Zhu Hao, Tung Keith Tsz-Suen, So Hung-Kwan, Siu Parco M, Wong Ian Chi Kei, Yam Jason C, Tung Joanna Yuet-Ling, Jan Yih-Kuen, He Li, Ip Patrick
Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Room 115, 1/F, New Clinical Building, 102 Pokfulam Road, Queen Mary Hospital, Hong Kong SAR, 999077, China (Hong Kong), 852 22554090.
Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China (Hong Kong).
J Med Internet Res. 2025 Aug 19;27:e75000. doi: 10.2196/75000.
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.
This study aims to evaluate the effectiveness of AVGs in managing BP among the population aged 6 to 25 years.
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.
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.
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.
儿童及青年期的血压与成年期心血管疾病风险之间存在显著关联，这凸显了早期控制血压的迫切需求。虽然诸如增加体育锻炼等生活方式的改变已被证明是有效的，但传统的运动形式往往存在动力不足和依从性差的问题。结合运动与引人入胜的游戏玩法的主动式电子游戏（AVG），可能为管理儿童和青年的血压提供一个有前景的替代方案。
本研究旨在评估主动式电子游戏在管理6至25岁人群血压方面的有效性。
遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，本研究检索并筛选了截至2024年12月30日在4个数据库（科学网、考克兰图书馆、PubMed和Embase）以及注册库（ClinicalTrials.gov）中存档的出版物。符合条件的研究被定义为涉及6至25岁参与者的干预试验，使用主动式电子游戏作为干预方案之一，并报告血压结果。如果研究涉及患有心脏病的参与者、将主动式电子游戏方案与其他干预成分相结合、将结果限于游戏后即刻血压，或仅包括接受额外体育活动干预的对照组，则将其排除。根据纳入试验之间的异质性，选择随机效应或固定效应模型来汇总各个试验的效应大小，并给出95%置信区间。使用考克兰对照试验偏倚风险工具和非随机研究的方法学指数对预设计进行偏倚风险评估。进行敏感性分析以评估结果的稳健性，同时使用Egger检验调查发表偏倚。
本研究共纳入了来自16项研究的17项试验，涉及503名血压正常的参与者。分析表明，主动式电子游戏显著降低了18岁以下儿童的收缩压（标准化平均差=-0.50，P<0.001，95%置信区间为-0.80至-0.20），并升高了舒张压（标准化平均差=0.23，P=0.03，95%置信区间为0.02至0.44），GRADE（推荐评估、制定和评价分级）表明收缩压证据的确定性为低，舒张压证据的确定性为中等。
这些发现揭示了主动式电子游戏对18岁以下儿童心血管的益处，强调了它们在改善血管弹性同时维持器官灌注方面的潜力。然而，考虑到样本量小以及纳入研究中分配隐藏和盲法不足所带来的局限性，这些发现应谨慎解读。
