Effectiveness of active video games for promoting physical activity: an umbrella review

Introduction: Active video games (AVG) have emerged as a potential strategy to combat global physical inactivity, transforming sedentary screen time into physical activity. However, the evidence on their effectiveness remains fragmented and heterogeneous. Objective: To synthesize the available evidence from systematic reviews on the effectiveness of active video games for promoting physical activity in different populations. Methods: An Umbrella Review (UR) was developed following PRIOR guidelines. Six databases were searched until April 2025. Systematic reviews that evaluated AVG and physical activity were included. Methodological quality was assessed with AMSTAR 2 and certainty of evidence with GRADE. Two independent reviewers performed selection and data extraction. Results: Twenty systematic reviews were included encompassing 418 unique primary studies with >180,000 participants. The most studied platforms were Nintendo Wii (16 reviews), Xbox Kinect (11 reviews), Dance Dance Revolution (8 reviews) and Pokémon Go (3 reviews). AVG consistently achieved light-moderate intensity (3–6 metabolic equivalents or METs) during gameplay. The overall effect was moderate (Hedges g = 0.525, 95%CI: 0.322–0.728) but with high heterogeneity (I² > 75%). Older adults showed the most consistent benefits [effect size (ES) = 0.64–0.68 muscle strength; ES = 0.79 cardiorespiratory fitness] with high certainty. Only 23% of interventions showed sustained post-intervention effects. Methodological heterogeneity was extreme: different metrics such as METs, moderate-vigorous physical activity (MVPA), steps/day; instruments (accelerometers, calorimetry, questionnaires) and protocols (single sessions to 48 weeks). Only 30% of reviews systematically reported adverse events. Conclusions: AVG are effective for promoting physical activity during their use, especially in older adults and overweight individuals. However, the lack of methodological standardization makes it impossible to establish specific recommendations. Consensus on measures and protocols is urgently required to realize the potential of AVG as a public health tool.