The increasing prevalence of overweight and obese individuals, particularly among children, has raised awareness of the need for comprehensive lifestyle modification. Included as part of these modifications is improved diet and increased physical activity. Currently, strong evidence exists that frequent physical activity promotes improvements in cardiovascular status, muscular strength, and overall health status in children (16). In addition, more active adults demonstrate lower rates of all-cause mortality, cardiovascular disease, high blood pressure, metabolic syndrome, colon cancer, breast cancer, and depression (17). These advantages are held through older age, with physically active seniors demonstrating improved functional and cognitive health, as well as a reduced risk for falls (17). Yet, despite these known benefits, exercise intervention strategies in both children and adults have demonstrated limited results.
Exercise programming also plays a significant role in the success of physical activity interventions. In particular, adding activities that are enjoyable and interesting tends to provide additional motivation and enhance compliance (5). Lifetime physical activity, beyond that of structured exercise, can help play a significant role in improving health, reducing disease, and maintaining functional independence throughout a lifetime.
ACTIVE GAMING ON ENERGY EXPENDITURE IN CHILDREN
Physical activity helps prevent a myriad of cardiovascular, metabolic, and psychological disorders in children (Table). In addition, increased sedentary time has been associated with increased adiposity among children (21). Currently, many children and adolescents are not meeting physical activity guidelines and are often sedentary because of the extended screen time associated with television viewing and computer use (8,20). Unfortunately, this trend worsens with age, particularly into adolescence (1,9). Although conventional exercise programs, including sports and outside play, provide the traditional modes for energy expenditure, limitations exist for many because of a lack of interest or availability, limited structure or supervision availabilities, or a diminished entertainment value associated with the activity. These limitations often lead to a withdrawal from exercise or limited participation in physical activity.
Video game popularity has increased significantly during the past decade (4,18), leading to an increase in the amount of sedentary leisure time spent in front of a computer or television screen (2,19). Recent technological innovations have introduced more active opportunities that help facilitate increased energy expenditure during various gaming formats. Dance Dance Revolution, an interactive dancing game set to music, has been found to increase energy expenditure by 68% versus seated video games (10), and in overweight and obese children, was able to increase heart rate to intensities that met recommendations of the American College of Sports Medicine (ACSM) for developing and maintaining cardiorespiratory fitness (22). More recently, motion-capture technology has allowed today's video games to become more interactive and allow for active participation in sporting and recreational activities. These games, which include boxing, golf, tennis, and baseball, have shown to increase energy expenditure by up to 6.5 kcal min-1 above resting levels and increased heart rate values up to 142 beats per minute in children aged 10 to 14 years (12,13).
USE OF ACTIVE GAMING TO PROMOTE PHYSICAL ACTIVITY IN ADULTS
American adults are recommended to participate in a minimum of 30 minutes per day of moderate to vigorous physical activity (6). Although most American adults do not achieve this recommended level of physical activity on a daily basis, more than half (53%) play video games, with 21% of them playing them on a daily basis (11). Although the rise in sedentary behavior has been linked to an increase in chronic diseases and obesity (17,23), traditional structured exercise and sporting activities have failed to elicit sufficient participation by most adults in a physically active lifestyle. To counter this, appropriate exercise programming should focus on activities that are safe, effective, and fun. In addition, activities designed to increase fitness should do so without increasing the risk for cardiovascular or musculoskeletal complications, yet should meet recommended levels of intensity, frequency, and duration. Active gaming would appear to meet these recommendations, particularly because the number of adults who play video games as part of their daily entertainment continues to rise. By using active gaming to increase energy expenditure during times previously reserved for sedentary activity, there seems to be potential to positively contribute to the health and fitness profiles of adults.
The potential for using active gaming activities as part of an overall physical activity program for adults has shown promise. Miyachi and associates (14) demonstrated that one third of the activities supplied in an active gaming system (Nintendo Wii) provided activities that fell into a moderate-intensity level (3-6 metabolic equivalents), thereby providing sufficient energy expenditure to partially count toward the daily amount of moderate activity required in ACSM's and the American Heart Association's physical activity recommendations (6,14). Although these increases in energy expenditure during the simulated sporting events did not meet the energy costs associated with the actual sport, the moderate-intensity levels associated with active gaming could provide sufficient energy expenditure to effectively prevent weight gain (14) and perhaps elicit weight loss. This energy expenditure would be in addition to daily physical activity and could accompany time already spent playing games, except with more activity.
POTENTIAL BENEFITS ASSOCIATED WITH ACTIVE GAMING IN THE SENIOR POPULATION
Benefits associated with active gaming also may be extended to the elderly population. Although moderate-intensity aerobic training programs have been associated with an increased exercise capacity in those older than 80 years (24), those up to age 92 years (7) have shown benefits with even low-intensity training. Thus, the use of an active gaming system would seem to have potential benefits in this population to maintain good health, promote functional independence, and reduce premature disability.
Additional benefits also could include the prevention of falls, as this is the leading cause of disability and injury deaths for those older than 65 years (15). Balance training and fall prevention could be enhanced because interactive gaming (e.g.,Nintendo Wii) offers variable exercises in the light-to-moderate range, many of which are aimed at balance and flexibility (14).
Although it seems that active gaming may provide an additional mechanism for increasing physical activity across the age continuum, additional research is needed to confirm the associated efficacy and behavioral aspects required to add this form of activity on a daily basis (16). The benefits of active gaming only will be achieved if it becomes as accepted as sedentary gaming is currently, and other entertainment alternatives are then replaced (16). In addition, active gaming will have to substitute for other nonactive leisure activities (16), reducing sedentary free-time activity. Because children and adults are most likely to engage in physical activities in which they feel competent and that they find enjoyable (3), it is essential that the video game industry continue to develop and produce active games that are accessible and of interest to a diverse group of individuals (16). Moreover, for active gaming to become a mainstream contributor to improved physical conditioning, societal issues will have to be addressed. Whereas current trends are to manufacture activity out of our lifestyle through improved technological advancements (i.e., moving sidewalks, computers), a role reversal will have to occur that allows a reintroduction of activity into leisure time. Although it is unlikely that video gaming will provide a complete resolution to the cardiovascular, metabolic, or obesity concerns present today, providing alternatives to traditional standardized exercise may increase accessibility to a physically active lifestyle. If started at an earlier age, perhaps through an introduction to active gaming, improvements may be seen in our ability to maintain a more physically active lifestyle through adulthood and old age, and thus, slow or reverse the trend of poor cardiovascular and metabolic health.
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