Effects of Exergames on Motor Skills, Psychological Well-Being, and Cognitive Abilities in Schoolchildren and Adolescents: Scoping Review

Introduction

The World Health Organization (WHO) has underlined the importance of physical activity, which is beneficial to health and mental and physical well-being, for the prevention of noncommunicable diseases [1]. Insufficient levels of physical exercise or physical inactivity may contribute to the development of diseases, such as obesity and overweight, cardiovascular disease, and motor development–related disorders [2,3]. Especially in children and adolescents, sedentary behavior increased adiposity and led to poorer cardiometabolic health, fitness, and behavioral conduct or prosocial behavior, as well as reduced sleep duration [1]. According to data from the Italian Institute of Statistics for the 2017‐2018 period, Italian children and adolescents did not engage in sufficient levels of physical activity [4] as recommended by the WHO, whereby they should practice at least 60 minutes of moderate to vigorous physical activity for 3 days in a week [5,6]. In addition, Italian Institute of Statistics data (2021) highlighted that continuous sporting activity in children and young people aged 3‐17 years has decreased significantly, from 51.3% to 36.2%, while sedentariness has increased (from 22.3% to 27.2%) [7]. This trend is in line with other countries [8-10].

In accordance with the above-mentioned data, schools are considered the main educational context for the promotion of physical activity. There are multiple opportunities for exercise in the context of school, such as during recess, sports, physical education (PE) lessons, and active movement to and from school [11]. Several studies have shown that school-based focused interventions have been effective in increasing children’s physical activity levels, achieving up to 50% of the weekly requirement identified by the WHO [1,12].

PE lessons aim to promote motivation and physical exercise in students [12]. However, the role of PE in the school system has led to some criticism concerning the methods and tools that are currently being used during classes, which generate very low interest among pupils and students [13]. With specific reference to educational processes connected to physical and sporting activity, the scientific community is now investigating the effects of incorporating devices into traditional teaching in order to increase student motivation and participation [14].

Among the technological tools available today, there are exergames. Their introduction in everyday life contexts not only helps children and young people to achieve the recommended levels of physical activity but also has a positive effect on their lives, as exergames foster the acquisition and development of motor skills and abilities, increasing participation in sporting activity [15].

Exergames—also known as active video games—are an activity combining video games and motor exercise and requiring physical effort on the part of the child [16]. They are characterized by the use of audio or visual feedback on performance compared to traditional physical activity, thus making it more enjoyable [16]. These digital motor activities aim to stimulate motor and motivational skills [12].

Exergames are based on the conversion of real movements within a virtual environment, allowing players to be more active by practicing virtual sports, fitness exercises, and other playful physical activities [15].

In addition to making health-promoting behavior more attractive and desirable, exergames also offer numerous advantages, such as increased motivation and engagement and a greater possibility for fun and challenge [17]. Their pros are also evident when they are compared with traditional exercises [18]. Exergames are more engaging, increasing motivation to train and consequently improving both motor skills, such as balance and mobility [17], and cognitive skills [18,19]. Moreover, they allow players to focus more on the impact of their own movements during the game and less on movements for their own sake [20]. Finally, they are easily adaptable to various contexts—they require a console and screen or projector—and can be carried out either alone or in small groups, encouraging collaboration and cooperation [18].

As claimed by previous reviews, exergames are able to promote a physically active lifestyle in children and young people [21,22]. However, most of the previous reviews have focused on exergame use in specific contexts and situations, such as nutrition and obesity [23-25], chronic diseases [26,27], and physical activity in general [15,28-30]. Specifically, Lamas and colleagues [21] have evaluated the effectiveness of using exergames to promote nutrition education and physical activity in children and adolescents. Their review points out the effectiveness of using exergames to promote health and prevent obesity by interventions aimed at increasing children’s and adolescents’ nutritional knowledge and introducing healthier and more balanced diets [21]. Other meta-analyses have focused on the benefits of exergames in school settings, specifically regarding PE learning. In particular, they have shown that exergames can improve performance in PE education and suggest using exergames in small classes, limiting the implementation cycle to 1‐2 months, and selecting games according to different age groups [31].

Although exergames have demonstrated various benefits concerning the health and physical activity of children and young people, no review has been carried out so far on their potential use and benefits in the school setting, exploring not only motor or physical effects but also psychological and cognitive effects.

Therefore, the aim of this study was to expand and update knowledge on the potential effects of exergames within the school context, considering the past 5 years. A scoping review was conducted to illustrate and analyze the effectiveness of the use of exergames in schools (children aged 6‐18 years) during PE lessons and play or sports activities, to understand their benefits and advantages, and their future application as inclusive tools.

Methods

This review was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines [32]. Four authors (IB, RN, ER, and SV) searched 3 bibliographic databases from 2019 to June 30, 2024: PubMed, Web of Science, and Scopus. The definitive search strategy is the following string: (“physical exercise” OR “physical education”) AND (“exergaming” OR “active video games” OR “exergames” OR “interactive videogame” OR “technology”) AND (“children” OR “adolescent”) AND (“school” OR “school education” OR “education”) NOT (meta-analysis OR review). For complete details of the search strings, refer to Multimedia Appendix 1. The search was manually completed, following the PCC (population, concept, and context) format (Table 1). We included all scientific studies involving children and adolescents, aged between 6 and 18 years, interacting with exergames during PE hours. We excluded papers not written in English, reviews and meta-analyses, and articles on adult participants or animals. We also excluded studies that used other types of technologies during PE hours or technologies with an evaluative purpose of sports performance and studies not related to the school setting.

All record titles and abstracts retrieved from the database search were screened by 4 blinded reviewers (IB, RN, ER, and SV), who excluded studies that did not meet the eligibility criteria. The same authors proceeded with the full-text screening of retained papers according to the inclusion criteria. In case of discordant opinions, the 4 authors voted to reach a decision. Interrater agreement was evaluated with the Fleiss kappa statistic (κ) [33,34]. Data from the articles were extracted into an extraction table, which includes columns for authors and year of publication; sample size, age, experimental groups, and country; methodology and duration of the sessions; outcome measures; and results.

Results

Our search from 3 databases produced 1694 articles. After screening titles and abstracts and removing duplicates, there were 57 articles. A total of 25 articles were included in this review. The PRISMA-ScR flowchart is shown in Figure 1. The interrater reliability for full-text screening was substantial across authors, with κ=0.65, κ=0.72, κ=0.68, and κ=0.71 [33,34].

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Table 2 summarizes the 25 studies included in this review, that is, research that used exergames within PE school hours. In two cases, the sample of study is the same but with different statistical analyses and research objectives. They are indicated by footnotes in the table.

All studies involve children and adolescents: 23 studies include elementary or middle school children, 1 study includes high school students [39], and another one includes the 8‐ to 18-year-old age group [47]. Most of the articles are fairly balanced between males and females, but sex difference is often not measured in statistical analyses. For 3 studies [40,56,57], the male-female distribution is not known. Most studies include the general population, while 2 studies include children with overweight or obesity [43,57]; 1 study includes children with attention deficit/hyperactivity disorder [44] and another study includes both children with attention deficit/hyperactivity disorder and fetal alcohol spectrum disorder; lastly, 2 studies include children diagnosed with intellectual disability [47,54]. Studies differ in research methodology: there were 6 randomized controlled trials [43-45,50,51,57], 8 nonrandomized controlled studies [12,35,36,38,39,47,53,58], 7 quasi-experimental studies [37,40,41,46,48,52,54], 2 cross-sectional studies [49,55], 1 case study [59], and 1 pilot interventional study [42].

The studies come from different countries, in particular, 2 from North America [49,58], 2 from South Africa [38,57], 4 from South America [35,36,40,51], 6 from Asia [37,39,43,44,47,48], 10 from Europe [12,41,42,45,46,50,53-56], and only one study includes different populations [52].

Thus, their length varied, too, from a minimum of a single session to a maximum of 3 months. In 2 studies, the trial or training duration is not given [40,49]. Regarding the type of exergame used, 7 studies used dance-based exergames, such as Just Dance 2015 on Microsoft Xbox consoles [35,36,40,43,46,49] or Just Dance Now [12,53]. Three studies used videos from the HOPSports Brain Breaks package, which includes different sports such as baseball, basketball, soccer, volleyball, swimming, golf, football, and rowing [37,38,52]. Five studies used exergames based on specific sports such as Nintendo Wii Sports (bowling, boxing, tennis, cycling, table tennis, and basketball) or Wii Fit (yoga, muscle exercises, aerobic exercises, and balance games) or Xbox Sports Season 1 and 2 (including soccer, beach volleyball, bowling, table tennis, track and field, boxing, American football, baseball, darts, golf, skiing, and tennis) [39,43,47,51] or boxing and hula hooping on the Wii Nintendo console [57]. Eight studies used various games involving movement using the Wii balance board (eg, Feline Runner, Hungry Monster, and Whack-a-Slime) [41,54] or Xbox (eg, Kinect Adventures) [48,51] or still other platforms, such as D&J Humancare’s Alchemist’s Treasure [44], Obie [58], or Exercube’s Sphery Racer [45,55]. Three studies developed specific exergames, building on existing ones [42,50,56].

All exergames could be played in a multiplayer mode, for example, by the whole class in some instances or small groups of 3‐4 in others.

The 25 studies were divided into three broad categories according to research objective and outcome measurement:

1. Research studying the effects on psychological or cognitive dimensions. There are 9 papers. The variables under investigation are psychological states or psychosomatic states [35,36]; self-esteem [36]; beliefs and attitudes and self-efficacy with respect to physical activity [37]; attention, concentration and response control, or executive function [44,46]; interest, enjoyment, commitment, flow state, and motivation [46,53,55]. All studies, except for two, found significant effects of exergames on the psychological variables under study. The two studies without significant effects or differences versus the control group specifically addressed intrinsic motivation, external regulation, decreasing amotivation, and perceived enjoyment [53,55].
2. Research studying direct effects on motor and anthropometric aspects or motor skills. There are 12 papers in total. The variables under investigation are physical fitness [38,43,45,57], anthropometric measures [38-40,43,45,47,57,58], physiological factors [39], daily steps [39], and various motor skills [40,41,47,50,51,54,58]. Significant effects of the application of exergames on anthropometric variables were found in 11 papers [38], including papers on children with obesity [43,57], on various motor or locomotor components [40,41,50,51,54,58], on various physiological components [39], and on physical fitness variables [38,45]. In some of these cases [43,51,54], the significant increase in some or all motor skills or anthropometric variables pretest versus posttest did not differ from that of the control group. Only one study on children with intellectual disabilities did not find any effects [47], so exergames were rated as ineffective.
3. Research on the simultaneous effects on motor or physical aspects and psychological variables. There are 4 articles. The variables under investigation include both anthropometric variables [48,49,52], motor skills [48], physical literacy [42], or psychosocial factors such as enjoyment, self-efficacy, and social support [48,49], as well as beliefs and attitudes toward physical activity [52], and improvements in performance and concentration in other school subjects [42]. Significant effects of exergames were found on some anthropometric or motor variables [42,48,49,52], as well as on psychological variables such as attitude toward physical activity, self-efficacy, and learning [52], or motivation, engagement, and concentration in other school subjects [42]. In two studies [48,49], no effects were found on self-efficacy and psychosocial factors.

Discussion

Discussion of Included Studies

This scoping review focused on the effect of the use of exergames at school in different countries, during PE lessons and play or sports activities, in order to understand their benefits and advantages and their future applications. For these purposes, 25 articles were included.

Considering the majority of the studies, use of exergames during PE hours and playful sports activities is associated with a number of improvements; more specifically, these devices can provide psychological or cognitive as well as motor benefits for children and adolescents with a median age of 10 years. The studies presented use different types of games and vary in frequency, with an overall average duration of 7 weeks, in line with findings from a recent meta-analysis [31]. Below, the specific effects observed are discussed.

Discussion on Psychological or Cognitive Effects

We found 4 studies investigating the psychological effects of exergames. Based on them, we reached the conclusion that exergames played during PE hours or during didactic hours can help increase the students’ sense of self-efficacy, vigor, learning, fun, and decrease tension, mental confusion, and perceived anxiety. In addition, they can improve the beliefs and attitudes that children and adolescents have toward sports and physical activities, leading to a general increase in exercise and physical activity [35-37,52]. Also, a review by Joronen and colleagues [59] aimed to observe nonphysical effects of exergames and found that exergames can increase situational interest and enjoyment during physical activity because they are perceived as being more enjoyable. For this reason, children are more likely to carry on playing exergames instead of traditional games. Despite some conflicting results, these researchers reported that successful experiences with exergames could increase perceived self-confidence and consequently the probability of future participation in motor activities [59]. An improvement in self-efficacy and self-confidence was also observed in a previous review and meta-analysis by Andrade and colleagues [60] investigating the effects of exergames in obese children. This could be related to the fact that exergames provide immediate feedback on the student’s actions. The ability to see the outcome of their actions in real time may engage and motivate students to continue the activity.

As far as cognitive abilities are concerned, based on two studies taken into account, it can be concluded that an exergame-based intervention can improve executive-attentive functions, specifically selective attention, self-control, sustained attention, cognitive flexibility, and also the students’ situational interest for the activity [44,46]. Additionally, some exercises with exergames can have positive effects on motivation and concentration in other school subjects, such as mathematics [42].

These improvements can also be observed at a physiological level, with alterations in event-related potential component N2 waves and cortical cingulate area activity, which are visible just after a single intervention [44]. Exergames would appear to better stimulate visual perception thanks to a virtual environment, which may be experienced by students as more dynamic and engaging. This thus suggests that exergames have attractive and interesting features for children, such as the nature of the game played, interactivity, and involvement through sounds and images. These features may increase participation in physical activity.

Although backed by only a few studies, these results were also confirmed in a previous review by Ramírez-Granizo and colleagues [61]: independently of the exergame used, cognitive performance significantly benefited from the sports or physical activity carried out using them. In particular, the use of electronic devices associated with motor activity seems to bring a general improvement in concentration, attention, and reaction speed.

Discussion on Effects of Motor Abilities

Most of the reviewed studies investigated the influence of exergames on various anthropometric parameters and physical performance. When compared to traditional physical activity interventions, exergames can demonstrably improve motor performance (such as jumping, running, shooting, football, and object control), flexibility and postural stability, and the students’ physical fitness at a general level [40,41,45,51,54]. In addition, exergames can improve muscle mass, decreasing waist circumference and body fat [38,43,47], but they can also lead to a significant reduction in sitting time at weekends [39].

Exergames are effective tools for assisting in the acquisition of motor skills, thanks to the immediate feedback that children receive on their performance. In line with our findings, recent reviews or meta-analyses found that interventions using exergames are effective in developing and improving several components of PE learning or physical fitness, such as agility, balance, and postural stability, while also benefiting the ability to control objects and locomotor skills [31,62]. It must be noted, however, that the authors concluded that their findings were not definitive due to the conflicting outcomes of the studies included in their review.

Despite this variability, most studies support the idea of integrating exergames into traditional PE lessons or using them during teaching hours. This approach can make physical activity more engaging for students while providing variety within the curriculum.

In summary, while current evidence points toward numerous benefits of exergames for improving motor skills and physical fitness among children and adolescents, ongoing research is essential to optimize their application and maximize their potential within educational settings. Further investigations can focus on which games are most effective and establish guidelines for their use to maximize the effectiveness and inclusivity of these tools (such as duration of use, single-player, or group gameplay).

Strengths and Limitations

As far as we are aware, this is the first scoping review aimed at investigating the motor, psychological, and cognitive benefits of exergame-based interventions in school settings and specifically during PE lessons and play activities.

While the primary strength of our study is its attempt to provide an up-to-date review—considering the last 5 years as a timeframe—of the effects of exergames on motor, psychological, and cognitive abilities, this study is not free of limitations, and, consequently, caution is required when interpreting its results.

First, we only included publications in English, which may have led to the exclusion of further available studies that explored this topic in other languages. Although the studies come from different continents, there is no complete heterogeneity. Second, no systematic review and meta-analysis were conducted to assess the effectiveness of exergames and the generalizability of the results.

Third, the studies considered in the review were highly heterogeneous and had several methodological biases. They used different types of exergames; the length was different as were outcomes and variables. For example, some studies used a single exergaming session [46,49], while other studies included several exergaming sessions, up to 3 months. Also, video games and devices were different across studies, and not all studies had a sufficient sample size or used sample randomization. All this could complicate the interpretation of findings and limit their generalizability.

Thus, more studies, such as systematic reviews and meta-analyses, are encouraged to reinforce the validity of the present findings.

Conclusions

In our scoping review of the effects of exergames on motor, psychological, and cognitive abilities during PE lessons and playful sports activities, we focused on the school context, given the central and important role that schools currently have in promoting physical activity in children and adolescents [11].

Our findings show that exergames can have a beneficial effect on children’s motor skills, cognitive flexibility and attentional functions, and overall well-being, improving the sense of self-efficacy, self-confidence, and mood during PE lessons.

This may have significant implications for public health or education: exergames may become accessible and useful devices for promoting physical activity in young people, potentially bringing benefits not only on a motor skill level but also on a psychological and cognitive level, increasing children’s participation in physical activities and leading to a general improvement in their sense of self-efficacy and well-being.

However, lack of knowledge of their potentials and benefits hinders their wider application. Furthermore, despite their effectiveness, their use is not yet common in the educational and school context.

For this reason, a more systematic application of digital technology in the school setting would contribute to improving and designing new immersive, effective, and inclusive interventions aimed at increasing the physical activity and well-being of children and adolescents. Exergames can improve children’s physical and cognitive skills, enjoyment, and involvement in exercise and general well-being, thus becoming a complementary and additional device to traditional PE exercises and helpful tools to increase motor activity during extracurricular activities.