Home‐based exergaming among children with overweight and obesity: a randomized clinical trial

Summary Background Given children's low levels of physical activity and high prevalence of obesity, there is an urgent need to identify innovative physical activity options. Objective This study aims to test the effectiveness of exergaming (video gaming that involves physical activity) to reduce children's adiposity and improve cardiometabolic health. Methods This randomized controlled trial assigned 46 children with overweight/obesity to a 24‐week exergaming or control condition. Intervention participants were provided a gaming console with exergames, a gameplay curriculum (1 h per session, three times a week) and video chat sessions with a fitness coach (telehealth coaching). Control participants were provided the exergames following final clinic visit. The primary outcome was body mass index (BMI) z‐score. Secondary outcomes were fat mass by dual energy X‐ray absorptiometry and cardiometabolic health metrics. Results Half of the participants were girls, and 57% were African–American. Intervention adherence was 94.4%, and children's ratings of acceptability and enjoyment were high. The intervention group significantly reduced BMI z‐score excluding one control outlier (intervention [standard error] vs. control [standard error]: −0.06 [0.03] vs. 0.03 [0.03], p = 0.016) with a marginal difference in intent‐to‐treat analysis (−0.06 [0.03] vs. 0.02 [0.03], p = 0.065). Compared with control, the intervention group improved systolic blood pressure, diastolic blood pressure, total cholesterol, low‐density lipoprotein‐cholesterol and moderate‐to‐vigorous physical activity (all p values <0.05). Conclusions Exergaming at home elicited high adherence and improved children's BMI z‐score, cardiometabolic health and physical activity levels. Exergaming with social support may be promoted as an exercise option for children.