Active Video Gaming compared to Treadmill Walking and TV watching in Obese Children and Adolescents
Authors: Smith Webb , Moran Ryan A , Fu Caroline A , Scott Trent A 
Published: November 2023

BackgroundScreen time and physical inactivity have dramatically increased in the last 20 yrs contributing to the obesity epidemic. Children now report upwards of 4 hours of game playing per day occupying time previously spent active.PurposeTo examine the physiological responses to playing active video games (AVG), walking, and watching television.MethodsTwenty youth with severe obesity (11–17 yrs.) were recruited and tested at the Healthy Lifestyle Clinic at Le Bonheur Children's Hospital. A counterbalanced, crossover design was used. Following a familiarization period with the Kinect, participants completed six randomized conditions: 1) walking on a treadmill at a self‐selected speed (TM), 2) watching television (TV), 3) Fitnexx, 4) river rush (RRH), 5) reflex ridge (RFR), and 6) space pop (SP). RRH, RFR, and SP are mini games within Kinect Adventures!, an active video game for the Xbox 360. Fitnexx is a prototype active video game. Conditions lasted ten minutes with a washout period of five minutes between each condition. Heart rate (HR), ΔHR, respiratory rate (RR), rating of perceived exertion (RPE), activity level, and posture were recorded for each condition. Physiological responses were recorded in 15 second intervals using a wireless physiological monitor (BioHarness 3 by Zephyr Performance Systems). Repeated‐measures ANOVA (with Bonferroni correction) was used to examine condition differences.ResultsTwenty patients (13.3 ± 2.1 yrs., 163.7 ± 0.1 cm, 104.8 ± 28.1 kg, and 38.7 ± 7.9 BMI) completed the study. Activity during Fitnexx (0.63 ± 0.19 g) was significantly higher than all other conditions and approached a high activity level (i.e. run). Activity during TV (0.02 ± 0.01 g) was significantly lower than all conditions and considered a static activity level. TM (0.21 ± 0.04 g), RRH (0.28 ± 0.06 g), RFR (0.3 ± 0.07 g), and SP (0.2 ± 0.05 g) were moderate activity levels (i.e. walk). HR for Fitnexx (156.8 ± 12.5 bpm) was significantly higher than all other conditions. HR during TV (92.3 ± 14.9 bpm) was significantly lower than all conditions. The difference between TM (117.2 ± 18.3 bpm), RRH (128 ± 18.8 bpm), RFR (127.4 ± 17.9 bpm), and SP (121.5 ± 17.4 bpm) was not significant. ΔHR for Fitnexx (66.3 ± 13.8 bpm) was significantly higher than all other conditions. ΔHR during TV (−5.1 ± 16.5 bpm) was significantly lower than all conditions. The difference between TM (24.9 ± 11.7 bpm), RR (33.6 ± 11.8 bpm), RFR (37.3 ± 10.2 bpm), and SP (29.7 ± 8.9 bpm) was not significant. RR during TM (38.7 ± 6.1 bpm) was significantly higher than Fitnexx (29.3 ± 3.4 bpm). RR during TV (10.9 ± 4.8 bpm) was significantly lower than all conditions. RR during RRH (24.5 ± 2.7 bpm) and SP (24 ± 4.2 bpm) was not significantly different. RPE for Fitnexx (5.3 ± 3.5) was significantly higher than all other conditions. RPE during TV (0.1 ± 0.4) was significantly lower than all conditions. RPE during SP (1.4 ± 1.3) was similar to TM (1.5 ± 1.9), RRH (2.3 ± 1.8), and RFR (3.2 ± 2.6). Patients reported greater interest and enjoyment in AVG trials than walking.ConclusionAVG can increase energy expenditure and activity levels in children and adolescents with obesity. The individual movement patterns driven by story lines influence responses which may inform use in targeted exercise prescriptions. Our results support the use of AVG as a therapeutic tool to improve health and quality of life including cardiovascular fitness, muscular strength, and body awareness.Support or Funding InformationCollaborative Research Network (CORNET) Award. University of Tennessee Health Science Center. 2016