A population level increase in physical activity (PA) is critical to reduce obesity in youth. Video games are highly popular and active video games (AVGs) have the potential to play a role in promoting youth PA. Studies on AVG play energy expenditure (EE) and maintenance of play in youth were systematically identified in the published literature and assessed for quality and informational value. Nine studies measuring AVG play EE were identified. The meta-analytic estimates of average METs across these studies were 3.1 (95% CI: 2.6, 3.6) to 3.2 (95% CI: 2.7, 3.7). No games elicited an average EE above the 6 MET threshold for vigorous EE. Observed differences between studies were likely due to the different types of games used, rather than age or gender. Four studies related to maintenance of play were identified. Most studies reported AVG use declined over time. Studies were of low-to-medium quality. AVGs are capable of generating EE in youth to attain PA guidelines. Few studies have assessed sustainability of AVG play, which appears to diminish after a short period of time for most players. Better-quality future research must address how AVG play could be maintained over longer periods of time.
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