The effect of animated Sci-Fi characters' racial presentation on narrative engagement, wishful identification, and physical activity intention among children.

Characters play an integral role in animated narratives, but their visual racial presentation has received limited attention. A diverse group of U.S. children watched a 15-min physical activity-promoting animated Sci-Fi narrative. They were randomly assigned to one of three conditions, which varied the lead characters' racial presentation: realistic racially unambiguous (Original: White children, Black mother), realistic racially ambiguous (Ambiguous: All with brown skin without specified race/ethnicity), and fantastical racially ambiguous (Fantastical: All with brown skin with fantastical hair-and-eye color schemes). We assessed narrative engagement, wishful identification, and physical activity intention. Controlling for social desirability and multigroup ethnic identity, children who watched Fantastical characters showed significantly higher narrative engagement than those who watched Original characters, but they did not statistically differ from those who watched Ambiguous characters. Structural equation modeling indicated that narrative engagement and wishful identification fully mediated the racial representation effect (Fantastical vs. Original) on physical activity intention.

Active Video Game Interventions Targeting Physical Activity Behaviors: Systematic Review and Meta-analysis.

BACKGROUND: Research on digital games designed to increase physical activity (PA), also known as exergames or active video games (AVGs), has proliferated over the past 2 decades. As a result, reviews of literature in this field can become outdated, revealing the need for updated high-quality reviews that identify overarching insights. Furthermore, given the significant heterogeneity in AVG research, study inclusion criteria may significantly influence conclusions. To the best of our knowledge, no prior systematic review or meta-analysis has specifically focused on studies of longitudinal AVG interventions targeting increases in PA behaviors. OBJECTIVE: The aim of this study was to obtain insights into when and why longitudinal AVG interventions are more or less successful for sustained increases in PA, especially for public health. METHODS: Six databases (PubMed, PsycINFO, SPORTDiscus, MEDLINE, Web of Science, and Google Scholar) were reviewed until December 31, 2020. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, randomized controlled trials had to prominently (>50% of intervention) feature AVG technology, involve repeated AVG exposure, and target changes in PA behavior. Experimental designs had to include ≥2 within- or between-participant conditions with ≥10 participants per condition. RESULTS: A total of 25 studies published in English between 1996 and 2020 were identified, with 19 studies providing sufficient data for inclusion in the meta-analysis. Our findings indicated that AVG interventions had a moderately positive effect, thereby increasing overall PA (Hedges g=0.525, 95% CI 0.322-0.728). Our analysis showed substantial heterogeneity (I2=87.7%; Q=154.1). The main findings were consistent across all subgroup analyses. The comparison between PA assessment type groups showed a moderate effect for objective measures (Hedges g=0.586, 95% CI 0.321-0.852) and a small effect for subjective measures (Hedges g=0.301, 95% CI 0.049-0.554) but no significant difference between the groups (P=.13). The platform subgroup analysis indicated a moderate effect for stepping devices (Hedges g=0.303, 95% CI 0.110-0.496), combination of handheld and body-sensing devices (Hedges g=0.512, 95% CI 0.288-0.736), and other devices (Hedges g=0.694, 95% CI 0.350-1.039). The type of control group showed a wide range of effects sizes, ranging from a small effect size (Hedges g=0.370, 95% CI 0.212-0.527) for the passive control group (nothing) to a moderate effect size for the conventional PA intervention group (Hedges g=0.693, 95% CI 0.107-1.279) and ultimately to a large effect size for sedentary game as control groups (Hedges g=0.932, 95% CI 0.043-1.821). There was no significant difference among the groups (P=.29). CONCLUSIONS: AVGs represent a promising tool for PA promotion among the general population and clinical subpopulations. However, significant variabilities in AVG quality, study design, and impact were also detected. Suggestions for improving AVG interventions and related research will be discussed. TRIAL REGISTRATION: PROSPERO CRD42020204191; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=204191.

The effect of narrative element incorporation on physical activity and game experience in active and sedentary virtual reality games.

Narratives are pervasive in video games and have been found to increase physical activity in active video games. However, the effect of incorporating narrative elements has seldom been examined in fully immersive virtual reality games. We investigated the effect of narrative element incorporation (between-subject: narrative vs. no narrative) in active virtual reality and sedentary virtual reality games (within-subject) and examined between- and within-subject effects on physical activity behavior, game experience, and physical activity engagement. We randomized 36 sedentary college students to either the narrative or the non-narrative group. All participants played an active virtual reality and a sedentary virtual reality game in counter-balanced order. Before each game session, they either watched a 5-min narrative video (narrative) or directly played the original virtual reality games without narratives (non-narrative). We collected participants' physical activity data using wrist-worn accelerometers; we obtained their game experience and physical activity engagement via questionnaires. The narrative group spent a greater proportion of time in moderate-to-vigorous physical activity (%) and had less non-movement time during the active virtual reality gameplay than the non-narrative group (all p values < .05). The active virtual reality sessions induced a greater positive affect and greater physical activity engagement ratings than the sedentary virtual reality sessions. The incorporation of narrative elements in active virtual reality increased the relative time spent in moderate-to-vigorous physical activity and reduced non-movement time, compared to the non-narrative group. Active virtual reality encouraged more activity by participants and offered them a more enjoyable gaming experience in which they engaged more. Active virtual reality is a feasible physical activity promotion option among sedentary adults; the incorporation of narrative elements in active virtual reality helps increase relative moderate-to-vigorous physical activity and should be further explored for its efficacy. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-023-00754-7.

Active video games in fully immersive virtual reality elicit moderate-to-vigorous physical activity and improve cognitive performance in sedentary college students.

BACKGROUND: Active video games are a new method for increasing physical activity (PA). Fully immersive virtual reality (VR) is a hardware device on which an active video game can run. Active (video games in) VR (AVR), might increase immersion, game engagement, and moderate-to-vigorous PA (MVPA), thereby yielding greater exercise-related benefits, e.g., cognitive performance. METHODS: We examined the induction of MVPA via an AVR and a sedentary VR (SVR) as well as the effects of VR play on cognitive performance, which was monitored using 2 different methods. Each of 29 sedentary college students attended three 20-min laboratory sessions (AVR, SVR, or control) in a randomized order; during the control session, they sat quietly doing nothing. A fully immersive headset was used for the 2 video game sessions. We monitored and computed participants' PA using hip-worn accelerometers (wGT3x-bt; ActiGraph, Pensacola, FL, USA) and a heart rate band (Polar H7; Polar, Kempele, Finland). After each session, the participants completed a mnemonic similarity test (MST) to measure recognition memory. They also filled out a motion sickness questionnaire and an abbreviated game experience questionnaire. RESULTS: The AVR session induced a significantly greater heart rate and more time spent in MVPA than did either of the other 2 sessions regardless of the PA monitoring method. AVR elicited greater game experience questionnaire-assessed sensory and imaginative immersion, challenge, and positive affect than did SVR. The mnemonic similarity test recognition score was marginally higher post-AVR session than it was post-SVR session. CONCLUSION: AVR elicited MVPA without a significant increase in motion sickness and induced a better game experience and better borderline cognitive performance than did SVR.

What Type of Body Shape Moves Children? An Experimental Exploration of the Impact of Narrative Cartoon Character Body Shape on Children's Narrative Engagement, Wishful Identification, and Exercise Motivation.

BACKGROUND: The incorporation of narratives helps to enhance children's engagement in active video games (AVGs), thus increasing moderate-to-vigorous physical activity (MVPA). Specific narrative elements, such as the visual representation of the characters' body shape, have been rarely manipulated to explore their role in modulating children's narrative engagement (NE) and exercise motivation. OBJECTIVE: To investigate the effects of character body shape manipulation (overweight/obese, average, or athletic slim) on children's narrative immersion (NI), NE, wishful identification (WI), as well as their mediating effect on AVG and PA motivation. METHODS: Children ages 8-12 years old (N = 87) were randomly assigned to watch a 15-min animated video (designed for an existing AVG) in which the main characters had an overweight/obese, or average∗, or athletic slim body shape (all other elements were identical). Children's NI, NE, WI, and AVG and physical activity (PA) motivation were then assessed. RESULTS: Controlling for social desirability, the analysis indicated that participants with a BMI of greater than the 75th percentile had a significantly higher NI, NE, WI, and PA motivation when video characters were set to the overweight/obese condition, than they did for video characters set to the average or athletic slim conditions. On the other hand, children of equal or less than the 75th percentile exposed to the average character body condition had a greater NE, WI, and PA motivation than overweight/obese or athletic slim conditions. A mediation analysis with structural equation modeling indicated that NE mediated the effect between character body shape and AVG and PA motivation. CONCLUSION: Narrative cartoon characters that mirror the target participant's body shape can increase NE, which in turn mediates AVG and PA motivation. Content producers should identify optimal strategies in character body shape design to encourage children of different weight status to participate in PA with engaging stories to maximize health narratives' persuasive potentials.∗The term average in this sense is not in reference to the national average body weight, but rather an average of the body weights represented in conditions A and C.

Rapid component of excess post-exercise oxygen consumption of children of different weight status after playing active video games.

BACKGROUND: Excess post-exercise oxygen consumption (EPOC) of children could indicate the potential of an exercise therapy to treat or prevent obesity. However, EPOC as a result of playing active video games (AVG) has been poorly investigated. Therefore, we aimed to investigate the rapid component of EPOC of children with healthy weight and overweight/obesity (according to their BMI percentile) after playing AVGs that feature predominately upper body (UB) and whole-body (WB) movement. METHODS: Twenty-one children with healthy weight (BMI percentile < 85%) and with overweight/obesity (BMI percentile ≥ 85%) randomly underwent two 10-min AVG sessions (UB and WB). The heart rate (HR), minute ventilation (VE), oxygen consumption (VO2) and carbon dioxide production (VCO2) were recorded during exercise and post-exercise recovery period. For the rapid component of EPOC in each AVG session, measurements were recorded every 15 s for 5-min of post-exercise recovery. The rate of perceived exertion (RPE) was also measured immediately before and after each AVG play. RESULTS: Children with overweight/obesity had a higher average of absolute VE, VO2, and VCO2 than their healthy-weight counterparts (BMI percentile < 85%; n = 21) during post-exercise recovery. RPE, HR, and HR% were not different between the game sessions and weight groups. Children with overweight/obesity showed a higher absolute VO2 during EPOC than healthy-weight children in both game sessions, but relative VO2 was higher in healthy-weight children during EPOC. No differences were observed for EPOC between UB and WB sessions. CONCLUSIONS: Children with overweight/obesity had a greater EPOC than healthy-weight children after AVG sessions in terms of absolute oxygen values, whereas healthy-weight children have higher EPOC considering relative VO2 when controlling for body mass. UB and WB AVGs induced a similar EPOC among children with healthy weight and overweight/obesity. As UB and WB AVGs induce the rapid component of EPOC in children regardless their weight status, AVGs could be used as an exercise method to treat and prevent child obesity.

Comparison of Inhibitory Control After Acute Bouts of Exergaming Between Children with Obesity and Their Normal-Weight Peers.

Objective: The benefits of exergaming on executive function in children have been increasingly reported; however, weight-dependent effects of exergames on executive function, and inhibitory control in particular, remain poorly understood. We examined performance on an inhibitory control task at baseline and following acute bouts of exergaming in children who varied in weight status. Materials and Methods: Forty 8-12-year-old children with obesity (n = 20) and normal weight (n = 20) performed neutral, congruent, and incongruent conditions of a Victoria Stroop Test (VST) before and after exergames through an Xbox One in an elementary classroom. We measured time spent in moderate-to vigorous-intensity activity through ActiGraph accelerometers and recorded gameplay time. Results: At baseline, children with obesity relative to their normal-weight peers had significantly longer reaction times (P = 0.011), resulting in significantly longer completion time (P = 0.005) during incongruent trials requiring greater inhibitory control, and therefore had higher interference scores (P = 0.024). However, following acute bouts of exergames, children with obesity compared with their normal-weight counterparts significantly decreased completion time (P = 0.013), made fewer errors (P = 0.012) during incongruent trials, and subsequently had reduced interference effects (P = 0.037). Children with obesity and normal-weight children spent similar time (minutes) (7.8 vs. 8.6, P = 0.725) in moderate-to vigorous-intensity activity during similar gameplay time (8.7 vs. 10.5, P = 0.819). Conclusion: Our results suggest that greater, acute cognitive gains occur in children with obesity relative to normal-weight children following similar intensity and duration of exergames, which may be due to reduced inhibitory control capacity at baseline in childhood obesity.

Correction: The Effect of Narrative on Physical Activity via Immersion During Active Video Game Play in Children: Mediation Analysis.

[This corrects the article DOI: 10.2196/17994.].

The Effect of Narrative on Physical Activity via Immersion During Active Video Game Play in Children: Mediation Analysis.

BACKGROUND: Active video games (AVGs) can increase physical activity (PA) and help produce higher physiological expenditure. Animated narrative videos (NVs) possess unique immersive and motivational properties. When added to AVGs, they have been found to increase moderate-to-vigorous physical activity (MVPA) as opposed to the original no video condition. However, there is no evidence of whether that was due to the NV or the addition of an animated video to an AVG. OBJECTIVE: This study aimed to investigate the differential effect of adding an NV versus a nonnarrative video (NNV) to an AVG on PA parameters and physiological responses and to explore the mediating role of immersion. METHODS: A total of 22 children aged 8 to 12 years were randomly assigned to the NV or NNV condition. They were instructed to play an AVG (on Xbox Kinect) for as long as they wanted. We used accelerometers to estimate the time spent (in minutes) in MVPA. Heart rate (HR) and rate of perceived exertion (RPE) were measured before, during, and after the AVG play session. The participants then reported their experience of narrative immersion via a questionnaire. RESULTS: The NV group had significantly higher narrative immersion (mean 3.50, SD 0.55 vs mean 2.91, SD 0.59; P=.03) and MVPA (mean 19.46, SD 13.31 vs mean 7.85, SD 5.83; P=.02) than the NNV group. Narrative immersion was positively correlated with MVPA (r=0.52; P=.01) and average HR during AVG (r=0.43; P=.05). Mediation analysis indicated that narrative immersion mediated the effect of NV (NV vs NNV) on MVPA (direct effect: beta=7.51; P=.01). The indirect effect was that NV was positively correlated with the mediator variable narrative immersion (beta=.59; P=.03), which was itself marginally associated with MVPA (beta=6.95; P=.09); when narrative immersion was included in the model, the regression coefficient was attenuated. CONCLUSIONS: AVG with added narratives elicits more narrative immersion, resulting in more minutes in MVPA. Narrative immersion served as a mediator between NV and MVPA via its elicitation of an elevated HR without increasing RPE. The inclusion of immersive narratives in AVG could be helpful for inducing MVPA, to enhance AVG engagement without additional exertion.

Using Narrative Game Design to Increase Children's Physical Activity: Exploratory Thematic Analysis.

BACKGROUND: Physical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children's physical activity. OBJECTIVE: Little is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games. METHODS: In this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis. RESULTS: Findings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity. CONCLUSIONS: This research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles.

Exploring Energy Expenditure and Body Movement of Exergaming in Children of Different Weight Status.

PURPOSE: This study examined differences in energy expenditure and bodily movement among children of different weight status during exergames that varied in mode and intensity. METHODS: Fifty-seven 8- to 12-year-old children including overweight/obesity (n = 28) and normal weight (n = 29) played three 10-minute interval Xbox One exergames (Fruit Ninja, Kung-Fu, and Shape Up) categorized based on predominantly upper-, whole-, or lower-limb movement, respectively. The authors measured bodily movement through accelerometry and obtained energy expenditure and metabolic equivalent (MET) via indirect calorimetry. RESULTS: Energy expended during gameplay was the highest in Shape Up (P < .01) and higher in Kung-Fu than Fruit Ninja (P < .01). Absolute energy expenditure was significantly higher in overweight/obese children (P < .01), but not when controlling for body mass across 3 exergames (P > .05). Based on the MET cut-points, overweight/obese children spent more time at light intensity (<3 METs) for Fruit Ninja (P < .05) and Shape Up (P < .01), but less time at vigorous intensity (≥6 METs) for Kung-Fu (P < .01) and Shape Up (P < .01). Lower-limb movements during Shape Up were less in overweight/obese children (P = .03). CONCLUSION: Although children in both groups expended similar energy relative to their body mass during gameplay, overweight/obese children spent more time at light intensity but less time at vigorous intensity with fewer movements especially while playing a lower limb-controlled exergame.

Nutrition Education and Dietary Behavior Change Games: A Scoping Review.

Games provide an attractive venue for engaging participants and increasing nutrition-related knowledge and dietary behavior change, but no review has appeared devoted to this literature. A scoping review of nutrition education and dietary behavior change videogames or interactive games was conducted. A systematic search was made of PubMed, Agricola, and Google Scholar. Information was abstracted from 22 publications. To be included, the publication had to include a videogame or interactive experience involving games (a videogame alone, minigames inserted into a larger multimedia experience, or game as part of a human-delivered intervention); game's design objective was to influence dietary behavior, a psychosocial determinant of a dietary behavior, or nutrition knowledge (hereinafter referred to as diet-related); must have been reported in English and must have appeared in a professional publication, including some report of outcomes or results (thereby passing some peer review). This review was restricted to the diet-related information in the selected games. Diversity in targeted dietary knowledge and intake behaviors, targeted populations/audiences, game mechanics, behavioral theories, research designs, and findings was revealed. The diversity and quality of the research in general was poor, precluding a meta-analysis or systematic review. All but one of the studies reported some positive outcome from playing the game(s). One reported that a web-based education program resulted in more change than the game-based intervention. Studies of games may have been missed; a number of dietary/nutrition games are known for which no evaluation is known; and the data presented on the games and research were limited and inconsistent. Conclusions and Implications: A firmer research base is needed to establish the efficacy and effectiveness of nutrition education and dietary behavior change games.

Application and Validation of Activity Monitors' Epoch Lengths and Placement Sites for Physical Activity Assessment in Exergaming.

We assessed the agreement of two ActiGraph activity monitors (wGT3X vs. GT9X) placed at the hip and the wrist and determined an appropriate epoch length for physical activity levels in an exergaming setting. Forty-seven young adults played a 30-min exergame while wearing wGT3X and GT9X on both hip and wrist placement sites and a heart rate sensor below the chest. Intraclass correlation coefficient indicated that intermonitor agreement in steps and activity counts was excellent on the hip and good on the wrist. Bland-Altman plots indicated good intermonitor agreement in the steps and activity counts on both placement sites but a significant intermonitor difference was detected in steps on the wrist. Time spent in sedentary and physical activity intensity levels varied across six epoch lengths and depended on the placement sites, whereas time spent from a 1-s epoch of the hip-worn monitors most accurately matched the relative exercise intensity by heart rate. Hip placement site was associated with better step-counting accuracy for both activity monitors and more valid estimation of physical activity levels. A 1-s epoch was the most appropriate epoch length to detect short bursts of intense physical activity and may be the best choice for data processing and analysis in exergaming studies examining intermittent physical activities.

Narrative and active video game in separate and additive effects of physical activity and cognitive function among young adults.

Physically active video games (AVGs) have been found to positively impact physical activity behaviors, especially when a narrative is added. However, the motivational and cognitive benefits of adding narrative to AVG are unclear. We examined the separate and additive effects of narrative and AVG on physical activity and cognitive function versus an active comparator, such as a sedentary video game (SVG). We randomly assigned young adults to one of four groups (narrative-AVG, AVG, narrative-SVG, or SVG) and had them complete sustained attention and working memory tasks before and after a 30-min experimental condition. Participants in both narrative-AVG and AVG groups achieved a moderate-intensity physical activity, while adding narrative to AVG resulted in higher step counts and more time spent in moderate-to-vigorous physical activity than AVG without narrative. Regardless of the narrative effect, participants in both AVG groups performed better on overall working memory than both SVG groups, while both AVG and SVG groups similarly achieved maximal performance in sustained attention. Working memory enhancement was positively correlated with increased heart rate. Participants in narrative-SVG group had a better response accuracy in working memory than those who played SVG without narrative. Taken together, adding narrative to AVG as a motivational component increased physical activity, which was the primary factor in the improvement of overall working memory.

A State-of-the-Art Systematic Content Analysis of Games for Health.

As the field of games for health continues to gain momentum, it is crucial to document the field's scale of growth, identify design patterns, and to address potential design issues for future health game development. Few studies have explored the attributes and usability features of games for health as a whole over time. We offer the first comprehensive systematic content analysis of digital games for health by examining 1743 health games released between 1983 and 2016 in 23 countries extracted from nine international English health game databases and directories. The majority of these games were developed in the United States (67.18%) and France (18.59%). The most popular platforms included web browsers (72.38%) and Windows (14.41%). Approximately four out of five (79.12%) of the games were available at no cost. We coded 1553 accessible games for an in-depth analysis and further assessed 1303 for usability. Popular health topics represented included: cognitive training (37.41%), indirect health education (13.33%), and medical care provision (9.98%). Most games (75.66%) could be completed within 60 minutes. The main game usability problems identified included a lack of customization, nonskippable contents, and a lack of feedback and instruction to the players. While most of the usability problems have improved as did the software and hardware technology, the players' ability to skip nonplayable contents has become slightly more restricted overtime. Comparison with game efficacy publications suggested that a further understanding of the scope for games for health is needed on a global level.

Screen Media Exposure and Obesity in Children and Adolescents.

Obesity is one of the best-documented outcomes of screen media exposure. Many observational studies find relationships between screen media exposure and increased risks of obesity. Randomized controlled trials of reducing screen time in community settings have reduced weight gain in children, demonstrating a cause and effect relationship. Current evidence suggests that screen media exposure leads to obesity in children and adolescents through increased eating while viewing; exposure to high-calorie, low-nutrient food and beverage marketing that influences children's preferences, purchase requests, consumption habits; and reduced sleep duration. Some evidence also suggests promise for using interactive media to improve eating and physical activity behaviors to prevent or reduce obesity. Future interdisciplinary research is needed to examine the effects of newer mobile and other digital media exposures on obesity; to examine the effectiveness of additional interventions to mitigate the adverse effects of media exposures on obesity and possible moderators and mediators of intervention effects; to effectively use digital media interventions to prevent and reduce obesity; and to uncover the mechanisms underlying the causal relationships and interactions between obesity-related outcomes and media content, characteristics, and context.

The Narrative Impact of Active Video Games on Physical Activity Among Children: A Feasibility Study.

BACKGROUND: Active video games (AVGs) capable of inducing physical activity offer an innovative approach to combating childhood obesity. Unfortunately, children's AVG game play decreases quickly, underscoring the need to identify novel methods for player engagement. Narratives have been demonstrated to influence behaviors. OBJECTIVE: The objective of this study was to test the hypothesis that a narrative would motivate increased AVG play, though a feasibility study that investigated the motivational effect of adding a previously developed narrative cutscene to an originally nonnarrative AVG, Nintendo Wii Sports Resort: Swordplay Showdown. METHODS: A total of 40 overweight and obese 8- to 11-year-olds equally divided by sex played the AVG. Half (n=20) were randomly assigned to a narrative group that watched the narrative cutscene before game play. The other half played the game without watching it. RESULTS: Children in the narrative group had significantly (P<.05) more steps per 10-second period (mean 3.2, SD 0.7) and overall (mean 523, SD 203) during game play compared with the nonnarrative group (10-second period: mean 2.7, SD 0.7; overall: mean 366, SD 172). CONCLUSIONS: The AVG with narrative induced increased physical activity. Additional research is needed to understand the mechanisms through which narrative increases physical activity during AVG game play.

Children's Cognitive and Affective Responses About a Narrative Versus a Non-Narrative Cartoon Designed for an Active Videogame.

OBJECTIVE: This article presents the results of interviews conducted with children regarding their cognitive and affective responses toward a narrative and a non-narrative cartoon. The findings will be used to further explore the role of a narrative in motivating continued active videogame play. MATERIALS AND METHODS: Twenty children (8-11 years old of mixed gender) watched two cartoons (narrative and non-narrative) and were subsequently interviewed. A thematic matrix was used to analyze the interviews. RESULTS: The narrative cartoon (n = 11) was only slightly preferred compared with the non-narrative one (n = 9), with little difference among the participants. The theme categories identified during the analyses were plot, characters, and suggestions. The fight scenes were mentioned by the children as a likeable aspect of the narrative cartoon. In the non-narrative cartoon, the vast majority (n = 17) liked the information about physical activity that was provided. The children enjoyed the appearance and personalities of the characters in both cartoons. A discrepancy in the data about the fight scenes (narrative cartoon) and characters (both cartoons) was found among the female participants (i.e., some girls did not like the fight and thought the characters were too aggressive). However, most of the children wanted to see more action in the story, an increase in the number of fight scenes (narrative cartoon), or more information about exercise and examples of exercises they could do (non-narrative cartoon). They also suggested adding a game to the non-narrative cartoon, including more characters, and improving the animation in both cartoons. CONCLUSIONS: The children preferred the narrative cartoon because of the story and the fight. Some gender differences were found, which further studies should investigate.

Games for Health for Children-Current Status and Needed Research.

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population's diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.

Narrative in Exergames: Thoughts on Procedure, Mechanism, and Others.

Narratives are stories with a beginning, middle, and end that provide information about the characters and plot. Exergames are videogames that require players to move or exercise. Narratives and exergames have seldom been examined together. Based on my review of the literature, there are five potential opportunities narratives could bring to exergames: Enhanced engagement with characters and with the plot, increased motivation, repeated play sessions, and better behavioral consequence. However, the rewards offered by these possibilities may be offset by the challenges they pose. These challenges include the difficulty in fully integrating narratives into the gameplay, the players' limited information processing capacity, difficulty in measurement, the lack of full understanding of the player-character identification process, and the narrative saturation effects. Innovative research is needed to bridge the two potentially important domains.