and Sedentary Behaviour Guidelines. Available from: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#apa1317
* ↑ Department of Health. (2016). Research and Statistics. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-active-evidence.htm
* 1 2 American College of Sports Medicine. (2013). Exergaming. Available from: https://www.acsm.org/docs/brochures/exergaming.pdf?sfvrsn=6
* ↑ Biddiss, E. & Irwin, J. (2010). Active Video Games to Promote Physical Activity in Children and Youth. Archives of Paediatrics and Adolescent Medicine, 164(7). 664-672. http://dx.doi.org/10.1001/archpediatrics.2010.104
* 1 2 Gao, Z. & Chen, S. (2014). Are field-based exergames useful in preventing childhood obesity? A systematic review. Obesity Review, 15(8), 676-691. http://dx.doi.org/10.1111/obr.12164