Effects and Moderators of Exergaming on Glucose and Lipid Metabolism in Children and Adolescents: Systematic Review and Meta-Analysis.

Abstract

Exergaming, or active video gaming, may make physical activity more engaging for children and adolescents. Earlier reviews have focused on activity, adiposity, fitness, or psychosocial outcomes, leaving effects on glycemic and lipid biomarkers uncertain. Their cardiometabolic relevance warrants synthesis. This systematic review and meta-analysis evaluated the effects of exergaming on glucose and lipid metabolism in children and adolescents, and explored potential moderators. Following PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), we searched PubMed, Embase, Scopus, Web of Science, the Psychology and Behavioral Sciences Collection, and CENTRAL from inception to April 27, 2026, with backward and forward citation searching. Eligible controlled interventions enrolled participants aged ≤18 years and compared exergaming with nonexergaming controls. Outcomes were glucose, insulin, total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Standardized mean differences (Hedges) were pooled with inverse-variance random-effects models and the Hartung-Knapp-Sidik-Jonkman adjustment. We reported 95% CIs, heterogeneity, 95% prediction intervals (PIs), risk of bias, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) certainty; subgroup analysis, meta-regression, and leave-one-out sensitivity analyses explored moderators and estimate stability. Ten controlled intervention studies involving 732 participants were included. Pooled effects were nonsignificant for glucose (9 studies, 528 participants; Hedges=-0.16, 95% CI -0.57 to 0.24; PI -1.12 to 0.79), insulin (5 studies, 308 participants; Hedges=-0.06, 95% CI -0.35 to 0.23; PI -0.39 to 0.27), TC (9 studies, 510 participants; Hedges=-0.39, 95% CI -1.11 to 0.33; PI -1.70 to 0.93), triglycerides (9 studies, 510 participants; Hedges=-0.17, 95% CI -0.50 to 0.17; PI -0.88 to 0.55), and HDL-C (9 studies, 510 participants; Hedges=-0.14, 95% CI -0.34 to 0.06; PI -0.35 to 0.07; effect sizes were reverse-oriented so that negative values favored exergaming). LDL-C showed a small favorable pooled average reduction (9 studies, 510 participants; Hedges=-0.29, 95% CI -0.55 to -0.04; PI -0.73 to 0.14), but its PI crossed the null. All PIs crossed the null; heterogeneity was substantial for glucose, considerable for TC, moderate for triglycerides, and low for insulin, HDL-C, and LDL-C. Subgroup signals were exploratory, no significant meta-regression moderators were identified, and leave-one-out analyses did not materially alter the glucose, TC, or triglycerides estimates. Most randomized trials had risk-of-bias concerns; the nonrandomized study had serious risk of bias. These limitations reduce confidence in the LDL-C signal. GRADE certainty was very low for glucose and TC and low for the remaining outcomes. This review provides a synthesis of pediatric glycemic and lipid biomarkers and potential moderators, extending earlier broader exergaming reviews. Exergaming may be an engaging complementary strategy for physical activity and lipid health, including LDL-C, in schools, families, and community settings. However, heterogeneous protocols, risk-of-bias concerns, very low-to-low certainty, and PIs crossing the null mean that the magnitude and generalizability of any metabolic benefit remain uncertain.