Current Cardiovascular Risk Reports

, Volume 7, Issue 4, pp 251–255 | Cite as

The Health Benefits of Active Gaming: Separating the Myths from the Virtual Reality

  • Darren E. R. Warburton
Invited Commentary


Video game play is a preferred leisure time activity of many children and adults. Video gaming is often viewed as the enemy of effective health promotion strategies owing to competition with for a finite availability for leisure time pursuits. However, recent advancements in active gaming (ie, video games that involve physical activity) have created a viable alternative for increasing physical activity and decreasing sedentary behaviors. This review outlines the potential for active gaming (particularly whole body gaming) to reach activity levels and intensities that are sufficient to reduce the risk for premature mortality and cardiovascular disease, and increase overall health and well-being. This review also looks at the anti-active gaming sentiment perpetuated by some individuals and organizations and how this stance is not supported by the preponderance of current literature. In fact, compelling literature (supported by numerous systematic reviews of the literature) demonstrates the health benefits of active gaming, and the suitability of active gaming for use in a menu of physical activity opportunities for children and adults alike. Collectively, this research supports active gaming as a viable means of improving physical activity levels and reducing sedentary behaviors in a wide range of individuals.


Active gaming Exergaming Leisure-time preferences Physical activity Video games 


Compliance with Ethics Guidelines

Conflict of Interest

Darren Warburton declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Warburton DE, Nicol C, Bredin SS. Prescribing exercise as preventive therapy. Can Med Assoc J. 2006;174:961–74.CrossRefGoogle Scholar
  2. 2.
    Warburton DE, Nicol C, Bredin SS. Health benefits of physical activity: the evidence. Can Med Assoc J. 2006;174:801–9.CrossRefGoogle Scholar
  3. 3.
    Warburton DER, Katzmarzyk PT, Rhodes RE, Shephard RJ. Evidence-informed physical activity guidelines for Canadian adults. Appl Physiol Nutr Metab. 2007;32:S16–68.CrossRefGoogle Scholar
  4. 4.
    World Health Organization. Global recommendations on physical activity for health. Switzerland: World Health Organization; 2010.Google Scholar
  5. 5.
    Stone MR, Faulkner GE, Buliung RN. How active are children in Toronto? a comparison with accelerometry data from the Canadian Health Measures Survey. Chronic Dis Inj Can. 2013;33:61–8.PubMedGoogle Scholar
  6. 6.
    Katzmarzyk PT. Physical activity, sedentary behavior, and health: paradigm paralysis or paradigm shift? Diabetes. 2010;59:2717–25. doi: 10.2337/db10-0822.PubMedCrossRefGoogle Scholar
  7. 7.
    Warburton DER. The physical activity and exercise continuum. In: Bouchard C, Katzmarzyk PT, editors. Advances in physical activity and obesity. Champaign: Human Kinetics Publishing; 2009. p. 7–17.Google Scholar
  8. 8.
    Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41:998–1005. doi: 10.1249/MSS.0b013e3181930355.PubMedCrossRefGoogle Scholar
  9. 9.
    Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, et al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol. 2008;167:875–81. doi: 10.1093/aje/kwm390.PubMedCrossRefGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention. A growing problem: what causes childhood obesity? Atlanta: Centers for Disease Control and Prevention; 2012.Google Scholar
  11. 11.
    •• Warburton DE, Charlesworth S, Ivey A, Nettlefold L, Bredin SS. A systematic review of the evidence for Canada’s Physical Activity Guidelines for Adults. Int J Behav Nutr Phys Act. 2010;7:39. doi: 10.1186/1479-5868-7-39. This systematic review of the literature evaluates critically the current evidence regarding the health benefits of physical activity. It demonstrates clearly that current international recommendations for physical activity are associated with a marked reduction in the risk for chronic disease (including cardiovascular disease) and premature mortality. This review also demonstrated a dose response relationship such that health benefits are seen at relatively low volumes of physical activity (far below international recommendations). PubMedCrossRefGoogle Scholar
  12. 12.
    Hansen L, Sanders SW. Active gaming: a new paradigm in childhood physical activity. Digit Cult Educ. 2011;3:123–39.Google Scholar
  13. 13.
    Entertainment Software Association. Industry facts. 2012.Google Scholar
  14. 14.
    Hersey J, Jordan A. Reducing children’s TV time to reduce the risk of childhood overweight: the children’s media use study. Atlanta: Centers for Disease Control and Prevention; 2007.Google Scholar
  15. 15.
    Guy S, Ratzki-Leewing A, Gwadry-Sridhar F. Moving beyond the stigma: systematic review of video games and their potential to combat obesity. Int J Hypertens. 2011;2011:179124. doi: 10.4061/2011/179124.PubMedGoogle Scholar
  16. 16.
    Rhodes RE, Warburton DE, Bredin SS. Predicting the effect of interactive video bikes on exercise adherence: an efficacy trial. Psychol Health Med. 2009;14:631–40. doi: 10.1080/13548500903281088.PubMedCrossRefGoogle Scholar
  17. 17.
    Warburton DE, Bredin SS, Horita LT, Zbogar D, Scott JM, Esch BT, et al. The health benefits of interactive video game exercise. Appl Physiol Nutr Metab. 2007;32:655–63.PubMedCrossRefGoogle Scholar
  18. 18.
    Warburton DE, Sarkany D, Johnson M, Rhodes RE, Whitford W, Esch BT, et al. Metabolic requirements of interactive video game cycling. Med Sci Sports Exerc. 2009;41:920–6. doi: 10.1249/MSS.0b013e31819012bd.PubMedCrossRefGoogle Scholar
  19. 19.
    Mark R, Rhodes RE, Warburton DER, Bredin SSD. Interactive video games and physical activity: a review of the literature and future directions. Health Fit J Canada. 2008;1:14–24.Google Scholar
  20. 20.
    Rhodes RE, Warburton DER, Coble JE. Effect of interactive video bikes on exercise adherence and social cognitive expectancies in young men: a pilot study. Ann Behav Med. 2008;35:S62.Google Scholar
  21. 21.
    Goldfield GS, Mallory R, Parker T, Cunningham T, Legg C, Lumb A, et al. Effects of open-loop feedback on physical activity and television viewing in overweight and obese children: a randomized, controlled trial. Pediatrics. 2006;118:e157–66.PubMedCrossRefGoogle Scholar
  22. 22.
    Roemmich JN, Gurgol CM, Epstein LH. Open-loop feedback increases physical activity of youth. Med Sci Sports Exerc. 2004;36:668–73.PubMedCrossRefGoogle Scholar
  23. 23.
    Siegel SR, Haddock B, Dubois AM, Wilkin LD. Active video/arcade games (exergaming) and energy expenditure in college students. Int J Exerc Sci. 2009;2:165–74.PubMedGoogle Scholar
  24. 24.
    Garn AC, Baker BL, Beasley EK, Solmon MA. What are the benefits of a commercial exergaming platform for college students? examining physical activity, enjoyment, and future intentions. J Phys Act Health. 2012;9:311–8.PubMedGoogle Scholar
  25. 25.
    White K, Schofield G, Kilding AE. Energy expended by boys playing active video games. J Sci Med Sport. 2011;14:130–4. doi: 10.1016/j.jsams.2010.07.005.PubMedCrossRefGoogle Scholar
  26. 26.
    Graf DL, Pratt LV, Hester CN, Short KR. Playing active video games increases energy expenditure in children. Pediatrics. 2009;124:534–40. doi: 10.1542/peds.2008-2851.PubMedCrossRefGoogle Scholar
  27. 27.
    Leatherdale ST, Woodruff SJ, Manske SR. Energy expenditure while playing active and inactive video games. Am J Health Behav. 2010;34:31–5. doi: 10.5555/ajhb.2010.34.1.31.PubMedCrossRefGoogle Scholar
  28. 28.
    O'Donovan C, Roche EF, Hussey J. The energy cost of playing active video games in children with obesity and children of a healthy weight. Pediatr Obes. 2013. doi: 10.1111/j.2047-6310.2013.00172.x.PubMedGoogle Scholar
  29. 29.
    Maddison R, Foley L, Ni Mhurchu C, Jiang Y, Jull A, Prapavessis H, et al. Effects of active video games on body composition: a randomized controlled trial. Am J Clin Nutr. 2011;94:156–63. doi: 10.3945/ajcn.110.009142.PubMedCrossRefGoogle Scholar
  30. 30.
    Maddison R, Mhurchu CN, Jull A, Prapavessis H, Foley LS, Jiang Y. Active video games: the mediating effect of aerobic fitness on body composition. Int J Behav Nutr Phys Act. 2012;9:54. doi: 10.1186/1479-5868-9-54.PubMedCrossRefGoogle Scholar
  31. 31.
    Mathieu ME, Kakinami L. Active video games could be the solution to the increased energy intake reported with sedentary video games. Am J Clin Nutr. 2011;94:1150–1. doi: 10.3945/ajcn.111.022202. author reply 1–2.PubMedCrossRefGoogle Scholar
  32. 32.
    Ni Mhurchu C, Maddison R, Jiang Y, Jull A, Prapavessis H, Rodgers A. Couch potatoes to jumping beans: a pilot study of the effect of active video games on physical activity in children. Int J Behav Nutr Phys Act. 2008;5:8. doi: 10.1186/1479-5868-5-8.PubMedCrossRefGoogle Scholar
  33. 33.
    Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for real: video games and stories for health-related behavior change. Am J Prev Med. 2008;34:74–82.PubMedCrossRefGoogle Scholar
  34. 34.
    •• Biddiss E, Irwin J. Active video games to promote physical activity in children and youth: a systematic review. Arch Pediatr Adolesc Med. 2010;164:664–72. doi: 10.1001/archpediatrics.2010.104. Biddiss and Irwin systematically reviewed the energy expenditure and changes in physical activity patterns associated with active video gaming in children. The authors revealed that the energy expenditures were highly variable across studies with higher metabolic requirements in activities that also involved the lower body (i.e., a larger muscle mass). There was clear evidence that active gaming can lead to light-to-moderate physical activity intensities. There was limited evidence at this point to make conclusive statements regarding the long-term efficacy of active gaming in physical activity promotion. PubMedCrossRefGoogle Scholar
  35. 35.
    Barnett A, Cerin E, Baranowski T. Active video games for youth: a systematic review. J Phys Act Health. 2011;8:724–37.PubMedGoogle Scholar
  36. 36.
    Primack BA, Carroll MV, McNamara M, Klem ML, King B, Rich M, et al. Role of video games in improving health-related outcomes: a systematic review. Am J Prev Med. 2012;42:630–8. doi: 10.1016/j.amepre.2012.02.023.PubMedCrossRefGoogle Scholar
  37. 37.
    •• Peng W, Crouse JC, Lin JH. Using active video games for physical activity promotion: a systematic review of the current state of research. Health Educ Behav. 2013;40:171–92. doi: 10.1177/1090198112444956. Peng and colleagues evaluated systematically the literature using active video games to increase physical activity and laboratory studies evaluating the intensity of active gaming in children and adults. The authors revealed that 100 % of laboratory-based studies demonstrated the ability of active video gaming to provide light-to-moderate intensity physical activity. There was somewhat limited evidence demonstrating the ability of active video gaming to increase physical activity levels and/or exercise attendance. PubMedCrossRefGoogle Scholar
  38. 38.
    Foley L, Maddison R. Use of active video games to increase physical activity in children: a (virtual) reality? Pediatr Exerc Sci. 2010;22:7–20.PubMedGoogle Scholar
  39. 39.
    Peng W, Lin JH, Crouse J. Is playing exergames really exercising? a meta-analysis of energy expenditure in active video games. Cyberpsychol Behav Soc Netw. 2011;14:681–8. doi: 10.1089/cyber.2010.0578.PubMedCrossRefGoogle Scholar
  40. 40.
    Lenzer J. US heart association endorses active video games. BMJ. 2010;340:c2802. doi: 10.1136/bmj.c2802.CrossRefGoogle Scholar
  41. 41.
    Lieberman DA, Chamberlin B, Medina Jr E, Franklin BA, Sanner BM, Vafiadis DK. The power of play: innovations in Getting Active Summit 2011: a science panel proceedings report from the American Heart Association. Circulation. 2011;123:2507–16. doi: 10.1161/CIR.0b013e318219661d.PubMedCrossRefGoogle Scholar
  42. 42.
    Tremblay MS, Warburton DE, Janssen I, Paterson DH, Latimer AE, Rhodes RE, et al. New Canadian physical activity guidelines. Appl Physiol Nutr Metab. 2011;36:36–46. doi: 10.1139/h11-009.PubMedCrossRefGoogle Scholar
  43. 43.
    Graham N, Mandryk R. GAMFIT: gaming for physical fitness. Graphics, animation, and new media, networks of centre of excellence, Government of Canada, Ottawa. 2012. Available at: Accessed 10 May 2013.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Physical Activity Promotion and Chronic Disease Prevention UnitUniversity of British ColumbiaVancouverCanada
  2. 2.Cardiovascular Physiology and Rehabilitation LaboratoryUniversity of British ColumbiaVancouverCanada
  3. 3.International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverCanada
  4. 4.University of British ColumbiaVancouverCanada

Personalised recommendations