Squire's Quest! Dietary outcome evaluation of a multimedia game. Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: The electronic games to aid motivation to exercise (eGAME) study The effect of active video gaming on children's physical activity, behavior preferences and body composition. The effect of active video games by ethnicity, sex and fitness: subgroup analysis from a randomised controlled trial Effects of interactive video game cycling on overweight and obese adolescent health. Design and Evaluation of a Computer Game to Promote a Healthy Diet for Young Adults Effects of active video games on body composition: a randomized controlled trial. The Fun Families Study: intervention to reduce children's TV viewing. Active video games to promote physical activity in children with cancer: a randomized clinical trial with follow-up Exergaming for Health Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes in Children? Impact of an Active Video Game on Healthy Children’s Physical Activity Active video games: the mediating effect of aerobic fitness on body composition Effects of a pediatric weight management program with and without active video games a randomized trial. Motivating Effects of Cooperative Exergame Play for Overweight and Obese Adolescents Interactive video gaming compared with health education in older adults with mild cognitive impairment: a feasibility study. Video game playing increases food intake in adolescents: a randomized crossover study. Childhood obesity prevention through a community-based cluster randomized controlled physical activity intervention among schools in china: the health legacy project of the 2nd world summer youth olympic Games (YOG-Obesity study) Reducing children's television viewing to prevent obesity: a randomized controlled trial. Content and ratings of teen-rated video games. Action video game training reduces the Simon Effect Management of chronic pediatric diseases with interactive health games: theory and research findings. Overweight and obesity related to activities in Portuguese children, 7-9 years.
BACKGROUND Fruit , juice , and vegetable  ( FJV ) consumption among children is low . Innovative programs are needed to enable children to increase FJV intake . Psychoeducational multimedia permits the delivery of interventions as design ed and capitalizes on known behavior change principles . DESIGN Elementary school was the unit of recruitment , assignment , and analysis . Twenty-six elementary schools were pair matched on size and percentage of free or reduced-price lunch , and r and omly assigned to treatment or control groups . Data were collected just before and just after the program . SETTING / PARTICIPANTS All fourth- grade students in participating elementary schools were invited to participate . Data were collected on 1578 students . MAIN OUTCOME Servings of fruit , 100 % juice , and vegetables consumed . INTERVENTION Squire 's Quest ! is a ten-session , psychoeducational , multimedia game delivered over 5 weeks , with each session lasting about 25 minutes . Based on social cognitive theory , educational activities attempted to increase preferences for FJV through multiple exposures and associating fun with their consumption , increase asking behaviors for FJV at home and while eating out , and increase skills in FJV preparation through making virtual recipes . MEASURES Four days of dietary intake were assessed before and after the intervention . Assessment was made by the Food Intake Recording Software System ( FIRSSt ) , which conducts a multiple pass , 24-hour dietary intake interview directly with the children . RESULTS Children participating in Squire 's Quest ! increased their FJV consumption by 1.0 servings more than the children not receiving the program . CONCLUSIONS Psychoeducational multimedia games have the potential to substantially change dietary behavior . More research is warranted Background Childhood obesity has reached epidemic proportions in developed countries . Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity . Active video games , where players physically interact with images onscreen , may have utility as a novel intervention to increase physical activity and improve body composition in children . The aim of the Electronic Games to Aid Motivation to Exercise ( eGAME ) study is to determine the effects of an active video game intervention over 6 months on : body mass index ( BMI ) , percent body fat , waist circumference , cardio-respiratory fitness , and physical activity levels in overweight children . Methods / Design Three hundred and thirty participants aged 10–14 years will be r and omized to receive either an  active video game up grade package  or to a control group ( no intervention ) .  Discussion An overview of the eGAME study is presented , providing an example of a large , pragmatic r and omized controlled trial in a community setting . Reflection is offered on key issues encountered during the course of the study . In particular , investigation into the feasibility of the proposed intervention , as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial . Trial registration Australian New Zeal and Clinical Trials Registry Active video game interventions typically provide children a single game that may become unappealing . A peripheral device ( jOG ) encourages step-powered gaming on multiple games . This trial evaluated the effect of jOG on children 's objective ly measured PA , body fat and self-reported behaviors . 42 of 58 eligible children ( 8 - 10 y ) r and omly assigned to an intervention ( jOG ) or control ( CON ) completed the trial . Intervention children received two jOG devices for home use . Analyses of covariance compared the intervention effect at 6 and 12 weeks from baseline . No differences were found between groups for counts per minute ( CPM ; primary outcome ) at 6 and 12 weeks ( p > .05 ) . Active video gaming increased ( adjusted change 0.95 ( 95 % CI 0.25 , 1.65 ) h·d⁻¹ , p < .01 ) and sedentary video gaming decreased ( -0.34 ( -1.24 , 0.56 ) h·d⁻¹ , p > .05 ) at 6 weeks relative to CON . No body fat changes were observed between groups . Targeted changes in video game use did not positively affect PA . Larger trials are needed to verify the impact of active video games on children 's PA and health Background The prevention and treatment of childhood obesity is a key public health challenge . However , certain groups within population s have markedly different risk profiles for obesity and related health behaviours . Well- design ed subgroup analysis can identify potential differential effects of obesity interventions , which may be important for reducing health inequalities . The study aim was to evaluate the consistency of the effects of active video games across important subgroups in a r and omised controlled trial ( RCT ) . Findings A two-arm , parallel RCT was conducted in overweight or obese children ( n = 322 ; aged 10–14 years ) to determine the effect of active video games on body composition . Statistically significant overall treatment effects favouring the intervention group were found for body mass index , body mass index z-score and percentage body fat at 24 weeks . For these outcomes , pre-specified subgroup analyses were conducted among important baseline demographic ( ethnicity , sex ) and prognostic ( cardiovascular fitness ) groups . No statistically significant interaction effects were found between the treatment and subgroup terms in the main regression model ( p = 0.36 to 0.93 ) , indicating a consistent treatment effect across these groups . Conclusions Preliminary evidence suggests an active video games intervention had a consistent positive effect on body composition among important subgroups . This may support the use of these games as a pragmatic public health intervention to displace sedentary behaviour with physical activity in young people The purpose of this study was to examine the efficacy of interactive video game stationary cycling ( GameBike ) in comparison with stationary cycling to music on adherence , energy expenditure measures , submaximal aerobic fitness , body composition , and cardiovascular disease risk markers in overweight and obese adolescents , using a r and omized controlled trial design . Thirty overweight ( with at least 1 metabolic complication ) or obese adolescents aged 12 - 17 years were stratified by gender and r and omized to video game or music condition , with 4 participants ( 2 per group ) failing to complete the twice weekly 60 min sessions of the 10-week trial . The music group had a higher rate of attendance compared with the video game group ( 92 % vs. 86 % , p < 0.05 ) . Time spent in minutes per session at vigorous intensity ( 80%-100 % of predicted peak heart rate ) ( 24.9 ± 20 min vs. 13.7 ± 12.8 min , p < 0.05 ) and average distance ( km ) pedaled per session ( 12.5 ± 2.8 km vs. 10.2 ± 2.2 km , p < 0.05 ) also favoured the music group . However , both interventions produced significant improvements in submaximal indicators of aerobic fitness as measured by a grade d cycle ergometer protocol . Also , when collapsed , the exercise modalities reduced body fat percentage and total cholesterol . The present study indicates that cycling to music was just as effective  as stationary cycling while playing video games at improving fitness , body composition , and cholesterol profiles in overweight and obese teens , and result ed in increased attendance , vigorous intensity of physical activity , and distance pedaled . Therefore , our data support the superiority of cycling to music and indicate investing in the more expensive GameBike may not be worth the cost This article reports the development and evaluation of a computer game ( RightWay Café ) as a special medium to promote a healthy diet for young adults . Structural features of computer games , such as interactive tailoring , role playing , the element of fun , and narrative , were operationalized in the RightWay Café game to afford behavior rehearsal in a safe and entertaining way . Theories such as the health belief model , social cognitive theory , and theory of reasoned action guided the content design of the game to influence mediators of behavior change , including self-efficacy , perceived benefits , perceived barriers , and behavior change intention . A r and omized controlled evaluation study with pretest , posttest , and follow-up design demonstrated that this game was effective in teaching nutrition and weight management knowledge and increasing people 's self-efficacy and perceived benefits of healthy eating , as well as their intention to be on a healthy diet . Limited long-term effects were also found : participants in the game-playing group had greater self-efficacy than participants in the control group after 1 month . This study vali date s the computer game – based approach to health promotion for young adults . Limitations and implication s are also discussed BACKGROUND Sedentary activities such as video gaming are independently associated with obesity .  Active video games , in which players physically interact with images on screen , may help increase physical activity and improve body composition . OBJECTIVE The aim of this study was to evaluate the effect of active video games over a 6-mo period on weight , body composition , physical activity , and physical fitness . DESIGN We conducted a 2-arm , parallel , r and omized controlled trial in Auckl and , New Zeal and . A total of 322 overweight and obese children aged 10 - 14 y , who were current users of sedentary video games , were r and omly assigned at a 1:1 ratio to receive either an active video game up grade package ( intervention , n = 160 ) or to have no change ( control group , n = 162 ) . The primary outcome was the change from baseline in body mass index ( BMI ; in kg/m(2 ) ) . Secondary outcomes were changes in percentage body fat , physical activity , cardiorespiratory fitness , video game play , and food snacking . RESULTS At 24 wk , the treatment effect on BMI ( -0.24 ; 95 % CI : -0.44 , -0.05 ; P = 0.02 ) favored the intervention group . The change ( ±SE ) in BMI from baseline increased in the control group ( 0.34 ± 0.08 ) but remained the same in the intervention group ( 0.09 ± 0.08 ) . There was also evidence of a reduction in body fat in the intervention group ( -0.83 % ; 95 % CI : -1.54 % , -0.12 % ; P = 0.02 ) . The change in daily time spent playing active video games at 24 wk increased ( 10.03 min ; 95 % CI : 6.26 , 13.81 min ; P < 0.0001 ) with the intervention accompanied by a reduction in the change in daily time spent playing nonactive video games ( -9.39 min ; 95 % CI : -19.38 , 0.59 min ; P = 0.06 ) . CONCLUSION An active video game intervention has a small but definite effect on BMI and body composition in overweight and obese children . This trial was registered in the Australian New Zeal and Clinical Trials Registry at http://www.anzctr.org.au/ as ACTRN12607000632493 Media consumption may contribute to  childhood obesity . This study developed and evaluated a theory-based , parent-focused intervention to reduce television and other media consumption to prevent and reduce childhood obesity .  Families ( n = 202 ) with children ages 6 - 9 were recruited from a large , urban multiethnic population into a r and omized controlled trial ( 101 families into the intervention group and 101 into the  control group ) , and were followed for 6 months . The intervention consisted of a 2-hour workshop and six bimonthly newsletters . Behavioral objectives included : ( i ) reduce TV watching ; ( ii ) turn off TV when nobody is watching ; ( iii ) no TV with meals ;  ( iv ) no TV in the child 's bedroom ; and ( v ) engage in fun non-media related activities .  Parents were 89 % female , 44 % white , 28 % African American , 17 % Latino , and 11 % Asian , mean age 40 years ( s.d . = 7.5 ) ; 72 % were married . Children were 49 % female , mean age 8 years ( s.d . = 0.95 ) . Sixty-five percent of households had three or more TVs and video game players ; 37 % had at least one h and held video game , and 53 % had three or more computers . Average children 's weekday media exposure was 6.1 hours . At 6 months follow-up , the intervention group was less likely to report the TV being on when nobody was watching ( adjusted odds ratio ( AOR ) = 0.23 , P < 0.05 ) , less likely to report eating snacks while watching TV ( AOR = 0.47 , P < 0.05 ) , and less likely to have a TV in the child 's bedroom ( AOR = 0.23 , P < 0.01 ) . There was a trend toward reducing actual media consumption but these outcomes did not reach statistical significance . Effective strategies to reduce children 's TV viewing were identified Background Low levels of physical activity , musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer . Intensive medical treatment and a decline in physical activity may also result in reduced motor performance . Therefore , simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children ’s cancer treatment . Methods The aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer . The research is conducted as a parallel r and omized clinical trial with follow-up . Patients between 3 and 16 years old , diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate . Based on statistical estimates , the target enrollment is 40 patients . The intervention includes playing elective active video games and , in addition , education and consultations for the family . The control group will receive a general recommendation for physical activity for 30 minutes per day . The main outcomes are the amount of physical activity and sedentary behavior . Other outcomes include motor performance , fatigue and metabolic risk factors . The outcomes are examined with question naires , diaries , physical examinations and blood tests at baseline and at 2 , 6 , 12 and 30 months after the baseline . Additionally , the children ’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months . Discussion This trial will help to answer the question of whether playing active video games is beneficial for children with cancer . It will also provide further reasoning for physical activity promotion and training of motor skills during treatment . Trial registration Clinical Trials.gov identifier : NCT01748058 ( October 15 , 2012 ) Objective . To evaluate the efficacy and feasibility of a multifaceted , community-based weight intervention program for children using exergaming technology ( activity-promoting video gaming ) .  Design and Methods . This is a prospect i ve observational pilot study . Forty-eight children , between the ages of 8 and 16 years , who are overweight or obese , enrolled in Exergaming for Health , a multidisciplinary weight management program , which used active video gaming . Primary outcome measures were change in body mass index ( BMI ) z scores . Results . Most children ( n = 40 , 83 % ) completed the program and participated in outcome evaluations . The average BMI change was −0.48 kg/m2 ( SD = 0.93 ) , P < .002 ( BMI z-score change was −0.072 , SD = 0.14 , P < .0001 ) . The average Global Self-Worth score improved , screen time and soda intake reduced , and exercise hours per week increased . Conclusions . The Exergaming for Health program may be an effective weight management intervention that is feasible with high participation rates . A larger r and omized controlled trial is needed to confirm these results Physical inactivity among children is a serious public health problem . It has been suggested that high levels of screen time are contributory factors that encourage sedentary lifestyles in young people . As physical inactivity and obesity levels continue to rise in young people , it has been proposed that new-generation active computer- and video-console games ( otherwise known as “ exergaming ” ) may offer the opportunity to contribute to young people 's energy expenditure during their free time . Although studies have produced some encouraging results regarding the energy costs involved in playing active video-console games , the energy costs of playing the authentic versions of activity-based video games are substantially larger , highlighting that active gaming is no substitute for real sports and activities . A small number of exergaming activities engage children in moderate-intensity activity , but most do not . Only 3 very small trials have considered the effects of exergaming on physical activity levels and /or other health outcomes in children . Evidence from these trials has been mixed ; positive trends for improvements in some health outcomes in the intervention groups were noted in 2 trials . No adequately powered r and omized , controlled trial has been published to date , and no trial has assessed the long-term impact of exergaming on children 's health . We now need high- quality r and omized , controlled trials to evaluate the effectiveness and sustainability of exergaming  , as well as its clinical relevance ; until such studies take place , we should remain cautious about its ability to positively affect children 's health OBJECTIVE : This naturalistic study tests whether children receiving a new ( to them ) active video game  spontaneously engage in more physical activity than those receiving an inactive video game  , and whether the effect would be greater among children in unsafe neighborhoods , who might not be allowed to play outside . METHODS : Participants were children 9 to 12 years of age , with a BMI > 50th percentile , but < 99th percentile ; none of these children a medical condition that would preclude physical activity or playing video games . A r and omized clinical trial assigned children to receiving 2 active or 2 inactive video games , the peripherals necessary to run the games , and a Wii console .  Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment . Neighborhood safety was assessed with a 12 item vali date d question naire . RESULTS : There was no evidence that children receiving the active video games were more active in general , or at anytime , than children receiving the inactive video games . The outcomes were not moderated by parent perceived neighborhood safety , child BMI z score , or other demographic characteristics . CONCLUSIONS : These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children Background Increased underst and ing of why and how physical activity impacts on health outcomes is needed to increase the effectiveness of physical activity interventions . A recent r and omized controlled trial of an active video game ( PlayStation EyeToy ™ ) intervention showed a statistically significant treatment effect on the primary outcome , change from baseline in body mass index ( BMI ) , which favored the intervention group at 24 weeks . In this short paper we evaluate the mediating effects of the secondary outcomes . Objective To identify mediators of the effect of an active video games intervention on body composition . Methods Data from a two-arm parallel r and omized controlled trial of an active video game intervention ( n = 322 ) were analyzed . The primary outcome was change from baseline in BMI . A priori secondary outcomes were considered as potential mediators of the intervention on BMI , including aerobic fitness ( VO2Max ) , time spent in moderate-to-vigorous physical activity ( MVPA ) , and food snacking at 24 weeks . Results Only aerobic fitness at 24 weeks met the conditions for mediation , and was a significant mediator of BMI . Conclusion Playing active video games can have a positive effect on body composition  in overweight or obese children and this effect is most likely mediated through improved aerobic fitness . Future trials should examine other potential mediators related to this type of intervention . Trial registration Australian New Zeal and Clinical Trials RegistryWebsite : http://www.anzctr.org.au Study ID number : IMPORTANCE Active video games may offer an effective strategy to increase physical activity in overweight and obese children . However , the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown . OBJECTIVE To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence -based weight management program delivered in the community . DESIGN , SETTING , AND PARTICIPANTS Group-r and omized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts , Rhode Isl and , and Texas . Seventy-five overweight or obese children ( 41 girls [ 55 % ] , 34 whites [ 45 % ] , 20 Hispanics [ 27 % ] , and 17 blacks [ 23 % ] ) enrolled in a community-based pediatric weight management program . Mean ( SD ) age of the participants was 10.0 ( 1.7 ) years ; body mass index ( BMI ) z score , 2.15 ( 0.40 ) ; and percentage overweight from the median BMI for age and sex , 64.3 % ( 19.9 % ) . INTERVENTIONS All participants received a comprehensive family-based pediatric weight management program  ( JOIN for ME ) . Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program . Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program . MAIN OUTCOMES AND MEASURES Objective ly measured daily moderate-to-vigorous and vigorous physical activity , percentage overweight , and BMI z score . RESULTS Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous ( mean [ SD ] , 7.4 [ 2.7 ] min/d ) and vigorous ( 2.8 [ 0.9 ] min/d ) physical activity at week 16 ( P < .05 ) . In the program-only group , a decline or no change was observed in the moderate-to-vigorous ( mean [ SD ] net difference , 8.0 [ 3.8 ] min/d ; P = .04 ) and vigorous ( 3.1 [ 1.3 ] min/d ; P = .02 ) physical activity . Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16 . However , the program and active gaming group exhibited significantly greater reductions in percentage overweight ( mean [ SD ] , -10.9%[1.6 % ] vs -5.5%[1.5 % ] ; P = .02 ) and BMI z score ( -0.25 [ 0.03 ] vs -0.11 [ 0.03 ] ; P < .001 ) . CONCLUSIONS AND RELEVANCE Incorporating active video gaming into an evidence -based pediatric weight management program has positive effects on physical activity and relative weight . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01757925 Background : Exergames ( i.e. , video games that require gross motor activity ) may provide intrinsically motivating experiences that engage youth in sustained physical activity . Method : Thirty-one low-income 15– to 19-year-old overweight and obese African American adolescents were r and omly assigned to a competitive exergame ( n = 17 ) or a cooperative exergame ( n = 14 ) condition . Participants played a preassigned Wii Active exergame routine that took between 30 and 60 min each school day , and sessions occurred during lunch time or an after-school program over a 6 month period . Participation was voluntary , so students decided whether to come or not on a given day . Cooperative exergame players worked together with a peer to expend calories and earn points , while competitive exergame players competed individually against a peer to expend calories and earn points . Motivation was measured through surveys and interviews at the end of the intervention , and energy expenditure was measured by accelerometry during game play . Results : Compared with the competitive group , the cooperative players were significantly more intrinsically motivated to play ( p = .034 , partial eta-squared = 0.366 ) and more psychologically attracted to the design of the exergame ( p = .034 , partial eta-squared = 0.320 ) . Intrinsic motivation was significantly positively correlated with energy expenditure during game play : Individuals who were motivated by control/choice had higher energy expenditure ( p = .026 ) , and those who were more goal motivated ( p = .004 ) and more immersed in game play ( p = .024 ) had lower energy expenditure during game play . Conclusions : Cooperative exergame play produced higher intrinsic motivation to play the exergame than competitive exergame play did . Intrinsic motivation that came from a desire for control/choice was related to higher energy expenditure during game play . Cooperative exergame play holds promise as a method for engaging overweight and obese youth in physical activity OBJECTIVE We evaluated the feasibility of a trial of Wii interactive video gaming , and its potential efficacy at improving cognitive functioning compared with health education , in a community sample of older adults with neuropsychologically defined mild cognitive impairment . METHODS Twenty older adults were equally r and omized to either group-based interactive video gaming or health education for 90 min each week for 24 weeks . Although the primary outcomes were related to study feasibility , we also explored the effect of the intervention on neuropsychological performance and other secondary outcomes . RESULTS All 20 participants completed the intervention , and 18 attended at least 80 % of the sessions . The majority ( 80 % ) of participants were " very much " satisfied with the intervention . Bowling was enjoyed by the most participants and was also rated the highest among the games for mental , social , and physical stimulation . We observed medium effect sizes for cognitive and physical functioning in favor of the interactive video gaming condition , but these effects were not statistically significant in this small sample . CONCLUSION Interactive video gaming is feasible for older adults with mild cognitive impairment , and medium effect sizes in favor of the Wii group warrant a larger efficacy trial BACKGROUND Video game playing has been linked to obesity in many observational studies . However , the influence of this sedentary activity on food intake is unknown . OBJECTIVE The objective was to examine the acute effects of sedentary video game play on various components of energy balance . DESIGN With the use of a r and omized crossover design , 22 healthy , normal-weight , male adolescents ( mean ± SD age : 16.7 ± 1.1 y ) completed two 1-h experimental conditions , namely video game play and rest in a sitting position , followed by an ad libitum lunch . The endpoints were spontaneous food intake , energy expenditure , stress markers , appetite sensations , and profiles of appetite-related hormones . RESULTS Heart rate , systolic and diastolic blood pressures , sympathetic tone , and mental workload were significantly higher during the video game play condition than during the resting condition ( P < 0.05 ) . Although energy expenditure was significantly higher during video game play than during rest ( mean increase over resting : 89 kJ ; P < 0.01 ) , ad libitum energy intake  after video game play exceeded that measured after rest by 335 kJ ( P < 0.05 ) . A daily energy surplus of 682 kJ ( 163 kcal ) over resting ( P < 0.01 ) was observed in the video game play condition . The increase in food intake  associated with video game play was observed without increased sensations of hunger and was not compensated for during the rest of the day . Finally , the profiles of glucose , insulin , cortisol , and ghrelin did not suggest an up-regulation of appetite during the video game play condition . CONCLUSION A single session of video game play in healthy male adolescents is associated with an increased food intake , regardless of appetite sensations . The trial was registered at clinical trials.gov as NCT01013246 Background : Childhood obesity has been becoming a worldwide public health problem . We conducted a community-based physical activity ( PA ) intervention program aim ing at childhood obesity prevention in general student population in Nanjing of China , the host city of the 2nd World Summer Youth Olympic Games ( YOG-Obesity study ) . Methods : This was a cluster r and omized controlled intervention study . Participants were the 4th ( mean age±s.e . : 9.0±0.01 ) and 7th ( mean age±s.e . : 12.0±0.01 ) grade students ( mean age±s.e . : 10.5±0.02 ) from 48 schools and r and omly allocated ( 1:1 ) to intervention or control groups at school level . Routine health education was provided to all schools , whereas the intervention schools additionally received an 1-year tailored multi-component PA intervention program , including classroom curricula , school environment support , family involvement and fun programs/events . The primary outcome measures were changes in body mass index , obesity occurrence and PA . Results : Overall , 9858 ( 97.7 % ) of the 10091 enrolled students completed the follow-up survey . Compared with the baseline , PA level increased by 33.13 min per week ( s.e . 10.86 ) in the intervention group but decreased by 1.76 min per week ( s.e . 11.53 ) in the control group ( P=0.028 ) . After adjustment for potential confounders , compared with the control group , the intervention group were more likely to have increased time of PA ( adj . Odds ratio=1.15 , 95 % confidence interval=1.06–1.25 ) , but had a smaller increase in mean body mass index ( BMI ) ( 0.22 ( s.e . 0.02 ) vs 0.46 ( 0.02 ) , P=0.01 ) and BMI z-score ( 0.07 ( 0.01 ) vs 0.16 ( 0.01 ) , P=0.01 ) , and were less likely to be obese ( adj . Odds ratio=0.7 , 95 % confidence interval=0.6 , 0.9 ) at study end . The intervention group had fewer new events of obesity/overweight but a larger proportion of formerly overweight/obese students having normal weight by study end . Conclusions : This large community-based PA intervention was feasible and effective in promoting PA and preventing obesity among the general student population in a large city in China . Experiences from this study are the lessons for China to control the childhood obesity epidemic CONTEXT Some observational studies have found an association between television viewing and child and adolescent adiposity .  OBJECTIVE To assess the effects of reducing television , videotape , and video game use on changes in adiposity , physical activity , and dietary intake . DESIGN R and omized controlled school-based trial conducted from September 1996 to April 1997 . SETTING Two sociodemographically and scholastically matched public elementary schools in San Jose , Calif. PARTICIPANTS Of 198 third- and fourth- grade students , who were given parental consent to participate , 192 students ( mean age , 8.9 years ) completed the study . INTERVENTION Children in 1 elementary school received an 18-lesson , 6-month classroom curriculum to reduce television , videotape , and video game use . MAIN OUTCOME MEASURES Changes in measures of height , weight , triceps skinfold thickness , waist and hip circumferences , and cardiorespiratory fitness ; self-reported media use , physical activity , and dietary behaviors ; and parental report of child and family behaviors . The primary outcome measure was body mass index , calculated as weight in kilograms divided by the square of height in meters . RESULTS Compared with controls , children in the intervention group had statistically significant relative decreases in body mass index ( intervention vs control change : 18.38 to 18.67 kg/m2 vs 18.10 to 18.81 kg/m2 , respectively ; adjusted difference -0.45 kg/m2 [ 95 % confidence interval [ CI ] , -0.73 to -0.17 ] ; P = .002 ) , triceps skinfold thickness ( intervention vs control change : 14.55 to 15.47 mm vs 13.97 to 16.46 mm , respectively ; adjusted difference , -1.47 mm [ 95 % CI , -2.41 to -0.54 ] ; P=.002 ) , waist circumference ( intervention vs control change : 60.48 to 63.57 cm vs 59.51 to 64.73 cm , respectively ; adjusted difference , -2.30 cm [ 95 % CI , -3.27 to -1.33 ] ; P<.001 ) , and waist-to-hip ratio ( intervention vs control change : 0.83 to 0.83 vs 0.82 to 0.84 , respectively ; adjusted difference , -0.02 [ 95 % CI , -0.03 to -0.01 ] ; P<.001 ) . Relative to controls , intervention group changes were accompanied by statistically significant decreases in children 's reported television viewing and meals eaten in front of the television . There were no statistically significant differences between groups for changes in high-fat food intake , moderate-to-vigorous physical activity , and cardiorespiratory fitness . CONCLUSIONS Reducing television , videotape , and video game use may be a promising , population -based approach to prevent childhood obesity CONTEXT Children 's exposure to violence , blood , sexual themes , profanity , substances , and gambling in the media remains a source of public health concern . However , content in video games played by older children and adolescents has not been quantified or compared with the rating information provided to consumers by the Entertainment Software Rating Board ( ESRB ) . OBJECTIVES To quantify and characterize the content in video games rated T ( for " Teen " ) and to measure the agreement between the content observed in game play and the ESRB-assigned content descriptors displayed on the game box . DESIGN AND SETTING We created a data base of all 396 T-rated video game titles released on the major video game consoles in the United States by April 1 , 2001 , to identify the distribution of games by genre and to characterize the distribution of ESRB-assigned content descriptors . We r and omly sample d 80 video game titles ( which included 81 games because 1 title included 2 separate games ) , played each game for at least 1 hour , quantitatively assessed the content , and compared the content we observed with the content descriptors assigned by the ESRB . MAIN OUTCOME MEASURES Depictions of violence , blood , sexual themes , gambling , and alcohol , tobacco , or other drugs ; whether injuring or killing characters is rewarded or is required to advance in the game ; characterization of gender associated with sexual themes ; and use of profanity in dialogue , lyrics , or gestures . RESULTS Analysis of all content descriptors assigned to the 396 T-rated video game titles showed 373 ( 94 % ) received content descriptors for violence , 102 ( 26 % ) for blood , 60 ( 15 % ) for sexual themes , 57 ( 14 % ) for profanity , 26 ( 7 % ) for comic mischief , 6 ( 2 % ) for substances , and none for gambling . In the r and om sample of 81 games we played , we found that 79 ( 98 % ) involved intentional violence for an average of 36 % of game play , 73 ( 90 % ) rewarded or required the player to injure characters , 56 ( 69 % ) rewarded or required the player to kill , 34 ( 42 % ) depicted blood , 22 ( 27 % ) depicted sexual themes , 22 ( 27 % ) contained profanity , 12 ( 15 % ) depicted substances , and 1 ( 1 % ) involved gambling . Our observations of 81 games match the ESRB content descriptors for violence in 77 games ( 95 % ) , for blood in 22 ( 27 % ) , for sexual themes in 16 ( 20 % ) , for profanity in 14 ( 17 % ) , and for substances in 1 ( 1 % ) . Games were significantly more likely to depict females partially nude or engaged in sexual behaviors than males . Overall , we identified 51 observations of content that could warrant a content descriptor in 39 games ( 48 % ) in which the ESRB had not assigned a content descriptor . We found that the ESRB assigned 7 content descriptors for 7 games ( 9 % ) in which we did not observe the content indicated within 1 hour of game play . CONCLUSIONS Content analysis suggests a significant amount of content in T-rated video games that might surprise adolescent players and their parents given the presence of this content in games without ESRB content descriptors . Physicians and parents should be aware that popular T-rated video games may be a source of exposure to a wide range of unexpected content A number of studies have shown that training on action video games improves various aspects of visual cognition including selective attention and inhibitory control . Here , we demonstrate that action video game play can also reduce the Simon Effect , and , hence , may have the potential to improve response selection during the planning and execution of goal -directed action . Non-game-players were r and omly assigned to one of four groups ; two trained on a first-person-shooter game ( Call of Duty ) on either Microsoft Xbox or Nintendo DS , one trained on a visual training game for Nintendo DS , and a control group who received no training .  Response times were used to contrast performance before and after training on a behavioral assay design ed to manipulate stimulus-response compatibility ( the Simon Task ) . The results revealed significantly faster response times and a reduced cost of stimulus-response incompatibility in the groups trained on the first-person-shooter game . No benefit of training was observed in the control group or the group trained on the visual training game . These findings are consistent with previous evidence that action game play elicits plastic changes in the neural circuits that serve attentional control , and suggest training may facilitate goal -directed action by improving players ’ ability to resolve conflict during response selection and execution In r and omized clinical trials , children and adolescents improved their self care and reduced their emergency clinical utilization after playing health education and disease management video games . A diabetes game reduced diabetes-related urgent and emergency visits by 77 percent after diabetic youngsters had the game at home for six months , compared to no reduction in clinical utilization in a control group of diabetic youngsters who took home an entertainment video game that had no health content . Positive impacts were also found in clinical trials of games for asthma self-management and smoking prevention BACKGROUND The purpose of the study was to explore the association among the following variables : physical activity , TV , videogames , and obesity . The study included a Portuguese r and om nationally representative sample of 3365 children ( 1610 girls and 1755 boys ) 7 - 9 year olds . METHODS A general question naire was completed by the parents of participating children to provide information about the hours spent per week watching television , computer use and electronic games , and the participation in physical education .  Overweight and obesity were calculated by using the body mass index ( BMI ) assessment and the cut-off points for overweight ( 25 kg/m(2 ) ) and obesity ( 30 kg/m(2 ) ) . RESULTS The data from the association between BMI and the independent variables ( analysis of variance ) were only significant for time playing electronic games for boys and girls ( P < 0.001 ; P < 0.029 ) . The association between hours of watching TV and BMI was significant only for boys ( P < 0.016 ) . The results from the logistic regression were only significant for electronic games both for boys and girls ( P < 0.000 ; P < 0.000 ) . CONCLUSIONS The results of this study suggest that the time spent playing electronic games is associated with obesity . Reducing childhood obesity calls for the reduction in sedentary behaviours , and the promotion of a more active lifestyle
Reflecting public health interest in the potential of exergames to encourage PA , many review s of this literature have appeared.18 - 20 Some review s have been sympathetic,21,22 whereas others have been critical.23,24 A reasonably balanced assessment revealed that , in research laboratories , exergames could provide an intense workout that included moderate-to-vigorous PA  , but under less-supervised circumstances , children tended not to get much activity18 and their interest in the activity waned over 1 week or less .
Video games , the most commonly enjoyed medium by this generation of children , generates more money than Hollywood productions .
Forty percent of these studies influenced obesity or obesogenic behavior in the desired directions.12 A roundtable discussion of investigators of G4H and obesity indicated substantial potential for video games to reduce child obesity , but emphasized the need for games to be fun , not just health promoting.13 Some of the obesity-related studies used games specially design ed to target diet and /or PA change outside the games.14 - 17 " Squire 's Quest ! , "