Table 3.

Characteristics of included studies.

Authors (Year) Country	Study description	Population	Frequency and duration	AVGs	Instrument	Measurement and main outcome	Key findings
Jacobs et al. (51)	To determine the feasibility of Nintendo Wii Fit to encourage undergraduate students to lose weight through a 12-week intervention program.	F = 5 Age ≥ 18 BMI ≥ 18 Race: Asian(n = 2,40%). White (n = 2, 40%). Mexican (n = 1, 20%).	Experimental group: 45 min each time, 4 times a week. Control group: walking to class. Duration is 12 weeks.	Nintendo Wii Wii Fit	1.Pedometer 2.Standard bathroom scale or Wii Fit balance board 3.Activity Level Test Questionnaire 4.BREQ-2 5.PAR-Q	1.Body weight and BMI. 2.Participants’ current activity level, personal exercise motivation, and physical health. 3.Measure RPE every Wii session. 4.Record steps, activity and self-reported daily food every day BMI↓, weight↓ sports motivation↑, PAL ↔	Using Wii Fit for exercise can increase exercise motivation and be used as a tool for college students to control their weight individually.
Peng et al. (52)	To assess the potential of active video games informed by theoretical guidance to enhance both MVPA and game involvement among college students, while also decreasing their sedentary behaviour.	F = 56; M = 65 (Invalid number, n = 31) Age: 18–25 Race: Asian (n = 11, 9.1%). White(n = 90,74.4%). African American (n = 12, 9.9%). Other (n = 8, 6.6%).	Experimental group: Three times a week for 4 weeks. Control group: no treatment.	A third person, fantasy role-playing game	ACTi Graph GT3X accelerometers PACES Active inputs (Wii mote, Nunchuk, and dance pad) Controller input (Xbox 360 controller)	1.Baseline measurement in week 0 2.Physical activity was objectively measured at week 0 (baseline), and week 1 and 5. 3.Calculate the attendance rate 4.Measure the players’ enjoyment, perceived need satisfaction of competence, and future play motivation in the first and fourth weeks. MVPA↑, attendance↑, psychological need satisfaction↑	An AVG designed with the motivation theory has a positive impact on attendance and MVPA, and can improve the effectiveness of AVG.
Warburton et al. (47)	To assess the efficacy of AVGs (combined with stationary cycling) in enhancing exercise adherence relative and physical fitness when compared to cycling training.	M = 14 Age: 18–25 BMI: Intervention group =27 ± 6. Control group = 28 ± 6.	30 min each time, three times a week. Duration is 6 weeks.	Sony PlayStation Game Bike	1.Polar s-510 2.Bioelectrical impedance 3.Television monitor 4.Electronically braked cycle ergometer 5.Metabolic cart 6.CPALFA 7.Vertec device 8.Flexometer 9.Pulse Wave	1.Attendance rates were monitored. 2.Physical fitness (VO2max, body composition, muscle strength, muscle burst, and flexibility) and resting blood pressure. VO2max↑, BM↔, BMI↔, FM↔, LBM↔, RSP↓, SBP↓	Compared to traditional bicycle training, AVG combined with fixed bicycles can lead to greater health improvements, and higher attendance leads to more physical activity.
Rodrigues et al. (50)	To compare metabolic and cardiovascular responses when using the AVG with and without the Mini trampoline.	M = 19 Age: 20.6 ± 2.01	Eight minutes each time, two times in total (with an interval of 2 days). Duration is 1 week.	Nintendo Wii Fit Plus Free Run	Bioelectrical Impedance Analyzer VO2000 portable automated system, treadmill, and prevent Pneumotach Polar	Day 1: measure height, weight, body composition, VO2 max and HR max Day 4: VO2, HR, and METs were measured in both MT-PT and EXG-PT groups. Day 7: experimental and control groups exchange game conditions. PAL↑, %VO2max↑, %HRmax↑, METs↑	Playing AVG on MT has greater physiological needs than playing AVG in traditional ways and can achieve moderate to intense physical activity. MT is an additional tool to enhance the physiological response when playing AVG.
Rahayu et al. (48)	To determine the effect of playing AVG (only use the upper and lower limbs) on BG, HR, and SpO2.	M = 24 Age: ±20 BMI: upperEx =24.6 ± 2.93. lowerEx =23.4 ± 2.47. control =24.6 ± 3.15.	Play avg. of 30 min. Lasts 120 min.	XBOX or Nintendo Wii	1.Accucheck Performa glucometer 2.OxyOne Finger Pulse Oximeter	1.Measure fasting BG, HR, SpO2 2.A sweet drink was given to all participants. Measure BG, HR, SpO2 at 30, 60, 90, 120 min 3.AVG groups played AVG within 30 to 60 min, while the control group did not exercise. SpO2↔, HR↔,BG↓	Only the upper and lower AVGs effect BG and HR, but will not affect the SpO+ of college students. Playing with upper and lower limb AVG is beneficial for health.
Russell et al. (53)	To examine AVG’s physiological and affective responses across user experience and social conditions (paired vs. solo).	F = 19; M = 29 Age: F = 21.4 ± 5.6. M = 22.4 ± 5.7.	30 min each time, two times total (Paired mode and solo mode).	Nintendo Wii Punchout	1.PAR-Q 2.Polar 3.Body fat analyser 4.StepWatch 3 pedometers 5.Borg’s modified 10-point scale 6.POMS	1.Physical Measures: in solo and paired mode, record heart rate every minute, and measure RPE every 5 min. Measure RecHR and SeRPE for 15 min after exercise. 2.Mood: Use the POMS scale 5 min before exercise, 5 min and 15 min after exercise to measure mood changes. resting HR↔, Steps↔, mood↔	Physical and emotional responses are not influenced by experience or social conditions when playing Wii punchout. Using AVG as a potential alternative to traditional sports activities requires consideration.
Douris et al. (54)	To contrast the physiological and psychological reactions between college students engaging in Nintendo Wii Fit games and those participating in moderate-intensity brisk walking for an equivalent duration.	F = 12; M = 9 Age: 23.2 ± 1.8 BMI:23.7 ± 3.7	30 min per day for 2 days. (One week apart).	Nintendo Wii Fit Free Run	1.PAR-Q 2.Standing blood pressure cuff 3.Stethoscope 4.Digital body weight scale, stopwatch, and measuring tape. 5.SEES 6.Treadmill	1.Every session was measured at 5-min intervals for HR, RR, BP, and RPE. 2.After each exercise condition, measurements of HR, BP, RPP, RPE, and SEES were recorded. HRmax↑, RPP↑, RPE↑, positive well-being↓	Wii Fit Free Run could serve as a viable alternative to conventional moderate-intensity aerobic exercise.
De Brito-Gomes et al. (49)	To examine and contrast the effects of structured and unstructured AVG on physical activity and motivation. Use indirect measure analysis (heart rate) to verify the effect of AVG on physical activity.	M = 13 Age: 19.4 ± 1.6 BMI: structured AVG = 23.6 ± 3.3. unstructured AVG = 22.6 ± 2.0	30 min each time, three times a week. Duration is 6 weeks (18 lessons).	XBOX 360 Kinect Kinect Sports: Boxing 2. Nike Kinect: Training	PAR-Q Polar FT1 2.Automated blood pressure machine 3.Metabolic gas analyser 4.Borg Scale (6–20 points) 5.Multimedia projector	1.Baseline assessments of height, BW, resting HR, BP, AE (VO2max), and peak workload. 2.Hemodynamic and inotropic measures SBP and DBP 3.In each session, measure maximum HR and average HR, RPE, EE, and MET through mathematical formulas. AE↔, pkHR↔,RPE↔, motivation↔, averge HR↑, MET↑, EE↑	The indirect measurements can analyse physical effort intensity. Structured AVG shows better HR and EE response than unstructured AVG.

BREQ-2, the Behavioural Regulation in Exercise Questionnaire-2; PAR-Q, Physical Activity Readiness Questionnaire; F, female; M, male; RPE, ratings of perceived exertion; SDT, self-determination theory; PACES, The Physical Activity Enjoyment Scale; CPAFLA, Canadian Physical Activity Fitness and Lifestyle Approach; MT, mini-trampoline; MT-PT, play AVG on mini-trampoline; EXG-PT, play AVG on wooden surface; BG, blood glucose; HR, heart rate; OSL, oxygen saturation levels; SpO₂, the percentage of oxygen saturation; upperEx, upper only extremities exergaming; lowerEx, only extremities exergaming; HRR, heart rate reserve; THR, target heart rate; pkHR, peak heart rate; RecHR, recovery heart rate; SeRPE, post exercise session rating of perceived exertion; POMS, The Profile of Mood States; RPP, rate pressure product; BP, blood pressure; BW, body weight; RSP, resting blood pressure; RR, respiratory rate; SEES, Subjective Exercise Experience Scale; SBP, systolic blood pressure; DBP, diastolic blood pressure; EE, energy expenditure; MET, metabolic equivalent; BM,body mass; BMI, body mass index; FM, fat mass; LBM, lean body mass;↑, significant improvement; ↓, significant decrease; ↔, no significant difference.