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Summary What is already known about this subject Active video games (AVGs) are being marketed as exercise tools. AVG play can result in light‐to‐moderate intensity physical activity. What this study adds A comparison correcting for body size between the energy expended by children with obesity and those of a healthy weight playing AVGs. An examination of several variables related to the energy cost of AVG play including steps taken and rate of perceived exertion. There may be some differences in how children with obesity and children of a healthy weight play AVGs. Background Increasing physical activity and reducing sedentary behaviour form a large part of the treatment of paediatric obesity. However, many children today spend prolonged periods of time playing sedentary video games. Active video games (AVGs) represent a novel and child friendly form of physical activity. Objectives To measure the energy cost of playing two AVGs in children with obesity and healthy age‐ and gender‐matched children. Methods The energy cost of gaming and heart rates achieved during gaming conditions were compared between groups. Results AVG play can result in light‐to‐moderate intensity physical activity (2.7–5.4 metabolic equivalents). When corrected for fat‐free mass those with obesity expended significantly less energy than healthy weight peers playing Nintendo Wii Fit Free Jogging (P = 0.017). No significant difference was seen between groups in the energy cost of playing Boxing. Conclusion Certain AVGs, particularly those that require lower limb movement, could be used to increase total energy expenditure, replace more sedentary activities, or achieve moderate intensity physical activity among children with obesity. There seems to be some differences in how children with obesity and children of a healthy weight play AVGs. This could result in those with obesity expending less energy than their lean peers during AVG play.

Active video games are a useful source of light to moderate intensity physical activity in children with cystic fibrosis.

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Habitual physical activity of all intensities is associated with reduced arterial stiffness among adults with hypertension.