Next Article in Journal
Long-Term Efficacy and Safety of Rifaximin in Japanese Patients with Hepatic Encephalopathy: A Multicenter Retrospective Study
Next Article in Special Issue
Effects of Family-Based Interventions Using Mobile Apps on Youth’s Physical Activity: A Systematic Review
Previous Article in Journal
Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 11
Issue 6
10.3390/jcm11061570
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial

by
Sascha Ketelhut
1,*,
Lisa Röglin
2,
Anna Lisa Martin-Niedecken
3,
Claudio R. Nigg
1 and
Kerstin Ketelhut
4
1
Institute of Sport Science, University of Bern, 3012 Bern, Switzerland
2
Institute of Sport Science, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
3
Institute for Design Research, Department of Design, Zurich University of the Arts, 8005 Zurich, Switzerland
4
Faculty of Natural Science, MSB Medical School Berlin, 14197 Berlin, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(6), 1570; https://doi.org/10.3390/jcm11061570
Submission received: 1 February 2022 / Revised: 9 March 2022 / Accepted: 9 March 2022 / Published: 12 March 2022
(This article belongs to the Special Issue Emerging Technology Applications to Promote Physical Activity and Health—Volume II)
Versions Notes

Abstract

:
This study aimed to investigate the effects of a school-based exergame intervention on anthropometric parameters and physical fitness. Fifty-eight students (10.4 ± 0.8 years; 48% girls) were randomized into an intervention (IG) and a control (CG) group. Both groups participated in regular physical education classes during the three-month intervention period. The IG additionally received a 20-minute exergame intervention twice per week. At baseline and following the intervention period, body mass index (BMI) and waist-to-height ratio (WHtR) were assessed. Furthermore, a sprint test (ST), a countermovement jump test (CMJ), and a shuttle run test (SRT) were performed. Due to prescribed quarantine measures, only 34 students (18 IG; 16 CG) were included in the final analysis. A significant group–time interaction was determined in CMJ performance (p < 0.001; η2 = 0.403), with a significant increase (+2.6 ± 2.4 cm; p < 0.001; η2 = 0.315) in the IG and a significant decrease (−2.0 ± 3.1 cm; p = 0.009; η2 = 0.190) in the CG. Furthermore, ST performance significantly improved in the IG (−0.03 ± 0.08 s; p = 0.012; η2 = 0.180) but not in the CG (0.13 ± 0.16 s; p = 0.460; η2 = 0.017), revealing significant interaction effects (p = 0.02; η2 = 0.157). Significant group–time interaction was observed for the SRT (p = 0.046; η2 = 0.122), with a significant increase (+87.8 ± 98.9 m; p = 0.028; η2 = 0.147) in the IG and no changes (−29.4 ± 219.7 m; p = 0.485; η2 = 0.016) in the CG. Concerning BMI (p = 0.157; η2 = 0.063) and WHtR (p = 0.063; η2 = 0.114), no significant interaction effects were detected. School-based exergaming is a suitable tool to influence students’ physical fitness positively.

1. Introduction

Activity guidelines recommend that children engage in at least 60 minutes of moderate- to vigorous-intensity physical activity (PA) per day to improve cardiovascular and metabolic health [1]. Despite the well-established positive effects of regular PA, 41% of children and adolescents worldwide fail to meet the current activity guidelines [2], placing them at risk for future non-communicable chronic diseases [3,4,5]. Thus, strategies to promote regular PA in children are highly warranted.
Physical fitness is considered a key determinant for promoting PA [6], as it is a foundation for competently performing PA [7]. Without a certain physical fitness level and basic competencies in different motor skills, children are limited in the amount and range of PA they can undertake [8]. According to the literature, there is a strong association between motor skill performance, physical fitness, and PA participation [9,10]. Therefore, strategies aiming to improve children’s PA need to ensure children have the competency to be physically active in the first place [11]. Especially in western industrialized countries, physical fitness levels in children are a growing concern among health professionals and physical educators [11,12]. Even though physical education (PE) classes are designed to offer opportunities to improve physical fitness, children often do not develop proficient fitness skills through PE alone [11,13]. The lack of effectiveness seen from standard PE classes demands effective intervention approaches that provide further opportunities to improve children’s physical fitness.
An innovative and motivational approach to promoting PA and developing physical fitness in a younger demographic could be through exergames. Exergames are active video games that require bodily movements to play the game. Already a decade ago, health professionals and scholars proposed exergames as a promising approach to facilitate PA [14]. Due to attractive and immersive design, exergames may reach children who are not as keen to engage in more traditional forms of PA. According to the growing body of empirical research, exergames can increase energy expenditure compared to sedentary behaviors [14,15,16], as well as promote light to moderate PA [15,16,17,18,19]. Especially in overweight and obese youth, exergames have the potential to increase PA participation, reduce sedentary behaviors, and reduce body fat [20].
In recent years, exergames have been increasingly applied within school settings, contributing to higher levels of PA [18,21,22]. However, results of the effects on physical fitness are inconsistent [16,18,23]. Barnett et al. [23] could not show any effects of a 6-week exergaming intervention conducted after school hours on movement skills. Gao et al. [18] reported positive effects of an 8-week exergaming intervention on promoting moderate to vigorous PA; however, they could not show significant intervention effects on motor skill competence. Only Ye et al. [16] were able to show positive effects from a 9-month exergaming intervention on body mass index and muscle strength, but not on aerobic fitness. These inconsistent results may be due to differences in study designs, as well as the variety of exergames applied. Most of the exergames used in previous studies were commercially available and prioritized an appealing game design rather than the integration of functional training programs. The exercise intensity achieved in most current exergames is, therefore, too low to result in meaningful fitness level advancement [24,25].
In the present study, we applied a new, functional fitness game called the ExerCube, facilitating an adaptive, individually tailored, whole-body gaming experience that may overcome many of the weaknesses seen in previous exergames [26]. By adjusting the game’s challenge level according to the player’s individual cognitive and physical abilities, this game guarantees an individually tailored training stimulus [27]. This study aimed to determine the effects of this innovative exergame on physical fitness during a 12-week school-based intervention.

2. Materials and Methods

2.1. Study Design and Participants

The study was designed as a two-armed randomized controlled trial with an intervention period of 12 weeks. An a priori power analysis was conducted utilizing G*Power (Version 3.1.2; Heinrich Heine Universität, Dusseldorf, Germany). Assuming an effect size of 0.8 with an alpha level of 0.05, 26 participants were required for the study to have sufficient power. The study sample was recruited in August 2020 from an elementary school located in a socially disadvantaged area of Berlin, Germany. Prior to the commencement of the study, participating children and their parents or legal guardians were informed about the purpose of the study, and written guardian consent was obtained. Children were eligible to participate if they (1) provided written informed parental or guardian consent, (2) had no physical limitations to exercise, and (3) were currently in the fifth or sixth grade. A cohort of 58 students was included in the study. The study was reviewed and approved by the Research Ethics Board of the Medical Center Berlin (2020-09-RK1).
After a baseline examination, the children were randomized into an intervention (IG) and a control group (CG). The principal investigator carried out the randomization using a computer-generated random number table. During the three-month intervention period, the IG and the CG participated in their normal PE classes twice a week. In addition to the standard PE classes, the IG participated in two additional exergaming sessions per week.

2.2. Baseline Assessment

Before and after the intervention, body mass index (BMI) and waist-to-height ratio (WHtR) were determined. Additionally, a 20-meter sprint test (ST), a countermovement jump test (CMJ), and a shuttle run test (SRT) were performed.
Pre- and post-tests were conducted in the morning hours at the school gym. Before the test procedure, the children participated in a 5-min guided warm-up. The same examiners were present during pre- and post-assessments.

2.2.1. Anthropometrics

The standing heights of the children were measured barefoot to the nearest 0.5 cm using a wall-mounted scale. Body mass was determined using a digital scale (BC-545N, Tanita Europe B.V., Amsterdam, The Netherlands) while the students wore light sportswear. Waist circumference was assessed to the nearest 0.5 cm at the umbilical line while the students were standing. BMI and WHtR were calculated for each student from their respective height, weight, and waist circumference measurements.

2.2.2. Physical Fitness

CMJ height is a valid and reliable method widely used to measure leg power and explosiveness [28], which are essential components of children’s musculoskeletal fitness and motor skill development [29].
After a familiarization test, the children conducted two bilateral countermovement jumps using an Optojump photocell system (Microgate, Bolzano, Italy), a validated tool for assessing jump height [30]. Children started from an upright position with their hands on their hips. They were instructed to dip down from a standing position and then jump as high as possible during the subsequent concentric phase. The flight time was measured, and the jump height was calculated. Both jumps were performed without shoes. The better result of the two CMJ trials was used for analysis.
Sprint tests are commonly used in school settings and have been included in several fitness test batteries to determine power and strength [31]. Sprint performance is considered an important component of physical fitness and has been shown to be a distinguishing characteristic of successful sports performance in children [32]. The 20-meter sprint times were assessed using portable electronic timing gates (KS-sport, Siebnen, Switzerland). The children were instructed to perform two 20-meter sprints separated by three minutes of rest. All students began with their front foot positioned 0.5 m behind the start line and were instructed to perform both sprints with a maximal effort. The better result of the two sprints was used for analysis.

2.2.3. Aerobic Fitness

Aerobic fitness was assessed by means of a multistage 20 m shuttle run test. The SRT is respected as a reliable method to predict aerobic fitness [33]. The students were instructed to run back and forth between two lines set 20 m apart. An audio signal emitted at specific frequencies was used to set the pace. Additionally, a study staff member participated in the test, giving the children an additional reference for the pace. The initial speed was set at 8.5 km/h and increased by 0.5 km/h every minute. The students were instructed to complete as many shuttles as possible. When a student gave up due to fatigue or two consecutive failures to finish a shuttle in the allotted time, the test was concluded. The numbers of completed shuttles and stages were recorded for each student to predict aerobic fitness.

2.3. Exergaming Intervention

The children in the IG participated in two exergaming sessions per week lasting 15–20 min. The sessions were integrated into the daily school schedule and took place before, between, or after classes, as well as during breaks. A study staff member coordinated and supervised all exergaming sessions.
The ExerCube is a physically immersive exergame setting shaped like an open cube [34]. The three cushioned walls of the cube serve as a projection screen for the game scenario and a haptic interface. During the game (Sphery Racer), the player navigates an avatar along a virtual racing track by performing a variety of whole-body movement tasks. A motion-capturing system using HTC Vive Trackers attached to the wrists and ankles detects the player’s movement in three dimensions through infrared sensor technology. By analyzing the timing and accuracy of movements throughout the game, the motion capturing system guarantees a correct execution of the different movement tasks. Before each game, the system was calibrated to match the targets to the body height of the player.
The game Sphery Racer implements six game levels, which guide the player through the workout while also gradually increasing duration. For a 15-minute session, the duration of the levels is 1:30, 2:00, 2:40, 3:50, and 5:10 min. For a 20-minute session, the duration of the levels is 1:50, 2:30, 3:20, 5:10, and 7:10 min. The levels are interspersed with short resting phases of about 30 s. The game continuously adjusts game difficulty and complexity to the player’s fitness and cognitive skills. When the player makes too many mistakes or reaches a predetermined heart rate (HR), the game’s speed slows down. HR is tracked by a Polar HR monitor (Polar Electro OY, Kempele, Finland) and a chest strap. The HR threshold was set to 90% of the individual maximum HR calculated using the formula (HRmax = 208 − 0.7 × age) from Tanaka et al. [35].
The COVID-19 measures did not affect the exergaming intervention, and the children were allowed to continue the intervention throughout the whole assessment period.

2.4. Physical Education Classes

Throughout the intervention period, both the IG and CG took part in regular PE classes of 1 × 45 and 1 × 90 min per week. A certified PE teacher conducted the classes following the regular school curriculum. Due to COVID-19 measures, PE classes were prohibited in the last week of the intervention period.

2.5. Statistics

Statistical analyses were performed using IBM SPSS Statistics 27.0 (SPSS Inc., Chicago, IL, USA). Differences in subject characteristics between the groups were determined using an independent samples t-test. A Levené test was used to check the homogeneity of variance. A series of two-way (groups: exergaming vs. control) ANOVAs with repeated measures (time: baseline vs. post-intervention) were performed to determine if significant differences occurred in the study outcomes. Post hoc analyses with Bonferroni’s correction were also performed. The effect size was measured by partial eta squared (η2). In the study, small, medium, and large effect sizes were designated as 0.01 ≤ 0.06, 0.06 < 0.14, and ≥0.14, respectively [36].
Test-retest reliability for both the CMJ and ST was assessed by the intraclass correlation coefficient (ICC). The criteria, suggested by Portney and Watkins [37], to evaluate reliability was calculated as: ≥0.75 (good), 0.50–0.74 (moderate), 0.26–0.50 (fair), and ≤0.25 (poor).

3. Results

The session attendance rates for the exergaming sessions were 94%. The attendance rates for the PE classes were 87% in the IG and 89% in the CG. No adverse events occurred during the intervention period in any of the participants. Due to two suspected COVID-19 cases and prescribed quarantine measures, three classes could not participate in the post-examination. Thus, only 34 students (18 IG, 16 CG) were included in the final analysis. Students’ characteristics are summarized in Table 1. According to age and sex-specific percentiles, eight students were classified as overweight and eight as obese. Based on WHtR, eight children showed values in the overweight range. There were no significant differences between the groups at baseline (Table 1).
A significant group–time interaction with a large effect was determined in CMJ performance, with a significant increase (+2.6 ± 2.4 cm; p < 0.001; η2 = 0.315) in jumping height in the IG and a significant decrease (−2.0 ± 3.1 cm; p = 0.009; η2 = 0.194) in the CG. Post hoc test results revealed no significant differences between groups before (p = 0.285; η2 = 0.0.036) or after (p = 0.103; η2 = 0.081) intervention. Furthermore, ST performance significantly improved in the IG (−0.03 ± 0.08 sec; p = 0.012; η2 = 0.180) but not in the CG (0.13 ± 0.16 s; p = 0.460; η2 = 0.0.017), revealing significant interaction effects and a large effect size. Again, there were no differences between the IG and CG in ST performance before (p = 0.635; η2 = 0.0.007) or after (p = 0.501; η2 = 0.014) intervention. Significant group–time interactions and a large effect size were observed for the SRT, with a significant increase in distance covered (+87.8 ± 98.9 m; p = 0.028; η2 = 0.147) in the IG. The CG showed no changes (−29.4 ± 219.7 m; p = 0.485; η2 = 0.016) over time (Table 2). Post hoc tests revealed no differences in SRT performance before (p = 0.645; η2 = 0.013) or after (p = 0.311; η2 = 0.033) the intervention period. No significant interactions were detected for the BMI and the WHtR measurements. During the exergaming sessions, the students reached a mean HR of 175.3 ± 2.1 bpm, corresponding to 87.4 ± 0.2% of their maximal HR. The ICC revealed a good test-retest reliability for both the CMJ (0.85) and ST (0.93).

4. Discussion

The present study investigated if a regular school-based exergaming intervention induced beneficial effects on physical fitness and anthropometric parameters. We presented evidence that a 12-week school-based exergaming program improved CMJ, ST, and SRT performance when compared to the CG. These findings are relevant given that physical fitness is considered a critical determinant for promoting PA [12].
The positive effects on sprint and jump performances are congruent with previous research by Smits-Engelsman et al. [38], which showed positive effects after just 5 weeks of exergaming in 6–10-year-old children. Dickinson and Place [39] reported significant improvements in standing long jump and sprint performances in children with autism (5–15 years) after a one-year exergaming intervention. Furthermore, McGann et al. [40] reported improvements in different locomotor skills (running, hopping, skipping, jumping, and sliding) after an 8-week exergame intervention in 5–6-year-old children. Other exergaming studies have failed to detect significant changes in motor skill performance in children [18,41]. A recent systematic review by Liu et al. [42] supported these inconsistent results.
Interestingly, children in the CG showed reduced performances in CMJ after the intervention period. It is possible that governmental restrictions due to the COVID-19 pandemic (closure of sports clubs after the first six weeks of the intervention period) may have limited children’s abilities to engage in sufficient levels of PA outside of school, potentially causing this performance decline [43]. Furthermore, PE classes were prohibited in the last week of the intervention period.
It has previously been reported that different school-based exercise interventions are able to improve aerobic fitness [44,45]. Whether exergame-based interventions can improve aerobic fitness to a similar extent remains questionable, as previous studies have claimed that the required exercise intensity during these games is insufficient to trigger relevant physiological adaptations [24,25,46]. Our study was able to show positive effects from exergaming on SRT performance, echoing some previous research [39,47]. In contrast, Ferguson et al. [48] detected non-significant changes in SRT performance after 9 weeks of exergaming in children with developmental coordination disorder. Ye et al. [21] even assessed lower aerobic fitness following an 8-week exergaming intervention.
No significant time–group interactions were detected in BMI and WHtR. In a previous study, Staiano et al. [49] showed that 24 weeks of home-based exergaming was able to decrease BMI in obese children. Maddison et al. [50] reported a reduction in body fat percentage for children from the intervention group following a 24-week exergaming intervention. In contrast, Graves et al. [51] revealed no significant differences in body fat percentage between children participating in a 12-week exergaming intervention and a control group, while a systematic review by Norris et al. [52] reported conflicting results.
The inconsistent results regarding the respective outcomes may be associated with considerable differences in study design, enrolled participants, and the respective exergames applied. We would argue that the positive effects in this study are attributed to the innovative game setup of the exergame employed. According to a previous study in adults, the ExerCube provided a form of vigorous PA that exceeded the exercise intensity of most commercial exergames [27]. It has been widely acknowledged that exercise of higher intensity leads to greater adaptations and more pronounced health benefits [53,54], even in children [44]. The relatively high exercise intensity reached in this exergame may be explained by the fact that the game triggers a whole-body functional exercise engaging large muscle groups. Most exergames predominantly require arm movements, engaging less muscle mass. Previous studies have shown that exergames requiring lower and upper body movements reach higher exercise intensities and are the most effective in achieving meaningful levels of PA [17]. The specific execution of lower body movements (e.g., jumping, skipping, and lunging) in the ExerCube may explain the CMJ and ST performance improvements seen in this study.
Furthermore, the ExerCube uses a motion capturing system that tracks upper and lower extremities. Thus, bodily movements can be traced more precisely than most consoles that use hand-held sensors. Tracking bodily movements utilizing hand-held devices was shown to result in poor quality movement outputs [23], as well as cheating, thus hampering improvements in motor skill performance [55].
Additionally, the sheer dimension of the game setup (~9 m2) requires a lot of movement to reach the targets and perform the required tasks. Finally, the current exergame’s ability to track HR throughout the game and adjust the game’s speed according to a predetermined threshold may account for the higher exercise intensity seen. Based on previous results, the ExerCube is able to offer an individually tailored exercise program that guarantees a progressive training stimulus and, therefore, can promote long-term performance developments [27].
Another strength of the study may be the fact that the intervention was integrated into a school setting with sessions included in the school timetable. This could explain the good adherence (94%) retained. Previous studies have reported lower adherence and higher dropout rates with home-based [56] compared to school-based exergaming for children [57,58].
Based on the intervention duration, this study lies within the median. Shorter interventions reported significant effects on motor skills and physical fitness [38]. However, it seems that positive effects on BMI may only be attained if longer intervention periods are applied [49,50].
Our results are of relevance as inadequate physical fitness in children may result in developmental delays, possibly decreasing PA engagement [59]. Children with high levels of physical fitness report higher levels of PA, are more fit [60], and accumulate lower levels of sedentary behavior [61]. Thus, developing adequate physical fitness levels during childhood may be an important step toward establishing lifelong PA engagement [62]. Furthermore, evidence strongly associates higher physical fitness with reduced cardiovascular risk in children [63].
Even though other exercise interventions are able to improve physical fitness in children, exergaming may present an innovative and more engaging approach. Exergames take advantage of children’s fascination with computer and video interaction [64]. Moreover, the immersive and engaging experience can help distract them from physiological cues during the exercise and, thus, enhance enjoyment [65]. Therefore, exergaming is often perceived as a form of entertainment rather than exercise [66]. Since research implies that PA enjoyment is linked to higher levels of participation in PA [67], exergames may present a valuable tool to promote lifelong PA.
A further advantage of exergames, such as the ExerCube, is that they allow children of different skill levels to engage in the game. Since the ExerCube adjusts the game speed to the player’s physical and cognitive performance, it guarantees an optimal balance between both the game’s challenge and the player’s skills and between the exercise intensity and their fitness level [68]. This allows players of all skill levels to experience success. In regular sports or PE classes, inadequate motor skills and physical fitness may impede successful participation. Furthermore, children with motor deficits may feel embarrassed by their performance in normal sports or PE classes and, subsequently, withdraw from PA [69]. Well-designed exergames can help all children experience positive feedback from enjoyment and successful achievement. This is relevant as perceived physical competence is correlated with enjoyment in PA and PE [70], supports prolonged engagement, and may even increase children’s interest in new exercise experiences [71].
An interesting feature of exergames is that they adhere to social distancing measures, which may be particularly useful in the current COVID-19 pandemic. Exergaming interventions can be continued when group exercises or PE classes are prohibited.

Limitations

Different limitations ought to be discussed when interpreting these results. First, the sample of this study was significantly diminished due to COVID-19 quarantine measures, meaning further large-scale studies are warranted.
Second, the results are limited to the specific game setting (ExerCube) and the applied game (Sphery Racer). Other exergames will likely produce different effects, probably linked to the attained exercise intensity. Third, the intervention duration was relatively short. Further long-term studies would be helpful to guide future recommendations. Fourth, different COVID-19 restrictions could have affected the outside school PA engagement of the children. Finally, we only assessed the effects in elementary school children. It is not clear if older children would benefit from the intervention to a similar extent.

5. Conclusions

Our findings indicated that integrating regular exergaming sessions into a school setting increased physical fitness in elementary school children. The fact that physical fitness is strongly associated with health benefits [9] and PA participation [11] underpins the significance of the present results. Furthermore, the findings supported the implementation of exergames as innovative PA programs in school settings, helping children develop a healthy and active lifestyle. This may be particularly relevant during the COVID-19 pandemic when other PA offerings, such as PE classes, are restricted.

Author Contributions

Conceptualization, K.K. and S.K.; methodology, S.K. and K.K.; validation, K.K. and S.K.; formal analysis, S.K. and L.R.; investigation, L.R., K.K. and S.K.; resources, K.K. and A.L.M.-N.; data curation, S.K.; writing—original draft preparation, S.K.; writing—review and editing, S.K., A.L.M.-N., K.K., L.R. and C.R.N.; visualization, S.K.; supervision, K.K. and A.L.M.-N.; project administration, K.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Research Ethics Board of the Medical Center Berlin (2020-09-RK1).

Informed Consent Statement

Informed parental or guardian consent was obtained for all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Acknowledgments

We would like to thank all students who participated in this study. Furthermore, we acknowledge the support of the teachers and school principal, without whom this study would not have been possible. We would like to thank Frank Brünner for supervising the exergaming sessions. Lastly, we thank Alex Bodman for his help in revising the manuscript.

Conflicts of Interest

S.K., K.K., L.R. and C.R.N. declare that they have no conflicts of interest. Besides being a Senior Researcher at the Zurich University of the Arts, A.L.M.-N. is also co-founder and CEO of the spinoff company Sphery. No revenue was paid (or promised to be paid) to A.L.M.-N., to Sphery, or to the research institutions.

References

  1. Bull, F.C.; Al-Ansari, S.S.; Biddle, S.; Borodulin, K.; Buman, M.P.; Cardon, G.; Carty, C.; Chaput, J.P.; Chastin, S.; Chou, R.; et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br. J. Sports Med. 2020, 54, 1451–1462. [Google Scholar] [CrossRef] [PubMed]
  2. Guthold, R.; Stevens, G.A.; Riley, L.M.; Bull, F.C. Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1·6 million participants. Lancet Child Adolesc. Heal. 2020, 4, 23–35. [Google Scholar] [CrossRef]
  3. Smith, J.J.; Eather, N.; Morgan, P.J.; Plotnikoff, R.C.; Faigenbaum, A.D.; Lubans, D.R. The health benefits of muscular fitness for children and adolescents: A systematic review and meta-analysis. Sports Med. 2014, 44, 1209–1223. [Google Scholar] [CrossRef]
  4. Casonatto, J.; Fernandes, R.A.; Batista, M.B.; Cyrino, E.S.; Coelho-e-Silva, M.J.; de Arruda, M.; Vaz Ronque, E.R. Association between health-related physical fitness and body mass index status in children. J. Child Heal. Care 2016, 20, 294–303. [Google Scholar] [CrossRef] [PubMed]
  5. Engelen, L.; Gale, J.; Chau, J.Y.; Hardy, L.L.; Mackey, M.; Johnson, N.; Shirley, D.; Bauman, A. Who is at risk of chronic disease? Associations between risk profiles of physical activity, sitting and cardio-metabolic disease in Australian adults. Aust. N. Z. J. Public Health 2017, 41, 178–183. [Google Scholar] [CrossRef] [PubMed]
  6. Hands, B.; Larkin, D.; Parker, H.; Straker, L.; Perry, M. The relationship among physical activity, motor competence and health-related fitness in 14-year-old adolescents. Scand. J. Med. Sci. Sports 2009, 19, 655–663. [Google Scholar] [CrossRef]
  7. Okely, A.D.; Booth, M.L.; Patterson, J.W. Relationship of physical activity to fundamental movement skills among adolescents. Med. Sci. Sports Exerc. 2001, 33, 1899–1904. [Google Scholar] [CrossRef] [PubMed]
  8. Bouffard, M.; Watkinson, J.E.; Thompson, L.P.; Causgrove Dunn, J.L.; Romanow, S.K.E. A test of the activity deficit hypothesis with children with movement difficulties. Adapt. Phys. Act. Q. 1996, 13, 61–73. [Google Scholar] [CrossRef]
  9. Lubans, D.R.; Morgan, P.J.; Cliff, D.P.; Barnett, L.M.; Okely, A.D. Fundamental movement skills in children and adolescents: Review of associated health benefits. Sports Med. 2010, 40, 1019–1035. [Google Scholar] [CrossRef] [Green Version]
  10. Ryu, S.; Lee, J.E.; Zeng, N.; Stodden, D.; McDonough, D.J.; Liu, W.; Gao, Z. Bidirectional relationships among children’s perceived competence, motor skill competence, physical activity, and cardiorespiratory fitness across one school year. Biomed Res. Int. 2021, 2021, 1704947. [Google Scholar] [CrossRef]
  11. Hardy, L.L.; Barnett, L.; Espinel, P.; Okely, A.D. Thirteen-year trends in child and adolescent fundamental movement skills: 1997–2010. Med. Sci. Sports Exerc. 2013, 45, 1965–1970. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  12. Barnett, L.M.; Morgan, P.J.; van Beurden, E.; Beard, J.R. Perceived sports competence mediates the relationship between childhood motor skill proficiency and adolescent physical activity and fitness: A longitudinal assessment. Int. J. Behav. Nutr. Phys. Act. 2008, 5, 40. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  13. Mitchell, B.; McLennan, S.; Latimer, K.; Graham, D.; Gilmore, J.; Rush, E. Improvement of fundamental movement skills through support and mentorship of class room teachers. Obes. Res. Clin. Pract. 2013, 7, e230–e234. [Google Scholar] [CrossRef]
  14. Peng, W.; Lin, J.H.; Crouse, J. Is playing exergames really exercising? A meta-analysis of energy expenditure in active video games. Cyberpsychol. Behav. Soc. Netw. 2011, 14, 681–688. [Google Scholar] [CrossRef] [Green Version]
  15. Gao, Z. Fight fire with fire? Promoting physical activity and health through active video games. J. Sport Heal. Sci. 2017, 6, 1–3. [Google Scholar] [CrossRef]
  16. Ye, S.; Lee, J.; Stodden, D.; Gao, Z. Impact of Exergaming on Children’s Motor Skill Competence and Health-Related Fitness: A Quasi-Experimental Study. J. Clin. Med. 2018, 7, 261. [Google Scholar] [CrossRef] [Green Version]
  17. Kari, T. Promoting physical activity and fitness with exergames: Updated systematic review of systematic reviews. In Transforming Gaming and Computer Simulation Technologies across Industries; Dubbels, B., Ed.; IGI Global: Hershey, PA, USA, 2016; pp. 225–245. ISBN 9781522518181. [Google Scholar]
  18. Gao, Z.; Zeng, N.; Pope, Z.C.; Wang, R.; Yu, F. Effects of exergaming on motor skill competence, perceived competence, and physical activity in preschool children. J. Sport Heal. Sci. 2019, 8, 106–113. [Google Scholar] [CrossRef]
  19. Gao, Z.; Pope, Z.C.; Lee, J.E.; Quan, M. Effects of active video games on children’s psychosocial beliefs and school day energy expenditure. J. Clin. Med. 2019, 8, 1268. [Google Scholar] [CrossRef] [Green Version]
  20. Gao, Z.; Zeng, N.; McDonough, D.J.; Su, X. A systematic review of active video games on youth’s body composition and physical activity. Int. J. Sports Med. 2020, 41, 561–573. [Google Scholar] [CrossRef] [PubMed]
  21. Ye, S.; Pope, Z.C.; Lee, J.E.; Gao, Z. Effects of school-based exergaming on urban children’s physical activity and cardiorespiratory fitness: A quasi-experimental study. Int. J. Environ. Res. Public Health 2019, 16, 4080. [Google Scholar] [CrossRef] [Green Version]
  22. Gao, Z.; Pope, Z.; Lee, J.E.; Stodden, D.; Roncesvalles, N.; Pasco, D.; Huang, C.C.; Feng, D. Impact of exergaming on young children’s school day energy expenditure and moderate-to-vigorous physical activity levels. J. Sport Heal. Sci. 2017, 6, 11–16. [Google Scholar] [CrossRef] [PubMed]
  23. Barnett, L.M.; Ridgers, N.D.; Reynolds, J.; Hanna, L.; Salmon, J. Playing Active Video Games may not develop movement skills: An intervention trial. Prev. Med. Rep. 2015, 2, 673–678. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  24. Lyons, E.J.; Tate, D.F.; Ward, D.S.; Bowling, J.M.; Ribisl, K.M.; Kalyararaman, S. Energy expenditure and enjoyment during video game play: Differences by game type. Med. Sci. Sports Exerc. 2011, 43, 1987–1993. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  25. Biddiss, E.; Irwin, J. Active video games to promote physical activity in children and youth: A systematic review. Arch. Pediatrics Adolesc. Med. 2010, 164, 664–672. [Google Scholar] [CrossRef]
  26. Martin-Niedecken, A.L.; Mahrer, A.; Rogers, K.; de Bruin, E.D.; Schättin, A. “HIIT” the ExerCube: Comparing the effectiveness of functional high-intensity interval training in conventional vs. exergame-based training. Front. Comput. Sci. 2020, 2, 33. [Google Scholar] [CrossRef]
  27. Ketelhut, S.; Röglin, L.; Kircher, E.; Martin-Niedecken, A.L.; Ketelhut, R.; Hottenrott, K.; Ketelhut, K. The New Way to Exercise? Evaluating an innovative heart-rate-controlled exergame. Int. J. Sports Med. 2021, 43, 77–82. [Google Scholar] [CrossRef] [PubMed]
  28. Focke, A.; Strutzenberger, G.; Jekauc, D.; Worth, A.; Woll, A.; Schwameder, H. Effects of age, sex and activity level on counter-movement jump performance in children and adolescents. Eur. J. Sport Sci. 2013, 13, 518–526. [Google Scholar] [CrossRef] [PubMed]
  29. Gomez-Bruton, A.; Gabel, L.; Nettlefold, L.; Macdonald, H.; Race, D.; McKay, H. Estimation of peak muscle power from a countermovement vertical jump in children and adolescents. J. Strength Cond. Res. 2019, 33, 390–398. [Google Scholar] [CrossRef] [PubMed]
  30. Glatthorn, J.F.; Gouge, S.; Nussbaumer, S.; Stauffacher, S.; Impellizzeri, F.M.; Maffiuletti, N.A. Validity and reliability of Optojump photoelectric cells for estimating vertical jump height. J. Strength Cond. Res. 2011, 25, 556–560. [Google Scholar] [CrossRef] [PubMed]
  31. Woll, A.; Kurth, B.M.; Opper, E.; Worth, A.; Bös, K. The “Motorik-Modul” (MoMo): Physical fitness and physical activity in German children and adolescents. Eur. J. Pediatrics 2011, 170, 1129–1142. [Google Scholar] [CrossRef]
  32. Pyne, D.B.; Gardner, A.S.; Sheehan, K.; Hopkins, W.G. Fitness testing and career progression in AFL football. J. Sci. Med. Sport 2005, 8, 321–332. [Google Scholar] [CrossRef]
  33. Léger, L.A.; Mercier, D.; Gadoury, C.; Lambert, J. The multistage 20 metre shuttle run test for aerobic fitness. J. Sports Sci. 1988, 6, 93–101. [Google Scholar] [CrossRef]
  34. Martin-Niedecken, A.L.; Rogers, K.; Vidal, L.T.; Mekler, E.D.; Segura, E.M. Exercube vs. Personal trainer: Evaluating a holistic, immersive, and adaptive fitness game setup. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems, Glasgow, Scotland, UK, 4–9 May 2019; pp. 1–15. [Google Scholar]
  35. Tanaka, H.; Monahan, K.D.; Seals, D.R. Age-predicted maximal heart rate revisited. J. Am. Coll. Cardiol. 2001, 37, 153–156. [Google Scholar] [CrossRef] [Green Version]
  36. Richardson, J.T.E. Eta squared and partial eta squared as measures of effect size in educational research. Educ. Res. Rev. 2011, 6, 135–147. [Google Scholar] [CrossRef]
  37. Portney, L.G.; Watkins, M.P. Foundations of Clinical Research: Applications to Practice; Pearson: Upper Saddle River, NJ, USA, 2009. [Google Scholar]
  38. Smits-Engelsman, B.C.M.; Jelsma, L.D.; Ferguson, G.D. The effect of exergames on functional strength, anaerobic fitness, balance and agility in children with and without motor coordination difficulties living in low-income communities. Hum. Mov. Sci. 2017, 55, 327–337. [Google Scholar] [CrossRef] [PubMed]
  39. Dickinson, K.; Place, M. A Randomised control trial of the impact of a computer-based activity programme upon the fitness of children with autism. Autism Res. Treat. 2014, 2014, 419653. [Google Scholar] [CrossRef] [Green Version]
  40. McGann, J.; Issartel, J.; Hederman, L.; Conlan, O. Hop.Skip.Jump.Games: The effect of “principled” exergameplay on children’s locomotor skill acquisition. Br. J. Educ. Technol. 2020, 51, 798–816. [Google Scholar] [CrossRef]
  41. Vernadakis, N.; Papastergiou, M.; Zetou, E.; Antoniou, P. The impact of an exergame-based intervention on children’s fundamental motor skills. Comput. Educ. 2015, 83, 90–102. [Google Scholar] [CrossRef]
  42. Liu, W.; Zeng, N.; McDonough, D.J.; Gao, Z. Effect of active video games on healthy children’s fundamental motor skills and physical fitness: A systematic review. Int. J. Environ. Res. Public Health 2020, 17, 8264. [Google Scholar] [CrossRef] [PubMed]
  43. Tsoukos, A.; Bogdanis, G.C. The effects of a five-month lockdown due to COVID-19 on physical fitness parameters in adolescent students: A comparison between cohorts. Int. J. Environ. Res. Public Health 2022, 19, 326. [Google Scholar] [CrossRef] [PubMed]
  44. Ketelhut, S.; Kircher, E.; Ketelhut, S.R.; Wehlan, E.; Ketelhut, K. Effectiveness of multi-activity, high-intensity interval training in school-aged children. Int. J. Sports Med. 2020, 41, 227–232. [Google Scholar] [CrossRef] [PubMed]
  45. Ketelhut, S.; Ketelhut, S.R.; Ketelhut, K. School-based exercise intervention improves blood pressure and parameters of arterial stiffness in children: A randomized controlled trial. Pediatr. Exerc. Sci. 2021, 33, 1–7. [Google Scholar] [CrossRef] [PubMed]
  46. LeBlanc, A.G.; Chaput, J.P.; McFarlane, A.; Colley, R.C.; Thivel, D.; Biddle, S.J.H.; Maddison, R.; Leatherdale, S.T.; Tremblay, M.S. Active video games and health indicators in children and youth: A systematic review. PLoS ONE 2013, 8, e65351. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  47. Gao, Z.; Hannan, P.; Xiang, P.; Stodden, D.F.; Valdez, V.E. Video game-based exercise, Latino children’s physical health, and academic achievement. Am. J. Prev. Med. 2013, 44, S240–S246. [Google Scholar] [CrossRef] [Green Version]
  48. Ferguson, G.D.; Jelsma, D.; Jelsma, J.; Smits-Engelsman, B.C.M. The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor task training and nintendo wii fit training. Res. Dev. Disabil. 2013, 34, 2449–2461. [Google Scholar] [CrossRef]
  49. Staiano, A.E.; Beyl, R.A.; Guan, W.; Hendrick, C.A.; Hsia, D.S.; Newton, R.L. Home-based exergaming among children with overweight and obesity: A randomized clinical trial. Pediatric Obes. 2018, 13, 724–733. [Google Scholar] [CrossRef]
  50. Maddison, R.; Mhurchu, C.N.; Jull, A.; Prapavessis, H.; Rodgers, A. Energy expended playing video console games: An opportunity to increase children’s physical activity? Ralph. Pediatric Exerc. Sci. 2007, 19, 334–343. [Google Scholar] [CrossRef]
  51. Graves, L.E.F.; Ridgers, N.D.; Williams, K.; Stratton, G.; Atkinson, G.; Cable, N.T. The physiological cost and enjoyment of Wii fit in adolescents, young adults, and older adults. J. Phys. Act. Health 2010, 7, 393–401. [Google Scholar] [CrossRef]
  52. Norris, E.; Hamer, M.; Stamatakis, E. Active video games in schools and effects on physical activity and health: A systematic review. J. Pediatrics 2016, 172, 40–46.e5. [Google Scholar] [CrossRef]
  53. Van De Laar, R.J.; Ferreira, I.; van Mechelen, W.; Prins, M.H.; Twisk, J.W.; Stehouwer, C.D. Lifetime vigorous but not light-to-moderate habitual physical activity impacts favorably on carotid stiffness in young adults: The amsterdam growth and health longitudinal study. Hypertension 2010, 55, 33–39. [Google Scholar] [CrossRef] [Green Version]
  54. Schnohr, P.; Marott, J.L.; Jensen, J.S.; Jensen, G.B. Intensity versus duration of cycling, impact on all-cause and coronary heart disease mortality: The Copenhagen City Heart Study. Eur. J. Prev. Cardiol. 2012, 19, 73–80. [Google Scholar] [CrossRef]
  55. Baranowski, T.; Maddison, R.; Maloney, A.; Medina, E.; Simons, M. Building a better mousetrap (exergame) to increase youth physical activity. Games Health J. 2014, 3, 72–78. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  56. Madsen, K.A.; Yen, S.; Wlasiuk, L.; Newman, T.B.; Lustig, R. Feasibility of a dance videogame to promote weight loss among overweight children and adolescents. Arch. Pediatrics Adolesc Med. 2007, 161, 105–107. [Google Scholar] [CrossRef] [PubMed]
  57. Finco, M.D.; Reategui, E.; Zaro, M.A.; Sheehan, D.D.; Katz, L. Exergaming as an alternative for students unmotivated to participate in regular physical education classes. Int. J. Game-Based Learn. 2015, 5, 1–10. [Google Scholar] [CrossRef] [Green Version]
  58. Sheehan, D.; Katz, L.; Kooiman, B. Exergaming and physical education: A qualitative examination from the teachers’ perspective. J. Case Stud. Educ. 2015, 4, 1–14. [Google Scholar]
  59. Goodway, J.D.; Branta, C.F. Influence of a motor skill intervention on fundamental motor skill development of disadvantaged preschool children. Res. Q. Exerc. Sport 2003, 74, 36–46. [Google Scholar] [CrossRef] [PubMed]
  60. Castelli, D.M.; Valley, J.A. Chapter 3: The relationship of physical fitness and motor competence to physical activity. J. Teach. Phys. Educ. 2007, 26, 358–374. [Google Scholar] [CrossRef]
  61. Wrotniak, B.H.; Epstein, L.H.; Dorn, J.M.; Jones, K.E.; Kondilis, V.A. The relationship between motor proficiency and physical activity in children. Pediatrics 2006, 118, e1758–e1765. [Google Scholar] [CrossRef] [PubMed]
  62. Boreham, C.; Riddoch, C. The physical activity, fitness and health of children. J. Sports Sci. 2001, 19, 915–929. [Google Scholar] [CrossRef]
  63. Wedderkopp, N.; Froberg, K.; Hansen, H.S.; Riddoch, C.; Andersen, L.B. Cardiovascular risk factors cluster in children and adolescents with low physical fitness: The European Youth Heart Study (EYHS). Pediatric Exerc. Sci. 2003, 15, 419–427. [Google Scholar] [CrossRef]
  64. Gao, Z.; Podlog, L.; Huang, C. Associations among children’s situational motivation, physical activity participation, and enjoyment in an active dance video game. J. Sport Heal. Sci. 2013, 2, 122–128. [Google Scholar] [CrossRef] [Green Version]
  65. Warburton, D.E.R.; Bredin, S.S.D.; Horita, L.T.L.; Zbogar, D.; Scott, J.M.; Esch, B.T.A.; Rhodes, R.E. The health benefits of interactive video game exercise. Appl. Physiol. Nutr. Metab. 2007, 32, 655–663. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  66. Klein, M.J.; Simmers, C.S. Exergaming: Virtual inspiration, real perspiration. Young Consum. 2009, 10, 35–45. [Google Scholar] [CrossRef]
  67. Dishman, R.K.; Motl, R.W.; Saunders, R.; Felton, G.; Ward, D.S.; Dowda, M.; Pate, R.R. Enjoyment mediates effects of a school-based physical-activity intervention. Med. Sci. Sports Exerc. 2005, 37, 478–487. [Google Scholar] [CrossRef] [PubMed]
  68. Röglin, L.; Ketelhut, S.; Ketelhut, K.; Kircher, E.; Ketelhut, R.G.; Martin-Niedecken, A.L.; Hottenrott, K.; Stoll, O. Adaptive high-intensity exergaming: The more enjoyable alternative to conventional training approaches despite working harder. Games Health J. 2021, 10, 400–407. [Google Scholar] [CrossRef] [PubMed]
  69. Cairney, J.; Hay, J.A.; Faught, B.E.; Wade, T.J.; Corna, L.; Flouris, A. Developmental coordination disorder, generalized self-efficacy toward physical activity, and participation in organized and free play activities. J. Pediatrics 2005, 147, 515–520. [Google Scholar] [CrossRef]
  70. Carroll, B.; Loumidis, J. Children’s perceived competence and enjoyment in physical education and physical activity outside school. Eur. Phys. Educ. Rev. 2001, 7, 24–43. [Google Scholar] [CrossRef]
  71. Barnett, L.M.; Hinkley, T.; Okely, A.D.; Hesketh, K.; Salmon, J. Use of electronic games by young children and fundamental movement skills? Percept. Mot. Skills 2012, 114, 1023–1034. [Google Scholar] [CrossRef] [PubMed]
Table
Table 1. Student’s characteristics at baseline.
Table 1. Student’s characteristics at baseline.
ItemsTotal (n = 34)IG (n = 18)CG (n = 16)
M ± SDM ± SDM ± SDp-Value
Boys/Girls (n)17/178/109/7
Age (yrs)10.5 ± 0.710.5 ± 0.710.5 ± 0.60.894
Height (cm)147.3 ± 7.6147.9 ± 8.7146.5 ± 6.30.591
Body mass (kg)45.3 ± 12.448.2 ± 12.442.1 ± 11.90.154
Body Mass Index (kg·m−2)20.6 ± 4.221.7 ± 4.019.3 ± 4.10.094
Waist-to-height ratio0.46 ± 0.060.47 ± 0.050.44 ± 0.070.285
Values are means (M) ± standard deviations (SD). p-values indicate differences between the IG and CG.
Table
Table 2. Changes in outcomes from before to after intervention for the intervention group (IG) and control group (CG).
Table 2. Changes in outcomes from before to after intervention for the intervention group (IG) and control group (CG).
OutcomeIG (n = 18)CG (n = 16)
PrePostPrePostp-Valuesη2
BMI (kg·m−2)21.7 ± 4.021.6 ± 4.219.3 ± 4.119.7 ± 4.1n.s.0.063
WHtR0.47 ± 0.050.46 ± 0.050.44 ± 0.070.45 ± 0.07n.s.0.114
CMJ (cm)18.6 ± 5.421.1 ± 5.2 ***20.5 ± 5.218.6 ± 3.6 **<0.0010.403
ST (s)4.12 ± 0.454.08 ± 0.474.06 ± 0.354.18 ± 0.320.0200.157
SRT (m)450.0 ± 228.0537.8 ± 210.5 *498.7 ± 208.3469.3 ± 162.30.0460.122
Abbreviations: Pre—before intervention; post—after intervention; BMI—body mass index; WHtR—waist-to-height ratio; CMJ—countermovement jump; ST—sprint test; SRT—shuttle run test; η2 –partial eta squared. * p < 0.05, ** p < 0.01, and *** p < 0.001 represent changes from before to after intervention for the IG and CG. p-values represent interaction effects.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Ketelhut, S.; Röglin, L.; Martin-Niedecken, A.L.; Nigg, C.R.; Ketelhut, K. Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial. J. Clin. Med. 2022, 11, 1570. https://doi.org/10.3390/jcm11061570

AMA Style

Ketelhut S, Röglin L, Martin-Niedecken AL, Nigg CR, Ketelhut K. Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial. Journal of Clinical Medicine. 2022; 11(6):1570. https://doi.org/10.3390/jcm11061570

Chicago/Turabian Style

Ketelhut, Sascha, Lisa Röglin, Anna Lisa Martin-Niedecken, Claudio R. Nigg, and Kerstin Ketelhut. 2022. "Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial" Journal of Clinical Medicine 11, no. 6: 1570. https://doi.org/10.3390/jcm11061570

APA Style

Ketelhut, S., Röglin, L., Martin-Niedecken, A. L., Nigg, C. R., & Ketelhut, K. (2022). Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial. Journal of Clinical Medicine, 11(6), 1570. https://doi.org/10.3390/jcm11061570

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop