Abstract
BACKGROUND: The significant association between blood pressure (BP) in children and young adulthood and risks of cardiovascular diseases in adulthood highlights the critical need for early BP control. While lifestyle modifications such as increased physical exercise have proven effective, traditional exercise forms always suffer from low motivation and adherence. Active video games (AVGs), combining exercise with engaging gameplay, may present a promising alternative for managing BP in children and young adults. OBJECTIVE: This study aims to evaluate the effectiveness of AVGs in managing BP among the population aged 6 to 25 years. METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, this study retrieved and screened publications archived in the 4 databases (Web of Science, Cochrane Library, PubMed, and Embase) and the registration (ClinicalTrials.gov) up to December 30, 2024. Eligible studies were defined as interventional trials involving participants aged 6 to 25 years, using AVGs as one of the intervention protocols, and reporting BP outcomes. Studies were excluded if they involved participants with heart diseases, combined AVGs protocol with other intervention components, limited outcomes to immediate postgame BP, or included only control groups that received additional physical activity interventions. Depending on the heterogeneity among included trials, random-effects or fixed-effects models were selected to pool the effect sizes of individual trials, with 95% CIs. The risk of bias was assessed using the Cochrane Risk of Bias tool for controlled trials and the Methodological Index for Non-Randomized Studies for prepost design. Sensitivity analyses were performed to evaluate result robustness, while Egger tests investigated publication bias. RESULTS: A total of 17 trials from 16 studies, involving 503 participants who are normotensive, were included in this study. The analysis showed that AVGs significantly reduced systolic blood pressure (standardized mean difference=-0.50, P<.001, 95% CIs -0.80 to -0.20) and increased diastolic blood pressure (standardized mean difference=0.23, P=.03, 95% CIs 0.02 to 0.44) in children younger than 18 years, with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) indicating the certainties of evidence as low for systolic blood pressure and moderate for diastolic blood pressure. CONCLUSIONS: These findings shed light on the cardiovascular benefits of AVGs in children younger than 18 years, underscoring their potential to improve vascular elasticity while maintaining organ perfusion. However, considering the limitations arising from small sample sizes, as well as inadequate allocation concealment and blinding in the included studies, these findings should be interpreted with caution.