Eighteen reports of 17 studies were included in the review (40 children plus 20 adults). Pedro scores for three RCTs ranged from four to six. All studies had small sample sizes (11 to 60 participants and only two studies with more than 40 participants).
Energy expenditure during active video game play was found to be highly variable with percentage increases from rest that ranged from 100% to 400% with a mean of 222% (100%). Percentage increases in heart rate varied from 26% to 98% with a mean of 64% (20%). Percentage increases in heart rate (-29%, 95% CI -47 to -11, p=0.03) and energy expenditure (-148%, 95% CI -231% to -66%, p=0.01) were significantly lower for games that primarily used upper body movements compared with those that engaged the lower body as well.
In terms of physical activity promotion, drop-out rates after 12 weeks ranged from zero to 41%. There was evidence from four studies of moderate increases in physical activity or decreases in sedentary time. Changes in physiological measures such as BMI were not statistically significant in two studies. Three studies noted a decrease in active video game play for various reasons, but two studies found that participants reported enjoyment of the active video game intervention. In three studies, group or competitive play with peers appeared to improve interest and participation in active video games.