Title : Effect of exergaming on BMI in overweight or obese xhildren and adolescents: Systematic review with meta-analysis
Abstract:
Background: Pediatric obesity is a growing global health concern, associated with long-term physical and psychosocial complications. Active video games (AVGs, or exergames) have been proposed to increase physical activity in children and adolescents, yet evidence for their effectiveness in reducing body mass index (BMI) is inconsistent.
Objectives: This systematic review and meta-analysis aimed to (1) assess the impact of AVG interventions on BMI, BMI z-score, and BMI percentile in children and adolescents with overweight or obesity, and (2) identify intervention characteristics associated with greater clinical benefit.
Methods: Following PRISMA 2020 guidelines, PubMed, SPORTDiscus, and Scopus were searched for randomized controlled trials published in English or Italian, including participants aged ≤18 years with BMI ≥85th percentile. Two reviewers independently performed study selection, data extraction, and quality assessment using Cochrane RoB 2, CERT, and TESTEX tools. Evidence certainty was rated using the GRADE framework. Pre–post changes in BMI z-score were pooled using a random-effects meta-analysis.
Results: Of 117 records screened, seven RCTs (n = 600; mean age 12.3 years) met inclusion criteria. Four studies reported significant within-group reductions in BMI (ΔBMI –0.06 to –0.82 kg/m²; ΔBMI z-score up to –0.14), although none reached thresholds for clinical relevance (≥5% BMI reduction, ≥10% BMI percentile decrease, or ≥0.25 SD z-score change). Meta-analysis of three trials (79 AVG vs 83 controls) demonstrated a moderate beneficial effect on BMI z-score (SMD = –0.52; 95% CI: –0.94 to –0.10; p = 0.016) with moderate heterogeneity (I² = 42.5%) and a wide prediction interval. No consistent relationships were observed between intervention features (duration, frequency, intensity, or device type) and BMI outcomes, likely reflecting methodological limitations, limited gamification design, and poor adherence monitoring.
Conclusions: AVG interventions may modestly reduce BMI z-score in children and adolescents with overweight or obesity; however, the overall certainty of evidence is very low and clinical significance remains unclear. Outcome variability appears driven more by intervention design weaknesses than by the intrinsic efficacy of exergames. Future research should focus on structured, personalized, and multidisciplinary programs incorporating behavioral and motivational strategies, objective adherence monitoring, and long-term follow-up to evaluate sustained effects.
Keywords: pediatric obesity; exergaming; active video games; body mass index; physical activity; randomized controlled trial
