PSYCHOLOGICAL RESEARCH IN POPULAR MEDIA CRITIQUE PAPER

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Available online at www.sciencedirect.com

Journal of Sport and Health Science 00 (2018) 1�8 www.jshs.org.cn

Original article

Effects of exergaming on motor skill competence, perceived competence,

and physical activity in preschool children

Zan Gao a,*, Nan Zeng b, Zachary C. Pope c, Ru Wang d, Fang Yu e

a School of Kinesiology, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA bDepartment of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA

c School of Public Health, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA d School of Kinesiology, Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China

e School of Nursing, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA

Received 24 August 2018; revised 24 S

eptember 2018; accepted 6 October 2018

Available online xxx

Abstract

Background: Few school settings offer opportunities for preschool children to engage in structured physical activity, and only a few studies have

been conducted examining exergaming’s effectiveness on health outcomes in this age group. This study’s purpose, therefore, was to examine a

school-based exergaming intervention’s effect on preschool children’s perceived competence, motor skill competence (MSC), and physical

activity versus usual care (recess), as well as to examine gender differences for these outcomes.

Methods: A total of 65 preschool children from 2 underserved urban schools were assigned to 1 of 2 conditions, with the school as the experimen-

tal unit: (1) usual care recess group (8 weeks of 100 min of recess/week (5 days£ 20 min)) and (2) exergaming intervention group (8 weeks of 100 min of exergaming/week (5 days£ 20 min) at school). All children underwent identical assessments of perceived competence, MSC, and moderate-to-vigorous physical activity (MVPA) at baseline and at the end of the eighth week.

Results: A significant Group£ Time effect was observed for MVPA, F(1, 52) = 4.37, p = 0.04, h2p = 0.04, but not for perceived competence, F(1, 52) = 0.83, p = 0.37, h2p = 0.02, or MSC, F(1, 52) = 0.02, p = 0.88, h

2 p = 0.00. Specifically, the intervention children displayed significantly greater

increased MVPA after 8 weeks than the comparison children. Additionally, there was a significant time effect for MSC, F(1, 52) = 15.61, p < 0.01,

h2p = 0.23, and gender effect for MVPA, F(1, 52) = 5.06, p = 0.02, h 2 p = 0.09. Although all preschoolers’ MSC improved across time, boys demonstrated

greater MVPA than girls at both time points.

Conclusion: Exergaming showed a positive effect in promoting preschool children’s MVPA at school and has the potential to enhance perceived

competence and MSC. More research with larger sample sizes and longer study durations are warranted.

� 2019 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Active video games; Childhood obesity; Gender differences; Moderate-to-vigorous physical activity; Recess

1. Introduction

The prevalence of childhood obesity has grown from 6.5% to

16.9% in the United States in the past 3 decades, which is par-

tially owing to low physical activity (PA).1 Low PA also results

in low cardiovascular fitness, which, along with obesity,

increases hypertension and hypercholesterolemia risk during

childhood and contributes to chronic disease development, such

as hypertension and diabetes, in adulthood.2�4 PA participation plays a key role in preventing and decreasing obesity and low

Peer review under responsibility of Shanghai University of Sport.

* Corresponding author.

E-mail address: [email protected] (Z. Gao).

https://doi.org/10.1016/j.jshs.2018.12.001

2095-2546/� 2019 Published by Elsevier B.V. on behalf of Shanghai University of (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Please cite this article as: Zan Gao et al., Effects of exergaming on motor skill competence,

Health Science (2018), https://doi.org/10.1016/j.jshs.2018.12.001

cardiovascular fitness among young children, and children of

low socioeconomic status are particularly more likely to be sed-

entary.5,6 Furthermore, the preschool years (ages 4�5 years) have been identified as a crucial time to promote healthy life-

style habits, which could assist in the prevention of obesity and

chronic diseases as children age.7,8 However, few studies have

focused on the effects of PA interventions in this population in

general and underserved populations in particular.

1.1. Literature on intervention studies among preschool children

Available intervention studies of curricular changes that

promote preschool children’s PA have yielded inconclusive

observations, with some indicating significantly increased PA

Sport. This is an open access article under the CC BY-NC-ND license.

perceived competence, and physical activity in preschool children, Journal of Sport and

ARTICLE IN PRESS

2 Z. Gao et al.

between intervention and control groups,9�11 whereas others found no between-group differences.12�14 In contrast with tra- ditional PA interventions, technology-enabled interventions

such as exergames have emerged, demonstrating initial posi-

tive influences on some components of motor skill competence

(MSC).15�21 Research has also suggested that low PA levels in preschool children might be related to delayed acquisition of

MSC in early childhood.22 Although school-based settings

offer opportunities to promote preschool children’s health,

most empirical studies to date were conducted in daycare and

Head Start centers.9�15 Thus, the implementation of develop- mentally appropriate and engaging PA interventions for pre-

school children within school-based settings has become a

high research priority.

1.2. Exergaming for PA promotion

Exergaming refers to active video games that are also a

form of exercise.23 Despite exergaming’s screen-based nature,

exergaming has the potential to help promote preschool child-

ren’s PA. Recently, exergaming has been increasingly used

within school-based settings as an innovative and fun approach

for promoting a physically active lifestyle, with positive and

promising results.24�29 However, previous studies targeted only older children and adolescents (age range:7�18 years). Yet, many developmentally appropriate exergames (e.g., Wii

Nickelodeon Fit) have been developed for preschool children,

thus facilitating examination of exergaming’s effect among

this population. Moreover, most exergaming studies have

focused on only 1 outcome (e.g., energy expenditure).24,29

Therefore, such studies have yet to explain exergaming’s

effects on other important aspects of child development such

as MSC and perceived competence.

1.3. Competence motivation theory

According to the competence motivation theory,30 a child’s

behavior can be explained and predicted by perceived compe-

tence and mastery competence. Perceived competence refers

to children’s self-evaluative judgment about their ability to

accomplish certain tasks, whereas mastery competence refers

to the actual ability to complete the tasks (e.g., actual MSC).31

According to this theory, successfully mastering skills/tasks

(e.g., improvement of MSC resulting from exergaming

play) will augment perceived competence, which in turn

boosts motivated behaviors (e.g., PA participation) and actual

performance (e.g., MSC).32,33 Furthermore, better MSC is

consistently associated with higher PA in longitudinal and

cross-sectional studies.34�36

Recent studies suggest that exergaming has the potential to

improve older children’s perceived competence, MSC, and

PA. For example, exergaming has been shown to be effective

in promoting elementary school children’s PA levels,24,37�40

and perceived competence or self-efficacy.41�43 Yet, exer- gaming’s effectiveness on children’s MSC is still under heated

debate. Zeng and Gao in their review44 suggested that exer-

gaming could serve as an alternative tool for enhancing body

management skills (e.g., balance, postural stability), but that

Please cite this article as: Zan Gao et al., Effects of exergaming on motor skill competence,

Health Science (2018), https://doi.org/10.1016/j.jshs.2018.12.001

exergaming offered insufficient stimulus for locomotor and

object control skills changes among children and young adults.

However, little empirical evidence of exergaming’s effect on

MSC in preschool children is available and suggests an impor-

tant avenue for research.

1.4. Gender differences

Gender differences have been reported for children’s MSC,

perceived competence, and PA.45�51 Specifically, boys have been found to be more proficient in motor competence for

most, but not all, motor skills (e.g., throwing)45,46 and are

more likely to exhibit greater perceived competence in sport

or PA than girls.47,48 Boys were also more physically active

than girls in most empirical studies.6,49,50 Yet, such gender dif-

ferences in preschool children remain largely unexplored.51

Thus, there is a clear need to examine the gender differences

for these variables in this population.

This study’s purpose was 2-fold: (1) to examine exer-

gaming’s effects on perceived competence, MSC, and PA in

underserved preschool children and (2) to evaluate whether

gender differences exist for exergaming’s effect on perceived

competence, MSC, and PA. To our knowledge, this is the first

study investigating exergaming’s effects on these outcomes in

this population. Examining a novel exergaming intervention’s

effects on children’s perceived competence, MSC, and PA will

help researchers and health professionals to understand how

innovative school-based PA interventions may be implemented

for preschool children’s PA and health promotion. This study is

also significant because it investigates the potential gender

differences that an exergaming intervention may minimize

among this age group, thus providing further understanding

of how a school-based exergaming program among preschool

children might be implemented with these differences in mind.

2. Methods

2.1. Research design and participants

The sample size was calculated by G*Power 3.1 (http://

www.gpower.hhu.de/en.html), indicating that 60 participants

would be sufficient for 80% power (a = 0.05, effect

size = 0.30) to test the primary outcome (i.e., PA). This study

used a 2-arm experimental design with repeated measures. A

total of 65 preschoolers (33 girls; 4.45 § 0.46 years (mean § SD)) from 2 urban underserved elementary schools in a Mid-

western U.S. state were enrolled, and were then assigned to

either the exergaming intervention or a standard care compari-

son group, with the school as the experimental unit. The school

district within which the study was conducted offered half-day

early childhood programs free of charge to parents. Two clas-

ses (morning and afternoon) with approximately 10�20 chil- dren in each class from each school were involved in the

current study. Participants were in school for approximately

3 h from Monday to Friday. The intervention took place over

an 8-week period for 30 min per session (including 20 min of

exergaming and 10 min of warm-up and cool-down) 5 days

perceived competence, and physical activity in preschool children, Journal of Sport and

ARTICLE IN PRESS

Exergaming and Motor Skills 3

per week. Children’s baseline perceived competence, MSC,

and PA were measured before and after the intervention.

To be eligible for this study, a school had to offer a pre-

school program (e.g., High Five) for children 4�5 years of age and serve low-income communities. The inclusion criteria for

children were that they (1) be enrolled in a public Title I ele-

mentary school (i.e., >50% of the children receive free or

reduced-price meals), (2) be 4�5 years of age, (3) have no diagnosed physical or mental disability, and (4) have parental

consent and the preschooler’s verbal assent. This study was

approved by the University of Minnesota Institutional Review

Board and school district according to the 1964 Helsinki Dec-

laration and its later amendments or comparable ethical stand-

ards.

2.2. Procedures

Participants were recruited at the schools’ preschool classes

with assistance from the classroom teachers. Specifically, the

teachers put flyers describing the study into potential partic-

ipants’ backpacks and instructed them give the flyers to their

parents. The preschool children who returned the signed con-

sent forms were then screened by the researchers. At baseline,

the researchers administered a battery of assessments for the

outcomes. All children underwent identical assessments at

the end of the eighth week. To protect privacy, perceived

competence assessments occurred in private rooms during

one-on-one sessions. MSC testing took place in the schools’

gyms, and PA tracking took place throughout the entirety of

the school day. All data were collected over a 2-week period

at baseline. First, the research team introduced the study and

obtained consent. Then, children’s height, weight, perceived

competence, MSC, and PA were measured based on school

schedules and space availabilities both at baseline and after the

8-week intervention period for each testing cycle. If a child was

absent from school on a day when measurements were being

conducted, we collected these data on another day. These proce-

dures ensured that missing data were minimized. A gift card for

USD20 was given to each child’s parents as an incentive for

successfully completing all data collection sessions.

2.3. Intervention implementation

2.3.1. Exergaming condition

The primary researcher collaborated with school adminis-

trators and teachers, and incorporated exergaming into the

intervention school’s preschool curriculum. Specifically, the

research team set up 8 exergaming stations in a large room

separate from the main classroom. Each station was equipped

with 1 exergaming system (Wii or Xbox Kinect), a television,

and necessary ancillary supplies. Several developmentally

appropriate exergames, such as Wii (Nintendo, Kyoto, Japan)

Just Dance for Kids, Wii Nickelodeon Fit, and Xbox 360 Kin-

ect (Microsoft, Seattle, WA, USA) Just Dance for Kids, were

offered during the program, which promoted autonomy and

sustained motivation for participation across time. Depending

on the children’s desires, exergaming play occurred individu-

ally, in pairs, or as a group, with the supervising teacher or

Please cite this article as: Zan Gao et al., Effects of exergaming on motor skill competence,

Health Science (2018), https://doi.org/10.1016/j.jshs.2018.12.001

research assistant assisting children in gameplay throughout to

ensure continuous gameplay and, thus, PA. Exergaming ses-

sions included daily 20-min nonstop exergaming play, with

about 10 min daily allocated for organization (e.g., lining up

and walking down the hallway to exergaming room) and

warm-up/cool-down time.

2.3.2. Comparison condition

Standard care was represented by recess and implemented

at the comparison school. Recess time remained constant

throughout the school year, with the comparison school offer-

ing identical active time to that of the intervention school.

Recess was held on an outside playground with standard play-

ground equipment apparatus and a grass field. On some occa-

sions, recess had to be held within a school classroom owing

to poor weather. Recess was supervised by the classroom

teachers and teaching aids, but no structured PA was offered

during the period. Participants engaged in varied activities dur-

ing recess, such as chasing, tag, 4 square, and playing with

other playground equipment (e.g., slides, swings).

2.3.3. Intervention fidelity

Intervention fidelity was continuously monitored for all

intervention components. Specifically, the primary researcher

met weekly with the exercise interventionist (NZ) for program

training and monitoring to ensure consistency of the exergam-

ing program at the school site. The research team monitored the

PA intervention implementation on a weekly basis with previ-

ously established protocols. Research process evaluators were

provided with a standardized protocol for each school visit and

completed a checklist for each visit indicating the elements of

the protocol that were covered in each PA session. We also col-

lected process and implementation surveys on a regular basis to

monitor implementation and content fidelity and child engage-

ment. In this study, intervention fidelity exceeded 90% for the

protocol elements covered in a given PA session.

2.4. Measures

2.4.1. Demographic and anthropometric data

Children’s demographic information (e.g., age, gender, race/

ethnicity) were collected from the teachers’ rosters. Their height

and weight were assessed with a Seca stadiometer (Seca, Ham-

burg, Germany) and Detecto digital weight scale (Detecto, Web

City, MO, USA), respectively, at each time point, with each

child measured in a private room adjacent to their classroom.

2.4.2. PA Levels

PA was assessed by ActiGraph GT9X Link accelerometers

(ActiGraph Corp., Pensacola, FL, USA). The ActiGraph Link

is lightweight and resembles a watch. It is a valid and reliable

measure of PA among children in school settings and free-

living settings.52,53 Specifically, children were instructed to

wear the accelerometers on the nondominant wrist at all times

during the school day for 3 school days during the first week

baseline and after the eighth week of the study. Activity counts

were set at 1-s epoch given the sporadic nature of children’s

perceived competence, and physical activity in preschool children, Journal of Sport and

Table 1

ARTICLE IN PRESS

4 Z. Gao et al.

PA. The activity counts recorded were interpreted using

empirically based cut points that define different intensities

(sedentary: 0�820; light PA: 821�2830; moderate-to-vigorous PA (MVPA): �2831 for ActiGraph vector magnitude) of pre- school children’s PA.52 Compliance with wearing accelerometers

was facilitated according to Trost et al.53 Children’s average per-

centages of time in MVPA at school were used as the outcome.

Notably, the accelerometers were not allowed to be taken home

given the following considerations: (1) additional burden for

underserved families, (2) possibility of lost or stolen devices, and

(3) incomplete and inaccurate measurements. Therefore, only PA

during school time was used for the current study.

2.4.3. MSC

The Test of Gross Motor Development-2 (TGMD-2)54 was

used to assess each participant’s MSC. The TGMD-2 is a qual-

itative measure of the gross motor skills of children aged

3�10 years. The 5 skills tested were subdivided into 2 skill areas: locomotor skills (run, hop, and jump) and object control

skills (throw and kick). Children executed each skill twice,

and the tests were videotaped for later evaluation. To indicate

skill performance, qualitative performance criteria were

scored, with 1 indicating its presence and 0 its absence. If a

skill was assessed using 3 performance criteria, the raw scores

could thus vary between 0 and 6. The sum of the scores was

used as each child’s MSC. Notably, 2 trained researchers (NZ,

ZCP) assessed and scored the TGMD-2 assessments, with

greater than 90% agreement between these researchers.

2.4.4. Perceived competence

The subscale of perceived physical competence from the Pic-

torial Scale of Perceived Competence and Social Acceptance55

was used to examine perceived competence. The scale was

selected for the following reasons: (1) it has strong psychometric

properties for children 4 years of age and older (i.e., a > 0.70);55

(2) it is developmental in nature, reflecting children’s changing

perception of self at young ages; and (3) it is widely used and

accepted in the literature.56,57 Children responded to a 5-item per-

ceived physical competence survey using a 4-point Likert-type

scale (1 (not to good) to 4 (really to good)). The average score

was calculated and used as a measure of each child’s perceived

competence, with the assessment individually administered within

a private room at each school to protect the children’s privacy.

Demographic characteristics of participants.

School A (n = 20) School B (n = 36) Total (n = 56)

Gender

Girl 9 (45) 22 (61.11) 31 (55.36)

Boy 11 (55) 14 (38.89) 25 (44.64)

Race

White 3 (15) 20 (55.56) 23 (41.07)

Black 12 (60) 5 (13.89) 17 (30.36)

Hispanic 4 (20) 5 (13.89) 9 (16.07)

Asian 0 (0) 5 (13.89) 5 (8.93)

Other 1 (5) 1 (2.77) 2 (3.57)

Age (year) 4.72 § 0.34 4.33 § 0.46 4.46 § 0.46 Height (cm) 111.58 § 5.61 107.07 § 5.77 108.71§ 6.07 Weight (kg) 20.22§ 3.99 18.27§ 2.75 18.98§ 3.35 Note: Data are presented as number (%) or mean § SD.

2.5. Data analysis

Data were imported from Excel into an SPSS 23.0 (IBMCorp.,

Armonk, NY, USA) dataset for descriptive and inferential statisti-

cal analyses. Screening for outliers and non-normality was con-

ducted before the main analysis. First, a descriptive analysis was

conducted to describe the sample characteristics, including fre-

quencies of gender and race/ethnicity and all variables’ means

and standard deviations. Second, a multivariate analysis of vari-

ance with repeated measures was used to examine changes in pre-

school children’s perceived competence, MSC, and MVPA

across time. The between-subject factors were group (i.e., inter-

vention vs. comparison school) and gender (boys vs. girls),

Please cite this article as: Zan Gao et al., Effects of exergaming on motor skill competence,

Health Science (2018), https://doi.org/10.1016/j.jshs.2018.12.001

whereas the within-subject factor was time. A significant

Group£ Time interaction effect would indicate that children in the intervention group have a different amount of the change in

the outcomes compared with those of the comparison group,

which was the major focus of this study. The significance level

was set at 0.05 for all statistical analyses, with effect sizes reported

for each comparison. Specifically, partial eta-squared (h2p) was used as an index of effect size, for which small, medium, and large

effect sizes were designated as 0.10, 0.25, and 0.40, respectively.58

3. Results

A total of 9 preschool children had missing data or outliers

for 1 or more outcome variables at either baseline or 8 weeks,

and thus were removed from the analysis. The final sample

comprised 56 preschool children (mean age: 4.46 years; 31

girls). Detailed demographic and anthropometric information

is displayed in Table 1. Table 2 shows the descriptive results

for the preschool children’s perceived competence, MSC, and

MVPA between intervention/gender groups and across time.

On average, the preschool children demonstrated moderate

levels of perceived competence and MSC since the means of

these variables were above the median scores across time (per-

ceived competence = 2.5; MSC = 24). Notably, children spent

nearly 40% of school time in MVPA.

As shown in Fig. 1A, a small, yet significant, Group£ Time interaction for MVPA was observed (F(1, 52) = 4.37, p = 0.04,

h2p = 0.04), but there were no significant interaction effects for

MSC (F(1, 52) = 0.02, p = 0.88, h2p = 0.00) (Fig. 2A), or perceived

competence (F(1, 52) = 0.83, p = 0.37, h2p = 0.02) Fig. 3A). In

detail, intervention children had significantly greater increased

percentage of time in MVPA than those in the comparison group

with small effect size. Moreover, there were no significant inter-

action effects of Group£Gender£ Time or Gender£ Time for any variables. Although the intervention children displayed

greater increased perceived competence and MSC at post-test

than the comparison children (Table 2), these improvements ver-

sus comparison did not reach statistical significance.

A significant time effect was observed for MSC

(F(1, 52) = 15.61, p < 0.01, h2p = 0.23) (Fig. 2A), but not MVPA

(F(1, 52) = 0.23, p = 0.64, h2p = 0.01) (Fig. 1A), or perceived

perceived competence, and physical activity in preschool children, Journal of Sport and

Table 2

Descriptive statistics of children’s MVPA, MSC, and PC (mean § SD). Pre-test Post-test

Girl Boy All Girl Boy All

Exergaming (n = 20)

MVPA 37.86§ 7.84 38.46§ 4.84 38.19§ 6.19 40.54§ 6.80 43.62§ 3.69 42.24 § 5.39 MSC 31.89§ 4.40 31.55§ 4.89 31.7 § 4.55 34.22§ 2.05 35.55§ 5.77 34.95 § 4.44 PC 3.26 § 0.39 3.08 § 0.49 3.16 § 0.44 3.15 § 0.44 3.24 § 0.60 3.2 § 0.52 Comparison (n = 36)

MVPA 36.46§ 10.07 44.09§ 13.66 39.43§ 12.01 36.07§ 5.63 39.53§ 2.89 37.42 § 5.00 MSC 29.09§ 8.62 33.86§ 4.85 30.94§ 7.67 33.82§ 7.47 35.00§ 5.46 34.28 § 6.70 PC 3.14 § 0.59 3.35 § 0.29 3.21 § 0.50 2.96 § 0.57 3.24 § 0.58 3.07 § 0.58 Abbreviations: MSC =motor skill competence; MVPA =moderate-to-vigorous physical activity; PC = perceived competence.

ARTICLE IN PRESS

Exergaming and Motor Skills 5

competence (F(1, 52) = 0.37, p = 0.54, h2p = 0.02) (Fig. 3A).

Further, there was no significant group effect for any variable.

Of note, a significant gender effect was observed for MVPA,

(F(1, 52) = 5.06, p = 0.02, h2p = 0.09) (Fig. 1B and 1C). Specifi-

cally, boys demonstrated higher MVPA than girls at both

time points. Gender effects were not observed for MSC

(F(1, 52) = 1.15, p = 0.29, h2p = 0.02) (Fig. 2B and 2C), or per-

ceived competence (F(1, 52) = 0.74, p = 0.39, h2p = 0.01) (Fig. 3B and 3C).

A

B

C

Exergaming Comparison

Exergaming Comparison

Exergaming Comparison

Pre-test Post-test

Pre-test Post-test

Pre-test Post-test

45

40

35

45

40

35

45

40

35

Fig. 1. Changes of preschoolers’ moderate-to-vigorous physical activity over

time for the whole sample (A) and by genders (B for boys, C for girls).

Please cite this article as: Zan Gao et al., Effects of exergaming on motor skill competence,

Health Science (2018), https://doi.org/10.1016/j.jshs.2018.12.001

4. Discussion

Exergaming has been increasingly integrated into various

school-based programs owing to its potential to promote PA

among children,24,27,28,59 yet no known studies are available

investigating exergaming’s effects on preschool children’s PA,

MSC, and perceived competence. This study attempted to fill

this knowledge gap. Study observations suggested that interven-

tion children a had small yet significantly greater increased

Fig. 2. Changes of preschoolers’ motor skill competence over time for the

whole sample (A) and by genders (B for boys, C for girls).

perceived competence, and physical activity in preschool children, Journal of Sport and

Exergaming Comparison

Exergaming Comparison

3.4

3.2

3.4

3.2

3.0

3.4

3.0

3.2

Pre-test Post-test

Pre-test Post-test

Pre-test Post-test

A

B

C

3.0

Exergaming Comparison

Fig. 3. Changes of preschoolers’ perceived competence over time for the

whole sample (A) and by genders (B for boys, C for girls).

ARTICLE IN PRESS

6 Z. Gao et al.

percentage of time in MVPA during the intervention versus

comparison, while also demonstrating nonsignificant yet greater

increased perceived competence and MSC at post-test than at

baseline versus comparison children.

The observation regarding exergaming’s effect on MVPA is

congruent with several previous studies,24,27,28,60 suggesting

positive effects of exergaming on youths’ PA levels. For

instance, Gao et al.24 recently reported that a school-based

exergaming program promoted the objectively determined

daily MVPA of children 7�10 years old over a 2-year period. It is posited that exergaming’s fun and entertaining nature lead

to such positive effects.27,28,42,60 This finding is notable

because PA enjoyment has been observed to be predictive of

children’s PA.23,27,28,32 Future research should investigate pre-

school children’s perceived enjoyment during exergaming ver-

sus comparison modes of PA, with follow-up examination in

later years of school (e.g., first or second grade) to discern

whether the potentially greater enjoyment of exergaming pro-

motes higher daily PA in later childhood.

Similar to the observations for MVPA, increases in MSC

and perceived competence were observed among the interven-

tion children during the intervention versus comparison.

Despite the nonsignificance of these increases, such trends

provide initial evidence for exergaming’s positive effect on

Please cite this article as: Zan Gao et al., Effects of exergaming on motor skill competence,

Health Science (2018), https://doi.org/10.1016/j.jshs.2018.12.001

these outcomes, particularly regarding perceived competence,

because the increased perceived competence among interven-

tion children was accompanied by decreases in this variable

among comparison children. These observations echo those of

previous studies20,27,43,44 and a recent study indicating exer-

gaming’s positive effect on perceived competence in children

with autism.21 Notably, the lack of significance may have been

attributable to the short intervention duration, along with other

factors such as small sample size and overall PA dose. Hence,

longer exergaming intervention periods among preschool chil-

dren is highly recommended in the future. Taken together,

these observations are the first of their kind in exergaming

studies among preschoolers and are encouraging given the fact

that greater increases in MVPA, perceived competence, and

MSC through exergaming may aid in long-term PA participa-

tion and subsequent health promotion.27,44

Unsurprisingly, preschoolers’ MSC significantly improved

from baseline to the eighth week regardless of group and gender

affiliations. This observation is consistent with those of previous

studies of preschool children.15,16 Several reasons may account

for MSC increases in the present study: (1) it may improve as

they age, (2) both intervention and comparison children

engaged in PA (i.e., exergaming or recess) during the interven-

tion period and thus their MSC may have improved simply

owing to PA participation, and (3) MSC scores improved par-

tially owing to a learned effect at the follow-up MSC assess-

ments.44 Notably, however, the whole sample’s MVPA and

perceived competence did not improve significantly across

time, because greater increases were observed in intervention

children, suggesting PA modality (exergaming vs. recess) did

influence these outcomes to some degree.

Finally, a significant gender effect for preschool children’s

MVPA was observed, with boys demonstrating greater MVPA

than girls across time. This observation mirrors that of Gao6 in

that gender differences in PA were identified in older children

during exergaming play. It is noteworthy that, in the current

study, the intervention children rotated gameplay stations and

engaged in various sports and dance games throughout the

8-week intervention. Hence, the significant gender difference

observed may be partially attributable to the child perceiving a

game as more or less gender appropriate (e.g., a girl may not be

as motivated to play a sport game as a dance game). Indeed, it

is plausible that a gender gap may begin in the preschool years.

However, no gender differences in MSC and perceived compe-

tence were identified, which is incongruent with observations in

studies with older children.45�48 Future research is needed among preschool-age populations to further examine these

trends. Nonetheless, this study’s observations do provide new,

much-needed empirical evidence on the gender differences in

MSC and perceived competence among preschool children.

The present study’s observations shed light on the practical

implications of integrating exergaming within a school-based

setting among preschoolers. First, exergaming could be consid-

ered an alternative component for school-based PA programs

among preschool children. Indeed, exergaming, with its enter-

taining and active nature, might help young children to become

more physically active while also having fun—components few

perceived competence, and physical activity in preschool children, Journal of Sport and

ARTICLE IN PRESS

Exergaming and Motor Skills 7

other traditional PA modalities offer. Also, exergaming’s enjoy-

able nature may lead to children’s long-term PA adherence.23,27

Thus, educators and health professionals might integrate exer-

gaming into the school’s overall curriculum to replace some

school-time sedentary activities for preschool children. Addi-

tionally, exergaming demonstrates the potential to improve per-

ceived competence and MSC in preschool children. It is

recommended that longer-term exergaming interventions be

adopted to fully elucidate whether these positive initial trends in

MSC and perceived competence can be built on. Finally, the

gender differences in MVPA, regardless of group affiliation,

also indicate that more gender-appropriate activities may be

offered to girls regardless of PA modality, with the goal of

decreasing the gender gap in PA participation.

This study had the following strengths: (1) it was the first

known study to integrate exergaming, a novel and enjoyable

PA modality, into school-based curriculum among preschool

children; (2) intervention fidelity was ensured at school set-

tings via process evaluation, such as biweekly surveys about

implementation, dose, and fidelity as well as student engage-

ment; and (3) a large number of underserved children of

minority and low socioeconomic status were targeted. Nev-

ertheless, the study is limited in the following ways. First,

participants came from only 2 underserved urban schools,

with the sample size being modest, which limits the gener-

alizability of the study observations. Consequently, a larger

sample of multiple school sites should be targeted in the

future. Second, in the current study, only preschool child-

ren’s time in MVPA during school hours was captured, thus

missing the important implications an intervention of this

type may have on PA outside of school. Future research

should use the same objective instruments to assess pre-

school children’s daily PA levels. Additionally, although

strict intervention fidelity protocol was used during this

study, it is noteworthy that the intervention length was rela-

tively short. Longer but similar high-quality interventions

are recommended for future studies. Finally, the intervention

was executed with school as the experimental unit, with ran-

domization at the individual level not adopted owing to the

inability to randomize children to different classrooms.

Hence, researchers could not control for some threats to this

study’s internal validity, for example, the history threat of

afterschool PA programs. In the future, a group randomized

controlled trial with multiple schools as experimental sites

may be used to minimize the internal validity threats.

5. Conclusion

The current study’s observations shed new light on exer-

gaming’s impact on preschool children’s PA, MSC, and per-

ceived competence when compared with usual care (recess)

practice. Indeed, exergaming demonstrated a positive effect in

promoting preschool children’s MVPA at school and has the

potential to enhance MSC and perceived competence. More

quality studies are called for to discern exergaming’s role in

improving PA and other health indices61 among underserved

preschool children.

Please cite this article as: Zan Gao et al., Effects of exergaming on motor skill competence,

Health Science (2018), https://doi.org/10.1016/j.jshs.2018.12.001

Acknowledgment

This study was funded by a grant from the National Insti-

tutes of Health (No. 1R56HL130078-01).

Authors’ contributions

ZG conceived of the study, participated in its design and

coordination, carried out the study, and drafted the manuscript;

NZ performed the data collection/sorting and helped to draft

the manuscript; ZCP helped to collect data and draft the manu-

script; RW helped with the data analysis and helped to draft

the manuscript; FY helped to draft the manuscript. All authors

have read and approved the final version of the manuscript,

and agree with the order of presentation of the authors.

Competing interests

The authors declare that they have no competing interests.

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