title: Active video games to promote physical activity in children and youth: a systematic review.
abstract: OBJECTIVE
  To systematically review levels of metabolic expenditure and changes in activity patterns associated with active video game (AVG) play in children and to provide directions for future research efforts.
  
  
  METHODS
  A review of the English-language literature (January 1, 1998, to January 1, 2010) via ISI Web of Knowledge, PubMed, and Scholars Portal using the following keywords: video game, exergame, physical activity, fitness, exercise, energy metabolism, energy expenditure, heart rate, disability, injury, musculoskeletal, enjoyment, adherence, and motivation.
  
  
  METHODS
  Only studies involving youth (< or = 21 years) and reporting measures of energy expenditure, activity patterns, physiological risks and benefits, and enjoyment and motivation associated with mainstream AVGs were included. Eighteen studies met the inclusion criteria. Articles were reviewed and data were extracted and synthesized by 2 independent reviewers. MAIN OUTCOME EXPOSURES: Energy expenditure during AVG play compared with rest (12 studies) and activity associated with AVG exposure (6 studies).
  
  
  METHODS
  Percentage increase in energy expenditure and heart rate (from rest).
  
  
  RESULTS
  Activity levels during AVG play were highly variable, with mean (SD) percentage increases of 222% (100%) in energy expenditure and 64% (20%) in heart rate. Energy expenditure was significantly lower for games played primarily through upper body movements compared with those that engaged the lower body (difference, -148%; 95% confidence interval, -231% to -66%; P = .001).
  
  
  CONCLUSIONS
  The AVGs enable light to moderate physical activity. Limited evidence is available to draw conclusions on the long-term efficacy of AVGs for physical activity promotion.
authors.affiliation: Bloorview Research Institute, Bloorview Kids Rehab, Toronto, Ontario, Canada. elaine.biddiss@utoronto.ca
authors.forename: Elaine
authors.initials: E
authors.lastname: Biddiss
authors.forename: Jennifer
authors.initials: J
authors.lastname: Irwin
mesh_terms: D000293:Adolescent; D004734:Energy Metabolism / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D009042:Motivation; D009043:Motor Activity / Q000502:physiology*; D018910:Video Games; D055815:Young Adult