Active Healthy Kids Canada’s Position on Active Video Games for Children and Youth

Abstract

The effect of active video games (AVGs) on acute energy expenditure has previously been reported; however, the influence of AVGs on other health-related lifestyle indicators remains unclear. To address this knowledge gap, Active Healthy Kids Canada (AHKC) convened an international group of researchers to conduct a systematic review to understand whether AVGs should be promoted to increase physical activity and improve health indicators in children and youth (zero to 17 years of age). The present article outlines the process and outcomes of the development of the AHKC’s position on active video games for children and youth. In light of the available evidence, AHKC does not recommend AVGs as a strategy to help children be more physically active. However, AVGs may exchange some sedentary time for light- to moderate-intensity physical activity, and there may be specific situations in which AVGs provide benefit (eg, motor skill development in special populations and rehabilitation).

Active video games (AVGs) have gained interest as a way to increase physical activity in children and youth. The effect of AVGs on acute energy expenditure has previously been reported (1–3); however, the influence of AVGs on other health-related lifestyle indicators remains unclear. To address this knowledge gap, Active Healthy Kids Canada convened an international group of researchers to conduct a systematic review of the evidence (4) to guide an evidence-informed response to the question of whether AVGs should be promoted to increase physical activity and improve health indicators in children and youth zero to 17 years of age. The Active Healthy Kids Canada’s Position on Active Video Games was developed and disseminated with the goal of educating parents and caregivers on healthy behaviour and lifestyle habits while also informing and influencing government, nongovernment and private-sector organizations with respect to their programs, campaigns, policies and products. The present article briefly outlines the process and outcomes for the development of the Active Healthy Kids Canada’s Position on Active Video Games for Children and Youth, which was released to the media in November 2012 (www.activehealthykids.ca/active-video-games-position.aspx).

METHODS

The position on AVGs was informed by a rigorous and transparent process, and recommendations are based on an organizational interpretation of the systematic review. A summary of the events leading to the development of the Position is presented in Figure 1. The Position is a product of Active Healthy Kids Canada, with leadership from key partners including researchers from the Healthy Active Living and Obesity Research Group at the Children’s Hospital of Eastern Ontario Research Institute (Ottawa, Ontario) and ParticipACTION (media relations and communications).

Figure 1).

Summary of the timeline and key events in the development of the Active Healthy Kids Canada’s Position on Active Video Games for Children and Youth (zero to 17 years of age)

The purpose of the systematic review (4) was to examine the relationship among AVGs and nine health and behavioural indicators in children and youth zero to 17 years of age (information on the indicators is presented in Table 1). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to guide the systematic review (5). Quality of evidence for each health indicator was assessed based on study design, risk of bias, consistency of results, directness of the intervention, precision of results and possible dose-response gradient.

TABLE 1.

A priori consensus rankings assigned by the Research Advisory Group for each health indicator

Health indicator	Priority
Acute energy expenditure and habitual physical activity	Critical
Adherence and appeal (participation and enjoyment)	Critical
Opportunity cost (both time and financial considerations)	Critical
Adiposity	Important
Cardiometabolic health indicators	Important
Energy intake (compensatory adjustment)	Important
Adaptation (effects of continued play)	Important
Learning and rehabilitation	Important
Video game evolution (sustainability of technology)	Important

Health indicators were ranked based on whether they were critical for decision making, important but not critical, or of low importance for decision making. The focus when searching and summarizing the evidence was on indicators that were important or critical. Rankings were based on the Grading of Recommendations Assessment, Development and Evaluation framework (5)

RESULTS

Systematic review

Complete details of the systematic review are published separately (4). This open-access article is freely available online (www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0065351). Overall, AVGs do not appear to result in sustained increases in habitual physical activity in children and youth. This means that AVGs are able to increase acute energy expenditure above rest and when compared with playing passive video games, but they do not appear to increase overall physical activity levels or physical fitness. The studies included in the systematic review also showed that AVGs do not make a significant contribution to enabling children and youth to meet guidelines of 60 min of moderate- to vigorous-intensity physical activity on a daily basis; however, AVGs may increase light- to moderate-intensity physical activity at the expense of some sedentary behaviours (including sedentary video games). The appeal of AVGs is high for some children, but long-term adherence to AVGs has not been demonstrated. In overweight and obese children and youth, sustained playing of AVGs has been shown to attenuate weight gain, whereas evidence in normal-weight children is inconclusive. Evidence for energy intake and AVG play is also inconclusive, as is the effect of AVG interventions on cardiometabolic health indicators or opportunity cost. Finally, there is evidence to suggest that AVGs can be beneficial to improve motor skill proficiency and movement cues in specific populations (eg, during rehabilitation or for those with movement challenges).

Active Healthy Kids Canada’s Position on Active Video Games for Children and Youth

The Active Healthy Kids Canada Position on Active Video Games is presented in both English (Appendix 1) and French (Appendix 2).

CONCLUSION

The present article summarizes the first Position by Active Healthy Kids Canada in an ongoing effort to advance knowledge to advocate for healthy behaviour change. Over the past several years, Active Healthy Kids Canada has been asked by media, stakeholders and government agencies for its expert opinion or research position on key topical issues affecting physical activity levels in children and youth. The research supporting this Position involved extensive input from content experts. The Position on AVGs is anchored to the current scientific evidence and, as such, it is possible that the Position may change as technology advances. Furthermore, the Position of Active Healthy Kids Canada supports the position of the Canadian Paediatric Society, which recommends that families engage in games promoting physical activity rather than those involving screen time (6).

In light of this process, Active Healthy Kids Canada does not recommend AVGs as a strategy to increase daily physical activity in children and youth. However, AVGs can exchange some sedentary time for light- to moderate-intensity physical activity, and there may be specific situations in which AVGs provide benefit (eg, motor skill development in special populations and rehabilitation). More research investigating the potential advantages and disadvantages of AVG play is required.

Appendix 1).

Active Healthy Kids Canada’s Position on Active Video Games. Reproduced with permission from Active Healthy Kids Canada

Appendix 2).

Position de Jeunes en forme Canada sur les jeux vidéo actifs. Reproduit avec l’autorisation de Jeunes en forme Canada