The Effects of Active Videogames on BMI among Young People: A Meta-Analysis

Introduction

For children and adolescents, rigorous physical exercise contributes to a healthy body weight (Must & Tybor, 2005). Promoting exercise is challenging, however, because physical activity has multiple antecedents (Bauman, Sallis, Dzewaltowski, & Owen, 2002). Interventions have generally had small effects (Brawley, Rejeski, & King, 2003; Waters et al., 2011) and have not been able to reverse an alarming increase in obesity rates (Ogden, Carroll, Curtin, Lamb, & Flegal, 2010). Therefore, it is critical that we try to identify novel approaches to promoting exercise. In the present chapter, we investigate whether so called active videogames (AVGs) are an effective instrument to promote exercise among children and adolescents.

AVGs are defined as “interactive video or electronic games that feature player movement, such as would occur in ‘real-life’ exercise participation” (Bailey & McInnis, 2011). In AVGs players can control avatars, obtain points and/or move the game’s narrative along by moving (parts of) their bodies. Usually, players’ movements are recorded by floor mats, infra-red cameras, or other devices, and serve as input in the game (e.g., Dance Dance RevolutionTM and Wii Sports ResortTM). Many of these games require considerable physical exertion to play the game, and hence are often denoted as ‘active videogames’ (LeBlanc et al., 2013) or ‘exergames’ (Larsen, Schou, Lund, & Langberg, 2013).

An example of a particularly popular and commercially successful AVG is Dance Dance Revolution^TM, in which players enter a virtual dancing contest. In Dance Dance Revolution^TM, players stand on a ‘dance pad’ while looking at a screen and listening to music. The dance pad contains colored arrows laid out in a cross, and the gameplay entails that players step on these arrows, timing their steps both to the rhythm of the music that is played and to arrows that appear on the screen. These on-screen arrows appear at the bottom of the screen and move upwards, passing over the ‘Step Zone’ near the top. When the moving arrows overlap with the Step Zone, the player must step on the dance pad arrows that correspond with the moving arrows on the screen. The game judges every step in terms of accuracy (from ‘miss’ to ‘marvelous’). Accurate steps fill the life bar, but inaccurate steps drain it. A fully depleted life bar means ‘game over’. Otherwise, the player is taken to the Results Screen, which rates the player’s performance. Receiving a passing score means that players will be allowed to choose another song and continue to play.

It has been repeatedly shown that active videogames such as Dance Dance Revolution^TM can result in increased physical activity, as well as related health-outcomes (Bethea, Berry, Maloney, & Sikich, 2012; Maddison et al., 2011). On the other hand, several studies have found the effect of AVGs to be non-significant (Madsen, Yen, Wlasiuk, Newman, & Lustig, 2007; Wagener, Fedele, Mignogna, Hester, & Gillaspy, 2012). The effects of AVGs among young people has been the subject of several systematic reviews (Biddiss & Irwin, 2010; LeBlanc et al., 2013; Lu, Kharrazi, Gharghabi, & Thompson, 2013; Peng, Lin, & Crouse, 2011). Importantly, conclusions in these reviews were based on statistical significance (i.e., p-values). This may not be surprising in light of the important role that p-values have traditionally played in behavioral science. Recently, however, scholars have increasingly stressed the importance of effect sizes, because these, unlike p-values, can be used if we want to estimate the substance and meaningfulness of the effect (Kline, 2004; Volker, 2006). With regards to the ‘robustness’ of these effect sizes, it has been argued that confidence intervals are more informative than p-values (Cumming, 2013). In this paper, we therefore report effect sizes and use these in a meta-analysis to be able to obtain an estimate of how meaningful and substantial the effects of AVGs actually are.