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Published in final edited form as: Contemp Clin Trials. 2025 Feb 12;151:107846. doi: 10.1016/j.cct.2025.107846

Is Exergaming a Viable Exercise Option for Obese Black Women?

Jennifer Hicks 1, Chiranjeev Dash 1, Danyel Smith 1, James Hagberg 2, Kepher Makambi 1,3, Lucile Adams-Campbell 1
PMCID: PMC11911071  NIHMSID: NIHMS2059127  PMID: 39952553

Abstract

Background:

Physical inactivity and obesity, which are disproportionately higher in Black women, are known risk factors of breast cancer. Novel methods to address this public health concern involve leveraging screen-viewing activities to reduce sedentary behavior and increase energy expenditure levels. Exergaming has demonstrated efficacy in increasing physical activity levels, yet no studies have examined exergaming in overweight/obese Black women. The primary objective of this study was to examine the effect of exergaming on anthropometric markers among overweight/obese Black women.

Methods:

This study was a 2-arm, 6-month randomized controlled trial examining the efficacy of exergaming in improving obesity-related anthropometric markers among overweight and obese Black women (N=100). Participants randomized to the exergaming condition (n=50) engaged in supervised exergaming activities (i.e., Nintendo Wii Fit/X-box Kinect for 3 days/week; 60-minutes), while the control group (n=50) maintained current physical activity levels. Assessments on anthropometric variables, physical activity, medical history and sociodemographic variables were completed at baseline, 3-, and 6-months. Two-sample t-tests were used to examine group differences in outcome variables at 6 months.

Results:

There were no significant between-group differences observed in waist circumference (108.7(14.6) cm vs 107.2(14.8) cm), fat mass (44.3(12.8) kg vs 46.1(12.5) kg) or lean mass (47.0(6.9) kg vs 48.2(4.7) kg) at 6-months.

Conclusions:

Exergaming did not demonstrate efficacy in improving obesity-related anthropometric markers in overweight/obese Black women. Exergaming is not a viable exercise for obese women. Future studies should consider pairing exergaming with traditional exercises (i.e., variety support) and exploring other factors related to energy expenditure (e.g., motivation, enjoyment).

Keywords: Physical Activity, clinical trial, Obesity, Active Video Games, Blacks

INTRODUCTION

Americans spend significant time engaging in screen-viewing activities, such as television, computers and videogames. Studies show that users spend nearly 4–5 hours per day on computers, television, and videogames combined.[1] Engaging in more than four hours of screen-viewing activities daily is associated with nonadherence to the national physical activity recommendations.[2] Consequently, increased screen-viewing activities contributes to a sedentary lifestyle—increasing the risk for chronic diseases, such as type II diabetes and heart disease.[3–7] Given the relationship between screen-viewing activities and physical inactivity, videogames that promote physical activity continue to be developed. Active videogame systems, such as Nintendo Wii and Xbox Kinect have recently gained popularity and are being used as an innovative and exciting alternative to traditional exercise programs[8–10]. Americans spend a considerable amount of time using sedentary games; thus, it is argued that by substituting exergames for sedentary games, physical activity levels can be improved. Exergaming has been explored as a viable solution to enhance motivation for PA and adherence to structured exercise regimens.

Several studies have demonstrated that exergaming can significantly help to reduce obesity [11–15]as well as attenuate other health conditions of metabolic syndrome such as high blood pressure [11, 12], total cholesterol[16], triglycerides [12], glucose levels [12], and waist circumference [11].

Studies show that exergaming can improve cardiovascular health [17, 18]; muscular fitness[19]; and mobility and balance[20–22] In children undergoing cancer treatment, cancer-related fatigue was significantly reduced following a 5-week exergaming intervention Masoud et al [23]. Similar results were found among adult cancer survivors, who showed significant improvements in cancer-related fatigue, muscular strength and endurance and quality of life[24]

Exergaming has also shown positive effects on cognitive and psychological health among healthy adults [17, 22, 25] and college aged students [26, 27] A systematic review of 17 randomized controlled trials by found exergaming significantly improved global cognition among both nonclinical and clinical populations with neurocognitive impairments [28].

The purpose of this study is to examine the efficacy of a six-month exergaming intervention on obesity-related anthropometric markers in overweight and obese Black women. To the best of our knowledge, there are no published studies addressing Wii exergaming interventions in overweight/obese Black women.

METHODS

Study Design

The study was a six-month, two-arm randomized clinical trial examining the efficacy of an exergaming intervention in improving obesity-related anthropometric markers among overweight and obese Black women. This study was approved by the Georgetown University Institutional Review Board (IRB approval number 2010–515). All participants provided written informed consent prior to study participation.

Eligibility Criteria for this study include: Black women; BMI ≤30 kg/m2 and ≤40kg/m2; aged 40–59 years; sedentary (<60 min/week exercise for past 6 months; never been diagnosed with cancer; ability to read and speak English and to provide meaningful consent; no physical limitations preventing them from exercising; and medical clearance by a health practitioner. Exclusion criteria included: any history of cancer; uncontrolled hypertension and medically treated diabetes; current enrollment in another physical activity and/or dietary study or a diet/weight loss program; pregnancy; inability to consent to study participation and complete assessments; telephone inaccessibility; physical limitations to exercise; and inability to commit to the intervention schedule. A total of 100 Black women were screened and randomized to a supervised facility-based exergaming group or a control group as shown in the CONSORT diagram (Figure 1). Participants were randomly assigned, in a 1:1 ratio to the exergaming or control group with a computer-based number generator.

Figure 1.

Figure 1

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POWER CONSORT Diagram

Study Arms

Exergaming Intervention (EI):

Participants in the intervention group were required to meet and maintain a goal of 150 min/week of moderate intensity exercise for 6 months. Individual goals were based on their baseline data. Exercise duration increased gradually from 75 min/week at week 1 to 150 min/week by week 4. Thereafter, women maintained >150 min/week of moderate-intensity physical activity. The training consisted of 3 days/week of supervised physical activity using active videogames for the Nintendo Wii Fit and/or the X-Box Kinect gaming systems. Participants exercised at an intensity equal to 45–65% of their VO2max. During aerobic exercise sessions, participants wore Polar heart rate monitors to determine exercise intensity. In addition, participants completed daily exercise diaries to record the type and duration of physical activity, exercise heart rate and rating of perceived exertion (RPE). Exergaming stations were set up with a variety of active videogames, which were chosen based on energy expenditure data. Only those active videogames that have shown to achieve energy expenditure levels above those necessary to achieve 60% HRmax were selected [29]. Participants selected active videogames to use for each session based on their individual preference (boxing, jogging, tennis, resistance training). Selections of videogames, such as boxing, skiing, tennis) remained the same throughout the study intervention. For example, if boxing and skiing were selected, these games remained constant through study completion.

Control

After baseline testing, participants in the control group were asked to maintain their current daily activities for the duration of the study. The control group was given the option to exercise at the exergaming stations following their completion of the study.

Assessments

Assessments were conducted at baseline and 6-months (study completion) Assessments included individual measurements of demographic variables, medical history, physical activity, VO2max, anthropometric variables (height, weight, waist and hip circumferences), and body composition (lean and fat mass). Assessments also included blood pressure and resting heart rate. Participants received $25 grocery gift cards as incentives for their baseline and follow-up visits.

Cardiovascular Fitness:

The Bruce treadmill protocol was used to determine VO2max using a ParvoMedics TrueOne 2400 metabolic cart (Sandy, UT). This test involves a 5 min warm-up followed by increases in treadmill speed and grade every 3 min until volitional exhaustion. Subjects had HR and respiratory variables measured continuously during exercise and recovery.

Obesity:

Weight was measured using a beam balance scale; height was measured using a calibrated stadiometer. BMI was calculated based on height and weight. Waist circumference was recorded using standard measuring tape and measured at the smallest part of the waist. Hip circumference was also recorded using standard measuring tape and measured at the widest part of the hips. Body composition (Total body fat, lean body mass and regional body fat) was determined using dual energy x-ray absorptiometry (DEXA).

Physical Activity:

The International Physical Activity Questionnaire is a structured interview that measures a person’s time spent engaging in physical activity over a 7-day period.[30] The Gladys Block Food Frequency Questionnaire (FFQ) will be administered to monitor changes in dietary intake.

Power and Sample Size

The sample size calculation is based on an ANCOVA comparing changes in VO2max between the two study groups, adjusting for baseline VO2max. It is reasonable to assume a conservative correlation coefficient of 0.4 between the baseline and after intervention VO2max measurements. Further, we projected a dropout rate of 20%, which is the same or worse than that in our previous exercise intervention trials and those reported by others[31–33] With the above guidelines and a level of significance of α=0.05 (two-sided), a sample size of 37 per arm was sufficient to obtain statistical significance between the groups with 90% power and an effect size of 0.80 between initial and final VO2max values. [34]

Statistical Analyses

We summarized baseline sample characteristics using descriptive statistics. For hypothesis testing, we employed two-samples t-tests to examine group differences in outcome variables at 6 months. We expected exergaming participants to demonstrate reduced waist and hip circumference, decreased fat mass, and increased lean mass compared to the control group.

RESULTS

Baseline characteristics (mean (SD) for participants are presented by study arm in Table 1. Overall, there were no significant between-group differences observed in waist circumference (108.7(14.6)cm vs 107.2(14.8) cm), fat mass (44.3(12.8)kg vs 46.1(12.5)kg) or lean mass (47.0(6.9)kg vs 48.2(4.7)kg) at 6-months (Table 2)

Table 1.

Baseline Participant Characteristics by Study Arm for Exergaming Intervention

Variable Intervention n =50 Controls n= 50
X(SD) n(%) X(SD) n(%)
Age (years) 51.6(4.8) 49.9(3.9)
Current/former smoker 25(50.0) 24(48.0)
Weight (lbs) 213.2(43.3) 224.4(46.6)
BMI (kg/m2) 35.2(6.6) 37.6(7.3)
Waist circumference (cm) 108.7(14.6) 112.6(16.3)
High blood pressure (mmHg) 18(36.0) 21(42.0)
Vigorous exercise (mins/week) 44.8(86.9) 29.1(51.1)
Moderate exercise (mins/week) 51.8(88.2) 38.1(65.3)
Sitting time (hrs/week) 33.2(27.4) 19.0(22.1)
Fat mass (kg) 44.3(12.8) 49.3(14.5)
Lean mass (kg) 47.0(6.9) 48.8(8.0)
Percent fat (%) 47.8(5.9) 49.5(6.1)
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1

X(SD) = standard deviation of mean X

Table 2.

Anthropometrics by study arm at baseline and 6 months

Variable Baseline
 6 Months
Intervention Control Intervention Control
X(SD) X (SD) X (SD) X (SD)
Waist circumference (cm) 108.7(14.6) 112.6(16.3) 107.2(14.8) 110.8(17.0)
Weight (lbs) 213.2(43.3) 224.4(46.6) 214.9(48.1) 217.8(46.8)
BMI (kg/m2) 35.2(6.6) 37.6(7.3) 35.6(7.2) 36.3(7.0)
Fat mass (kg) 44.3(12.8) 49.3(14.5) 46.1(12.5) 46.2(13.1)
Lean mass (kg) 47.0(6.9) 48.8(8.0) 48.2(4.7) 48.0(7.4)
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2

X(SD) = standard deviation of mean X

DISCUSSION

While several studies have explored the role of exergaming in physical activity levels and other obesity-related factors, most have been conducted among young, White men and women.[35] This study was the first, to our knowledge, to employ a randomized clinical trial design to examine potential efficacy of exergaming in improving obesity-related anthropometric markers among overweight/obese Black women. Results suggest that the exergaming intervention did not facilitate significant changes waist circumference, lean mass or fat mass.

These results are inconsistent with prior studies examining exergaming in Black and Latinx women, which found a significant effect of exergaming on waist circumference (~2 cm reduction). [36, 37]Null results of the present study suggest that other factors related to exergaming (e.g., enjoyment) may impact energy expenditure in Black women. As novelty of exergaming subsides, initial enjoyment and motivation may also wane, yielding less energy expenditure. Indeed, exergaming participants have been shown to expend more energy when the game is viewed as enjoyable.[38]According to self-determination theory,[39] enjoyment in a behavior undergirds intrinsic motivation for consistent behavioral engagement. In prior studies with supervised exercise programs, participants with higher intrinsic motivation had higher attendance in exercise programs,[40] and adhered to physical activity recommendations even after structured coaching and supervision was removed.[41] Moreover, exergames that are viewed as personally enjoyable and culturally relevant to Black women (e.g., dance-based) may facilitate greater energy expenditure. For example, dance-based exergames have been shown to increase perceived competency to engage regularly in physical activity among Black and Latinx youth.[42] Future studies should examine motivation and other psychological correlates (e.g., perceived competency, self-efficacy) of physical activity and exergaming in Black women that may promote longer term engagement in physical activity.

In addition, null results may also reflect lack of variety in the intervention exercise sessions (i.e., variety support). Variety support describes the degree to which exercises are structured to promote feelings of variety in participants by alternating between new and familiar exercise tasks and activities.[43, 44] Structuring exercise programs to promote variety, increases participants’ feelings of variety during exercise and facilitates greater exercise adherence in adults.[44] Prior studies have examined differences in energy expenditure across a variety of exercise activities (e.g., treadmill, exergaming),[45] while others have mixed exergame type (e.g., Wii Walk, Run, Ski Jump) in short bouts of exercise.[46] In the present study, the intervention group only engaged in one modality of exercise, which may have limited participants’ experience of variety. Future studies should explore the role of variety support in exergaming interventions to identify potential combined effects of exergaming and traditional exercise modalities among overweight/obese Black women.

Findings from the current study should be interpreted in the context of its limitations and strengths. First, study participants were middle-aged Black women; thus, results may not be generalizable to younger Black women (ages 22–29 years) who report more screen-based activities than older Black women.[4] Additionally study results may not be generalizable to other settings where conditions are not controlled.[47] Although the study procedures took place in a community-based setting, exergaming activities were conducted in a controlled setting and supervised by study personnel, thus limiting our ability to assess the generalizability of the effects of exergaming in anthropometric markers in natural settings (e.g., home) and with naturally-occurring stimuli (e.g., family members). A recent meta-analysis of exergaming in persons with overweight and obesity, highlighted the need for future studies to conduct exergaming interventions in home-based settings without supervision.[35] A home-based setting for an exergaming intervention would be particularly important for Black women who report several intrapersonal (e.g., family responsibilities/caregiving, lack of time) and environmental barriers (e.g., lack of facilities)[48] to physical activity. Secondly, the study’s small sample reduced statistical power to detect a smaller effect size and also may explain null findings among other study variables.

Strengths of this study include: a study population of Black women who experience physical inactivity and obesity at a disparate rate, provision of exergames in accordance with ACSM guidelines to achieve moderate intensity physical activity energy expenditure levels as well as participant autonomy in exergame selection for supervised exercise sessions.

Overall results suggest that exergaming did not facilitate changes in obesity-related anthropometric markers among obese/overweight Black women. However, more studies are needed to assess factors associated with long-term adherence to exergaming and subsequent cardiovascular and anthropometric benefits. Additionally, future studies should examine psychosocial correlates of exergaming (e.g., motivation, enjoyment) as well as the role of structured exergaming interventions that promote variety in exercise activities. Lastly, future studies should examine the feasibility of home-based exergaming interventions among Black women with obesity.

CONCLUSIONS

This study expanded current research on exergaming in an understudied population of overweight/obese Black women through a randomized clinical trial design. Exergaming did not demonstrate efficacy in facilitating short-term changes in obesity-related anthropometric markers among overweight/obese Black women. Future studies should consider pairing exergaming with more traditional exercises to promote variety and increase motivation to exercise among Black women.

Funding Source

This work was supported by a grant (R21 CA165067) funded by the National Cancer Institute, National Institutes of Health awarded to Drs. Adams-Campbell and Hagberg. This study is registered at www.clinicaltrials.gov (NCT02152462). Dr. Smith was supported by a postdoctoral training fellowship (T32 CA261787).

Footnotes

Declaration of interests

The authors have nothing to declare.

Declaration of generative AI in scientific writing

The authors have not used generative AI and AI-assisted technologies in the writing process.

Definitions of sex and/or gender

Throughout the text, sex refers to biological sex at birth and gender refers to the self-identification with a gender status.

Declaration of Interest Statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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