The Effects of Active Video Games on Psychology among Overweight and Obese Adolescents: A Systematic Review

The Effects of Active Video Games on Psychology among Overweight and Obese Adolescents: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Effects of Active Video Games on Psychology among Overweight and Obese Adolescents: A Systematic Review Yiqiang Mai, Kim Geok Soh, Hazizi Abu Saad, Nuannuan Deng, Qiang Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4530750/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This systematic review aimed to analyse the effects of active video games (AVGs) on psychology among overweight and obese adolescents. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement guidelines were used to search the PubMed, SCOPUS, EBSCOhost (SPORTDiscus), and Web of Science databases for studies published in the last 10 years (2013–2023). Keywords related to psychology, being overweight or obese, and adolescents were used. From the 713 studies, 10 fulfilled all eligibility criteria and were included in this review. Results The study results revealed that AVGs could positively impact the psychological well-being. However, due to different experimental designs, experimental environments, experimental objectives, and game consoles, the results of self-efficacy, social and peer support, and self-esteem are still conflicting. Additionally, due to measurement issues, quality of life has not yielded a positive effect. Conclusion Future research should standardise methods and look into the underlying mechanisms to come up with personalised plans for improving the psychology of overweight and obese adolescents who are involved in AVG interventions as part of health promotion programmes. Biological sciences/Psychology Health sciences/Health care psychology overweight obese adolescents self-efficacy Figures Figure 1 1. INTRODUCTION The prevalence of overweight and obesity among children and adolescents aged 5–19 has risen dramatically from just 4% in 1975 to just over 18% in 2016 (WHO, 2021 ). Due to the worldwide increase in the prevalence of obesity among children and adolescents, it has been identified as a public health concern (Yanovski, 2015 ). Overweight and obesity in adolescents increase the risk of obesity in adulthood (Yuca et al., 2017 ) and are associated with cardiovascular diseases and long-term complications (Llewellyn et al., 2016 ). Furthermore, adolescence is chosen because it is well recognised that adolescence is one of the most rapid phases of human development (WHO, 2020 ). It is characterised by confusion, trouble, poor self-esteem, at times academic difficulties and even suicide (Choo et al., 2017 ), these adverse effects may be exacerbated in overweight and obese young people, who often face discrimination, bullying and social rejection (Stangl et al., 2019 ), leading to a low level of the movtivation towards the whole physical activity (PA). Adolescence is particularly meaningful for psychology well-being and obesity intervention, as it follows the beginning of puberty, from childhood when parents and schools monitor healthy behavior to adolescence when healthy behavior is also largely influenced by peers and the medias such as televisions, electronic games, and computers (Echeverria et al., 2014 ; Brown et al., 2015 ). Adolescents who are overweight or obese exhibited elevated levels of depression (Blasco et al., 2020 ), diminished levels of self-efficacy and self-esteem, and increased body dissatisfaction compared to adolescents with a healthy weight (Taylor et al., 2012 ; Matias et al., 2010 ; Stewart et al., 2017 ). Physical activity might mitigate the harmful consequences caused by overweight or obesity during adolescence. Active video game (AVG), a new generation of video games, requires players to physically interact with video games during gameplay through various arm, leg, or whole-body movements such as dancing, jogging, and kicking (Zeng & Gao, 2016 ). Given that children spend a large proportion of their time engaging in screen-based sedentary behavior (Cai et al., 2017 ), AVGs bring physical benefits to children and adolescents in attenuating weight gain, psychological well-being, and physiological fitness. Potentially, it increases physical activity and energy expenditure, minimising monotony of repeated movements by increasing enjoyment and adherence (Martí et al., 2015 ; Sun, 2013 ; Gao et al., 2013 ; Lee et al., 2017 ). Therefore, AVG may be a beneficial way to encourage sedentary behaviour changes in overweight or obese children and adolescents (Calcaterra et al., 2023 ). Additionally, as a theory of healthy behaviour impact analysis, the Social Cognitive Theory (SCT) conceptualizes behavioral change as the result of links among behaviors, the environment, and individual factors (Bandura, 2004a ). Despite the existence of a syetematic review (Lee et al., 2017 ) and a meta-analysis (Andrade et al., 2019 ) investigating the effectiveness of AVG interventions in improving psychological well-being, these studies have certain limitations. One notable limitation is the lack of a strong theoretical foundation underlying the research. Additionally, these studies often include people of all ages, from children to the elderly, which can introduce heterogeneity in the results. Therefore,there is a lack of sufficient evidence regarding the psychological effects of AVG in overweight and obese adolescents. The Social Cognitive Theory serves as the guide for this systematic review, which aims to systematically review experimental studies in order to confirm the psychological effects of AVGs on adolescents who are overweight or obese. By synthesising existing empirical evidence, we seek to contribute to a comprehensive understanding of the impact of AVGs on psychological well-being in this specific population. 2. METHODS 2.1 Protocol and Registration The study followed the guidelines outlined in the recommended reporting items for systematic review and meta-analysis (PRISMA) declaration (Page et al., 2021 ). The use of the PRISMA statement, consisting of a 27-item checklist and a flowchart, facilitated authors in presenting their systematic review in a concise and comprehensible manner. This enabled the evaluation of the advantages and limitations of the research. Furthermore, the review was prospectively registered on the International Prospective Register of Systematic Reviews with the registration number INPLASY202410084, ensuring transparency and accountability in the systematic review process, available at https://inplasy.com/ . This indicates that the review adhered to established reporting standards and was pre-registered to enhance transparency and credibility in the research process. 2.2 Search Strategy The literature search for this review utilized four international databases: SCOPUS, PubMed, EBSCOhost (SPORTDiscus), and Web of Science. The search was conducted on October 10, 2023. In each database, a title search was performed using a predefined combination of keywords to identify relevant studies for inclusion in the review: ("exergame*" OR "active video game*" OR "interactive game*" OR "exercise video game*") AND ("child*" OR "adolescent*" OR "student*" OR "youth" OR "juvenile*" OR "teenager*" OR "youngster*" OR "kid*") AND ("overweight and obese" OR "obesity") AND ("emotion" OR "mood" OR "mental" OR "confidence" OR "competence" OR "psycholog*"OR "fun" OR "enjoyment" OR "motivation" OR "self-efficacy" OR "self-esteem" OR "attitude"). In addition to the studies included in the review, we conducted a comprehensive search for relevant articles by exploring the reference lists of these studies. We also examined the reference lists of previous related reviews and google scholar to ensure a thorough coverage of the literature. This involved a manual search of all titles for potential inclusion. Furthermore, we retrieved reference lists from the papers obtained, author names, and review articles to identify any additional relevant citations that might contribute to the overall understanding of the topic. 2.3 Eligibility Criteria The inclusion criteria for this review were established using the PICOS (population, intervention, comparison, outcome, study designs) framework, as detailed in Table 1 . The search was restricted to English-language articles published between 2013 and 2023, since the field of AVG and related technologies has undergone significant advancements in the past decade. Selecting a recent article allows researchers to capture the latest innovations in AVG platforms, game design, and technology integration, providing a more accurate reflection of the current state of the field. Only records that investigated the effects of AVGs or exergames on psychology or mental health in overweight (z score > + 1 and/or percentiles > 75th) and obese (z score > + 2 and/or percentiles > 90th) or overweight adolescents (mean age: 10–19 years) were considered for inclusion. Since adolescence is defined by the WHO as the second decade of life (10–19 years of age) (WHO, 2023 ). Studies meeting the following criteria were included in the analysis: i. A comprehensive, peer-reviewed study published in English is sought, detailing the implementation of Active Video Games (AVGs) (Xbox, Wii, Dance Dance Revolution, etc.) in overweight and obese adolescents. The study should examine the effects of AVG interventions on psychology, utilising several study designs including randomised controlled trials (RCT), non-randomized controlled trials (Non-RCT) with multiple groups, and single-group trials with a pre- and post-test design; ii. Studies on planned and organised AVG interventions to improve psychology well-being or mental health (i.e., psychological and psychosocial variables); iii. Studies investigating the effects of AVGs on psychology among overweight and obese adolescents and using quantitative methods to assess at least one psychology-related outcome that was analysed in relation to the psychological aspects evaluated through scales or questionnaires; and iv. No constraints were imposed on the sample size, study location, or intervention duration for the studies that were incorporated. On the other hand, studies were excluded if they met the exclusion criteria: i. Meeting abstracts, case reports, theses, and short communications in languages other than English; ii. Interventions focusing solely on counselling for AVG implementation; and iii. Studies not available in full. Table 1 Inclusion criteria according to the PICOS conditions. Items Detailed inclusion criteria Population Overweight or with obesity adolescents (mean age: 10–19 years old) Intervention Active video games or exergames Comparison Two or more groups and single-group trials Outcome intrinsic motivation, enjoyment, liking, situational interest, self-efficacy, self-worth, attitudes, intention, mood, satisfaction. Study design RCT or Non-RCT 2.4 Study Selection The studies that were collected were imported into Zotero Software in order to eliminate any duplicate data. A experienced librarian first aided in devising the search strategies. Furthermore, a group of three reviewers conducted the initial screening of found articles. They carefully evaluated the titles and abstracts to identify relevant studies. During this step, any unnecessary materials were removed from the database. Subsequently, all remaining titles and abstracts were evaluated based on established criteria for inclusion and exclusion. Articles that successfully passed this screening and were included in the quantitative synthesis underwent a comprehensive analysis of the complete text. Articles lacking the complete text were omitted. To ensure the rigour of the review process, the second, fifth, and sixth authors were consulted in cases of differences until a consensus was obtained. 2.5 Data Extraction and Quality Assessment Following the conclusion of the data search, information from eligible studies was gathered using a pre-established extraction form. This form systematically captured key details, including (1) author, publication year, and study location; (2) sample characteristics, encompassing the number of participants, their age, and gender distribution; (3) a comprehensive description of the intervention, design, duration, and specific characteristics; (4) the measure index employed in the study; and (5) the outcomes of the research. The authors Mai and Wang abstracted information into the standard form, and the others, Soh, Saad, and Deng, checked it. The design quality analysis of the AVG intervention studies was calculated using the 10-item scale in Table 2 . Specifically, each item was rated as “yes”(1), “no”(0), or “not applicable(N/A).” In accordance with previous studies (Peng et al., 2013 ; Z. Gao & Chen, 2014 ), the authors individually assessed the research design quality of each study using a 10-item scale. A design quality score, ranging from 0 to 10, was calculated by summing up the favorable rates for each item. High quality was defined when a RCT or controlled trial scored above the median score of 5.5. Table 2 Design qulity analysis for the AVGs intervention studies References 1.Randomization 2.Control 3.Isolate AVG 4.Pre-post 5.Retention 6.Baseline 7.Missing date 8.Power analysis 9.Validity measure 10.6-month Score (Staiano et al., 2013 ) 1 1 1 1 1 1 1 0 1 0 8 (Li et al., 2014 ) 1 1 1 1 1 1 0 0 1 0 7 (Martí et al., 2015 ) 1 1 1 1 1 1 0 0 1 0 7 (Duman et al., 2016 ) 1 1 0 1 1 1 1 0 1 0 7 (Christison et al., 2016a ) 1 1 0 1 1 1 1 1 1 1 9 (Staiano et al., 2017a ) 1 1 1 1 1 1 0 0 1 0 8 (Flynn et al., 2018 ) 1 1 1 1 1 1 1 0 1 0 8 (Staiano et al., 2018 ) 1 1 1 1 1 1 0 0 1 0 8 (Staiano et al., 2019 ) 1 1 1 1 1 1 0 1 1 1 9 (Abedelmalek, 2022 ) 1 1 1 1 1 1 0 1 1 0 8 Note.1 = randomization procedure were adequately described and carried out; 2 = research design allowed for comparison between the AVG intervention group and the control/comparison group; 3 = research design allowed for test of effectiveness of the AVGs alone (not combined with other exercises) as compared with the control/comparison group; 4 = outcome variables were measured before and after the intervention; 5 = dropouts were described and not more than 30%; 6 = groups are comparable at baseline on key outcome variables through statistical analyses; 7 = data analyses were conducted while considering missing data; 8 = power analysis was conducted to determine the appropriate sample size; 9 = the reliability and validity of the measures were provided; 10 = participation were followde up for a minimum of 6 months. NA = not applicable. 3. RESULTS The search results underwent screening and evaluation based on formulated inclusion and exclusion criteria in the literature. This systematic review comprises 10 articles encompassing RCTs and Non-RCTs investigating the effects of AVGs on psychology among overweight and obese adolescents. They were published between the years 2013 and 2023. Table 3 summarises the characteristics of these studies. Table 3 Characteristics of the studies examined in the present review Author(Year) Country Sample characteristics Design Interventions description AVGs Settiing Measures index Outcomes Staiano et al., 2013 ,USA n = 54; 15-19yrs old; OW/OB, F = 30 RCT 20weeks; Freq: 5times/week; 30-60mins/session; EG1-cooperative AVG; EG2-competitive AVG; CG-normal activity Nintendo Wii School Self-efficacy- Exercise Confidence Survey; self-esteem- Rosenberg Self-Esteem scale; peer support- Friendship Quality Questionnaire Self-efficacy↑ than CG;self-efficacy↔beween EG1 and EG2;Peer support↑ than CG;peer support ↔ between EG1 and EG2 Li et al., 2014 , Singapore n = 140;10-12yrs old;M = 83;OW Pre-post test 2weeks; 30min/session EG1 (Stereotype threat absent); CG (2 groups)-normal and OW body size avatar; EG2 (Stereotype threat present); CG (2 groups)- normal and OW body size avatar; M and FM are grouped separately Nintendo Wii School Exercise attitude- bipolar adjective scales; exercise motivation- Likert scale; exercise motivation toward AVG- Likert scale; game performance- time spent in the workout Exercise attitude↑, exercise motivation↑, motivation toward AVG ↑, (stereotype threat absent) Duman et al., 2016 , Turkey n = 50; mean age : 12.16 ± 0.99 yrs old; FM = 29; OW/OB Pre-post test 8weeks;Freq:3 days/week; EG-AVG + exercise programme; No CG No mentioned School Depression- Depression Scale for Children; Self-concept- Piers-Harris Scale Self-esteem↑; psychological wellness↑; Flynn et al., 2018 , USA n = 126;10-15yrs old;51%FM;50%OW/OB Pre-post test 6weeks; Freq: 30min/week; EG-AVG play; No CG Nintendo Wii School Attitudes toward PA- Reynolds Influences of Physical Activity Self-efficacy↑; Intention to exercise↑; Social support for PA↑ Staiano et al., 2019 , USA n = 46,10-12yrs old; mean age:11.02 ± 0.8y;OW/OB;50%FM RCT 24weeks; Freq: 3times/week; 1h/session; EG-AVG (with peer or family member); CG- normal level of PA Kinect for the Xbox 360 Home Quality of life- KIDSCREEN-10 index; peer support- Friendship Quality Questionnaire;self-efficacy for PA- Self-Efficacy for Physical Activity self-efficacy toward PA↑, quality of life ↔ ; peer support↔ Abedelmalek, 2022 , Africa n = 24M;mean age: 16.25 ± 0.8 yrs; Pre-post test 1 month; 5 days/week; 45mins/session; EG-cooperative AVG; CG-normal activities No mentioned Home Mood- The Profile of Mood States (POMS) questionnaire Mood↑ Christison et al., 2016, USA n = 80; mean age:10.1 ± 1.3 yrs; M = 34;OW/OB RCT 10weeks;EG- AVG + didactics (parent /guardian); CG- didactics(parent /guardian); Freq: 2h/week; AVGsession-60mins(week1-5) and 30mins(week6-10) DDR, Exerbike XG, Nintendo Wii,Makoto Interactive arena,Lightspace Pay Floor,Cybex Trazer,Xavix Community Self-perception related to general self-esteem and related to physical attributes-Children and youth physical self-perception profile (CY-PSPP)- Perception of physical attributes or self-esteem↔; Global self-worth and physical self-worth↑ Martí et al., 2015 , Spain n = 42; mean age : 10.8 ± 1.6 yrs old;; 50% OW/OB; 50% normal weight RCT 60mins; A session; EG-walking teadmill with AVG; CG-walking on the treadmill Nintendo Wii Laboratory Self-Efficacy, Positive Expectations and Satisfaction-Scale Self-efficacy ↔; Expectations and satisfaction ↑; Staiano et al., 2017, USA n = 41FM; 14-18yrs old; mean age:16.80 ± 0.05y;OW and OB; RCT 12weeks;Freq:3times /week;1h/session;EG-AVGs;CG - normal level of PA Kinect for the Xbox 360 Laboratory PA-Acc,SR;Exercise transfer effects-baseline and behavioral observation;self-efficacy toward PA- Self-Efficacy for Healthy Eating and Physical Activ ity measure; intrinsic motivation toward AVGs- Intrinsic Motivation Inventory self-efficacy toward PA↑, intrinsic motivation toward AVGs↑. Staiano et al., 2018 , USA n = 41F; 14-18yrs old; mean age:16.80 ± 0.05y;OW / OB; RCT 12weeks;Freq:3times /week;1h/session;EG-AVGs (with peers); CG –no treatment Kinect for the Xbox 360 Laboratory SH-single-item Likert scale;PS-21-item Friendship Quality Questionnaire; Health-related quality of life-KIDSCREEN-10 Index; Enjoyment of AVG-rating scale SH↑,PS↔, Health-related quality of life↔,Enjoyment of AVG↑ Note:↑, significant improvement from pretest to post-test or compared with CG; ↔, non-significant within-group change from pretest to post-test; M, male; FM, female; OW, overweight; OB, obese; RCT, randomized control trial; EG, experimental group; CG,control group; VG, video game Freq, frequency; PA, physical activity; SR, self report; Perceived Competence Scale; SH, subjective health; PS, peer support 3.1 Study Selection Figure 1 illustrates the flowchart representing the process of selecting records. A total of 714 publications with potential were identified using the electronic database search. Specifically, 64 articles were found on PubMed, 100 on SCOPUS, 432 on EBSCOhost (SPORTDiscus), 117 on the Web of Science, and 1 from a reference source. After removing duplicates (78), researchers assessed the title and abstract of 636 publications to determine their eligibility. The articles removed due to missing information include: 583 articles without average values (423); 83 review papers; 45 articles without an experimental design; and 32 articles that were either merely abstracts or not written in English. After that, the remaining 53 papers were later studied, and 43 articles were deleted according to inclusion criteria, eventually leaving 10 relevant articles that satisfied the inclusion criteria for the review. 3.2 Population Characteristics i. Nationality of participants In the included studies, only one study reported that the participants were in Singapore, Asia (Li et al., 2014 ); one study reported that the participants were in Tunisia, Africa (Abedelmalek, 2022 ); two studies reported their participants were in Europe, one in Turkey (Duman et al., 2016 ) and another in Spain (Martí et al., 2015 ); the remaining six articles reported that participants were in the United States (Staiano et al., 2013 ; Christison et al., 2016; Staiano et al., 2017; Flynn et al., 2018 ; Staiano et al., 2018 ; Staiano et al., 2019 ). ii. Gender Two of the 10 studies focused on girls (Staiano et al., 2017; Staiano et al., 2018 ), one study focused on boys (Abedelmalek, 2022 ), and the subjects in the remaining seven studies were mixed male and female (Li et al., 2014 ; Duman et al., 2016 ; Martí et al., 2015 ; Christison et al., 2016; Staiano et al., 2013 ; Staiano et al., 2019 ; Flynn et al., 2018 ). 3.3 Interventions Characteristics The intervention characteristics of these fifteen studies were reported based on the following aspects: i. AVG mode Four studies only used AVGs as an intervention method and adoped multiplayer modes, with their partners being peers or siblings (Staiano et al., 2013 ; Staiano et al., 2019 ; Abedelmalek, 2022 ; Staiano et al., 2018 ). Four studies only used AVGs as an intervention method and adoped single player modes (Li et al., 2014 ; Flynn et al., 2018 ; Martí et al., 2015 ; Staiano et al., 2017). The remaining two articles used AVG combined with health programme as intervention methods (Christison et al., 2016; Duman et al., 2016 ). ii. Experimental setting Among the 10 articles, four were conducted in school setting (Staiano et al., 2013 ; Li et al., 2014 ; Duman et al., 2016 ; Flynn et al., 2018 ), two were conducted in home setting (Staiano et al., 2019 ; Abedelmalek, 2022 ), one was conducted in community setting (Christison et al., 2016a ), three were conducted in laboratory setting (Martí et al., 2015 ; Staiano et al., 2017; Staiano et al., 2018 ). iii. The type of AVG console In the 10 articles, four studies only used Nintendo Wii as intervention (Staiano et al., 2013 ; Li et al., 2014 ; Flynn et al., 2018 ; Martí et al., 2015 ). One study used eight different consoles: DDR, Exerbike XG, Nintendo Wii, Makoto Interactive Arena, Lightspace Play Floor, Cybex Bring, Treadwall, and Xavix System (Christison et al., 2016a ). Three studies only used Kinect for the Xbox 360 as intervention (Staiano et al., 2017; Staiano et al., 2018 ; Staiano et al., 2019 ). Two studies did not report the console model (Duman et al., 2016 ; Abedelmalek, 2022 ). 3.4 Comparison i. Comparison between AVG and normal activities Among the 10 articles, four conducted a comparison between two groups: one engaged in AVG (play with peers or siblings) and the other involved in normal activities (Staiano et al., 2017; Staiano et al., 2019 ; Staiano et al., 2018 ; Abedelmalek, 2022 ). Specifically, the experimental groups in Staiano et al. ( 2019 ) and Staiano et al. ( 2018 ) were comprised of individuals who participated in group-based AVG. ii. Comparison based on weight classification A comparative analysis was performed on two groups, one consisting of individuals classified as overweight and the other consisting of those with a normal weight (Li et al., 2014 ; Martí et al., 2015 ). In the study conducted by Li et al. ( 2014 ), the experimental group consisted of avatars with overweight body size, while the control group consisted of avatars with normal body size. In the study conducted by Martí et al. ( 2015 ), the experimental group consisted of overweight adolescents, while the control group consisted of adolescents with normal weight. iii. Comparison based on pre and post experiment One group was adopted in the studies, namely the AVG play group, as mentioned in the studies of Flynn et al. ( 2018 ) and Duman et al. ( 2016 ). iv. Comparison with health programme Two studies adopted two groups to contrast the effects of an AVG combined with a health programme, compared to a health programme alone (Christison et al., 2016; Martí et al., 2015 ). v. Three-group comparison Another study adopted three groups to compare the effects of a cooperative AVG, a competitive AVG, and normal activities (Staiano et al., 2013 ). 3.5 Outcomes The psychological effects of AVG on overweight and obese adolescents mainly focus on self-efficacy (n = 5), social support and peer support (n = 4), motivation (n = 3), quality of life (n = 2), and self-esteem (n = 2). In total, 25 different psychological outcomes were examined in the studies. The details are shown in Table 3 . i. Self-efficacy Regarding self-efficacy, Staiano et al. ( 2013 ) found that there were no significant differences in self-efficacy between the cooperative group and the competitive group. However, both of these groups showed substantial differences in self-efficacy compared to the control group, which engaged in regular activities. Flynn et al. ( 2018 ) reported that the experimental group of AVG shown a notable improvement in self-efficacy. According to Staiano et al. ( 2019 ), the study found that participating in group-based AVG significantly boosted individuals' self-efficacy towards physical PA. Staiano et al. (2017) reported significant differences in self-efficacy towards PA within the AVG group. Nevertheless, Martí et al. ( 2015 ) found insignificant differences in self-efficacy among the groups (overweight and normal weight) and circumstances (treadmill and treadmill + AVG). ii. Social support and peer support Regarding social support and peer support, Staiano et al. ( 2013 ) discovered that there were no substantial differences in peer support between the cooperative group and the competitive group. However, significant differences were observed between these two groups when compared to the control group (engaging in normal activity). Flynn et al. ( 2018 ) reported that the AVG experimental group exhibited notable enhancement in social support, whereas Staiano et al. ( 2018 ) and Staiano et al. ( 2019 ) found no significant effect of peer support in group-based AVG. iii. Motivation With regard to motivation, Li et al. ( 2014 ) found that overweight students who were allocated to a group with avatars representing normal body size showed greater motivation for exercise compared to those in a group with avatars representing large body size. Flynn et al. ( 2018 ) indicated that the participants in AVG group increased the motivation to exercise significantly. Staiano et al. (2017) reported significant differences in intrinsic motivation within the AVG group. iv. Quality of life In terms of quality of life, Staiano et al. ( 2018 ) reported no significant difference in health-related quality of life (HRQoL) within the group-based AVG group. According to Staiano et al. ( 2019 ), the group-based AVG did not provide a statistically meaningful enhancement in quality of life. v. Self-esteem In terms of self-esteem, Duman et al. ( 2016 ) found that participants who underwent an intervention involving a mixed exercise programme with AVGs experienced notable improvements in self-esteem compared to their initial measurements. On the other hand, Christison et al. (2016) examined the impact of a comprehensive weight intervention programme that was community-based and included the integration of AVGs into the curriculum. The findings indicated that there was not a significant difference in self-esteem. vi. Other psychological outcomes With regarding to other psychological outcomes, Li et al. ( 2014 ) r found that overweight students who were assigned to participate in the group with avatars depicting a normal body size showed a more positive attitude compared to those in the group with avatars representing a large body size. In a study conducted by Duman et al. ( 2016 ), it was found that participants who underwent an AVG mixed exercise programme observed notable improvements in their depression when compared to their baseline assessments. Abedelmalek. (2022) found that cooperative AVG has a significant beneficial effect on mood state. Christison et al. (2016) found that both groups (AVG + programme vs programme) observed a significant increase in global self-worth and physical self-worth. In the study conducted by Martí et al. ( 2015 ), it found that obese children exhibited considerably greater differences in expectancies and satisfaction in the AVG condition compared to both overweight and normal weight children, across both the treadmill and treadmill + AVG conditions. Staiano et al. ( 2018 ) found that group-based AVG had substantial effects on both subjective health and enjoyment of AVG. 4. DISCUSSION This systematic review aimed to analyse the psychological impact of AVG (Active Video Games) on overweight and obese adolescents. This review included 10 studies and the analysis was based on the results of PICO (Population, Intervention, Comparison, Outcome). 4.1 Population i. Nationality of participants The studies in this review were conducted across different countries, including Singapore, Tunisia, Turkey, Spain, and the USA. Notably, a majority of the AVG interventions took place in the USA, accounting for 60% of the selected studies. It is crucial to highlight that only one study took place in Singapore. According to World Obesity (2022), the prevalence of obesity among children and adolescents aged five to 19 years in Southeast Asia will reach more than 21 million by 2030. Furthermore, it is important to acknowledge that in China, which has the highest population, the incidence of obesity in children and adolescents has reached 11.9% (Cai et al., 2017). Hence, it is imperative to develop innovative strategies to address the issue of obesity in these areas. ii. Gender The results revealed that in seven out of the 10 research, the participants consisted of both males and females. Meanwhile, two studies fully focused on females, while only one study solely focused on males. Between 2000 and 2019, the prevalence of obesity among boys in China had a growth rate that was nearly double that of females (Zhang et al., 2022). Hence, it is imperative to conduct a targeted study on male adolescents who are overweight or obese in the future research. 4.2 Interventions i. AVG mode The results indicated that the primary intervention approaches employed in the 10 chosen publications were single-player AVG and multi-player AVG. Nevertheless, it is important to acknowledge that in the multi-player AVG, the individuals' partners were solely limited to peers or siblings, with no parental involvement. Grossman et al. (2017) indicated that family participation strategy underscored the parents' capacity to influence the adoption of healthy behaviors and the weight status of their children. The weight-related behaviours of children, which are mostly observed in the family setting and influenced by parental modelling, can be effectively influenced in a positive manner. Therefore, it underscores the need of parental involvement in the therapy procedure (Altman & Wilfley, 2015). Moreover, a review examining interventions aimed at decreasing sedentary time in children through parental involvement was more crucial than the specific intervention itself (Marsh et al., 2014). Another meta-analysis also highlighted that direct parental involvement and role modeling play a crucial role in the physical activity intervention of adolescents (Guo et al., 2023). ii. Experimental setting Regarding AVG interventions in various environments, the results indicate that there is insufficient evidence to verify the effects of AVG interventions in the family environment on the psychology of overweight and obese adolescents. The World Health Organisation (WHO) has consistently emphasised the significance of family sports, particularly the involvement of parents in fostering physical activity among adolescents (WHO, 2022). Family factors, including the physical environment (such as sports facilities and equipment), family structure, economic income, parental education, and family environment, have been found to be associated with adolescents' physical exercise (Chang & Wu, 2008; Lv et al., 2020; Weaver et al., 2018; Cleland et al., 2011). However, the behaviour and words of parents may have a more direct, influential, and representative impact on children's social cognition and behaviour acquisition (Hu et al., 2017; Gao & Wang, 2015; Liu et al., 2020). During the crucial stage of social development, the behavioural decisions and behaviours of adolescents are frequently influenced by their parents' independent support and physical activity routines (Hu et al., 2017; Dong & Mao, 2018; Fuemmeler et al., 2011; Adamo et al., 2012). In summary, given the information provided, future studies on AVG intervention should prioritise investigating the family environment and delves into the influence of parental involvement on adolescent obesity and the psychological issues associated with obesity. iii. The type of AVG console In terms of the type of AVG console, the results indicated that there were a variety of AVG consoles utilised across the 10 studies, ranging from a single console, such as Nintendo Wii and Kinect for Xbox 360, to the use of multiple consoles in a single study. This diversity in intervention methods underscores the flexibility and adaptability of AVGs in research settings. According to the results, both the Nintendo Wii and Kinect for Xbox360 have a notable positive impact on self-efficacy (Staiano et al., 2013; Flynn et al., 2018; Staiano et al., 2019; Staiano et al., 2017). However, when it comes to social support and peer support, the Nintendo Wii surpasses the Kinect for Xbox360 significantly (Staiano et al., 2013 Staiano et al., 2019 Staiano et al., 2018). Additionally, research has demonstrated that the Wii is more attractive and cost-effective when compared to other home-based technology (Glen et al., 2017). Therefore, it is imperative for future studies to thoroughly evaluate the economic feasibility and accessibility of AVG, taking into account the distinctive features of various game consoles. Researchers should select different game consoles based on specific research objectives in order to maximise the benefits offered by each console. 4.3 Comparison A total of 10 studies examined five different types of comparison. Despite the varying study designs, AVG shows promise as a viable intervention to improve the psychological well-being of overweight and obese adolescents. From the provided results, it can be inferred that AVG has the potential to significantly enhance the psychological well-being of adolescents, especially those who are overweight or obese. Furthermore, cooperating with AVG has a substantial impact on psychosocial factors. However, additional investigation is required to examine other experimental designs in relation to the quality of life in order to improve it. Additionally, there is insufficient evidence to assess the psychological impact of individual AVG and group-based AVG, and it has still to be determined whether AVG can effectively replace conventional sedentary activities like as watching TV, video gaming, and mobile phone usage. How may AVG be integrated into the leisure time activities of overweight and obese adolescents to decrease their sedentary behaviour while maintaining their psychological well-being? This question necessitates cautious consideration by researchers in future research. Hence, it is imperative for future studies to do a comparative analysis among individual AVG and group-based AVG, and traditional sedentary behaviour. 4.4 Outcomes i. Self-efficacy While Staiano et al. (2013) found no significant differences between cooperative and competitive groups, both groups showed improvements compared to the control group. Flynn et al. (2018) and Staiano et al. (2017) reported a notable improvement in self-efficacy in the AVG group. Staiano et al. (2019) highlighted a significant boost in self-efficacy with group-based AVG. Yet, Martí et al. (2015) reported that when comparing the effects of AVG combined with treadmills, both the overweight and normal weight groups of adolescents did not demonstrate any significant improvement in self-efficacy. Possible explanation for inconsistent self-efficacy evaluations is due to the diverse intervention strategies. Previous research has employed independent AVG as an intervention, whereas Martí et al. (2015) has utilised AVG in conjunction with a treadmill as an intervention. Studies have demonstrated that engaging in treadmill exercise does not yield a substantial impact on enhancing self-efficacy (Hambly et al., 2017; Shaughnessy et al., 2012). ii. Social support and peer support From the results, it can be found that cooperative AVG, competitive AVG, and individual AVG can effectively improve peer support and social support. However, in group-based AVG, peer support did not show significant improvement. There could be multiple factors contributing to this phenomenon: 1. Controlled setting for conducting experiments. Staiano et al. (2013) conducted their study in a school setting, with participants who were all peers. The participants played the game either through cooperation or competition with their peers, which increased interaction during the game and improved peer support. In contrast, Staiano et al. (2019) conducted their study in a family setting, where the partners of the participants could be peers, family members, or siblings. This led to limited social interaction with peers during the gaming process, resulting in no improvement in peer support. Staiano et al. (2018) conducted their study in a laboratory setting. However, it is important to note that the laboratory environment does not fully replicate real social environments. As a result, participants may not have the same psychological response as they would in a real-life scenario. Previous study has demonstrated that findings from laboratory experiments, where researchers actively manipulate and control variables, may not easily apply to other real-life situations, leading to limited external validity (AQA, 2022); 2. Different game console. Staiano et al. (2013) employed the Nintendo Wii console and specifically selected sports games like basketball, baseball, tennis, and volleyball for their experiment. In contrast, Staiano et al. (2018) utilised Just Dance, a game available on Kinect for Xbox 360, which could potentially result in participants experiencing boredom with the game during the experiment. Empirical studies have shown that AVG fails to maintain player engagement over a longer period (Liang & Lau, 2014). Additionally, the selection of a sole game can also induce feelings of boredom among players (Radhakrishnan et al., 2019). Based on the above information, self-efficacy, as per social cognitive theory (Bandura, 2004b), is the primary factor that influences healthy behaviour. Moreover, it can also exert an impact on social structural variables and outcome expectations, and these two aspects can also serve as mediators in promoting healthy behaviour. Hence, it is easily comprehensible why self-efficacy and social support, or peer support, comprise the largest share among the articles selected. Nevertheless, the authors of these articles have failed to consider the impact of parental support on influencing adolescent health behaviours within family settings while examining social support components. Research has demonstrated that parental support of physical exercise can impact children's engagement in moderate-to-vigorous physical activities (Hosokawa et al., 2023). Furthermore, a global survey encompassing 74 nations revealed a strong association between parental support and adolescents’ physical activity in the Western Pacific region (Khan et al., 2020). iii. Motivation The results indicate that AVG has a substantial influence on the exercise motivation of both overweight and obese adolescents. It is noteworthy that Li et al. (2014) revealed a higher level of exercise motivation among individuals in the group with normal avatar body size. According to Peña & Kim (2014), females who controlled avatars with a normal weight engaged in more physical activity compared to those who controlled avatars with obesity. Males who utilise avatars with a normal weight would experience an increase in their physical activity levels during the process of playing AVGs (Peña et al., 2016). Therefore, it is imperative to consider this matter in future research on AVG experiments to enable participants to elicit greater positive psychological responses. iv. Quality of life Staiano et al. (2018) and Staiano et al. (2019) did not find any substantial influence of AVG on quality of life. This could be attributed to the fact that both researches utilised 10-item version of the KIDSCREEN Index for assessing quality of life, as stated by the author. Although the 10-item version has demonstrated criterion validity and test-retest reliability (Ravens-Sieberer et al., 2010), its limited number of items leads to reduced variability compared to longer scales, potentially resulting in null effects. Therefore, further research should prioritise the examination of alternative evaluation instruments such as the PedsQL, which are widely employed and have the potential to offer more comprehensive evaluations of domains that are susceptible to modifications and hold significance for adolescents with obesity, including physical, emotional, and social functioning (Buttitta et al., 2014). v. Self-esteem The results revealed that the combination of AVG and health programmes yielded inconclusive outcomes in relation to self-esteem. Duman et al. (2016) incorporated an exercise programme that consisted of a greater amount of aerobic activity. This led to noteworthy enhancements in BMI, waist circumference, and triceps skinfold thickness among the participants. Additionally, there was a considerable boost in self-esteem. In contrast, Christison et al. (2016) incorporated a greater number of nutritious dietary habits into the health programme. While the individuals' BMI and physical fitness demonstrated improvement, there was no statistically significant difference, and self-esteem did not exhibit notable improvement. Additionally, there is an adverse association between greater BMI and self-esteem, as demonstrated by Kiviruusu et al. (2016). Furthermore, self-esteem is inversely related to certain attitudes and behaviours around weight and body shape, including physical dissatisfaction and cognitive impression of being overweight. (van den Berg et al., 2010; Perrin et al., 2010). According to the above information, for future experiments that combine AVG with health programmes, it is recommended to incorporate more exercise components into the health programme. This will help to enhance the level of exercise, potentially leading to a considerable improvement in the weight status of participants and an improvement in their self-esteem. vi. Other psychological outcomes The results revealed diverse positive effects on various psychological outcomes, including attitudes (Li et al., 2014), depression (Duman et al., 2016), mood state (Abedelmalek, 2022), self-worth (Christison et al., 2016a), subjective health, enjoyment (Staiano et al., 2018), satisfaction, and expectancies (Flynn et al., 2018). These results suggest that AVG has the potential to improve the psychological well-being of overweight and obese adolescents. 5. LIMITATIONS This review offers substantial evidence of acceptable quality supporting the positive effects of AVGs on psychology among overweight and obese adolescents. However, certain limitations need consideration. First, the diversity of AVG consoles and games used in the studies introduces variability in the interventions. Different consoles may offer distinct features, and the nature of the games played could impact psychological outcomes differently. This heterogeneity makes it challenging to pinpoint the specific elements contributing to the observed effects. Secondly, the low number of studies included. Due to the scarcity of research examining the use of AVGs among overweight or obese adolescents, the number of studies exploring the same psychological effects was limited. 6. CONCLUSION In conclusion, the examination of AVG interventions on the psychological well-being of overweight and obese adolescents reveals a nuanced landscape characterized by mixed findings. The impact on self-efficacy varies across studies, underscoring the intricate relationship between AVG engagement, intervention nature, and specific platforms. Social and peer support outcomes exhibit diversity, highlighting the influence of group dynamics and intervention specifics. Positive trends in exercise motivation suggest a potential avenue for technology-driven enhancement, with avatar representation playing a role. Mixed results in HRQoL outcomes indicate variability in the broader impact of AVG interventions. Similarly, self-esteem outcomes present contrasting findings, emphasizing the need for a nuanced understanding. As we navigate this complexity, future research should standardize methodologies and delve into the underlying mechanisms, offering tailored strategies to optimize psychological outcomes for overweight and obese adolescents engaged in AVG interventions within health promotion initiatives. Declarations ACKNOWLEDGMENT No funding was provided to support this project. CONFLICT OF INTERESTS The authors declare that there are no conflict of interests. AUTHOR CONTRIBUTIONS All authors have contributed equally with ideas and preparation of the manuscript. DATA AVAILABILITY STATEMENT The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. References Abedelmalek, S. (2022). Exergaming During Ramadan Intermittent Fasting Improve Body Composition as Well as Physiological and Psychological Responses to Physical Exercise in Adolescents With Obesity. Frontiers in Nutrition , 9 . Adamo, K. B., Langlois, K. A., Brett, K. E., & Colley, R. C. (2012). Young children and parental physical activity levels: Findings from the Canadian health measures survey. American Journal of Preventive Medicine , 43 (2), 168–175. https://doi.org/10.1016/j.amepre.2012.02.032 Ae, S., Ra, B., W, G., Ca, H., Ds, H., & Rl, N. (2018). Home-based exergaming among children with overweight and obesity: A randomized clinical trial. Pediatric Obesity , 13 (11). https://doi.org/10.1111/ijpo.12438 Altman, M., & Wilfley, D. E. (2015). Evidence update on the treatment of overweight and obesity in children and adolescents. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 , 44 (4), 521–537. https://doi.org/10.1080/15374416.2014.963854 Andrade, A., Correia, C. K., & Coimbra, D. R. (2019). The Psychological Effects of Exergames for Children and Adolescents with Obesity: A Systematic Review and Meta-Analysis. Cyberpsychology, Behavior and Social Networking , 22 (11), 724–735. https://doi.org/10.1089/cyber.2019.0341 AQA. (2022). Types of Experiment: Overview . https://www.tutor2u.net/psychology/reference/types-of-experiment-overview Bandura, A. (2004a). Health Promotion by Social Cognitive Means. Health Education & Behavior , 31 (2), 143–164. https://doi.org/10.1177/1090198104263660 Bandura, A. (2004b). Health promotion by social cognitive means. Health Education & Behavior: The Official Publication of the Society for Public Health Education , 31 (2), 143–164. https://doi.org/10.1177/1090198104263660 Blasco, B. V., García-Jiménez, J., Bodoano, I., & Gutiérrez-Rojas, L. (2020). Obesity and Depression: Its Prevalence and Influence as a Prognostic Factor: A Systematic Review. Psychiatry Investigation , 17 (8), 715–724. https://doi.org/10.30773/pi.2020.0099 Brown, C. L., Halvorson, E. E., Cohen, G. M., Lazorick, S., & Skelton, J. A. (2015). Addressing Childhood Obesity: Opportunities for Prevention. Pediatric Clinics of North America , 62 (5), 1241–1261. https://doi.org/10.1016/j.pcl.2015.05.013 Buttitta, M., Iliescu, C., Rousseau, A., & Guerrien, A. (2014). Quality of life in overweight and obese children and adolescents: A literature review. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation , 23 (4), 1117–1139. https://doi.org/10.1007/s11136-013-0568-5 Cai, Y., Zhu, X., & Wu, X. (2017). Overweight, obesity, and screen-time viewing among Chinese school-aged children: National prevalence estimates from the 2016 Physical Activity and Fitness in China-The Youth Study. Journal of Sport and Health Science , 6 (4), 404–409. https://doi.org/10.1016/j.jshs.2017.09.002 Calcaterra, V., Vandoni, M., Marin, L., Carnevale Pellino, V., Rossi, V., Gatti, A., Patanè, P., Cavallo, C., Re, F., Albanese, I., Silvestri, D., De Nunzio, A., & Zuccotti, G. (2023). Exergames to Limit Weight Gain and to Fight Sedentarism in Children and Adolescents with Obesity. Children , 10 (6), 928. https://doi.org/10.3390/children10060928 Chang, S., & Wu, J. (2008). Investigation and analysis of family factors influencing college students’ physical exercise behavior. 体育学刊, 15 (3), 4. Choo, C. C., Harris, K. M., Chew, P. K. H., & Ho, R. C. (2017). What predicts medical lethality of suicide attempts in Asian youths? Asian Journal of Psychiatry , 29 , 136–141. https://doi.org/10.1016/j.ajp.2017.05.008 Christison, A. L., Evans, T. A., Bleess, B. B., Wang, H., Aldag, J. C., & Binns, H. J. (2016a). Exergaming for Health: A Randomized Study of Community-Based Exergaming Curriculum in Pediatric Weight Management. Games for Health Journal , 5 (6), 413–421. https://doi.org/10.1089/g4h.2015.0097 Christison, A. L., Evans, T. A., Bleess, B. B., Wang, H., Aldag, J. C., & Binns, H. J. (2016b). Exergaming for Health: A Randomized Study of Community-Based Exergaming Curriculum in Pediatric Weight Management. Games for Health Journal , 5 (6), 413–421. https://doi.org/10.1089/g4h.2015.0097 Cleland, V., Timperio, A., Salmon, J., Hume, C., Telford, A., & Crawford, D. (2011). A longitudinal study of the family physical activity environment and physical activity among youth. American Journal of Health Promotion: AJHP , 25 (3), 159–167. https://doi.org/10.4278/ajhp.090303-QUAN-93 Dong, B., & Mao, L. (2018). Parental autonomy support and adolescents’ exercise persistence: The multiple mediations of control belief and exercise engagement. 天津体育学院学报, 33 (1), 8. Duman, F., Kokaçya, M. H., Doğru, E., Katayıfcı, N., Canbay, Ö., & Aman, F. (2016). The Role of Active Video-Accompanied Exercises in Improvement of the Obese State in Children: A Prospective Study from Turkey. Journal of Clinical Research in Pediatric Endocrinology , 8 (3), 334–340. https://doi.org/10.4274/jcrpe.2284 Echeverria, S. E., Luan Kang, A., Isasi, C. R., Johnson-Dias, J., & Pacquiao, D. (2014). A community survey on neighborhood violence, park use, and physical activity among urban youth. Journal of Physical Activity & Health , 11 (1), 186–194. https://doi.org/10.1123/jpah.2012-0023 Flynn, R. M., Staiano, A. E., Beyl, R., Richert, R. A., Wartella, E., & Calvert, S. L. (2018). The Influence of Active Gaming on Cardiorespiratory Fitness in Black and Hispanic Youth. Journal of School Health , 88 (10), 768–775. https://doi.org/10.1111/josh.12679 Fuemmeler, B. F., Anderson, C. B., & Mâsse, L. C. (2011). Parent-child relationship of directly measured physical activity. The International Journal of Behavioral Nutrition and Physical Activity , 8 , 17. https://doi.org/10.1186/1479-5868-8-17 Gao, Y., & Wang, X. (2015). The influence of parental support and peer friendship quality on adolescents’ motivation and involvement in sports. 天津体育学院学报, 30 (6), 8. Gao, Z., & Chen, S. (2014). Are field-based exergames useful in preventing childhood obesity? A systematic review. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity , 15 (8), 676–691. https://doi.org/10.1111/obr.12164 Gao, Z., Podlog, L., & Huang, C. (2013). Associations among children’s situational motivation, physical activity participation, and enjoyment in an active dance video game. Journal of Sport and Health Science , 2 (2), 122–128. https://doi.org/10.1016/j.jshs.2012.07.001 Glen, K., Eston, R., Loetscher, T., & Parfitt, G. (2017). Exergaming: Feels good despite working harder. PLOS ONE , 12 (10), e0186526. https://doi.org/10.1371/journal.pone.0186526 Grossman, D. C., Bibbins-Domingo, K., Curry, S. J., Barry, M. J., Davidson, K. W., Doubeni, C. A., Epling, J. W., Kemper, A. R., Krist, A. H., Kurth, A. E., Landefeld, C. S., Mangione, C. M., Phipps, M. G., Silverstein, M., Simon, M. A., & Tseng, C.-W. (2017). Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA , 317 (23), 2417–2426. https://doi.org/10.1001/jama.2017.6803 Guo, X., Cai, S., Dang, J., & Chen, Y. (2023). The effects of parental involvement on physical activity in children and adolescents: A meta-analysis . http://119.45.101.87:9195/kns8s/defaultresult/index Hambly, K., Poomsalood, S., & Mundy, E. (2017). Return to running following knee osteochondral repair using an anti-gravity treadmill: A case report. Physical Therapy in Sport , 26 , 35–40. Hosokawa, R., Fujimoto, M., & Katsura, T. (2023). Parental support for physical activity and children’s physical activities: A cross-sectional study. BMC Sports Science, Medicine and Rehabilitation , 15 (1), 90. https://doi.org/10.1186/s13102-023-00700-9 Hu, X., Tang, Y., Zhang, J., & Liu, Y. (2017). The influence of parental factors on moderate to vigorous physical activity in adolescents. 中国体育科技, 53 (3), 8. Khan, S. R., Uddin, R., Mandic, S., & Khan, A. (2020). Parental and Peer Support are Associated with Physical Activity in Adolescents: Evidence from 74 Countries. International Journal of Environmental Research and Public Health , 17 (12), 4435. https://doi.org/10.3390/ijerph17124435 Kiviruusu, O., Konttinen, H., Huurre, T., Aro, H., Marttunen, M., & Haukkala, A. (2016). Self-esteem and Body Mass Index from Adolescence to Mid-adulthood. A 26-year Follow-up. International Journal of Behavioral Medicine , 23 (3), 355–363. https://doi.org/10.1007/s12529-015-9529-4 Lee, S., Kim, W., Park, T., & Peng, W. (2017). The Psychological Effects of Playing Exergames: A Systematic Review. Cyberpsychology, Behavior and Social Networking , 20 (9), 513–532. https://doi.org/10.1089/cyber.2017.0183 Li, B. J., Lwin, M. O., & Jung, Y. (2014). Wii, Myself, and Size: The Influence of Proteus Effect and Stereotype Threat on Overweight Children’s Exercise Motivation and Behavior in Exergames. Games for Health Journal , 3 (1), 40–48. https://doi.org/10.1089/g4h.2013.0081 Liang, Y., & Lau, P. W. C. (2014). Effects of Active Videogames on Physical Activity and Related Outcomes Among Healthy Children: A Systematic Review. Games for Health Journal , 3 (3), 122–144. https://doi.org/10.1089/g4h.2013.0070 Liu J., He X., He G., & Zhang Y. (2020). Parental involvement, school inclusion, and the mental health of migrant children: Evidence from the China Education Tracking Survey. 中国青年研究, 0 (3), 39–48. Llewellyn, A., Simmonds, M., Owen, C. G., & Woolacott, N. (2016). Childhood obesity as a predictor of morbidity in adulthood: A systematic review and meta-analysis. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity , 17 (1), 56–67. https://doi.org/10.1111/obr.12316 Lv, H., Wang, K., & Liu, H. (2020). Family sports environment and children’s sports lifestyle: The mediating role of family social capital. 北京体育大学学报, 43 (5), 12. Marsh, S., Foley, L. S., Wilks, D. C., & Maddison, R. (2014). Family-based interventions for reducing sedentary time in youth: A systematic review of randomized controlled trials. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity , 15 (2), 117–133. https://doi.org/10.1111/obr.12105 Martí, A. C., Álvarez, J. C., & Provinciale, J. G. (2015). OPCIONES ALTERNATIVAS PARA PRESCRIBIR ACTIVIDAD FÍSICA ENTRE NIÑOS Y. NUTRICION HOSPITALARIA , 2 , 841–848. https://doi.org/10.3305/nh.2015.31.2.7929 Matias, T., Kieling Sebold BarrosRolim, M., Kretzer, F., Schmoelz, C., & Andrade, A. (2010). Corporal satisfaction associated with physical activity practice during adolescence. Motriz. Revista de Educação Física , 16 , 370–378. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ , 372 , n71. https://doi.org/10.1136/bmj.n71 Peña, J., Khan, S., & Alexopoulos, C. (2016). I Am What I See: How Avatar and Opponent Agent Body Size Affects Physical Activity Among Men Playing Exergames. Journal of Computer-Mediated Communication , 21 (3), 195–209. https://doi.org/10.1111/jcc4.12151 Peña, J., & Kim, E. (2014). Increasing exergame physical activity through self and opponent avatar appearance. Computers in Human Behavior , 41 , 262–267. https://doi.org/10.1016/j.chb.2014.09.038 Peng, W., Crouse, J. C., & Lin, J.-H. (2013). Using active video games for physical activity promotion: A systematic review of the current state of research. Health Education & Behavior: The Official Publication of the Society for Public Health Education , 40 (2), 171–192. https://doi.org/10.1177/1090198112444956 Perrin, E. M., Boone-Heinonen, J., Field, A. E., Coyne-Beasley, T., & Gordon-Larsen, P. (2010). Perception of overweight and self-esteem during adolescence. The International Journal of Eating Disorders , 43 (5), 447–454. https://doi.org/10.1002/eat.20710 Radhakrishnan, K., Baranowski, T., Julien, C., Thomaz, E., & Kim, M. (2019). Role of Digital Games in Self-Management of Cardiovascular Diseases: A Scoping Review. Games for Health Journal , 8 (2), 65–73. https://doi.org/10.1089/g4h.2018.0011 Ravens-Sieberer, U., Erhart, M., Rajmil, L., Herdman, M., Auquier, P., Bruil, J., Power, M., Duer, W., Abel, T., Czemy, L., Mazur, J., Czimbalmos, A., Tountas, Y., Hagquist, C., Kilroe, J., & European KIDSCREEN Group. (2010). Reliability, construct and criterion validity of the KIDSCREEN-10 score: A short measure for children and adolescents’ well-being and health-related quality of life. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation , 19 (10), 1487–1500. https://doi.org/10.1007/s11136-010-9706-5 Shaughnessy, M., Michael, K., & Resnick, B. (2012). Impact of Treadmill Exercise on Efficacy Expectations, Physical Activity, and Stroke Recovery. The Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses , 44 (1), 27–35. https://doi.org/10.1097/JNN.0b013e31823ae4b5 Staiano, A. E., Abraham, A. A., & Calvert, S. L. (2013). Adolescent Exergame Play for Weight Loss and Psychosocial Improvement: A Controlled Physical Activity Intervention. Obesity . https://doi.org/10.1038/oby.2012.143 Staiano, A. E., Beyl, R. A., Guan, W., Hendrick, C. A., Hsia, D. S., & Newton, R. L. (2019). Home-Based Exergaming among Children with Overweight and Obesity . Staiano, A. E., Beyl, R. A., Hsia, D. S., Katzmarzyk, P. T., & Newton Jr, R. L. (2018). A 12-week randomized controlled pilot study of dance exergaming in a group: Influence on psychosocial factors in adolescent girls. Cyberpsychology: Journal of Psychosocial Research on Cyberspace , 12 (2). https://doi.org/10.5817/CP2018-2-3 Staiano, A. E., Beyl, R. A., Hsia, D. S., Katzmarzyk, P. T., & Newton, R. L. (2017a). Twelve weeks of dance exergaming in overweight and obese adolescent girls: Transfer effects on physical activity, screen time, and self-efficacy. Journal of Sport and Health Science , 6 (1), 4–10. https://doi.org/10.1016/j.jshs.2016.11.005 Staiano, A. E., Beyl, R. A., Hsia, D. S., Katzmarzyk, P. T., & Newton, R. L. (2017b). Twelve weeks of dance exergaming in overweight and obese adolescent girls: Transfer effects on physical activity, screen time, and self-efficacy. Journal of Sport and Health Science , 6 (1), 4–10. https://doi.org/10.1016/j.jshs.2016.11.005 Stangl, A. L., Earnshaw, V. A., Logie, C. H., van Brakel, W., C. Simbayi, L., Barré, I., & Dovidio, J. F. (2019). The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine , 17 (1), 31. https://doi.org/10.1186/s12916-019-1271-3 Stewart, J. G., Esposito, E. C., Glenn, C. R., Gilman, S. E., Pridgen, B., Gold, J., & Auerbach, R. P. (2017). Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters. Journal of Psychiatric Research , 84 , 105–112. https://doi.org/10.1016/j.jpsychires.2016.09.031 Sun, H. (2013). Impact of exergames on physical activity and motivation in elementary school students: A follow-up study. Journal of Sport and Health Science , 2 (3), 138–145. https://doi.org/10.1016/j.jshs.2013.02.003 Taylor, A., Wilson, C., Slater, A., & Mohr, P. (2012). Self-esteem and body dissatisfaction in young children: Associations with weight and perceived parenting style. Clinical Psychologist , 16 (1), 25–35. https://doi.org/10.1111/j.1742-9552.2011.00038.x van den Berg, P. A., Mond, J., Eisenberg, M., Ackard, D., & Neumark-Sztainer, D. (2010). The link between body dissatisfaction and self-esteem in adolescents: Similarities across gender, age, weight status, race/ethnicity, and socioeconomic status. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine , 47 (3), 290–296. https://doi.org/10.1016/j.jadohealth.2010.02.004 Weaver, R. G., Webster, C. A., Beets, M. W., Brazendale, K., Schisler, L., & Aziz, M. (2018). An Intervention to Increase Students’ Physical Activity: A 2-Year Pilot Study. American Journal of Preventive Medicine , 55 (1), e1–e10. https://doi.org/10.1016/j.amepre.2018.03.005 WHO. (2020). Adolescent health and development . https://www.who.int/news-room/questions-and-answers/item/adolescent-health-and-development WHO. (2021). Obesity and overweight . https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight WHO. (2022, October). Physical activity . https://www.who.int/news-room/fact-sheets/detail/physical-activity WHO. (2023). Adolescent health . https://www.who.int/health-topics/adolescent-health World Obesity. (2022). Battling Obesity in ASEAN . World Obesity Federation. https://www.worldobesity.org Yanovski, J. A. (2015). Pediatric obesity. An introduction. Appetite , 93 , 3–12. https://doi.org/10.1016/j.appet.2015.03.028 Yuca, S. A., Cimbek, E. A., Şen, Y., Güvenç, O., Vatansev, H., Buğrul, F., Gün, F., & Oran, B. (2017). The Relationship between Metabolic Parameters, Cardiac Parameters and MIC-1/GDF15 in Obese Children. Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association , 125 (2), 86–90. https://doi.org/10.1055/s-0042-114220 Zeng, N., & Gao, Z. (2016). Exergaming and obesity in youth: Current perspectives. International Journal of General Medicine , 9 , 275–284. https://doi.org/10.2147/IJGM.S99025 Zhang, Y., Lou, H., Huang, Y., Wang, R., Wen, X., Wu, C., Hao, C., Li, R., Gao, G., Lou, X., & Wang, X. (2022). Trends of overweight and obesity prevalence in school-aged children among Henan Province from 2000 to 2019. Frontiers in Public Health , 10 . https://www.frontiersin.org/articles/10.3389/fpubh.2022.1046026 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4530750","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":318426448,"identity":"3cc5d5eb-5020-4c40-bbf6-9f9f57916a2e","order_by":0,"name":"Yiqiang Mai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYFACxgaGBAYJIIP54IMPFRJy/CRoYUs2nHHGwliygXjreMykedsqEjcQ0qLbfrhN4kGZhbw5/xoDad55EowbGJgfPrqBR4vZmcQ2iYRzEoY7ZzwrMJy7TYLZnIHN2DgHn5YDQC1AxLjhxuENCW+3SbBZNvCwSePVcv4hWIv9hhsHDA7wzpHgMThASMsNiC2JG863GDbyNkhIEKHlYbMF0C/JG26wJTPOOCZhINlMyC/n0x/e/FFWZ7vh/OHjPz7U1NX3szc/fIxPCxCwSDCwASmJBCifGb9ysJIPYC38BwgrHQWjYBSMgpEJACcUUv5X5nF4AAAAAElFTkSuQmCC","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":true,"prefix":"","firstName":"Yiqiang","middleName":"","lastName":"Mai","suffix":""},{"id":318426449,"identity":"22e979a5-f2c2-44aa-b0d8-7bbe5406b573","order_by":1,"name":"Kim Geok Soh","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Kim","middleName":"Geok","lastName":"Soh","suffix":""},{"id":318426450,"identity":"0c67c868-6bff-4005-90f2-9bc4f5e41621","order_by":2,"name":"Hazizi Abu Saad","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Hazizi","middleName":"Abu","lastName":"Saad","suffix":""},{"id":318426451,"identity":"887f45d8-55b5-4767-b6c6-0572b39f7c04","order_by":3,"name":"Nuannuan Deng","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Nuannuan","middleName":"","lastName":"Deng","suffix":""},{"id":318426452,"identity":"83b10436-6609-4763-ba80-732ef87c8013","order_by":4,"name":"Qiang Wang","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Qiang","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-06-05 02:08:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4530750/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4530750/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59075507,"identity":"baaf2fc3-4c12-44f6-8f56-d946a68938b5","added_by":"auto","created_at":"2024-06-26 06:00:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40939,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow chart of the study selection process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4530750/v1/51647e13eaa0b708e6f7ffbf.png"},{"id":62345758,"identity":"4d7d7699-bca5-41f8-aff1-7fd84cd27c80","added_by":"auto","created_at":"2024-08-13 07:19:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":965185,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4530750/v1/cb1c1fcf-a1ea-4147-b284-abc6c0bd32e4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effects of Active Video Games on Psychology among Overweight and Obese Adolescents: A Systematic Review","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eThe prevalence of overweight and obesity among children and adolescents aged 5\u0026ndash;19 has risen dramatically from just 4% in 1975 to just over 18% in 2016 (WHO, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Due to the worldwide increase in the prevalence of obesity among children and adolescents, it has been identified as a public health concern (Yanovski, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Overweight and obesity in adolescents increase the risk of obesity in adulthood (Yuca et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and are associated with cardiovascular diseases and long-term complications (Llewellyn et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Furthermore, adolescence is chosen because it is well recognised that adolescence is one of the most rapid phases of human development (WHO, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It is characterised by confusion, trouble, poor self-esteem, at times academic difficulties and even suicide (Choo et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), these adverse effects may be exacerbated in overweight and obese young people, who often face discrimination, bullying and social rejection (Stangl et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), leading to a low level of the movtivation towards the whole physical activity (PA).\u003c/p\u003e \u003cp\u003eAdolescence is particularly meaningful for psychology well-being and obesity intervention, as it follows the beginning of puberty, from childhood when parents and schools monitor healthy behavior to adolescence when healthy behavior is also largely influenced by peers and the medias such as televisions, electronic games, and computers (Echeverria et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Brown et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Adolescents who are overweight or obese exhibited elevated levels of depression (Blasco et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), diminished levels of self-efficacy and self-esteem, and increased body dissatisfaction compared to adolescents with a healthy weight (Taylor et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Matias et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Stewart et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Physical activity might mitigate the harmful consequences caused by overweight or obesity during adolescence.\u003c/p\u003e \u003cp\u003eActive video game (AVG), a new generation of video games, requires players to physically interact with video games during gameplay through various arm, leg, or whole-body movements such as dancing, jogging, and kicking (Zeng \u0026amp; Gao, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Given that children spend a large proportion of their time engaging in screen-based sedentary behavior (Cai et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), AVGs bring physical benefits to children and adolescents in attenuating weight gain, psychological well-being, and physiological fitness. Potentially, it increases physical activity and energy expenditure, minimising monotony of repeated movements by increasing enjoyment and adherence (Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Sun, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Gao et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Lee et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Therefore, AVG may be a beneficial way to encourage sedentary behaviour changes in overweight or obese children and adolescents (Calcaterra et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, as a theory of healthy behaviour impact analysis, the Social Cognitive Theory (SCT) conceptualizes behavioral change as the result of links among behaviors, the environment, and individual factors (Bandura, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2004a\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the existence of a syetematic review (Lee et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and a meta-analysis (Andrade et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) investigating the effectiveness of AVG interventions in improving psychological well-being, these studies have certain limitations. One notable limitation is the lack of a strong theoretical foundation underlying the research. Additionally, these studies often include people of all ages, from children to the elderly, which can introduce heterogeneity in the results. Therefore,there is a lack of sufficient evidence regarding the psychological effects of AVG in overweight and obese adolescents.\u003c/p\u003e \u003cp\u003eThe Social Cognitive Theory serves as the guide for this systematic review, which aims to systematically review experimental studies in order to confirm the psychological effects of AVGs on adolescents who are overweight or obese. By synthesising existing empirical evidence, we seek to contribute to a comprehensive understanding of the impact of AVGs on psychological well-being in this specific population.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Protocol and Registration\u003c/h2\u003e \u003cp\u003eThe study followed the guidelines outlined in the recommended reporting items for systematic review and meta-analysis (PRISMA) declaration (Page et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The use of the PRISMA statement, consisting of a 27-item checklist and a flowchart, facilitated authors in presenting their systematic review in a concise and comprehensible manner. This enabled the evaluation of the advantages and limitations of the research. Furthermore, the review was prospectively registered on the International Prospective Register of Systematic Reviews with the registration number INPLASY202410084, ensuring transparency and accountability in the systematic review process, available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://inplasy.com/\u003c/span\u003e\u003cspan address=\"https://inplasy.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. This indicates that the review adhered to established reporting standards and was pre-registered to enhance transparency and credibility in the research process.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Search Strategy\u003c/h2\u003e \u003cp\u003eThe literature search for this review utilized four international databases: SCOPUS, PubMed, EBSCOhost (SPORTDiscus), and Web of Science. The search was conducted on October 10, 2023. In each database, a title search was performed using a predefined combination of keywords to identify relevant studies for inclusion in the review: (\"exergame*\" OR \"active video game*\" OR \"interactive game*\" OR \"exercise video game*\") AND (\"child*\" OR \"adolescent*\" OR \"student*\" OR \"youth\" OR \"juvenile*\" OR \"teenager*\" OR \"youngster*\" OR \"kid*\") AND (\"overweight and obese\" OR \"obesity\") AND (\"emotion\" OR \"mood\" OR \"mental\" OR \"confidence\" OR \"competence\" OR \"psycholog*\"OR \"fun\" OR \"enjoyment\" OR \"motivation\" OR \"self-efficacy\" OR \"self-esteem\" OR \"attitude\"). In addition to the studies included in the review, we conducted a comprehensive search for relevant articles by exploring the reference lists of these studies. We also examined the reference lists of previous related reviews and google scholar to ensure a thorough coverage of the literature. This involved a manual search of all titles for potential inclusion. Furthermore, we retrieved reference lists from the papers obtained, author names, and review articles to identify any additional relevant citations that might contribute to the overall understanding of the topic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Eligibility Criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for this review were established using the PICOS (population, intervention, comparison, outcome, study designs) framework, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The search was restricted to English-language articles published between 2013 and 2023, since the field of AVG and related technologies has undergone significant advancements in the past decade. Selecting a recent article allows researchers to capture the latest innovations in AVG platforms, game design, and technology integration, providing a more accurate reflection of the current state of the field. Only records that investigated the effects of AVGs or exergames on psychology or mental health in overweight (z score\u0026thinsp;\u0026gt;\u0026thinsp;+\u0026thinsp;1 and/or percentiles\u0026thinsp;\u0026gt;\u0026thinsp;75th) and obese (z score\u0026thinsp;\u0026gt;\u0026thinsp;+\u0026thinsp;2 and/or percentiles\u0026thinsp;\u0026gt;\u0026thinsp;90th) or overweight adolescents (mean age: 10\u0026ndash;19 years) were considered for inclusion. Since adolescence is defined by the WHO as the second decade of life (10\u0026ndash;19 years of age) (WHO, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Studies meeting the following criteria were included in the analysis:\u003c/p\u003e\u003cp\u003ei. A comprehensive, peer-reviewed study published in English is sought, detailing the implementation of Active Video Games (AVGs) (Xbox, Wii, Dance Dance Revolution, etc.) in overweight and obese adolescents. The study should examine the effects of AVG interventions on psychology, utilising several study designs including randomised controlled trials (RCT), non-randomized controlled trials (Non-RCT) with multiple groups, and single-group trials with a pre- and post-test design;\u003c/p\u003e\n\u003cp\u003eii. Studies on planned and organised AVG interventions to improve psychology well-being or mental health (i.e., psychological and psychosocial variables);\u003c/p\u003e\n\u003cp\u003eiii. Studies investigating the effects of AVGs on psychology among overweight and obese adolescents and using quantitative methods to assess at least one psychology-related outcome that was \u0026nbsp;analysed in relation to the psychological aspects evaluated through scales or questionnaires; and\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eiv. No constraints were imposed on the sample size, study location, or intervention duration for the studies that were incorporated.\u003c/p\u003e\n\u003cp\u003eOn the other hand, studies were excluded if they met the exclusion criteria:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ei.\u0026nbsp;Meeting abstracts, case reports,\u0026nbsp;theses,\u0026nbsp;and short communications in languages other than English;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eii.\u0026nbsp;Interventions focusing solely on counselling for AVG implementation; and\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eiii. Studies not available in full.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInclusion criteria according to the PICOS conditions.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDetailed inclusion criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight or with obesity adolescents (mean age: 10\u0026ndash;19 years old)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActive video games or exergames\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComparison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo or more groups and single-group trials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eintrinsic motivation, enjoyment, liking, situational interest, self-efficacy, self-worth, attitudes, intention, mood, satisfaction.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRCT or Non-RCT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Study Selection\u003c/h2\u003e \u003cp\u003eThe studies that were collected were imported into Zotero Software in order to eliminate any duplicate data. A experienced librarian first aided in devising the search strategies. Furthermore, a group of three reviewers conducted the initial screening of found articles. They carefully evaluated the titles and abstracts to identify relevant studies. During this step, any unnecessary materials were removed from the database. Subsequently, all remaining titles and abstracts were evaluated based on established criteria for inclusion and exclusion. Articles that successfully passed this screening and were included in the quantitative synthesis underwent a comprehensive analysis of the complete text. Articles lacking the complete text were omitted. To ensure the rigour of the review process, the second, fifth, and sixth authors were consulted in cases of differences until a consensus was obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Extraction and Quality Assessment\u003c/h2\u003e \u003cp\u003eFollowing the conclusion of the data search, information from eligible studies was gathered using a pre-established extraction form. This form systematically captured key details, including (1) author, publication year, and study location; (2) sample characteristics, encompassing the number of participants, their age, and gender distribution; (3) a comprehensive description of the intervention, design, duration, and specific characteristics; (4) the measure index employed in the study; and (5) the outcomes of the research. The authors Mai and Wang abstracted information into the standard form, and the others, Soh, Saad, and Deng, checked it.\u003c/p\u003e \u003cp\u003eThe design quality analysis of the AVG intervention studies was calculated using the 10-item scale in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Specifically, each item was rated as \u0026ldquo;yes\u0026rdquo;(1), \u0026ldquo;no\u0026rdquo;(0), or \u0026ldquo;not applicable(N/A).\u0026rdquo; In accordance with previous studies (Peng et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Z. Gao \u0026amp; Chen, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), the authors individually assessed the research design quality of each study using a 10-item scale. A design quality score, ranging from 0 to 10, was calculated by summing up the favorable rates for each item. High quality was defined when a RCT or controlled trial scored above the median score of 5.5.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDesign qulity analysis for the AVGs intervention studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.Randomization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.Control\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.Isolate AVG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.Pre-post\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.Retention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.Baseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.Missing date\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.Power analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9.Validity measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10.6-month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Staiano et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Li et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Duman et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Christison et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016a\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Staiano et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2017a\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Flynn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Staiano et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Staiano et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Abedelmalek, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eNote.1\u0026thinsp;=\u0026thinsp;randomization procedure were adequately described and carried out; 2\u0026thinsp;=\u0026thinsp;research design allowed for comparison between the AVG intervention group and the control/comparison group; 3\u0026thinsp;=\u0026thinsp;research design allowed for test of effectiveness of the AVGs alone (not combined with other exercises) as compared with the control/comparison group; 4\u0026thinsp;=\u0026thinsp;outcome variables were measured before and after the intervention; 5\u0026thinsp;=\u0026thinsp;dropouts were described and not more than 30%; 6\u0026thinsp;=\u0026thinsp;groups are comparable at baseline on key outcome variables through statistical analyses; 7\u0026thinsp;=\u0026thinsp;data analyses were conducted while considering missing data; 8\u0026thinsp;=\u0026thinsp;power analysis was conducted to determine the appropriate sample size; 9\u0026thinsp;=\u0026thinsp;the reliability and validity of the measures were provided; 10\u0026thinsp;=\u0026thinsp;participation were followde up for a minimum of 6 months. NA\u0026thinsp;=\u0026thinsp;not applicable.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eThe search results underwent screening and evaluation based on formulated inclusion and exclusion criteria in the literature. This systematic review comprises 10 articles encompassing RCTs and Non-RCTs investigating the effects of AVGs on psychology among overweight and obese adolescents. They were published between the years 2013 and 2023. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the characteristics of these studies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the studies examined in the present review\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor(Year)\u003c/p\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSample\u003c/p\u003e \u003cp\u003echaracteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDesign\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInterventions\u003c/p\u003e \u003cp\u003edescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAVGs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSettiing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMeasures index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaiano et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e,USA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;54; 15-19yrs old; OW/OB, F\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20weeks; Freq: 5times/week; 30-60mins/session; EG1-cooperative AVG; EG2-competitive AVG; CG-normal activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNintendo Wii\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSelf-efficacy- Exercise Confidence Survey; self-esteem- Rosenberg Self-Esteem scale; peer support- Friendship Quality Questionnaire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSelf-efficacy\u0026uarr; than CG;self-efficacy\u0026harr;beween EG1 and EG2;Peer support\u0026uarr; than CG;peer support \u0026harr; between EG1 and EG2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLi et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e, Singapore\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;140;10-12yrs old;M\u0026thinsp;=\u0026thinsp;83;OW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-post test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2weeks; 30min/session EG1 (Stereotype threat absent); CG (2 groups)-normal and OW body size avatar; EG2 (Stereotype threat present); CG (2 groups)- normal and OW body size avatar; M and FM are grouped separately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNintendo Wii\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eExercise attitude- bipolar adjective scales; exercise motivation- Likert scale; exercise motivation toward AVG- Likert scale; game performance- time spent in the workout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eExercise attitude\u0026uarr;, exercise motivation\u0026uarr;, motivation toward AVG \u0026uarr;, (stereotype threat absent)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuman et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e, Turkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;50; mean age : 12.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99 yrs old; FM\u0026thinsp;=\u0026thinsp;29; OW/OB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-post test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8weeks;Freq:3 days/week; EG-AVG\u0026thinsp;+\u0026thinsp;exercise programme; No CG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo mentioned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDepression- Depression Scale for Children; Self-concept- Piers-Harris Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSelf-esteem\u0026uarr;; psychological wellness\u0026uarr;;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlynn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, USA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;126;10-15yrs old;51%FM;50%OW/OB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-post test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6weeks; Freq: 30min/week; EG-AVG play; No CG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNintendo Wii\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAttitudes toward PA- Reynolds Influences of Physical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSelf-efficacy\u0026uarr;; Intention to exercise\u0026uarr;; Social support for PA\u0026uarr;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaiano et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, USA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;46,10-12yrs old; mean age:11.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8y;OW/OB;50%FM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24weeks; Freq: 3times/week; 1h/session; EG-AVG (with peer or family member); CG- normal level of PA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKinect for the Xbox 360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eQuality of life- KIDSCREEN-10 index; peer support- Friendship Quality Questionnaire;self-efficacy for PA- Self-Efficacy for Physical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eself-efficacy toward PA\u0026uarr;,\u003c/p\u003e \u003cp\u003equality of life \u0026harr; ; peer support\u0026harr;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbedelmalek, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;24M;mean age: 16.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 yrs;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-post test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 month; 5 days/week; 45mins/session; EG-cooperative AVG; CG-normal activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo mentioned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMood- The Profile of Mood States (POMS) questionnaire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMood\u0026uarr;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristison et al., 2016, USA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;80; mean age:10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 yrs; M\u0026thinsp;=\u0026thinsp;34;OW/OB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10weeks;EG- AVG\u0026thinsp;+\u0026thinsp;didactics (parent /guardian); CG- didactics(parent /guardian); Freq: 2h/week; AVGsession-60mins(week1-5) and 30mins(week6-10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDDR,\u003c/p\u003e \u003cp\u003eExerbike XG, Nintendo Wii,Makoto Interactive arena,Lightspace Pay Floor,Cybex Trazer,Xavix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSelf-perception related to general self-esteem and related to physical attributes-Children and youth physical self-perception profile (CY-PSPP)-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePerception of physical attributes or self-esteem\u0026harr;; Global self-worth and physical self-worth\u0026uarr;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e, Spain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;42; mean age : 10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 yrs old;; 50% OW/OB; 50% normal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60mins; A session; EG-walking teadmill with AVG; CG-walking on the treadmill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNintendo Wii\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLaboratory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSelf-Efficacy, Positive Expectations and Satisfaction-Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSelf-efficacy \u0026harr;; Expectations and satisfaction \u0026uarr;;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaiano et al., 2017, USA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;41FM; 14-18yrs old; mean age:16.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05y;OW and OB;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12weeks;Freq:3times /week;1h/session;EG-AVGs;CG - normal level of PA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKinect for the Xbox 360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLaboratory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePA-Acc,SR;Exercise transfer effects-baseline and behavioral observation;self-efficacy toward PA- Self-Efficacy for Healthy Eating and Physical Activ ity measure; intrinsic motivation toward AVGs- Intrinsic Motivation Inventory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eself-efficacy toward PA\u0026uarr;, intrinsic motivation toward AVGs\u0026uarr;.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaiano et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, USA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;41F; 14-18yrs old; mean age:16.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05y;OW / OB;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12weeks;Freq:3times /week;1h/session;EG-AVGs (with peers); CG \u0026ndash;no treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKinect for the Xbox 360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLaboratory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSH-single-item Likert scale;PS-21-item Friendship Quality Questionnaire; Health-related quality of life-KIDSCREEN-10 Index; Enjoyment of AVG-rating scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSH\u0026uarr;,PS\u0026harr;, Health-related quality of life\u0026harr;,Enjoyment of AVG\u0026uarr;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote:\u0026uarr;, significant improvement from pretest to post-test or compared with CG; \u0026harr;, non-significant within-group change from pretest to post-test; M, male; FM, female; OW, overweight; OB, obese; RCT, randomized control trial; EG, experimental group; CG,control group; VG, video game Freq, frequency; PA, physical activity; SR, self report; Perceived Competence Scale; SH, subjective health; PS, peer support\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study Selection\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the flowchart representing the process of selecting records. A total of 714 publications with potential were identified using the electronic database search. Specifically, 64 articles were found on PubMed, 100 on SCOPUS, 432 on EBSCOhost (SPORTDiscus), 117 on the Web of Science, and 1 from a reference source. After removing duplicates (78), researchers assessed the title and abstract of 636 publications to determine their eligibility. The articles removed due to missing information include: 583 articles without average values (423); 83 review papers; 45 articles without an experimental design; and 32 articles that were either merely abstracts or not written in English. After that, the remaining 53 papers were later studied, and 43 articles were deleted according to inclusion criteria, eventually leaving 10 relevant articles that satisfied the inclusion criteria for the review.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Population Characteristics\u003c/h2\u003e \u003cp\u003e \u003cb\u003ei. Nationality of participants\u003c/b\u003e In the included studies, only one study reported that the participants were in Singapore, Asia (Li et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e); one study reported that the participants were in Tunisia, Africa (Abedelmalek, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); two studies reported their participants were in Europe, one in Turkey (Duman et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) and another in Spain (Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e); the remaining six articles reported that participants were in the United States (Staiano et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Christison et al., 2016; Staiano et al., 2017; Flynn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Staiano et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Staiano et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eii. Gender\u003c/b\u003e Two of the 10 studies focused on girls (Staiano et al., 2017; Staiano et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), one study focused on boys (Abedelmalek, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and the subjects in the remaining seven studies were mixed male and female (Li et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Duman et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Christison et al., 2016; Staiano et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Staiano et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Flynn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Interventions Characteristics\u003c/h2\u003e \u003cp\u003eThe intervention characteristics of these fifteen studies were reported based on the following aspects:\u003c/p\u003e \u003cp\u003e \u003cb\u003ei. AVG mode\u003c/b\u003e Four studies only used AVGs as an intervention method and adoped multiplayer modes, with their partners being peers or siblings (Staiano et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Staiano et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Abedelmalek, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Staiano et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Four studies only used AVGs as an intervention method and adoped single player modes (Li et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Flynn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Staiano et al., 2017). The remaining two articles used AVG combined with health programme as intervention methods (Christison et al., 2016; Duman et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eii. Experimental setting\u003c/b\u003e Among the 10 articles, four were conducted in school setting (Staiano et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Duman et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Flynn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), two were conducted in home setting (Staiano et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Abedelmalek, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), one was conducted in community setting (Christison et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016a\u003c/span\u003e), three were conducted in laboratory setting (Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Staiano et al., 2017; Staiano et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eiii. The type of AVG console\u003c/b\u003e In the 10 articles, four studies only used Nintendo Wii as intervention (Staiano et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Flynn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). One study used eight different consoles: DDR, Exerbike XG, Nintendo Wii, Makoto Interactive Arena, Lightspace Play Floor, Cybex Bring, Treadwall, and Xavix System (Christison et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016a\u003c/span\u003e). Three studies only used Kinect for the Xbox 360 as intervention (Staiano et al., 2017; Staiano et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Staiano et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Two studies did not report the console model (Duman et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Abedelmalek, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Comparison\u003c/h2\u003e \u003cp\u003e \u003cb\u003ei. Comparison between AVG and normal activities\u003c/b\u003e Among the 10 articles, four conducted a comparison between two groups: one engaged in AVG (play with peers or siblings) and the other involved in normal activities (Staiano et al., 2017; Staiano et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Staiano et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Abedelmalek, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Specifically, the experimental groups in Staiano et al. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and Staiano et al. (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) were comprised of individuals who participated in group-based AVG.\u003c/p\u003e \u003cp\u003e \u003cb\u003eii. Comparison based on weight classification\u003c/b\u003e A comparative analysis was performed on two groups, one consisting of individuals classified as overweight and the other consisting of those with a normal weight (Li et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In the study conducted by Li et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), the experimental group consisted of avatars with overweight body size, while the control group consisted of avatars with normal body size. In the study conducted by Mart\u0026iacute; et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), the experimental group consisted of overweight adolescents, while the control group consisted of adolescents with normal weight.\u003c/p\u003e \u003cp\u003e \u003cb\u003eiii. Comparison based on pre and post experiment\u003c/b\u003e One group was adopted in the studies, namely the AVG play group, as mentioned in the studies of Flynn et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and Duman et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eiv. Comparison with health programme\u003c/b\u003e Two studies adopted two groups to contrast the effects of an AVG combined with a health programme, compared to a health programme alone (Christison et al., 2016; Mart\u0026iacute; et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003ev. Three-group comparison\u003c/b\u003e Another study adopted three groups to compare the effects of a cooperative AVG, a competitive AVG, and normal activities (Staiano et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Outcomes\u003c/h2\u003e \u003cp\u003eThe psychological effects of AVG on overweight and obese adolescents mainly focus on self-efficacy (n\u0026thinsp;=\u0026thinsp;5), social support and peer support (n\u0026thinsp;=\u0026thinsp;4), motivation (n\u0026thinsp;=\u0026thinsp;3), quality of life (n\u0026thinsp;=\u0026thinsp;2), and self-esteem (n\u0026thinsp;=\u0026thinsp;2). In total, 25 different psychological outcomes were examined in the studies. The details are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003ei. Self-efficacy\u003c/b\u003e Regarding self-efficacy, Staiano et al. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) found that there were no significant differences in self-efficacy between the cooperative group and the competitive group. However, both of these groups showed substantial differences in self-efficacy compared to the control group, which engaged in regular activities. Flynn et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) reported that the experimental group of AVG shown a notable improvement in self-efficacy. According to Staiano et al. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), the study found that participating in group-based AVG significantly boosted individuals' self-efficacy towards physical PA. Staiano et al. (2017) reported significant differences in self-efficacy towards PA within the AVG group. Nevertheless, Mart\u0026iacute; et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) found insignificant differences in self-efficacy among the groups (overweight and normal weight) and circumstances (treadmill and treadmill\u0026thinsp;+\u0026thinsp;AVG).\u003c/p\u003e\u003cp\u003e \u003cb\u003eii. Social support and peer support\u003c/b\u003e Regarding social support and peer support, Staiano et al. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) discovered that there were no substantial differences in peer support between the cooperative group and the competitive group. However, significant differences were observed between these two groups when compared to the control group (engaging in normal activity). Flynn et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) reported that the AVG experimental group exhibited notable enhancement in social support, whereas Staiano et al. (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and Staiano et al. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found no significant effect of peer support in group-based AVG.\u003c/p\u003e\u003cp\u003e \u003cb\u003eiii. Motivation\u003c/b\u003e With regard to motivation, Li et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) found that overweight students who were allocated to a group with avatars representing normal body size showed greater motivation for exercise compared to those in a group with avatars representing large body size. Flynn et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) indicated that the participants in AVG group increased the motivation to exercise significantly. Staiano et al. (2017) reported significant differences in intrinsic motivation within the AVG group.\u003c/p\u003e \u003cp\u003e \u003cb\u003eiv. Quality of life\u003c/b\u003e In terms of quality of life, Staiano et al. (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) reported no significant difference in health-related quality of life (HRQoL) within the group-based AVG group. According to Staiano et al. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), the group-based AVG did not provide a statistically meaningful enhancement in quality of life.\u003c/p\u003e \u003cp\u003e \u003cb\u003ev. Self-esteem\u003c/b\u003e In terms of self-esteem, Duman et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) found that participants who underwent an intervention involving a mixed exercise programme with AVGs experienced notable improvements in self-esteem compared to their initial measurements. On the other hand, Christison et al. (2016) examined the impact of a comprehensive weight intervention programme that was community-based and included the integration of AVGs into the curriculum. The findings indicated that there was not a significant difference in self-esteem.\u003c/p\u003e \u003cp\u003e \u003cb\u003evi. Other psychological outcomes\u003c/b\u003e With regarding to other psychological outcomes, Li et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) r found that overweight students who were assigned to participate in the group with avatars depicting a normal body size showed a more positive attitude compared to those in the group with avatars representing a large body size. In a study conducted by Duman et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), it was found that participants who underwent an AVG mixed exercise programme observed notable improvements in their depression when compared to their baseline assessments. Abedelmalek. (2022) found that cooperative AVG has a significant beneficial effect on mood state. Christison et al. (2016) found that both groups (AVG\u0026thinsp;+\u0026thinsp;programme vs programme) observed a significant increase in global self-worth and physical self-worth. In the study conducted by Mart\u0026iacute; et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), it found that obese children exhibited considerably greater differences in expectancies and satisfaction in the AVG condition compared to both overweight and normal weight children, across both the treadmill and treadmill\u0026thinsp;+\u0026thinsp;AVG conditions. Staiano et al. (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that group-based AVG had substantial effects on both subjective health and enjoyment of AVG.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThis systematic review aimed to analyse the psychological impact of AVG (Active Video Games) on overweight and obese adolescents. This review included 10 studies and the analysis was based on the results of PICO (Population, Intervention, Comparison, Outcome).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ei. Nationality of participants\u003c/strong\u003e The studies in this review were conducted across different countries, including Singapore, Tunisia, Turkey, Spain, and the USA. Notably, a majority of the AVG interventions took place in the USA, accounting for 60% of the selected studies. It is crucial to highlight that only one study took place in Singapore. According to\u0026nbsp;World Obesity (2022), the prevalence of obesity among children and adolescents aged five to 19 years in Southeast Asia will reach more than 21 million by 2030. Furthermore, it is important to acknowledge that in China, which has the highest population, the incidence of obesity in children and adolescents has reached 11.9%\u0026nbsp;(Cai et al., 2017). Hence, it is imperative to develop innovative strategies to address the issue of obesity in these areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. Gender\u003c/strong\u003e The results revealed that in seven out of the 10 research, the participants consisted of both males and females. Meanwhile, two studies fully focused on females, while only one study solely focused on males. Between 2000 and 2019, the prevalence of obesity among boys in China had a growth rate that was nearly double that of females\u0026nbsp;(Zhang et al., 2022). Hence, it is imperative to conduct a targeted study on male adolescents who are overweight or obese in the future research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Interventions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ei. AVG mode\u003c/strong\u003e The results indicated that the primary intervention approaches employed in the 10 chosen publications were single-player AVG and multi-player AVG. Nevertheless, it is important to acknowledge that in the multi-player AVG, the individuals\u0026apos; partners were solely limited to peers or siblings, with no parental involvement. \u0026nbsp;Grossman et al. (2017)\u0026nbsp;indicated that family participation strategy underscored the parents\u0026apos; capacity to influence the adoption of healthy behaviors and the weight status of their children. The weight-related behaviours of children, which are mostly observed in the family setting and influenced by parental modelling, can be effectively influenced in a positive manner. Therefore, it underscores the need of parental involvement in the therapy procedure\u0026nbsp;(Altman \u0026amp; Wilfley, 2015). Moreover, a review examining interventions aimed at decreasing sedentary time in children through parental involvement was more crucial than the specific intervention itself\u0026nbsp;(Marsh et al., 2014). Another meta-analysis also highlighted that direct parental involvement and role modeling play a crucial role in the physical activity intervention of adolescents\u0026nbsp;(Guo et al., 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. Experimental setting\u003c/strong\u003e Regarding AVG interventions in various environments, the results indicate that there is insufficient evidence to verify the effects of AVG interventions in the family environment on the psychology of overweight and obese adolescents. The World Health Organisation (WHO) has consistently emphasised the significance of family sports, particularly the involvement of parents in fostering physical activity among adolescents\u0026nbsp;(WHO, 2022). Family factors, including the physical environment (such as sports facilities and equipment), family structure, economic income, parental education, and family environment, have been found to be associated with adolescents\u0026apos; physical exercise\u0026nbsp;(Chang \u0026amp; Wu, 2008;\u0026nbsp;Lv et al., 2020;\u0026nbsp;Weaver et al., 2018;\u0026nbsp;Cleland et al., 2011). However, the behaviour and words of parents may have a more direct, influential, and representative impact on children\u0026apos;s social cognition and behaviour acquisition\u0026nbsp;(Hu et al., 2017;\u0026nbsp;Gao \u0026amp; Wang, 2015;\u0026nbsp;Liu et al., 2020).\u0026nbsp;During the crucial stage of social development, the behavioural decisions and behaviours of adolescents are frequently influenced by their parents\u0026apos; independent support and physical activity routines\u0026nbsp;(Hu et al., 2017;\u0026nbsp;Dong \u0026amp; Mao, 2018;\u0026nbsp;Fuemmeler et al., 2011;\u0026nbsp;Adamo et al., 2012).\u003c/p\u003e\n\u003cp\u003eIn summary, given the information provided, future studies on AVG intervention should prioritise investigating the family environment and delves into the influence of parental involvement on adolescent obesity and the psychological issues associated with obesity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. The type of AVG console\u003c/strong\u003e In terms of the type of AVG console, the results indicated that there were a variety of AVG consoles utilised across the 10 studies, ranging from a single console, such as Nintendo Wii and Kinect for Xbox 360, to the use of multiple consoles in a single study. This diversity in intervention methods underscores the flexibility and adaptability of AVGs in research settings.\u003c/p\u003e\n\u003cp\u003eAccording to the results, both the Nintendo Wii and Kinect for Xbox360 have a notable positive impact on self-efficacy (Staiano et al., 2013;\u0026nbsp;Flynn et al., 2018;\u0026nbsp;Staiano et al., 2019;\u0026nbsp;Staiano et al., 2017). However, when it comes to social support and peer support, the Nintendo Wii surpasses the Kinect for Xbox360 significantly (Staiano et al., 2013\u0026nbsp;Staiano et al., 2019\u0026nbsp;Staiano et al., 2018).\u0026nbsp;Additionally, research has demonstrated that the Wii is more attractive and cost-effective when compared to other home-based technology\u0026nbsp;(Glen et al., 2017).\u003c/p\u003e\n\u003cp\u003eTherefore, it is imperative for future studies to thoroughly evaluate the economic feasibility and accessibility of AVG, taking into account the distinctive features of various game consoles. Researchers should select different game consoles based on specific research objectives in order to maximise the benefits offered by each console.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Comparison\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 10 studies examined five different types of comparison. Despite the varying study designs, AVG shows promise as a viable intervention to improve the psychological well-being of overweight and obese adolescents.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom the provided results, it can be inferred that AVG has the potential to significantly enhance the psychological well-being of adolescents, especially those who are overweight or obese. Furthermore, cooperating with AVG has a substantial impact on psychosocial factors. However, additional investigation is required to examine other experimental designs in relation to the quality of life in order to improve it. Additionally, there is insufficient evidence to assess the psychological impact of individual AVG and group-based AVG, and it has still to be determined whether AVG can effectively replace conventional sedentary activities like as watching TV, video gaming, and mobile phone usage. How may AVG be integrated into the leisure time activities of overweight and obese adolescents to decrease their sedentary behaviour while maintaining their psychological well-being? This question necessitates cautious consideration by researchers in future research. Hence, it is imperative for future studies to do a comparative analysis among individual AVG and group-based AVG, and traditional sedentary behaviour.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ei. Self-efficacy\u0026nbsp;\u003c/strong\u003eWhile\u0026nbsp;Staiano et al. (2013)\u0026nbsp;found no significant differences between cooperative and competitive groups, both groups showed improvements compared to the control group.\u0026nbsp;Flynn et al. (2018)\u0026nbsp;and\u0026nbsp;Staiano et al. (2017)\u0026nbsp;reported a notable improvement in self-efficacy in the AVG group.\u0026nbsp;Staiano et al. (2019)\u0026nbsp;highlighted a significant boost in self-efficacy with group-based AVG. Yet,\u0026nbsp;Mart\u0026iacute; et al. (2015)\u0026nbsp;reported that when comparing the effects of AVG combined with treadmills, both the overweight and normal weight groups of adolescents did not demonstrate any significant improvement in self-efficacy. Possible explanation for inconsistent self-efficacy evaluations is due to the diverse intervention strategies. Previous research has employed independent AVG as an intervention, whereas\u0026nbsp;Mart\u0026iacute; et al. (2015)\u0026nbsp;has utilised AVG in conjunction with a treadmill as an intervention. Studies have demonstrated that engaging in treadmill exercise does not yield a substantial impact on enhancing self-efficacy\u0026nbsp;(Hambly et al., 2017;\u0026nbsp;Shaughnessy et al., 2012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. Social support and peer support\u003c/strong\u003e From the results, it can be found that cooperative AVG, competitive AVG, and individual AVG can effectively improve peer support and social support. However, in group-based AVG, peer support did not show significant improvement. There could be multiple factors contributing to this phenomenon: 1. Controlled setting for conducting experiments.\u0026nbsp;Staiano et al. (2013)\u0026nbsp;conducted their study in a school setting, with participants who were all peers. The participants played the game either through cooperation or competition with their peers, which increased interaction during the game and improved peer support. In contrast,\u0026nbsp;Staiano et al. (2019)\u0026nbsp;conducted their study in a family setting, where the partners of the participants could be peers, family members, or siblings. This led to limited social interaction with peers during the gaming process, resulting in no improvement in peer support.\u0026nbsp;Staiano et al. (2018) conducted their study in a laboratory setting. However, it is important to note that the laboratory environment does not fully replicate real social environments. As a result, participants may not have the same psychological response as they would in a real-life scenario. Previous study has demonstrated that findings from laboratory experiments, where researchers actively manipulate and control variables, may not easily apply to other real-life situations, leading to limited external validity\u0026nbsp;(AQA, 2022);\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Different game console.\u0026nbsp;Staiano et al. (2013)\u0026nbsp;employed the Nintendo Wii console and specifically selected sports games like basketball, baseball, tennis, and volleyball for their experiment. In contrast,\u0026nbsp;Staiano et al. (2018) utilised Just Dance, a game available on Kinect for Xbox 360, which could potentially result in participants experiencing boredom with the game during the experiment. Empirical studies have shown that AVG fails to maintain player engagement over a longer period\u0026nbsp;(Liang \u0026amp; Lau, 2014). Additionally, the selection of a sole game can also induce feelings of boredom among players\u0026nbsp;(Radhakrishnan et al., 2019).\u003c/p\u003e\n\u003cp\u003eBased on the above information, self-efficacy, as per social cognitive theory\u0026nbsp;(Bandura, 2004b), is the primary factor that influences healthy behaviour. Moreover, it can also exert an impact on social structural variables and outcome expectations, and these two aspects can also serve as mediators in promoting healthy behaviour. Hence, it is easily comprehensible why self-efficacy and social support, or peer support, comprise the largest share among the articles selected. Nevertheless, the authors of these articles have failed to consider the impact of parental support on influencing adolescent health behaviours within family settings while examining social support components. Research has demonstrated that parental support of physical exercise can impact children\u0026apos;s engagement in moderate-to-vigorous physical activities\u0026nbsp;(Hosokawa et al., 2023). Furthermore, a global survey encompassing 74 nations revealed a strong association between parental support and adolescents\u0026rsquo; physical activity in the Western Pacific region\u0026nbsp;(Khan et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. Motivation\u0026nbsp;\u003c/strong\u003eThe results indicate that AVG has a substantial influence on the exercise motivation of both overweight and obese adolescents. It is noteworthy that\u0026nbsp;Li et al. (2014)\u0026nbsp;revealed a higher level of exercise motivation among individuals in the group with normal avatar body size. According to\u0026nbsp;Pe\u0026ntilde;a \u0026amp; Kim (2014), females who controlled avatars with a normal weight engaged in more physical activity compared to those who controlled avatars with obesity. Males who utilise avatars with a normal weight would experience an increase in their physical activity levels during the process of playing AVGs\u0026nbsp;(Pe\u0026ntilde;a et al., 2016). Therefore, it is imperative to consider this matter in future research on AVG experiments to enable participants to elicit greater positive psychological responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiv. Quality of life\u0026nbsp;\u003c/strong\u003eStaiano et al. (2018)\u0026nbsp;and\u0026nbsp;Staiano et al. (2019)\u0026nbsp;did not find any substantial influence of AVG on quality of life. This could be attributed to the fact that both researches utilised 10-item version of the KIDSCREEN Index for assessing quality of life, as stated by the author. Although the 10-item version has demonstrated criterion validity and test-retest reliability\u0026nbsp;(Ravens-Sieberer et al., 2010), its limited number of items leads to reduced variability compared to longer scales, potentially resulting in null effects. Therefore, further research should prioritise the examination of alternative evaluation instruments such as the PedsQL, which are widely employed and have the potential to offer more comprehensive evaluations of domains that are susceptible to modifications and hold significance for adolescents with obesity, including physical, emotional, and social functioning\u0026nbsp;(Buttitta et al., 2014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ev. Self-esteem\u0026nbsp;\u003c/strong\u003eThe results revealed that the combination of AVG and health programmes yielded inconclusive outcomes in relation to self-esteem.\u0026nbsp;Duman et al. (2016)\u0026nbsp;incorporated an exercise programme that consisted of a greater amount of aerobic activity. This led to noteworthy enhancements in BMI, waist circumference, and triceps skinfold thickness among the participants. Additionally, there was a considerable boost in self-esteem. In contrast,\u0026nbsp;Christison et al. (2016)\u0026nbsp;incorporated a greater number of nutritious dietary habits into the health programme. While the individuals\u0026apos; BMI and physical fitness demonstrated improvement, there was no statistically significant difference, and self-esteem did not exhibit notable improvement. Additionally, there is an adverse association between greater BMI and self-esteem, as demonstrated by\u0026nbsp;Kiviruusu et al. (2016). Furthermore, self-esteem is inversely related to certain attitudes and behaviours around weight and body shape, including physical dissatisfaction and cognitive impression of being overweight.\u0026nbsp;(van den Berg et al., 2010;\u0026nbsp;Perrin et al., 2010).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the above information, for future experiments that combine AVG with health programmes, it is recommended to incorporate more exercise components into the health programme. This will help to enhance the level of exercise, potentially leading to a considerable improvement in the weight status of participants and an improvement in their self-esteem.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003evi. Other psychological outcomes\u0026nbsp;\u003c/strong\u003eThe results revealed diverse positive effects on various psychological outcomes, including attitudes (Li et al., 2014), depression (Duman et al., 2016), mood state (Abedelmalek, 2022), self-worth (Christison et al., 2016a), subjective health, enjoyment (Staiano et al., 2018), satisfaction, and expectancies (Flynn et al., 2018). These results suggest that AVG has the potential to improve the psychological well-being of overweight and obese adolescents.\u003c/p\u003e"},{"header":"5. LIMITATIONS","content":"\u003cp\u003eThis review offers substantial evidence of acceptable quality supporting the positive effects of AVGs on psychology among overweight and obese adolescents. However, certain limitations need consideration. First, the diversity of AVG consoles and games used in the studies introduces variability in the interventions. Different consoles may offer distinct features, and the nature of the games played could impact psychological outcomes differently. This heterogeneity makes it challenging to pinpoint the specific elements contributing to the observed effects. Secondly, the low number of studies included. Due to the scarcity of research examining the use of AVGs among overweight or obese adolescents, the number of studies exploring the same psychological effects was limited.\u003c/p\u003e"},{"header":"6. CONCLUSION","content":"\u003cp\u003eIn conclusion, the examination of AVG interventions on the psychological well-being of overweight and obese adolescents reveals a nuanced landscape characterized by mixed findings. The impact on self-efficacy varies across studies, underscoring the intricate relationship between AVG engagement, intervention nature, and specific platforms. Social and peer support outcomes exhibit diversity, highlighting the influence of group dynamics and intervention specifics. Positive trends in exercise motivation suggest a potential avenue for technology-driven enhancement, with avatar representation playing a role. Mixed results in HRQoL outcomes indicate variability in the broader impact of AVG interventions. Similarly, self-esteem outcomes present contrasting findings, emphasizing the need for a nuanced understanding. As we navigate this complexity, future research should standardize methodologies and delve into the underlying mechanisms, offering tailored strategies to optimize psychological outcomes for overweight and obese adolescents engaged in AVG interventions within health promotion initiatives.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was provided to support this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflict of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have contributed equally with ideas and preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbedelmalek, S. (2022). Exergaming During Ramadan Intermittent Fasting Improve Body Composition as Well as Physiological and Psychological Responses to Physical Exercise in Adolescents With Obesity. \u003cem\u003eFrontiers in Nutrition\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eAdamo, K. B., Langlois, K. A., Brett, K. E., \u0026amp; Colley, R. C. (2012). Young children and parental physical activity levels: Findings from the Canadian health measures survey. \u003cem\u003eAmerican Journal of Preventive Medicine\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(2), 168\u0026ndash;175. https://doi.org/10.1016/j.amepre.2012.02.032\u003c/li\u003e\n\u003cli\u003eAe, S., Ra, B., W, G., Ca, H., Ds, H., \u0026amp; Rl, N. (2018). Home-based exergaming among children with overweight and obesity: A randomized clinical trial. \u003cem\u003ePediatric Obesity\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(11). https://doi.org/10.1111/ijpo.12438\u003c/li\u003e\n\u003cli\u003eAltman, M., \u0026amp; Wilfley, D. E. (2015). Evidence update on the treatment of overweight and obesity in children and adolescents. \u003cem\u003eJournal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(4), 521\u0026ndash;537. https://doi.org/10.1080/15374416.2014.963854\u003c/li\u003e\n\u003cli\u003eAndrade, A., Correia, C. K., \u0026amp; Coimbra, D. R. (2019). The Psychological Effects of Exergames for Children and Adolescents with Obesity: A Systematic Review and Meta-Analysis. \u003cem\u003eCyberpsychology, Behavior and Social Networking\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(11), 724\u0026ndash;735. https://doi.org/10.1089/cyber.2019.0341\u003c/li\u003e\n\u003cli\u003eAQA. (2022). \u003cem\u003eTypes of Experiment: Overview\u003c/em\u003e. https://www.tutor2u.net/psychology/reference/types-of-experiment-overview\u003c/li\u003e\n\u003cli\u003eBandura, A. (2004a). Health Promotion by Social Cognitive Means. \u003cem\u003eHealth Education \u0026amp; Behavior\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(2), 143\u0026ndash;164. https://doi.org/10.1177/1090198104263660\u003c/li\u003e\n\u003cli\u003eBandura, A. (2004b). Health promotion by social cognitive means. \u003cem\u003eHealth Education \u0026amp; Behavior: The Official Publication of the Society for Public Health Education\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(2), 143\u0026ndash;164. https://doi.org/10.1177/1090198104263660\u003c/li\u003e\n\u003cli\u003eBlasco, B. V., Garc\u0026iacute;a-Jim\u0026eacute;nez, J., Bodoano, I., \u0026amp; Guti\u0026eacute;rrez-Rojas, L. (2020). Obesity and Depression: Its Prevalence and Influence as a Prognostic Factor: A Systematic Review. \u003cem\u003ePsychiatry Investigation\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(8), 715\u0026ndash;724. https://doi.org/10.30773/pi.2020.0099\u003c/li\u003e\n\u003cli\u003eBrown, C. L., Halvorson, E. E., Cohen, G. M., Lazorick, S., \u0026amp; Skelton, J. A. (2015). Addressing Childhood Obesity: Opportunities for Prevention. \u003cem\u003ePediatric Clinics of North America\u003c/em\u003e, \u003cem\u003e62\u003c/em\u003e(5), 1241\u0026ndash;1261. https://doi.org/10.1016/j.pcl.2015.05.013\u003c/li\u003e\n\u003cli\u003eButtitta, M., Iliescu, C., Rousseau, A., \u0026amp; Guerrien, A. (2014). Quality of life in overweight and obese children and adolescents: A literature review. \u003cem\u003eQuality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(4), 1117\u0026ndash;1139. https://doi.org/10.1007/s11136-013-0568-5\u003c/li\u003e\n\u003cli\u003eCai, Y., Zhu, X., \u0026amp; Wu, X. (2017). Overweight, obesity, and screen-time viewing among Chinese school-aged children: National prevalence estimates from the 2016 Physical Activity and Fitness in China-The Youth Study. \u003cem\u003eJournal of Sport and Health Science\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(4), 404\u0026ndash;409. https://doi.org/10.1016/j.jshs.2017.09.002\u003c/li\u003e\n\u003cli\u003eCalcaterra, V., Vandoni, M., Marin, L., Carnevale Pellino, V., Rossi, V., Gatti, A., Patan\u0026egrave;, P., Cavallo, C., Re, F., Albanese, I., Silvestri, D., De Nunzio, A., \u0026amp; Zuccotti, G. (2023). Exergames to Limit Weight Gain and to Fight Sedentarism in Children and Adolescents with Obesity. \u003cem\u003eChildren\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(6), 928. https://doi.org/10.3390/children10060928\u003c/li\u003e\n\u003cli\u003eChang, S., \u0026amp; Wu, J. (2008). Investigation and analysis of family factors influencing college students\u0026rsquo; physical exercise behavior. 体育学刊, \u003cem\u003e15\u003c/em\u003e(3), 4.\u003c/li\u003e\n\u003cli\u003eChoo, C. C., Harris, K. M., Chew, P. K. H., \u0026amp; Ho, R. C. (2017). What predicts medical lethality of suicide attempts in Asian youths? \u003cem\u003eAsian Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e, 136\u0026ndash;141. https://doi.org/10.1016/j.ajp.2017.05.008\u003c/li\u003e\n\u003cli\u003eChristison, A. L., Evans, T. A., Bleess, B. B., Wang, H., Aldag, J. C., \u0026amp; Binns, H. J. (2016a). Exergaming for Health: A Randomized Study of Community-Based Exergaming Curriculum in Pediatric Weight Management. \u003cem\u003eGames for Health Journal\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(6), 413\u0026ndash;421. https://doi.org/10.1089/g4h.2015.0097\u003c/li\u003e\n\u003cli\u003eChristison, A. L., Evans, T. A., Bleess, B. B., Wang, H., Aldag, J. C., \u0026amp; Binns, H. J. (2016b). Exergaming for Health: A Randomized Study of Community-Based Exergaming Curriculum in Pediatric Weight Management. \u003cem\u003eGames for Health Journal\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(6), 413\u0026ndash;421. https://doi.org/10.1089/g4h.2015.0097\u003c/li\u003e\n\u003cli\u003eCleland, V., Timperio, A., Salmon, J., Hume, C., Telford, A., \u0026amp; Crawford, D. (2011). A longitudinal study of the family physical activity environment and physical activity among youth. \u003cem\u003eAmerican Journal of Health Promotion: AJHP\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(3), 159\u0026ndash;167. https://doi.org/10.4278/ajhp.090303-QUAN-93\u003c/li\u003e\n\u003cli\u003eDong, B., \u0026amp; Mao, L. (2018). Parental autonomy support and adolescents\u0026rsquo; exercise persistence: The multiple mediations of control belief and exercise engagement. 天津体育学院学报, \u003cem\u003e33\u003c/em\u003e(1), 8.\u003c/li\u003e\n\u003cli\u003eDuman, F., Koka\u0026ccedil;ya, M. H., Doğru, E., Katayıfcı, N., Canbay, \u0026Ouml;., \u0026amp; Aman, F. (2016). The Role of Active Video-Accompanied Exercises in Improvement of the Obese State in Children: A Prospective Study from Turkey. \u003cem\u003eJournal of Clinical Research in Pediatric Endocrinology\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(3), 334\u0026ndash;340. https://doi.org/10.4274/jcrpe.2284\u003c/li\u003e\n\u003cli\u003eEcheverria, S. E., Luan Kang, A., Isasi, C. R., Johnson-Dias, J., \u0026amp; Pacquiao, D. (2014). A community survey on neighborhood violence, park use, and physical activity among urban youth. \u003cem\u003eJournal of Physical Activity \u0026amp; Health\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 186\u0026ndash;194. https://doi.org/10.1123/jpah.2012-0023\u003c/li\u003e\n\u003cli\u003eFlynn, R. M., Staiano, A. E., Beyl, R., Richert, R. A., Wartella, E., \u0026amp; Calvert, S. L. (2018). The Influence of Active Gaming on Cardiorespiratory Fitness in Black and Hispanic Youth. \u003cem\u003eJournal of School Health\u003c/em\u003e, \u003cem\u003e88\u003c/em\u003e(10), 768\u0026ndash;775. https://doi.org/10.1111/josh.12679\u003c/li\u003e\n\u003cli\u003eFuemmeler, B. F., Anderson, C. B., \u0026amp; M\u0026acirc;sse, L. C. (2011). Parent-child relationship of directly measured physical activity. \u003cem\u003eThe International Journal of Behavioral Nutrition and Physical Activity\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e, 17. https://doi.org/10.1186/1479-5868-8-17\u003c/li\u003e\n\u003cli\u003eGao, Y., \u0026amp; Wang, X. (2015). The influence of parental support and peer friendship quality on adolescents\u0026rsquo; motivation and involvement in sports. 天津体育学院学报, \u003cem\u003e30\u003c/em\u003e(6), 8.\u003c/li\u003e\n\u003cli\u003eGao, Z., \u0026amp; Chen, S. (2014). Are field-based exergames useful in preventing childhood obesity? A systematic review. \u003cem\u003eObesity Reviews: An Official Journal of the International Association for the Study of Obesity\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(8), 676\u0026ndash;691. https://doi.org/10.1111/obr.12164\u003c/li\u003e\n\u003cli\u003eGao, Z., Podlog, L., \u0026amp; Huang, C. (2013). Associations among children\u0026rsquo;s situational motivation, physical activity participation, and enjoyment in an active dance video game. \u003cem\u003eJournal of Sport and Health Science\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(2), 122\u0026ndash;128. https://doi.org/10.1016/j.jshs.2012.07.001\u003c/li\u003e\n\u003cli\u003eGlen, K., Eston, R., Loetscher, T., \u0026amp; Parfitt, G. (2017). Exergaming: Feels good despite working harder. \u003cem\u003ePLOS ONE\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(10), e0186526. https://doi.org/10.1371/journal.pone.0186526\u003c/li\u003e\n\u003cli\u003eGrossman, D. C., Bibbins-Domingo, K., Curry, S. J., Barry, M. J., Davidson, K. W., Doubeni, C. A., Epling, J. W., Kemper, A. R., Krist, A. H., Kurth, A. E., Landefeld, C. S., Mangione, C. M., Phipps, M. G., Silverstein, M., Simon, M. A., \u0026amp; Tseng, C.-W. (2017). Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. \u003cem\u003eJAMA\u003c/em\u003e, \u003cem\u003e317\u003c/em\u003e(23), 2417\u0026ndash;2426. https://doi.org/10.1001/jama.2017.6803\u003c/li\u003e\n\u003cli\u003eGuo, X., Cai, S., Dang, J., \u0026amp; Chen, Y. (2023). \u003cem\u003eThe effects of parental involvement on physical activity in children and adolescents: A meta-analysis\u003c/em\u003e. http://119.45.101.87:9195/kns8s/defaultresult/index\u003c/li\u003e\n\u003cli\u003eHambly, K., Poomsalood, S., \u0026amp; Mundy, E. (2017). Return to running following knee osteochondral repair using an anti-gravity treadmill: A case report. \u003cem\u003ePhysical Therapy in Sport\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e, 35\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eHosokawa, R., Fujimoto, M., \u0026amp; Katsura, T. (2023). Parental support for physical activity and children\u0026rsquo;s physical activities: A cross-sectional study. \u003cem\u003eBMC Sports Science, Medicine and Rehabilitation\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(1), 90. https://doi.org/10.1186/s13102-023-00700-9\u003c/li\u003e\n\u003cli\u003eHu, X., Tang, Y., Zhang, J., \u0026amp; Liu, Y. (2017). The influence of parental factors on moderate to vigorous physical activity in adolescents. 中国体育科技, \u003cem\u003e53\u003c/em\u003e(3), 8.\u003c/li\u003e\n\u003cli\u003eKhan, S. R., Uddin, R., Mandic, S., \u0026amp; Khan, A. (2020). Parental and Peer Support are Associated with Physical Activity in Adolescents: Evidence from 74 Countries. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(12), 4435. https://doi.org/10.3390/ijerph17124435\u003c/li\u003e\n\u003cli\u003eKiviruusu, O., Konttinen, H., Huurre, T., Aro, H., Marttunen, M., \u0026amp; Haukkala, A. (2016). Self-esteem and Body Mass Index from Adolescence to Mid-adulthood. A 26-year Follow-up. \u003cem\u003eInternational Journal of Behavioral Medicine\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(3), 355\u0026ndash;363. https://doi.org/10.1007/s12529-015-9529-4\u003c/li\u003e\n\u003cli\u003eLee, S., Kim, W., Park, T., \u0026amp; Peng, W. (2017). The Psychological Effects of Playing Exergames: A Systematic Review. \u003cem\u003eCyberpsychology, Behavior and Social Networking\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(9), 513\u0026ndash;532. https://doi.org/10.1089/cyber.2017.0183\u003c/li\u003e\n\u003cli\u003eLi, B. J., Lwin, M. O., \u0026amp; Jung, Y. (2014). Wii, Myself, and Size: The Influence of Proteus Effect and Stereotype Threat on Overweight Children\u0026rsquo;s Exercise Motivation and Behavior in Exergames. \u003cem\u003eGames for Health Journal\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 40\u0026ndash;48. https://doi.org/10.1089/g4h.2013.0081\u003c/li\u003e\n\u003cli\u003eLiang, Y., \u0026amp; Lau, P. W. C. (2014). Effects of Active Videogames on Physical Activity and Related Outcomes Among Healthy Children: A Systematic Review. \u003cem\u003eGames for Health Journal\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(3), 122\u0026ndash;144. https://doi.org/10.1089/g4h.2013.0070\u003c/li\u003e\n\u003cli\u003eLiu J., He X., He G., \u0026amp; Zhang Y. (2020). Parental involvement, school inclusion, and the mental health of migrant children: Evidence from the China Education Tracking Survey. 中国青年研究, \u003cem\u003e0\u003c/em\u003e(3), 39\u0026ndash;48.\u003c/li\u003e\n\u003cli\u003eLlewellyn, A., Simmonds, M., Owen, C. G., \u0026amp; Woolacott, N. (2016). Childhood obesity as a predictor of morbidity in adulthood: A systematic review and meta-analysis. \u003cem\u003eObesity Reviews: An Official Journal of the International Association for the Study of Obesity\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(1), 56\u0026ndash;67. https://doi.org/10.1111/obr.12316\u003c/li\u003e\n\u003cli\u003eLv, H., Wang, K., \u0026amp; Liu, H. (2020). Family sports environment and children\u0026rsquo;s sports lifestyle: The mediating role of family social capital. 北京体育大学学报, \u003cem\u003e43\u003c/em\u003e(5), 12.\u003c/li\u003e\n\u003cli\u003eMarsh, S., Foley, L. S., Wilks, D. C., \u0026amp; Maddison, R. (2014). Family-based interventions for reducing sedentary time in youth: A systematic review of randomized controlled trials. \u003cem\u003eObesity Reviews: An Official Journal of the International Association for the Study of Obesity\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(2), 117\u0026ndash;133. https://doi.org/10.1111/obr.12105\u003c/li\u003e\n\u003cli\u003eMart\u0026iacute;, A. C., \u0026Aacute;lvarez, J. C., \u0026amp; Provinciale, J. G. (2015). OPCIONES ALTERNATIVAS PARA PRESCRIBIR ACTIVIDAD F\u0026Iacute;SICA ENTRE NI\u0026Ntilde;OS Y. \u003cem\u003eNUTRICION HOSPITALARIA\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e, 841\u0026ndash;848. https://doi.org/10.3305/nh.2015.31.2.7929\u003c/li\u003e\n\u003cli\u003eMatias, T., Kieling Sebold BarrosRolim, M., Kretzer, F., Schmoelz, C., \u0026amp; Andrade, A. (2010). Corporal satisfaction associated with physical activity practice during adolescence. \u003cem\u003eMotriz. Revista de Educa\u0026ccedil;\u0026atilde;o F\u0026iacute;sica\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e, 370\u0026ndash;378.\u003c/li\u003e\n\u003cli\u003ePage, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hr\u0026oacute;bjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., \u0026hellip; Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. \u003cem\u003eBMJ\u003c/em\u003e, \u003cem\u003e372\u003c/em\u003e, n71. https://doi.org/10.1136/bmj.n71\u003c/li\u003e\n\u003cli\u003ePe\u0026ntilde;a, J., Khan, S., \u0026amp; Alexopoulos, C. (2016). I Am What I See: How Avatar and Opponent Agent Body Size Affects Physical Activity Among Men Playing Exergames. \u003cem\u003eJournal of Computer-Mediated Communication\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(3), 195\u0026ndash;209. https://doi.org/10.1111/jcc4.12151\u003c/li\u003e\n\u003cli\u003ePe\u0026ntilde;a, J., \u0026amp; Kim, E. (2014). Increasing exergame physical activity through self and opponent avatar appearance. \u003cem\u003eComputers in Human Behavior\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e, 262\u0026ndash;267. https://doi.org/10.1016/j.chb.2014.09.038\u003c/li\u003e\n\u003cli\u003ePeng, W., Crouse, J. C., \u0026amp; Lin, J.-H. (2013). Using active video games for physical activity promotion: A systematic review of the current state of research. \u003cem\u003eHealth Education \u0026amp; Behavior: The Official Publication of the Society for Public Health Education\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(2), 171\u0026ndash;192. https://doi.org/10.1177/1090198112444956\u003c/li\u003e\n\u003cli\u003ePerrin, E. M., Boone-Heinonen, J., Field, A. E., Coyne-Beasley, T., \u0026amp; Gordon-Larsen, P. (2010). Perception of overweight and self-esteem during adolescence. \u003cem\u003eThe International Journal of Eating Disorders\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(5), 447\u0026ndash;454. https://doi.org/10.1002/eat.20710\u003c/li\u003e\n\u003cli\u003eRadhakrishnan, K., Baranowski, T., Julien, C., Thomaz, E., \u0026amp; Kim, M. (2019). Role of Digital Games in Self-Management of Cardiovascular Diseases: A Scoping Review. \u003cem\u003eGames for Health Journal\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(2), 65\u0026ndash;73. https://doi.org/10.1089/g4h.2018.0011\u003c/li\u003e\n\u003cli\u003eRavens-Sieberer, U., Erhart, M., Rajmil, L., Herdman, M., Auquier, P., Bruil, J., Power, M., Duer, W., Abel, T., Czemy, L., Mazur, J., Czimbalmos, A., Tountas, Y., Hagquist, C., Kilroe, J., \u0026amp; European KIDSCREEN Group. (2010). Reliability, construct and criterion validity of the KIDSCREEN-10 score: A short measure for children and adolescents\u0026rsquo; well-being and health-related quality of life. \u003cem\u003eQuality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(10), 1487\u0026ndash;1500. https://doi.org/10.1007/s11136-010-9706-5\u003c/li\u003e\n\u003cli\u003eShaughnessy, M., Michael, K., \u0026amp; Resnick, B. (2012). Impact of Treadmill Exercise on Efficacy Expectations, Physical Activity, and Stroke Recovery. \u003cem\u003eThe Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(1), 27\u0026ndash;35. https://doi.org/10.1097/JNN.0b013e31823ae4b5\u003c/li\u003e\n\u003cli\u003eStaiano, A. E., Abraham, A. A., \u0026amp; Calvert, S. L. (2013). Adolescent Exergame Play for Weight Loss and Psychosocial Improvement: A Controlled Physical Activity Intervention. \u003cem\u003eObesity\u003c/em\u003e. https://doi.org/10.1038/oby.2012.143\u003c/li\u003e\n\u003cli\u003eStaiano, A. E., Beyl, R. A., Guan, W., Hendrick, C. A., Hsia, D. S., \u0026amp; Newton, R. L. (2019). \u003cem\u003eHome-Based Exergaming among Children with Overweight and Obesity\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eStaiano, A. E., Beyl, R. A., Hsia, D. S., Katzmarzyk, P. T., \u0026amp; Newton Jr, R. L. (2018). A 12-week randomized controlled pilot study of dance exergaming in a group: Influence on psychosocial factors in adolescent girls. \u003cem\u003eCyberpsychology: Journal of Psychosocial Research on Cyberspace\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(2). https://doi.org/10.5817/CP2018-2-3\u003c/li\u003e\n\u003cli\u003eStaiano, A. E., Beyl, R. A., Hsia, D. S., Katzmarzyk, P. T., \u0026amp; Newton, R. L. (2017a). Twelve weeks of dance exergaming in overweight and obese adolescent girls: Transfer effects on physical activity, screen time, and self-efficacy. \u003cem\u003eJournal of Sport and Health Science\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(1), 4\u0026ndash;10. https://doi.org/10.1016/j.jshs.2016.11.005\u003c/li\u003e\n\u003cli\u003eStaiano, A. E., Beyl, R. A., Hsia, D. S., Katzmarzyk, P. T., \u0026amp; Newton, R. L. (2017b). Twelve weeks of dance exergaming in overweight and obese adolescent girls: Transfer effects on physical activity, screen time, and self-efficacy. \u003cem\u003eJournal of Sport and Health Science\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(1), 4\u0026ndash;10. https://doi.org/10.1016/j.jshs.2016.11.005\u003c/li\u003e\n\u003cli\u003eStangl, A. L., Earnshaw, V. A., Logie, C. H., van Brakel, W., C. Simbayi, L., Barr\u0026eacute;, I., \u0026amp; Dovidio, J. F. (2019). The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. \u003cem\u003eBMC Medicine\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(1), 31. https://doi.org/10.1186/s12916-019-1271-3\u003c/li\u003e\n\u003cli\u003eStewart, J. G., Esposito, E. C., Glenn, C. R., Gilman, S. E., Pridgen, B., Gold, J., \u0026amp; Auerbach, R. P. (2017). Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters. \u003cem\u003eJournal of Psychiatric Research\u003c/em\u003e, \u003cem\u003e84\u003c/em\u003e, 105\u0026ndash;112. https://doi.org/10.1016/j.jpsychires.2016.09.031\u003c/li\u003e\n\u003cli\u003eSun, H. (2013). Impact of exergames on physical activity and motivation in elementary school students: A follow-up study. \u003cem\u003eJournal of Sport and Health Science\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(3), 138\u0026ndash;145. https://doi.org/10.1016/j.jshs.2013.02.003\u003c/li\u003e\n\u003cli\u003eTaylor, A., Wilson, C., Slater, A., \u0026amp; Mohr, P. (2012). Self-esteem and body dissatisfaction in young children: Associations with weight and perceived parenting style. \u003cem\u003eClinical Psychologist\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(1), 25\u0026ndash;35. https://doi.org/10.1111/j.1742-9552.2011.00038.x\u003c/li\u003e\n\u003cli\u003evan den Berg, P. A., Mond, J., Eisenberg, M., Ackard, D., \u0026amp; Neumark-Sztainer, D. (2010). The link between body dissatisfaction and self-esteem in adolescents: Similarities across gender, age, weight status, race/ethnicity, and socioeconomic status. \u003cem\u003eThe Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(3), 290\u0026ndash;296. https://doi.org/10.1016/j.jadohealth.2010.02.004\u003c/li\u003e\n\u003cli\u003eWeaver, R. G., Webster, C. A., Beets, M. W., Brazendale, K., Schisler, L., \u0026amp; Aziz, M. (2018). An Intervention to Increase Students\u0026rsquo; Physical Activity: A 2-Year Pilot Study. \u003cem\u003eAmerican Journal of Preventive Medicine\u003c/em\u003e, \u003cem\u003e55\u003c/em\u003e(1), e1\u0026ndash;e10. https://doi.org/10.1016/j.amepre.2018.03.005\u003c/li\u003e\n\u003cli\u003eWHO. (2020). \u003cem\u003eAdolescent health and development\u003c/em\u003e. https://www.who.int/news-room/questions-and-answers/item/adolescent-health-and-development\u003c/li\u003e\n\u003cli\u003eWHO. (2021). \u003cem\u003eObesity and overweight\u003c/em\u003e. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\u003c/li\u003e\n\u003cli\u003eWHO. (2022, October). \u003cem\u003ePhysical activity\u003c/em\u003e. https://www.who.int/news-room/fact-sheets/detail/physical-activity\u003c/li\u003e\n\u003cli\u003eWHO. (2023). \u003cem\u003eAdolescent health\u003c/em\u003e. https://www.who.int/health-topics/adolescent-health\u003c/li\u003e\n\u003cli\u003eWorld Obesity. (2022). \u003cem\u003eBattling Obesity in ASEAN\u003c/em\u003e. World Obesity Federation. https://www.worldobesity.org\u003c/li\u003e\n\u003cli\u003eYanovski, J. A. (2015). Pediatric obesity. An introduction. \u003cem\u003eAppetite\u003c/em\u003e, \u003cem\u003e93\u003c/em\u003e, 3\u0026ndash;12. https://doi.org/10.1016/j.appet.2015.03.028\u003c/li\u003e\n\u003cli\u003eYuca, S. A., Cimbek, E. A., Şen, Y., G\u0026uuml;ven\u0026ccedil;, O., Vatansev, H., Buğrul, F., G\u0026uuml;n, F., \u0026amp; Oran, B. (2017). The Relationship between Metabolic Parameters, Cardiac Parameters and MIC-1/GDF15 in Obese Children. \u003cem\u003eExperimental and Clinical Endocrinology \u0026amp; Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association\u003c/em\u003e, \u003cem\u003e125\u003c/em\u003e(2), 86\u0026ndash;90. https://doi.org/10.1055/s-0042-114220\u003c/li\u003e\n\u003cli\u003eZeng, N., \u0026amp; Gao, Z. (2016). Exergaming and obesity in youth: Current perspectives. \u003cem\u003eInternational Journal of General Medicine\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e, 275\u0026ndash;284. https://doi.org/10.2147/IJGM.S99025\u003c/li\u003e\n\u003cli\u003eZhang, Y., Lou, H., Huang, Y., Wang, R., Wen, X., Wu, C., Hao, C., Li, R., Gao, G., Lou, X., \u0026amp; Wang, X. (2022). Trends of overweight and obesity prevalence in school-aged children among Henan Province from 2000 to 2019. \u003cem\u003eFrontiers in Public Health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e. https://www.frontiersin.org/articles/10.3389/fpubh.2022.1046026\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"psychology, overweight, obese, adolescents, self-efficacy","lastPublishedDoi":"10.21203/rs.3.rs-4530750/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4530750/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis systematic review aimed to analyse the effects of active video games (AVGs) on psychology among overweight and obese adolescents.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003e The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement guidelines were used to search the PubMed, SCOPUS, EBSCOhost (SPORTDiscus), and Web of Science databases for studies published in the last 10 years (2013\u0026ndash;2023). Keywords related to psychology, being overweight or obese, and adolescents were used. From the 713 studies, 10 fulfilled all eligibility criteria and were included in this review.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study results revealed that AVGs could positively impact the psychological well-being. However, due to different experimental designs, experimental environments, experimental objectives, and game consoles, the results of self-efficacy, social and peer support, and self-esteem are still conflicting. Additionally, due to measurement issues, quality of life has not yielded a positive effect.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFuture research should standardise methods and look into the underlying mechanisms to come up with personalised plans for improving the psychology of overweight and obese adolescents who are involved in AVG interventions as part of health promotion programmes.\u003c/p\u003e","manuscriptTitle":"The Effects of Active Video Games on Psychology among Overweight and Obese Adolescents: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-26 06:00:07","doi":"10.21203/rs.3.rs-4530750/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c4ba010-e6d1-4545-bbae-487373aba2cb","owner":[],"postedDate":"June 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33669593,"name":"Biological sciences/Psychology"},{"id":33669594,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2024-08-13T07:11:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-26 06:00:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4530750","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4530750","identity":"rs-4530750","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}