Exercise as it relates to Disease/Can playing physically-engaging video games be beneficial for metabolic health?

This Wiki document critiques the article: Worley J, Rogers S, Kraemer R. Metabolic Responses to Wii Fit™ Video Games at Different Game Levels. Journal of Strength and Conditioning Research. 2011;25(3):689-693.

What is the background to this research?
Video gaming has become an increasingly popular phenomenon since the early 2000's. It has quickly become one of the most popular recreational pastimes of many people. Digital Australia has reported that over 67% of Australians play video games, of that 46% are females and 77% of players are over 18 years old. This demographic averages 89 minutes of game time daily. An adverse effect of the increasing popularity and technological advancements of video gaming is time spent sedentary. Video gaming and other screen-based activities have replaced many active behaviours and have been independently associated with metabolic syndrome. For example, in New Zealand one third of children are over weight or obese, and 3 in 10 children take part in little to no physical activity, both mimicking world-wide trends.

Interventions aimed at decreasing screen time have continuously failed due to the high value placed on these games. Interventions based on making physically engaging video games became popular as all other interventions failed. Games like Wii Fit, Wii Sports, and Dance Dance Revolution became increasingly popular. With the rise of these games people started to wonder if they proved effective in increasing physical activity and overall metabolic health. This study was the first to determine the %VO 2 max and caloric expenditure elicited by the different Wii Fit games at different game levels in adults Using data from this study we can determine whether or not these new physically engaging video games have an actual effect on metabolic health.

Where is this research from?
Writers Worley, Rogers, and Kraemer from the department of Kinesiology and Health Studies, at Southeastern Louisiana University published this article in the Journal of Strength Research and Conditioning under the National Strength and Conditioning Association. The independent status of this journal removes the risk of potential bias from other organisations that could benefit from the results. There is no disclosure of funding.

What Kind of research is this?
This study is a clinical trial that examined 8 healthy females from the University of Southeastern Louisiana and tried to determine their physiological responses while playing Wii Fit during 2 separate counterbalanced trials. Clinical trial studies can be used when looking at how a group of people respond to a new intervention, to then determine if the intervention is beneficial to use.

What did the research involve?
This study consisted of 8 apparently healthy female university students. All participants had to fill out a medical history questionnaire and give informed consent. None of the students were collegiate athletes, meaning they didn't have a strenuous exercise regiment, none of them had any history with cardio vascular disease, diabetes, or any other metabolic health concerns.

The subjects participated in 3 separate sessions all completed on separate days. The first session was a graded exercise test to determine participants VO 2 max on a treadmill, as well as getting basic measurements such as height and weight. The next 2 sessions consisted of the subjects playing Wii Fit. Subjects played the "Hula game" during session 2 then played the "Intermediate Step game" in session 3. In both session the participants played the game for 10 minutes with a 1 minute warm up. They completed a total of 3, 10-minute sessions, with a 5-minute break in between where HR (heart rate), BP (blood pressure), and RPE (rate of perceived exertion) using a 6-20 Borg Scale was measured. During the first 2, 10-minute sessions they played at the beginning level, and the last session was played on the intermediate setting. The subjects VO 2, % VO 2 max, RER, RPE, and caloric expenditure were all recorded and compared between the 2 trials.

The methodology of this study was beneficial in establishing the validity of the Wii Fit Hula and Step games in young, healthy adult women. However, limitations exist that compromise the reliability of the study. The subjects were all females of similar ages' that attended the same university. These participants were also all healthy with no history of any metabolic issues. Due to the limited population studied the results can not accurately represent or benefit the general population.

What were the basic results?
Upon analysis the intermediate game levels produced the most metabolic stress and energy expenditure in each of the subjects. For both games the physiological responses significantly increased from the beginning level to the intermediate level. The intermediate Hula game resulted in the highest levels for all physiological responses.
 * The table represents the mean data for % VO 2 max, RER, caloric expenditure, and RPE.

Using the results, the researchers compared the VO 2 and energy expenditure rates for both beginning and intermediate games to grade walking. By using a standard equation to predict VO 2 from walking speed they took the lowest VO 2 and found that it was equivalent to 4.02 km/hr, then took the highest VO 2 and found it to be equivalent to 5.79 km/hr.

What conclusions can we take from this research?
Results from this study reveal that playing Wii Fit games can be used as a form of physical activity for adult females. It is recommended that games are played on the intermediate level to induce the highest metabolic stress and energy expenditure for the participant. At the time this was the first study to determine the exact VO 2, % VO 2 max , and caloric expenditure in response to Wii Fit at different gaming levels. Unfortunately, the study examined a limited population meaning that the results do not accurately reflect the same benefits on the general population. Other studies have since been conducted looking at other populations playing active video games. For example, a study looking at children playing Dance Dance revolution found that it increases heart rate and caloric expenditure. Though this study was conducted in 2006 the problem surrounding increasing sedentary behaviours due to gaming and screen time have only increased. Recent studies have looked at games like Pokémon Go, a very popular smart phone game and its effects on physical activity. The study found that playing this game can be an effective way to increase daily walking. However, there is a lack of evidence of long-term effectiveness surrounding these games.

Practical advice
The results of this study show that playing physically engaging games can beneficial to increasing physical activity levels, and young adult females should be encouraged to engage with these games. It is important to note however, that while these games can be beneficial to metabolic health, at their highest level they only contribute to a caloric expenditure similar to walking at 5.79 km/hr. This expenditure is lower than other recommended forms of physical activity, therefore, is not as effective as a daily means of exercise.

Further information/resources
For further information regarding recommended daily energy expenditures, and sedentary behaviours; click on the links below
 * Australian movement guidelines
 * Determinants of sedentary behaviour in youth
 * Help for gaming addicts