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Meta-Analysis
. 2020 Apr 1;22(4):e14549.
doi: 10.2196/14549.

Effectiveness of Serious Games to Increase Physical Activity in Children With a Chronic Disease: Systematic Review With Meta-Analysis

Daniël Bossen #  1 , Aline Broekema #  1 , Bart Visser  1 , Annette Brons  2 , Annieck Timmerman  3 , Faridi van Etten-Jamaludin  4 , Katja Braam  1 , Raoul Engelbert  1   5   6
Affiliations
Meta-Analysis

Effectiveness of Serious Games to Increase Physical Activity in Children With a Chronic Disease: Systematic Review With Meta-Analysis

Daniël Bossen et al. J Med Internet Res. .

Abstract

Background: Physical activity (PA) is important for children with a chronic disease. Serious games may be useful to promote PA levels among these children.

Objective: The primary purpose of this systematic review was to evaluate the effectiveness of serious games on PA levels in children with a chronic disease.

Methods: PubMed, EMBASE, PsycINFO, ERIC, Cochrane Library, and CINAHL were systematically searched for articles published from January 1990 to May 2018. Both randomized controlled trials and controlled clinical trials were included to examine the effects of serious games on PA levels in children with a chronic disease. Two investigators independently assessed the intervention, methods, and methodological quality in all articles using the Cochrane risk of bias tool. Both qualitative and quantitative analyses were performed.

Results: This systematic review included 9 randomized controlled trials (886 participants). In 2 of the studies, significant between-group differences in PA levels in favor of the intervention group were reported. The meta-analysis on PA levels showed a nonsignificant effect on moderate to vigorous PA (measured in minutes per day) between the intervention and control groups (standardized mean difference 0.30, 95% CI -0.15 to 0.75, P=.19). The analysis of body composition resulted in significantly greater reductions in BMI in the intervention group (standardized mean difference -0.24, 95% CI -0.45 to 0.04, P=.02).

Conclusions: This review does not support the hypothesis that serious games improve PA levels in children with a chronic disease. The meta-analysis on body composition showed positive intervention effects with significantly greater reductions in BMI in favor of the intervention group. A high percentage of nonuse was identified in the study of serious games, and little attention was paid to behavior change theories and specific theoretical approaches to enhance PA in serious games. Small sample sizes, large variability between intervention designs, and limited details about the interventions were the main limitations. Future research should determine which strategies enhance the effectiveness of serious games, possibly by incorporating behavior change techniques.

Keywords: chronic disease; computer games; exercise therapy; health education; pediatrics; video games.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart showing the selection procedure for the studies in this systematic review and meta-analysis.
Figure 2
Figure 2
Risk of bias summary of the included studies.
Figure 3
Figure 3
Forest plot for the meta-analysis of moderate to vigorous physical activity (minutes per day).
Figure 4
Figure 4
Forest plot for the meta-analysis of physical activity (step counts).
Figure 5
Figure 5
Forest plot for the meta-analysis of cardiorespiratory endurance (6-minute walk test).
Figure 6
Figure 6
Forest plot for the meta-analysis of functional muscle strength.
Figure 7
Figure 7
Forest plot for the meta-analysis of BMI.
See this image and copyright information in PMC

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