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Review Article Obesity & Control therapies: Open Access Open Access

Effects of Different Types of Exergaming on Physiological Responses in Different Age Groups Any Good for Countries with Hot Climates? Literature Review Taha Yassine Temlali, Monem Jemni* 1Sport Science Program, College of Arts and Sciences, Qatar University, Doha - Qatar

Received: 06 November, 2017; Accepted: 15 December, 2017; Published: 29 December, 2017

*Corresponding author: Monem Jemni, Sport Science Program, College of Arts and Sciences, Qatar University, Doha – Qatar, Tel: 00974-4403- 7693; Fax: 00974-4403-4501; Email: [email protected], [email protected]

life style is associated with a huge number of comorbidities such Abstract as obesity, diabetes, hypertension, osteoporosis and depression Sedentary screen time behaviors have increased dramatically in the Gulf region, whereas the prevalence rate of physical inactivity is increasing. Existing evidence show that Active Video Games (AVG) worldwide[2-4]. According are living to WHO,a sedentary two thirdslife style of which children will around have some the can be a promising tool to create a safe, pleasant environment for world are not sufficiently active. Nowadays, 59 to 84 % of people performing light to moderate intensity exercise. serious implications on their health status at some point of their lives. Different reasons have been attributed for the lack Purpose: This review aims to provide an overview of studies of exercise and physical activities per gender, culture, ethnic that tested the effect of active video gaming (exergaming) on multiple minorities, religions, socio economic status, knowledge, aptitudes health biomarkers in different age groups for both genders. A secondary objective is to discuss the possibility of introducing active video games as a new physical activity option in different age groups Physical inactivity has increased progressively in the past in countries with hot climates. toward exercise and facility availabilities [2,3,5,6]. few decades, largely due to the increased screen time behaviors Method: A systematic review was carried out on studies that in many countries [7]. Screen time refers to time spent browsing tested the physiological responses (mainly energy expenditure) to the Internet, watching TV or playing traditional video games active video gaming in different age categories for both genders; also, studies that looked at whether this type of activities (exergaming) between both low PA levels, chronic diseases (diabetes, obesity, [8]. Many studies have shown consistent positive relationship activity recommended by the ACSM for both youth, adults and elderly hypertension, musculoskeletal fragility, depression) and inactive population.can induce health benefits and meet the minimal amount of physical physical inactivity in the gulf region is among the highest in the Results: AVGs were found to reduce body weight (BW), world“screen [14]. time” We behaviorsshall recall [9-13]. that this Statistics part of showthe world that is levels known of decrease abdominal subcutaneous adiposity, percentage of leg fatincrease and total trunk adiposity. and spine In addition, bone mineral they were density, able andto elicit significantly light to moderate intensities and to meet the American college of sport theby itsvast very number hot and of humidpeople climatein Qatar which suffering makes from it difficult multiple to medicine’s (ACSM) recommendations for maintaining and improving exercise outside for a significant period of the year. For example,

non-communicable diseases (NCD) is driven partially by the cardiorespiratoryConclusion: AVGs fitness should (CRF) be for considered both genders as a physicalin all ages. activity (PA) contributors to health problems in the world. The most spread option because of its ability to create a safe, pleasant environment for high levels of physical inactivity, which is among the main five performing light to moderate intensity of exercise. It can also break of adolescents; both males and females aged between 14 and 20 the perceived barriers to PA, whether it is related to the bad weather, yearsdiseases old in are the obese). Gulf region In 2003, are diabetesa study done (17%) by and Peeters obesity found (59.9% that lack of facilities or the shortage of time. diabetes and obesity can reduce someone’s life by approximately Keywords: sedentary screen time, active video games, energy expenditure eightSedentary years [15]. screen time behaviors have increased dramatically Introduction of the internet, watching TV, playing traditional video games. This Physical inactivity is one of the biggest concerns in the world. meansin the Gulf less countries time is available due to the for dramatic individuals increase to participate in the utilization in PA because of the prolonged periods of time spent sitting inactively. inactivity as the fourth leading risk among other risk factors for globalRecently, mortality, the World where Health it is Organization the primary (WHO) cause of identified the death physical of two million people each year (6 % of death worldwide) [1]. Sedentary Rahim, et al. found that the prevalence rate of physical inactivity in Qatar was 46 % [14]. These findings support the importance of minimizing inactive screen time. Although physical activity is a Symbiosis Group * Corresponding author email: [email protected], [email protected] Effects of Different Types of Exergaming on Physiological Responses in Different Age Copyright: Groups Any Good for Countries with Hot Climates? Literature Review © 2017 Monem Jemni, et al. major determinant of a good health, important number of Qataris that are not published in English, publication date before 2000, do not exercise. studies that looked at the therapeutically use of active video games to treat cognitive and behavioral diseases, and studies Mistakenly, there is a common perception that video games

that are funded by video gaming companies. However, there was are played only by young people. However, a six nation’ survey meta-analyses and systematic reviews were used and chosen accordingno restriction to these criteria inclusion for the and country exclusion of study. criteria. Original articles, hoursperformed weekly by playing Northwestern video games university while individualsin 2014 found who that are aged17% of individuals aged from 25 to 44 years old or more spend four Information Sources and Keywords between 18 and 25 or older represent 30 % of the population and they spend up to 5 hours a week gaming [16,17]. The survey took The search included the following databases: SPORT Discuss placeThe in usethe ofMiddle active East video and games the North to overcome African (MINA)physical countries. inactivity System online-national library of medicine), Web of science and and promote healthy lifestyle is becoming an emerging trend in with Full Text, Medline (Medical Literature Analysis and Retrieval

separatelyScopus. University or combined and when other required. related The organizations following words websites are thatthe physicalincrease fitnessthe user’s domain. energy Active expenditure video games, by requiring exergames him orto relatedwere also to searchedthe physiological for additional responses resources. to exergaming Keywords in were different used applyinteractive full body fitness motion games to are play terms the usedgame. to Various describe types video of games AVGs age groups with different health status: exergaming, energy exist such as; interactive aerobic video games, censored pads and expenditure, sedentary screen time, physical activity, physical motion sensor video cameras. inactivity, active video gaming, old adults, young, adults, obese, step count, PA recommendations, oxygen consumption, metabolic This review aims to provide an overview of studies that tested equivalent and ratings of perceived exertion. the effect of active video gaming (exergaming) on multiple health biomarkers in different age groups for both genders. A secondary Articles Collection Process objective is to discuss the usefulness of such video games as

The duplicates were excluded and the titles and abstracts were conditions. Exercising under extreme weather conditions could Analyzing and screening the articles was performed manually. bea physicalimpossible activity and even option dangerous in countries in several with countries; difficult climatehence, papers retrieved were chosen according to the restriction criteria the point is see if exergaming could be a safer option to exercise screened. Before the final qualitative synthesis of the studies; the indoors. The original articles, systematic reviews and meta-analysis were Method mentioned above, and their full text were analyzed afterwards. them were exuded for not meeting the inclusion criteria. Mainly A systematic review was carried out on studies that tested oneanalyzed investigator separately. conducted A total ofthe 29 articles studies screening. were identified; Data obtained eight of the physiological responses (mainly energy expenditure) to active video gaming in different age categories for both genders. tables for further interpretation. A particular interest was paid to studies that checked whether from the selected experimental studies were summarized into Results recommendation of physical activity by the ACSM for both youth, adultsexergaming and elderly can induce population. health benefits and meet the minimal Overall Results Twenty-one studies that examined levels of energy Inclusion criteria expenditure during active play were selected. Studies published between 2000 and 2017 reporting: correlated to active video game play. The vast majority of studies showedEnergy expenditure that exergaming and heart elicited rate light were to found moderate to be andsignificantly in some metabolic responses, energy expenditure, rating of perceived cases vigorous intensities that fall under the recommendations of exertion,• Different step health count, biomarkers body composition] [heart rate, and oxygen energy uptake expenditure (VO2), during exergaming. showed the ability of exergaming to alter body composition positivelythe ACSM forby improvingreducing fitnessfat percentage and general and heath. increasing Some studies bone mineral density. It was proposed that playing active video games • Young, adult and old subjects • Healthy and/or unhealthy subjects Dance revolution, Bike games, , Xavix, Eye toy. for longer periods of time can induce even greater benefits. Table • Most popular exergaming systems, such as the Konami Dance 1Game summarizes Bike the studies selected for this review. tests. • Health biomarkers assessed using valid and reliable physical promote exercise through playing video games. The user is Exclusion criteria requiredGame to bike pedal is and one to ofturn the the interactive handlebars fitness to steer devices and control that

expenditure between both riding a traditional stationary bike Restriction criteria was imposed by limiting the publications the character’s acceleration. Haddock, et al. compared the energy Citation: Yassine Temlali T, Monem Jemni Page 2 of 10 4(3): 1-10. (2017) Effects of Different Types of Exergaming on Physiological Responses in Different Age Groups Any Good for Countries with Hot Climates? Literature Review. Obes Control Ther Effects of Different Types of Exergaming on Physiological Responses in Different Age Copyright: Groups Any Good for Countries with Hot Climates? Literature Review © 2017 Monem Jemni, et al.

Table 1: Summary of experimental studies that explored the effect of exergaming on health biomarkers using active bike games

Reference Objective Sample and design Dose Results To compare the energy Interactive cycling video expenditure between both riding Haddock, et al. children (overweight)- Comparison 20 minutes on a traditional stationary bike and greater energy expenditure 2009 N=20 aged study-7 to 14 years old stationary bike the interactive cycling video gamecompared elicited to significantlytraditional game. cycling. Lab based Game bike elicited 30 minutes trial To compare the physiological, of Game Bike and perceptual and enjoyment and more enjoyment another 30 minutes Monedero J, et al. significantlycompared to VO2reserve traditional trial of traditional 2015 of interactive cycling video game cycling. N= 34, young,based men, women- cycling at a peak Responsesand traditional between cycling a single at the bout the subjects’ work Randomized control study- lab power output of same intensity intensity was greater during Game Bike trail and riding an interactive cycling video game (stationary bike to 55%. control the video game) in overweight children. The participants’ weregaming randomly using assigned Wii to onthree reducing different body groups; weight competitive in African- (subjectsAmerican compete adolescents. against 45 each overweight other) and and cooperative obese adolescents (subjects measuredages ranged while from performing 7 to 14 yearsthe test old on with a stationary a BMI classification bike for 20 play together to get higher scores) active video game groups of “overweight” [18]. Participants’ energy expenditure was and a control group. The exergaming groups especially the minutes. For both conditions; energy expenditure and oxygen kg) compared to the control group [20]. consumption increased significantly above -1 resting) compared levels. to cooperative group reduced their weight significantly (1.65 + 4.52 In a comparison study, Mellecker, et al. compared active However, interactive cycling video game-1) (p < elicited 0.05). There significantly was no greater energy expenditure (4.4 ± 102 Kcal.min and inactive video games in terms of energy expenditure and thetraditional two sessions cycling (p (3.7 > 0.05 ± 1.1). Kcal.min significant difference in the rating of perceived exertion between during inactive video gaming, and during exergaming (Xavix J-Matcardiovascular and Xavix responses bowling) inwere children. measured Heart in rateaddition values to atenergy rest, compared physiological, perceptual and enjoyment responses betweenAnother a single study bout in of 2015, interactive conducted cycling by video Monedero, game (Game et al. Bike) and traditional cycling at the same intensity. 34 healthy expenditure at rest. Results showed that energy expenditure and participants performed a 30 minutes trial of Game Bike and toheart baseline rate during and inactive Xavix bowlingcomputer (102 games ± 20 [21]. beats/min) and Xavix another 30 minutes trial of traditional cycling at a peak power J-Mat (160 ± 20 beats/min) were significantly higher compared Testing adults this time, Miyachi, et al. conducted a study -1), and higher output of 55%. Game bike elicited significantly higher energy on energy expenditure. 12 adults from both genders performed 2 to determine the effect of Wii Fit Plus and Nintendo Wii Sports comparedexpenditure to (505.8 traditional ± 75.2 cycling. vs 487 Taking ± 81.2 intoj.Kg.min consideration the individual’spercentage ofventilatory VO reserve threshold; (68.2% the ± 9.2% subjects’ vs 64.7 work % intensity ± 8.1%) and68 activities resistance) that and were Wii dividedsport exercises into Wii (baseball, Fit Plus exercisesgolf, bowling, that boxing,involve tennis). 63 activities 44 of (categorizedthe activities as elicited aerobics, light balance, intensity yoga of was greater during Game Bike trial (11.86 + 3.08 W) compared to traditionalInteractive cycling Aerobic (7.55 Fitness + 3.16 W) Games [19]. moderate intensity (3.0 to 6.0 METs) that met the American heart associationexercise, while and 22 American activities collegeout of 68 of (33% sport of medicine activities) guidelines elicited a [22]. Similar results were found by Guderian, et al. who looked technology to improve and promote cardiovascular activities. Interactive aerobic fitness games are devices that apply cardiovascular responses. Twenty middle aged and older adults games that include a variety of activities that allows the user to at the effect of Wii Fit video games on the metabolic and The Xavix gaming system and the Nintendo Wii Fit are exercise (males and females) performed aerobic and balance exercises develop and benefit from different fitness components through games. A total of 12 published studies that evaluated energy using Wii Fit video games during a 20-minute testing session. different games such as strength, aerobics, balance and flexibility Results showed that Wii fit video games met the ACSM guidelines All studies examined the acute effect of exergaming on subjects in for sustaining and developing cardiorespiratory fitness in middle expenditure during interactive fitness game plays were reviewed. games can successfully replace some traditional aerobic activities aged and elderly people. It was suggested that Wii Fit video a single session of interactive fitness games. Data collected from et al. where they compared the enjoyment and physiological cost above baseline during exergaming sessions (Table 2). [23]. Consistent findings were found in a study done by Graves, six studies showed a significant increase of energy expenditure adults and older adults. The results showed that exergaming on of Wii Fit game play with aerobic exercise in adolescents, young One of these studies tested the effect of 20 weeks of active video Citation: Yassine Temlali T, Monem Jemni Page 3 of 10 4(3): 1-10. (2017) Effects of Different Types of Exergaming on Physiological Responses in Different Age Groups Any Good for Countries with Hot Climates? Literature Review. Obes Control Ther Effects of Different Types of Exergaming on Physiological Responses in Different Age Copyright: Groups Any Good for Countries with Hot Climates? Literature Review © 2017 Monem Jemni, et al.

Table 2:

ReferenSummaryce of experimentalObjective studies that explored the effect ofSample exergaming and design on health biomarkers usingDose interactive aerobic fitnessResults games

The exergaming American adolescents – obese and To test the effect of 20 weeks of active 30 to 60 minutes per groups; especially the Staiano, et al. overweight-N=45 overweight randomly and obese assigned African to 3 school day for 20 cooperative group 2013 different (control, AVG, cooperative reducing body weight weeks reduced their weight video gaming using Nintendo Wii on groups – school based AVG) -Randomized control study Energysignificantly. expenditure and heart rate during To compare active and inactive videos Xavix bowling and Mellecker, et games in terms of energy expenditure 25-minute protocol - 5 Xavix J-Mat were min rest - 5 min seated and cardiovascular responses in N= 18 children (11m, 7 f) – ages 6 to – short term, comparison study computer bowling- 5 children 12 years old- Caucasian- Lab based compared to baseline al. 2008 min XavixJ-Mat bowling- 5 andsignificantly inactive computer higher min rest- 5 min Xavix games.

(33% of activities) Miyachi, et al. 22elicited activities a moderate out of 68 2010 To determine the effect of Wii Fit Plus N= 12 Japanese adults – ages 25 -44 intensity. The other 44 expenditure. short term effect study 8 minutes of each of and Nintendo Wii Sports on energy years old – (7 m ,5 f). Lab based – activities elicited low the 68 activities. intensity.

the ACSM guidelines Wii fitfor video sustaining games met Guderian, et on the metabolic and cardiovascular and developing al. 2010 To test the effect of Wii Fit video games responses. N=20 middle aged men and women cardiorespiratory 20 minutes of Wii Fiit Lab based- short term effect study and elderly people fitness in middle aged exergaming on Wii To compare the enjoyment and Graves, et al. intensity activity young, adults and older adults- lab Fit elicited moderate in 2010 with aerobic exercise in adolescents, N= 42 - both genders -adolescents, in all 3 populations physiological cost of Wii Fit game play based Short term effect study young adults and older adults. 10 minutes of Wii Fiit when compared to traditional games. Energy expenditure To compare the effect of sedentary higher during Wii Graves, et al. video games and active video games on sportswas significantly game play in in 2007 energy expenditure on adolescents of N= 13Short Caucasian term childreneffect study - (7 M- 6 boxing bowling and both genders F) ages 11 to 17 years old-lab based 15 minutes of Wii Fiit when compared to sedentary video game. Active video gaming results in a To compare the energy expenditure 30 minutes of Wii between active and inactive video energy expenditure et al. 2010 based Short term effect study tennis significantly greater Leatherdale, gaming N= 51 undergraduate students - lab when compared to sedentary video gaming. Energy expenditure To measure energy expenditure during during exergaming is Mitre, et al. active video gaming and compare it 2011 with television watching and inactivate overweightN=19, 11 m or and obese- 8 f children, lab based sedentary screen time video games. agesShort 8-12 yearsterm effectold - 11 study lean - 8 10 minutes of Wii Fiit 50% higheractivities. than other

consumption, and To test metabolic and cardiovascular energyHeart rate, expenditure oxygen Mullins, et al. responses of young and older adults years old - lab based Short term 2012 N=20, 10 m and 10 f , ages 19 - 64 during active video game play. effect study 4 bouts of 15 minutes greater than were significantly using Wii Fiit resting levels for all participants.

Citation: Yassine Temlali T, Monem Jemni Page 4 of 10 4(3): 1-10. (2017) Effects of Different Types of Exergaming on Physiological Responses in Different Age Groups Any Good for Countries with Hot Climates? Literature Review. Obes Control Ther Effects of Different Types of Exergaming on Physiological Responses in Different Age Copyright: Groups Any Good for Countries with Hot Climates? Literature Review © 2017 Monem Jemni, et al.

Energy expenditure White, et al. To measure energy expenditure during using AVG increased 2010 active video gaming term effect game N= 26 children – lab based – short 8 minutes for Wii Fiit above resting level. Aerobic resulted in the highest energy expenditure among Worley, et al. max % and energy 10 minutes for each 2 all activities and had a 2011 expenditure during exergaming effect. To determine VO N=8 girls – lab based – short term similar energy cost of level of WII Fiit walking at a speed of

Exergaming resulted in To determine energy expenditure 5.63 km.h. during rest, standing, sitting watching 10 minutes of Wii N=22 adolescents- ages 10-14 years in energy expenditure Lanningham- TV, inactive video games play while boxing a significant increase old and 20 adults -ages 23-45 years above resting levels in Foster, et al. seated and exergaming. short term effect. old from both genders. Lab based – both kids and adults. 2009

[24]. In 2007, Graves et al. compared the effect of sedentary 2 max percentage and energy expenditure during exergaming. Wii Fit elicited moderate intensity activity in all three groups Aerobiceight young games girls such using as athe variety intermediate of Wii Fit hula games and to step determine games energy expenditure on adolescents of both genders aged between resultedVO in the highest energy expenditure among all activities video games ( 360) and active video games (Wii sports) on

13-15 years old. Results showed that energy expenditure was bothand had children a similar and energy adults costduring of walking exergaming at a speed and inactive of 5.63 km/hvideo significantly higher during Wii sports game play in boxing (198.1 gaming.[30]. Lanningham, 22 healthy et adolescentsal. compared and energy twenty expenditure adults from between both + 33.9 kl/kg/min), bowling (190.6 + 22.2 kl/kg/min) and tennis genders participated in the study. Indirect calorimeter and A(202.5 similar + 31.5 study kl/kg/min) compared when the energy compared expenditure to XBOX between 360 which active is a accelerometers were used to determine energy expenditure sedentary video game (125.5 + 13.7 kl/kg/min) (p < 0.001) [25]. during rest, standing, sitting watching TV, inactive video games Sense Wear armbands and heart rate monitors. It was concluded and inactive video gaming in 51 undergraduate students using play while seated and exergaming using Nintendo Wii aerobic that active video gaming results in a significantly greater energy game (boxing).P < .001Exergaming resulted in a significantP increase< .001). Asin 64.7expenditure kcal) with when the comparedheart rate monitorsto sedentary [26]. video In 2011, gaming Mitre (192.4 et al., energy expenditure above resting levels in both, children (189 ± measuredkcal vs 42.6 energy kcal) with expenditure the Sense in Wear obese armbands and lean and children (97.4 duringkcal vs 63 kcal/hr, ) and adults (148 ± 71 kcal/hr, active video gaming and compare it with television watching and [31].for the movement pattern, it was significantly greater for children inactivate video games. Energy expenditure during exergaming (55 ±5 vs 23 ± 2 arbitrary acceleration units) compared to adults Dance Simulation Games (Table 3)

(125.3 ± 38.2p < 0.0001 kcal/hr)). It was was significantly shown that higherenergy than expenditure inactive dance simulation games. The players should step on arrows laid video gaming (79.4 ±15.7 kcal/hr) and watching TV (79.7± 20.1 on aDance dance Danceplatform Revolution in response (DDR) to visual is one cues of the displayed most popular on the kcal/hr) ( screen accompanied with music. A total of four published studies during exergaming is 50% higher than other sedentary screen that examined the acute effect of dance simulation games on healthytime activities younger [27]. and Results older thatadults are this consistent time, the with metabolic the previous and cardiovascularstudy were found responses by White of participants et al. in 2011 during [28]. active Targeting video by Sell et al., compared energy expenditure levels between experiencedenergy expenditure and amateur were reviewed. players Induring 2008, active one study video performed gaming. Twelve male college students who are experienced in Dance Dance game play (Wii Fit) were tested and the levels of physical activity during Wii Fit play were compared with the American college of sport medicine recommendations for physical activity. Heart rate, Revolution (DDR) and seven students who have no experience greater than resting levels for all participants; with the strength 2 andoxygen aerobic consumption, games inducing and energy the expenditurehighest elevations. were significantly Young and gamein DDR play. were Values chosen of oxygen for the consumption, study. The participants heart rate, respiratory finished a older adult’s responses were the same except that in terms exchangeVO max test ratio and and a 30-minute step counts session were of recorded Dance Dance throughout Revolution the of heart rate reserve and ratings of perceived exertion; older examination. Unexperienced players showed lower values for all adults perceived the activities as more intense. The majority of measured variables including levels of energy expenditure, and games elicited light intensity physical activity for young adults, exercise intensity reached. In addition, they expended more time while oxygen consumption and peak heart rate values of older p < .05) compared to experienced adults for strength (plank, rowing squat, single leg extension) and aerobics (rhythmic boxing, advanced step, super hula hoop) and steps to burn 150 kcal ( games elicited moderate intensity physical activity recommended unexperienced)players. The main by findingworking was at higher that experienced game intensities players [32]. can Unnithanexpand significantly and colleagues more (2006) energy compared (315.5 kcal submaximal vs 144.0 kcalenergy for by the ACSM [29]. Testing only females, Worley, et al. examined Citation: Yassine Temlali T, Monem Jemni Page of 10 4(3): 1-10. (2017) Effects of Different Types of Exergaming on Physiological Responses in Different 5 Age Groups Any Good for Countries with Hot Climates? Literature Review. Obes Control Ther Effects of Different Types of Exergaming on Physiological Responses in Different Age Copyright: Groups Any Good for Countries with Hot Climates? Literature Review © 2017 Monem Jemni, et al.

Table 3: Summary of experimental studies that explored the effect of exergaming on health biomarkers using dance simulation games Reference Objective Sample and design Dose Results Experienced players To compare energy expenditure students – ages 17-24 years between experienced and N=19 Caucasian male more energy compared to amateur players during active game play inexperiencedcan expand significantly players by inexperienced – lab base- acute video gaming 30 minutes of DDR working at higher game Sell, et al. 2008 old -12intervention experienced study. in DDR- 7 intensities.

To determine whether the intensities elicited by the Heartabove rate the intensitiesminimal intensity elicited Unnithan, et al. simulation video game will N=20, Caucasian children and duringrecommended the DDR by session the ACSM was 2006 meet the ACSM guidelines for game play. adolescents,lab base- acute n=12 intervention lean, n= 10 improving and preserving 12 minutes of DDR overweight, study(16 M and 6 F). – both overweight and the lean to improve aerobicgroup. fitness for To determineaerobic whether fitness. energy The intensity levels reached expenditure and intensity during dance simulation test levels reached during dance 6 bouts of 10 minutes Tan, et al. 2002 met the minimum amount of simulation games can meet the N= acute40 Caucasians intervention – n=21 study F and intensity recommended by the ACSM guidelines for developing n=19 M - ages 17.5 – lab base- of DDR ACSM.

aerobic fitness. Dance simulation games can To determine the intensity and be used by adolescent girls 10 minutes at 3 the energy expended during the lab base- acute intervention to meet moderate intensity 2010 N= 20 Caucasian girls - age 17 different levels Fawkner, et al. activity. study recommendations of daily exercise. More than 2600 steps were recorded each session. The To test the effect of active video abdominal subcutaneous gaming on cardiovascular adiposity, percentage of leg fat Staiano, et al. risk (blood pressure, glucose, teenage girls - ages 14- 36 hours over a period 2017 insulin, cholesterol, and N= 41 obese and overweight of 3 months. decreased in the exergaming triglycerides) and body intervention study andgroup. total Bone adiposity mineral significantly density of composition 18 years old. Long term the spine and trunk increased in the exergaming group.

- expenditure between 10 lean and 10 overweight children and 2 of 24.6 ml * kg 1-min-1 and an average heart rate of 137 bpm for both males and to determine whether the intensities elicited by the simulation Revolutionfemales. The was intensity estimated levels by 480reached , average during VO dance simulation videoadolescents game duringwill meet Dance the Dance ACSM Revolution guidelines game for improvingplay and aimed and test met the minimum amount of intensity recommended by the ACSM. Tan, et al. concluded that in order for players to develop playpreserving and a maximal aerobic walking fitness. test Cardiorespiratoryon the treadmill. When assessment oxygen they are required to play for longer periods [34]. Testing only required finishing a 12-minute session of Dance Dance revolution their cardiorespiratory fitness and manage their body weight; was observed in the average energy expenditure between the two dance simulation game to determine the intensity and the groups.uptake wasThe normalized average absolute to fat free oxygen mass; uptake no significant of the overweight difference girls, Fawkner and colleagues tested 20 adolescent girls during

-1) during the Dance Dance energy expended during the activity. Resting heart rate and group (917.1 ± 287.1 ml/min -1) was significantly higher than 30VO2 minutes. were assessed Energy expenditure at rest (seated) increased and during proportionally three levels as the of sessionthe lean wasgroup above (590.6 the ± minimal147.9 ml/min intensity recommended by the increasing difficulty play; each one lasted for 10 minutes; total -1of) Revolution session. Heart rate intensities elicited during the DDR -1) to stage 3 (4.14 ± 0.71 kcal.min- level1). All ofstages’ difficulty mean increased activity during from stage dance 1 simulation (3.63 ± 0.58 game kcal.min elicited al.ACSM conducted to improve a study aerobic to determine fitness for whether both overweight energy expenditure (64.83 % ± to stage 2 (3.65 ± 0.54 kcal.min and7.14) intensity and the levelslean group reached (64.51 during % ± dance 7.71) simulation[33]. Similarly, games Tan, can et that dance simulation games can be used by adolescent girls to moderate intensity (> 3 METS). The main finding of the study was Supporting the previous 2 studies, Staiano, et al. conducted a study meet the ACSM guidelines for developing aerobic fitness. 19 meet moderate intensity recommendations of daily exercise [35]. 2 max to test the effect of active video gaming on cardiovascular risk werefemales assessed and 21 duringmales ageda maximal 17.5 ± 0.7treadmill years oldtest were and chosenduring toa (blood pressure, glucose, insulin, cholesterol, and triglycerides) participate in the study. The subjects’ heart rate and VO the test showed that energy expenditure during Dance Dance session of Dance Dance Revolution. Data were collected after and body composition on teenage girls. Forty-one girls aged between 14 and 18 who are suffering from either overweight or Citation: Yassine Temlali T, Monem Jemni Page 6 of 10 4(3): 1-10. (2017) Effects of Different Types of Exergaming on Physiological Responses in Different Age Groups Any Good for Countries with Hot Climates? Literature Review. Obes Control Ther Effects of Different Types of Exergaming on Physiological Responses in Different Age Copyright: Groups Any Good for Countries with Hot Climates? Literature Review © 2017 Monem Jemni, et al. obesity were divided into a control group (no intervention) and an active video gaming group that required the subjects to play authors suggested that using the motion capture technology 36 hours over a period of 3 months. More than 2600 steps were gamesthat 194 such counts as the per Sony minute Eye Toyis considered can promote as andlight develop intensity levels PA; recorded each session. The abdominal subcutaneous adiposity, of PA in kids [37]. Another study used motion capture based in the exergaming group. Bone mineral density of the spine and trunkpercentage increased of leg in fatthe and exergaming total adiposity group [36].significantly decreased girlsgaming and device 34 boys) to examine who are the involved influence in ofa credibleexergaming program on levels for of physical activity and weight reduction in 75 children (41 Sony Eye Toy (Table 4) ± 1.7 were chosen from a pediatric program for weight loss. A weight management. Overweight and obese children aged 10 unlike a regular webcam, the Eye Toy processes the photos capturedJust like by the using webcam; computer the Eye vision Toy is aand digital gesture camera. recognition However, videoweight gaming management was assigned program only called to the “JOIN intervention for ME” wasgroup. assigned There allowing the users to use movement to interact with the game. wasto both no thechange intervention or a decrease and the in controlthe moderate groups. toHowever, vigorous active and vigorous physical activity in the control group (program only) during active video using the Eye Toy. Twenty children aged 12 ±One years study old investigatedwere randomly levels assigned of physical to either activity the intervention in children group (Eye Toy gaming) or the control group. Accelerometers and (mean net difference, 8.0 ± 3.8 min/day; p=.04 and 3.1 ± 1.3 PA questionnaire for children were used throughout the twelve- min/day; p=.02). Whereas moderate to vigorous and vigorous week intervention to determine how physical activity was affected. physical activity levels significantly increased in the program and Time spent using sedentary video game and exergaming using exergaming group in the 16th week (mean SD. 7.4 ± 2.7 min/day the Eye Toy was estimated by using an activity log. Accelerometer higherand 2.8 reductions ± 0.9 min/day). were observedAt week 16, in theBMI exergaming z scores and and overweight program showed that energy expenditure expended during Sony Eye Toy percentage significantly decreased in both groups. Nevertheless, exergaming group was higher at 6th p < .001 at the 12th group in the BMI z scores and overweight percentage (mean SD, week (194 counts/min) and -0.25 ± 0.03 vs -011 ± 0.03; ) and (-10.9% ± 1.6% vs -5.5% week (48 counts/min). Taking into consideration ± 1.5%) respectively [38]. Table 4: Summary of experimental studies that explored the effect of exergaming on health biomarkers using Sony Eye toy AVG Reference Objective Sample and design Dose Results energy expenditure expended during To investigate levels of -ages 12 years old – (12 M Sony Eye Toy exergaming group was physical activity in children N= 20 Caucasian children 12 week of Sony eye during active video using the toy game play Eye Toy. Ni, et al. 2007 , 8 F) – n=10 intervention – higher at 6th weekmin). (194 counts/min) n= 10 control – home based and at the 12th week (48 counts/ – randomized control study. of exergaming on levels of BMI z scores and overweight % Trost, et al. 2014 16 weeks physicalTo examine activity the andinfluence weight N= 75 overweight and reductionssignificantly were decreased observed in inboth the reduction obeseintervention children- study. n= 41 exergaminggroups. andNevertheless, program group higher in the F -n= 34 M - long term

Discussion reached during active video gamingBMI z scores didn’t and only overweight meet %ACSM

Since active video games are gaining popularity among but also it induced several important health outcomes such different age groups, youngsters, adults and even elderly recommendations for preserving and improving aerobic fitness, populations, it is important to review what studies have found in relation to physical activities and active video gaming. Therefore, subcutaneousas significantly adiposity, reducing and body decreasing weight, increasingpercentage trunkof leg andfat this review aimed to provide evidences from studies that tested andspine total bone adiposity mineral in density, overweight significantly and obese decreasing subjects. abdominal Although the effect of active video gaming (exergaming) on different health most of these studies investigated the acute effects of exergaming, biomarkers in different age categories for both genders. As also mentioned above, this review aims to discuss the possibility of increasing energy expenditure above resting levels and elicit introducing active video games as a new physical activity option lightthey showedto moderate-vigorous that these active exercise gaming intensities is capable in ofa shortsignificantly period in different age groups in countries with hot climates. of time. Therefore, taking into consideration what Weaver et al. All evidence from the 21 reviewed studies showed that found, playing in the traditional environment (home) can result exergaming can elicit intensities that meet light and moderate in even higher energy expenditure when compared to lab based inactively. All studies that evaluated the physiological responses We shall remind that exergame that induced the highest suchACSM as recommendations heart rate, metabolic as well equivalents, as minimizing cardiorespiratory time spent testing [39]. during exergaming showed that intensities 2 there was an increase of 300% in energy expenditure above energy cost was the Dance Dance revolution by Konami where fitness, VO Citation: Yassine Temlali T, Monem Jemni Page 7 of 10 4(3): 1-10. (2017) Effects of Different Types of Exergaming on Physiological Responses in Different Age Groups Any Good for Countries with Hot Climates? Literature Review. Obes Control Ther Effects of Different Types of Exergaming on Physiological Responses in Different Age Copyright: Groups Any Good for Countries with Hot Climates? Literature Review © 2017 Monem Jemni, et al.

showed that half of the time spent in exergaming was spent at a moderate to vigorous intensity levels. In addition, reductions in baseline [35]. Followed by a 230% increase in energy expenditure BMI percentages were higher in the exergaming group compared induced by Nintendo Wii play and a 108% increase induced by theUsefulness Sony Eye Toyto Countries [25, 40]. with Hot Climates There is a paucity of literature sources regarding the use of gamingto the control affect group levels (5.6 of %physical vs 0.2 respectively) activity in [43].four Supportingsedentary exergaming in countries with hot climates, however, amongst the these findings, another study examined how can active video nine years old were chosen based on their low physical activity children during physical education class. Four 5th graders aged Thisones amount we reviewed meets itthe has weekly been physicalshown that activity significant recommendations number of the amount of time spent being physically active was higher indeed.children The and questionadults spend would 4 to be: 5 hours could playing this be video a good games alternative weekly. during classesactive videoand their gaming low fitnesscompared scores. to Resultstraditional showed physical that education class. Moreover, it was socially accepted to use active We shall remind that the prevalence rate of physical inactivity in video gaming for both the teacher and the students. These two Qatarto remedy for instance to the is lack 46% of which physical is among activities the highest in these in countries? the world studies suggest that active video gaming is a promising method to overcome high levels of physical inactivity among sedentary and for authorities and public health services in the gulf region, as obese children [44]. physicaland the region inactivity [15]. is Sedentary directly linked life style to major has been health a major complications concern Several schools in the United States have indeed started such as diabetes, obesity, hypertension, musculoskeletal fragility and depression [13-14]. As these numbers keep on rising among have been implemented in physical education programs in young people and traditional strategies failed to overcome these 20putting public this schools method in into west action. Virginia For sinceexample, 2006, Dance and revolutionit showed health issues, a new strategy should be introduced to overcome promising results; where some of the students showed weight physical inactivity since previous methods do not seem to be so effective. Active video games can be used in schools during beenlost between using the 2.5 Dance to 5 revolutionkg. This number classroom increased edition to game 765 schoolsin their Children could exercise within a safe environment and without schoolsnowadays thanks [45]. to Fourteen a partnership different between regions the creator in California of the game have anyphysical risk of education excessive classes sun exposure. when the Exergaming weather iscould so difficult.also be used during school breaks which might increase the interest of children and adolescents and attract them to a more regular KonamiLimitations and California of Exergaming endowment. exercise and ultimately will help them increasing their daily energy expenditure. It is likely that active video gaming would supported the positive impact that active video gaming has on better appeal to physically inactive children and adults who promotingAlthough physical current activity findings and fromits ability different to increase studies energy have might suffer from overweight or obesity over traditional physical expenditure above resting levels and establish moderate to activities [41]. Exergames are indeed less intimidating for those vigorous intensities researchers still question the ability of who suffer from low self-image and lack of self-esteem. In addition, it has been argued that traditional physical education exergaming to replace vigorous physical activity [18-25-46]. today’s young generation of students. These later might be more timeDespite spent the working numerous at abenefits moderate of activeintensity video due games; to the theymultiple still interestedclasses might and notmotivated fulfill the to take interest part inand the connect learning properly process with resthave periodssome limitations. following eachOne ofintense the limitations but short isbursts the inadequate of energy. activities that are technologically driven, involve communication and have better rewarding system, such as active video games total play duration. Daley showed that exergaming at home compared to traditional physical education classes [42]. usuallyThese periodslasts between of rest 1 mightto 2 hours have whereas artificially exercise increased sessions the Some studies in the United States that examined the (exergaming) lasted 10 to 30 minutes in the vast majority of the effectiveness of active video games in schools’ settings found studies reviewed [41]. Therefore, a mutual limitation between the that exergaming can be a great tool that can be used to meet the majority of studies reviewed is the lack of compatibility between guidelines of daily physical activity during physical education the testing procedures and the typical exergaming conditions at classes. A long-term intervention study aimed to determine home in terms of the duration of play and therefore the amount whether 40 minutes of dance exergame per week can meet the of energy expended. middle school youth aged 13.7 ± 0.6 years old were divided into intensity of moderate to vigorous physical activity. Fifty-eight energy expenditure. Even within the same exergame device system,Furthermore, energy cost different can differ exergames between a yield game different and another rates [41- of study that lasted 20 weeks. The intervention group was assigned toa control play an group active and video an gameintervention from the group start (Generation of session oneFit) thatin a is composed of 10 weeks whereas the control group joined in one47]. Anotherstudy showed limitation that is interactive the significant cycling lower video energy game expended elicited during exergames when compared to real sports. However,-1) -1 the second session (week 10 to week 20). From the first to the ) (p < 0.05) significantly greater energy expenditure (4.4 ± 1.02 Kcal.min second session, average exergaming time increased from 49 compared to traditional cycling (3.7 ± 1.1 Kcal.min to 54 minutes per week. Data collected from accelerometers Citation: Yassine Temlali T, Monem Jemni [18]. Page of 10 4(3): 1-10. (2017) Effects of Different Types of Exergaming on Physiological Responses in Different 8 Age Groups Any Good for Countries with Hot Climates? Literature Review. Obes Control Ther Effects of Different Types of Exergaming on Physiological Responses in Different Age Copyright: Groups Any Good for Countries with Hot Climates? Literature Review © 2017 Monem Jemni, et al.

3. face the strategy of implementing exergames in schools is the From another front, one of the biggest problems that can Bianco A, Mammina C, Jemni M, Filippi AR, Patti A, Thomas E, et al. A challenge of maintaining the interest and a long-term adherence fitness index model for Italian adolescents living in Southern Italy. The of the users. It was reported in some studies that because of the 4. ASSO project. J Sports Med Phys Fitness. 2016;56(11):1279-1288. lack of progression and the repetitive nature of some active video Bortz II WM. The Disuse Syndrome. West J Med. 1984;141(5):691-694. games; children tend to lose their interest and motivation to Implementation, and Evaluation of the Adolescents and Surveillance participate in active video games [47]. 5. Tabacchi G, Bianco A, Alessi N, Filippi AR, Napoli G, Jemni M, et al. Design,

System for the Obesity Prevention Project. Medicine (Baltimore). and displaying the user’s oneself on the screen was found to 6. 2016;95(12):e3143.Zaman MJ, Jemni M. Southdoi: 10.1097/MD.0000000000003143 Asians, physical exercise and heart disease. Finally, some of the exergames that rely on motion capturing exercise in those who have a negative body image about themselves 7. Heart. 2011;97(8):607-609. doi: 10.1136/hrt.2010.214908 [44].be positively Motivational related strategies to reducing within self-efficacy the exergame and itself enjoyment that aims of et al. Amount of time spent in sedentary behaviors in the United States, to maintain the interest and the attraction of children towards Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, physical activity should be developed and improved to ensure a 2003-2004. Am J Epidemiol. 2008;167(7):875-881. doi: 10.1093/aje/ kwm390Marshall SJ, Gorely T, Biddle SJ. A descriptive epidemiology of the situational interest can be used in the future to create games screen-based media use in youth: a review and critique. J Adolesc. long-term adherence. The five-dimension model that measures 8.

2006;29(3):333-349. isthat capable can maintain of providing the immediateinterest of enjoyment,the children develop through innovation fulfilling inactivity in young adults: public health perils and potentials of new and satisfyinginterest, exploration, the five situational attracts interest attention sources. and it’s If the challenging, exergame 9. Fotheringham MJ, Wonnacott RL, Owen N. Computer use and physical

10.information technologies. Ann Behav Med. 2000;22(4):269-275. and sedentary behavior trends: adolescence to adulthood. Am J Prev childrenConclusion and adults will be more interested [48]. Gordon-Larsen P, Nelson MC, Popkin BM. Longitudinal physical activity In conclusion, existing evidence shows that active video games 11.Med. 2004;27(4):277-283. can be a promising tool to create a safe, pleasant environment for performing light to moderate intensity of exercise. Exergames aJemni cohort M, epidemiological Zaman J, La Rocca study. D, Tabacchi The Adolescents G. Southern Surveillance Italian teenagers: System were found to reduce body weight, increase trunk and spine the older they get, the unfit they become with girls worse than boys

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Citation: Yassine Temlali T, Monem Jemni Page 10 of 10 4(3): 1-10. (2017) Effects of Different Types of Exergaming on Physiological Responses in Different Age Groups Any Good for Countries with Hot Climates? Literature Review. Obes Control Ther