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Active Video-Gaming: The Next Step?

Competition is heating up as other companies enter the active video gaming (AVG) sector to challenge the Wii. Children and adults alike have taken to the fun associated with physically interactive games. In fact, manufacturers suggest that these games may be an important part of modern lifestyle activities. Several recent research studies have explored the actual contribution these games have on daily energy expenditure with mixed reviews. The Journal of Science and Medicine in Sport (2010) examined gaming outcomes in energy expenditure for 11 and 12 year old boys (n=26). Subjects participated in both sedentary (resting, watching television and sedentary gaming), and active playing activities on the Nintendo Wii (Bowling, Boxing, Tennis, and Wii Fit Skiing and Step), as well as performed traditional walking and running, including a maximal fitness test.

The active video gaming resulted in statistically significant higher energy expenditure when compared to the sedentary activities. Interestingly, researchers found no significant differences in energy expenditure between the most active video games and normal walking. Researchers concluded, that although boys expend more energy during active gaming compared to sedentary activities, the actual energy expenditure is video game-specific and even the most active of the games tested were not intense enough to contribute toward the recommended 60 minutes of daily moderate-to-vigorous physical activity.

In a related review published in the Archives of Pediatric and Adolescent Medicine (2010), researchers reviewed the literature to identify the levels of metabolic expenditure and changes in activity patterns associated with active video game play in children. Investigators analyzed twelve studies of energy expenditure during AVG play compared with rest and six studies of activity associated with AVG exposure. Activity levels varied among AVG game play. Energy expenditure was significantly lower for games played primarily through upper body movements compared with those that primarily engaged the lower body. Researchers concluded that active video gaming can elicit light to moderate physical activity, but that there was not enough evidence to draw conclusions on the long-term efficacy of AVGs for adequate physical activity promotion.

Active video gaming is not just for kids. To demonstrate the potential impact of AVG on adults, researchers from National Institute of Health and Nutrition, Tokyo, Japan analyzed the energy expenditure of adults while participating in Wii Fit Plus and Wii Sports game activities. The research published in Medicine and Science in Sports and Exercise (2010) used twelve adult men and women. Each performed five activities of Wii Sports (golf, bowling, tennis, baseball, and boxing) and 63 activities of Wii Fit Plus (yoga, resistance, balance, and aerobic exercises). Each activity was continued for at least 8 minutes while energy expenditure was assessed in an open-circuit indirect metabolic chamber. Investigators calculated MET value from resting and steady-state energy expenditure during each activity. The mean MET values of all 68 activities ranged widely, from 1.3 METs (yoga) to 5.6 METs (resistance). The mean MET values in Wii Fit Plus was 2.6, with resistance training and aerobic activities demonstrating the highest yield, while the mean of Wii Sports was 3.0 METs. Of all the activities examined, 46 averaged less than 3 METs, and were classified as light intensity, and 22 activities were classified as moderate intensity (defined by a measure between 3.0-6.0 METs). No activities reached the vigorous-intensity level (>6.0 METs). Researchers concluded that adults may use the most physically demanding activities of AVG as part of a strategy to meet the goal of at least 30 minutes of moderate exercise five days a week.

Although the AVG activities are relatively low in intensity they still are associated with a risk for injury. A review of the literature demonstrates that active video gaming increases one’s risk for soft tissue injury and even the potential of fractures. It is unclear whether it is a matter of overuse or overexertion but recent peer articles including studies published in Informatics in Primary Care (2009) and Physician and Sports Medicine (2009) demonstrate the plausible concern for AVG injury. Researchers reviewed the database of self-reported Wii related injuries and categorized the data by type of injury and game-related injury to investigate if there were any identifiable injury patterns associated with Wii use. Although the likelihood of injury being reported is very low, 39 Wii related injuries were documented over a two-year span (2007-2009). A particularly high percentage (46%) occurred while playing the Wii Sports Tennis. In addition, investigators found 14 distinct injury patterns (including laceration) were sustained during AVG play. According to the National Electronic Injury Surveillance System (NEISS) for 2007, results indicated that females were more prone to injuries and the mean age for injury was 16 years. Consistent with the aforementioned, the NEISS stated most injuries were soft tissue in nature and located in the shoulders, hands and fingers, face and neck region although Wii knee, Wii shoulder, and Wii elbow have been discussed in the literature.

Even with the possible risk of overuse/exertion the active video games have demonstrated positive outcomes for (ironically) the elderly population. In a study published in the Health Promotion Journal of Australia (2010) researchers interviewed direct care staff in 54 centers that used the Wii technology. Based on responses researchers found those considered “more able” clients easily mastered the Wii activities with minimal risk. Additionally respondents reported that the active gaming activities provided health promoting physical benefits including improvements in mobility, range of motion, dexterity, coordination, distraction from pain along with psychosocial gains such as social engagement, self-esteem, mastery, and ability to pacify challenging behaviors. Caretakers reported the active games were a useful adjunct to other care practices within these aged-care and disabilities services. The authors concluded based on staff interview that “Wii activities provided purposeful and meaningful opportunities to promote wellbeing for aged and disabled clients within an aged-care and disability service.” The caretakers though suggested those clients who had significant cognitive and/or physical disabilities did not find the same success. These outcomes are likely associated with the MET levels identified in the previous studies, as light exercise is known be better tolerated by those with higher faculties in an assisted care environment.

Based on the findings it seems that AVG activities provide benefit when they replace sedentary behavior and may be a suitable adjunct for those in assisted living facilities. Adults and children alike may enjoy the activities on a routine basis with limited risk based on the literature, but warning of risks related to overuse or over exertion are increasing in anecdotal reports and practical environments. Any physical activity is a move in the right direction and video gaming can certainly play a role, but as it stands, active video games have not replaced the need for routine exercise. If video games are a part of a strategy for increased physical activity a variety of actions should be employed to prevent overuse injuries and balance health related components of fitness.

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