literature review for video games

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Peer-reviewed

Research Article

Video games and board games: Effects of playing practice on cognition

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Writing – original draft

Affiliation Centre de Recherches sur la Cognition et l’Apprentissage, Université de Poitiers, Poitiers, France

Roles Conceptualization, Methodology, Software, Writing – review & editing

Roles Conceptualization, Methodology, Writing – review & editing

* E-mail: [email protected]

• Léa Martinez, 
• Manuel Gimenes, 
• Eric Lambert

• Published: March 27, 2023
• https://doi.org/10.1371/journal.pone.0283654
• Reader Comments

The worldwide popularity of playing practices has led to a growing research interest in games’ impact on behavior and cognition. Many studies have already reported the benefits of both video games and board games for cognitive functions. However, these studies have mainly defined the term players according to a minimum play time or in connection to a specific game genre. No study has confronted the cognitive implications of video games and board games in the same statistical model. Thus, it remains unclear whether the cognitive benefits of play are due to play time or game type. To address this issue, in this study, we conducted an online experiment in which 496 participants completed six cognitive tests and a playing practice questionnaire. We examined the between the participants’ overall video game and board game play times and cognitive abilities. The results demonstrated significant relations between overall play time and all cognitive functions. Importantly, video games significantly predicted mental flexibility, planning, visual working memory, visuospatial processing, fluid intelligence, and verbal working memory performance, while board games were not found to predict any cognitive performance. These findings suggest that video games affect cognitive functions in specific ways compared to board games. We encourage further investigation to consider players’ individual differences through their play time and the specific features of the games they play.

Citation: Martinez L, Gimenes M, Lambert E (2023) Video games and board games: Effects of playing practice on cognition. PLoS ONE 18(3): e0283654. https://doi.org/10.1371/journal.pone.0283654

Editor: Stefano Triberti, University of Milan, ITALY

Received: September 28, 2022; Accepted: March 13, 2023; Published: March 27, 2023

Copyright: © 2023 Martinez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data are available in an Open Science Framework repository, which can be accessed at: https://osf.io/bfv97/ .

Funding: This work was supported by a grant from the ANRT https://www.anrt.asso.fr/fr/cifre-35654 and the Asmodee Company [Bourse CIFRE 2020/0536] to Léa Martinez. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Boasting global markets of over US$150 billion for video games [ 1 ] and over US$7 billion for board games [ 2 ], the game industry represents a major entertainment market. Indeed, the video and board game industries offer a wide range of games that are usable in various domains. The growing popularity of games markets has led to an increasing amount of research on how game practice affects human behavior and cognitive functions. A common method of carrying out such research is to compare players’ and nonplayers’ abilities. Therefore, recent studies have mainly shown that players demonstrate better cognitive performance than non-players do [ 3 , 4 ]. Until now, players have generally been defined according to an overall minimum play time or to a minimum game genre-specific play time. However, player profiles are numerous and represent a wide diversity of playing practices. Moreover, a primary limitation of such research involves the lack of consideration of variability in the players’ play time and the type of game they play. Therefore, it remains unclear whether the cognitive benefits of play are due to overall play time or to specific game types.

Play time–based definition of players

Video games’ benefits for cognitive functions have already been widely demonstrated, with a main effect on executive functions [ 3 ]. Many studies have shown that video gamers outperform non-gamers in terms of attention, visuospatial, working memory, and mental flexibility performances [ 5 – 7 ]. For example, one study considered visual working memory skills and found that participants who played video games for more than 5 hours per week outperformed participants who played video games for less than 5 hours per week in connection to these skills [ 8 ]. Similarly, video game training has been shown to improve attention, visuospatial, and working memory skills [ 9 – 11 ]. For example, playing Call of Duty for 28 hours significantly improved visual working memory performance [ 9 ]. Therefore, recent literature widely supports the beneficial effect of video gaming on cognitive and executive abilities. However, these findings are mainly based on the opposition between gamers and non-gamers as a way to compare the cognitive performance of the two groups. In this way, a first limitation to fully understanding the relationship between play and cognitive functions is the failure to consider individual differences within the gamer group [ 12 ], such as variability in gamers’ overall play time.

Most studies have focused on video gamers and defined them according to their amount of play time in the previous months (e.g., Wong & Chang, (2018) [ 13 ] defined participants who played video games for more than 4 hours a week over the past 6 months as video gamers). However, a consensus has not been reached on the amount of play time defining a video gamer. In their literature review on video games and cognitive enhancement, Choi et al. (2020) [ 3 ] listed 10 studies in which video gamers were defined based on the number of hours spent playing video games per week. In the various studies, participants were considered video gamers if they played for more than 2 hours to 15 hours per week, whereas non-gamers were defined as playing less than 1 hour to 8 hours per week. Therefore, the current way of defining gamers into two groups (i.e., gamers and non-gamers) without considering the variability of their gaming experience represents a bias. Only a few studies have focused on the effect of video gaming on cognitive functions according to specific gamers’ expertise and their play time. These studies mostly examined electronic sports (e-sports) gamers’ cognitive abilities. The term e-sports refers to the individual and collective practice of engaging in video game competitions [ 14 ]. E-sports gamers are mostly considered expert gamers, and they are sometimes professional gamers. Since e-sports gamers report higher play times than casual gamers do [ 5 ], focusing on these gamers allows the effects of intensive video game practice on cognitive functions to be studied. Professional e-sports gamers usually outperform nonprofessional, casual gamers on cognitive tests, such as visuospatial processing, visuospatial memory, and attention tests [ 5 , 15 ]. For example, professional e-sports gamers who play more than 20 hours a week have shown better visuospatial processing, visuospatial memory, and attention performance compared with casual video gamers who play more than 5 hours per week [ 5 ]. The same results have been found when comparing professional and nonprofessional e-sports gamers. Professional e-sports gamers who play about 35 hours a week have been found to outperform nonprofessional e-sports gamers who play about 20 hours a week on a simple visual reaction test [ 15 ]. Thus, whether professional or not, it seems that the more time gamers spend playing video games, the higher their cognitive performance becomes. However, the comparison between e-sports gamers and amateur gamers leads to a confounding variable. Indeed, e-sports corresponds to a specific game practice based on specific video game genres and on competition only. Thus, there is a need to confirm that play time affects the cognitive performance of amateur players. Recent studies overcame the gamer/non-gamer dichotomy by using ordinal variables [ 16 ] or continuous variables [ 17 ] to account for gaming time. Kowal et al. (2018) [ 16 ] categorized participants into five video game time groups (i.e., 0, 1–7, 8–15, 16–22, and 23+ hours per week) and compared the groups’ inhibition and mental flexibility skills. The findings showed that the group with the highest video game time had the lowest overall reaction times to the Stroop test and the lowest non-switching and switching reaction times to the Trail Making Test. However, it remains unclear whether play time, taken as a continuous variable, underlies cognitive performance. Waris et al. (2019) [ 17 ] assessed the relations between time spent playing video games per week and working memory skills. The authors found strong evidence for positive linear relations between weekly video game time and visual working memory and updating skills. However, no significant relation was found considering verbal working memory skills. Therefore, it remains to be confirmed whether play time, taken as a continuous variable, is a significant predictor of overall cognitive abilities.

Game type–based definition of players

In addition to the dichotomous definition of players, a second limitation that restricts a full understanding of the potential relationship between play and cognitive functions is the lack of consideration of playing practice diversity. Numerous studies have highlighted the great potential of action video games to improve cognitive abilities. Action video games can be defined as video games with time pressure, requiring switching between distributed and focused attention and preventing full task automatization [ 18 ]. Bediou et al.’s (2018) [ 19 ] meta-analysis showed that playing action video games robustly improves attention and visuospatial cognition. However, any video game genre (e.g., traditional, simulation, strategy, action, or fantasy video games) may also have the potential to improve cognitive performance [ 3 ]. For example, one study found that players’ visuospatial skills significantly improved after playing the strategy game Portal 2 for 8 hours [ 11 ].

Furthermore, few studies have focused on the effects of non-digital games, such as board games, on cognitive functions. However, a clear-cut distinction exists between video games and board games, as they are defined by unique game features that do not apply equally to both types of games. Inherently, video games correspond to numeric leisure, while board games are mainly analog games. Even though some digitized board games that fully reflect their analog versions exist, they represent only the minority of board games and practices. Moreover, video games are mainly played alone, while board games are played in groups. There is a current trend in which online video game players are playing these games because they allow for interactions between gamers, but these are remote interactions, while board games mostly imply physical and social interactions between the players. In addition, video games are mostly defined by real-time dynamics. Gamers are most often required to make real-time decisions, which are led by the pace of the game. They provide a diversity of actions and environments in a single game, training strategy adaptation skills [ 20 ]. Rather, board games are defined by their requirement for social interactions. They allow for the training of specific strategies and actions in a given game, which mainly depend on players’ interactions.

A new research field on board games and cognitive functions recently emerged [ 21 ], but the number of studies in this field remains limited. These studies have mostly focused on the effects of traditional board games’ effects on the cognitive and executive abilities of the elderly and children’s cognitive and executive abilities [ 22 , 23 ]. Traditional board games correspond to abstract strategy games (e.g., chess, checkers, game of Go). Some training programs using this kind of game have been found to enhance working memory, attention, and global executive abilities [ 4 ]. Chess practice is positively related to fluid intelligence, short-term memory [ 24 ] and decision making performance [ 25 ], whereas game of Go practice enhances working memory performance [ 26 ]. Playing traditional board games has been shown to be related to a neural reorganization of brain areas associated with attentional control, working memory, and problem solving [ 27 , 28 ]. Similarly, playing modern board games also seems to improve cognitive and executive abilities.

Compared with traditional board games, modern board games correspond to newer games that offer a wide range of game mechanics (e.g., Ticket to Ride, Splendor, Carcassonne). Playing modern board games has been shown to be related to logical thinking [ 29 ], improved fluid intelligence [ 30 ], and improved verbal working memory [ 31 ]. Moreover, modern board games seem to enhance social abilities, including verbal, relationship, and emotional skills [ 32 ]. Although the number of studies on board games and cognitive functions remains limited, board gaming appears to affect cognitive abilities differently compared with video gaming. Board gaming seems to enhance fluid intelligence, verbal working memory, and social performance, whereas video gaming improves attention, visuospatial, working memory, and mental flexibility performance. Therefore, recent literature widely supports the beneficial effects of play on cognitive functions, but the nature of the relationship between game-specific practice and cognitive abilities still needs to be clarified. To our knowledge, no study has examined the cognitive implications of video games and board games in the same model; instead, until now, all studies have examined video gamers’ and board gamers’ cognitive abilities independently. However, the time spent playing video games and board games may be positively related. Players tend to play both game types proportionally, which leads to confounding variables. It remains unclear whether the benefits of play are due to specific game practices (i.e., video gaming and board gaming) or to overall playing practice, regardless of game type. Therefore, further investigations are needed to study the specific cognitive contributions of video games and board games concurrently in the same model.

Considering the recent literature on games and cognitive functions, the remaining question is whether the benefits of play on cognitive functions are due to the overall play time or to specific game types. To address this original question, we conducted an online experiment in which we aimed to overcome the dichotomous categorization of players. To do this, we examine the association between overall and game-specific play times and cognitive functions, considering play times as continuous variables and comparing video game and board game contributions in the same statistical model. More precisely, we compare the relationships between cognitive abilities and overall play time (i.e., the time spent playing video games and board games), the time spent playing video games and the time spent playing board games. Considering the recent literature on play and cognitive functions, we expected a significant relation between overall play time and overall cognitive performance [ 16 ], but we expected differentiated relations between game-specific play times and specific cognitive measures [ 3 , 4 ].

Materials and methods

The experiment was approved by the General Data Protection Regulation service of University XXX (declaration no. 202186).

Participants

Four hundred ninety-six French participants (268 women, mean age = 28.08 years) were recruited among undergraduate students, gaming associations, and social networks. All participants gave their written informed consent to participate and received either financial compensation (£8.5) or student course credit to complete their course unit. Individuals who played video games for 0–40 hours per week (M = 7.72, SD = 8.69) and board games 0–30 hours per week (M = 2.37, SD = 3.54), with an overall play time in the range of 0–48 hours per week (M = 10.09, SD = 10.00), were recruited ( Fig 1 ).

• PPT PowerPoint slide
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Note. Each binwidth = 1 hour.

https://doi.org/10.1371/journal.pone.0283654.g001

Regarding their main leisure activity, 24.2% of the participants reported video games, 4.03% board games, and 71.8% another leisure activity. Considering video gamers only–participants who played video games at least 1 hour per week– 72.2% reported their preferred video games as action video games (e.g., first-person shooter or multiplayer online battle arena). In addition, 27.8% reported non-action video games (e.g., strategy games and management games) as their preferred game. We noted that the most played video games were Leagues of Legends, Animal Crossing, and Mario Kart. For board gamers only–participants who played board games at least 1 hour per week– 71.3% reported their preferred board games as casual board games (e.g., party games and quiz games), and 28.7% reported expert board games (e.g., abstract games and role play games) as their preferred games. We noted that the most frequently played board games were Uno, Monopoly, and chess. Only 12.9% of the participants played digitized board games (–considered board games in this study) at least once a week, and it is important to note that only 11 participants played chess online.

Cognitive tests

Fluid intelligence..

Raven’s matrices SPM38 [ 33 ], series D and E, were computerized to measure fluid intelligence. The exact same series were used by Bartolucci et al. (2019) [ 30 ] to assess the effects of board games on fluid intelligence. Similarly, Raven’s matrices APM were used by James et al. (2011) [ 34 ] to assess the effects of video games on fluid intelligence. In this test, participants were presented with a picture composed of eight figures linked by a logical pattern and a missing figure. The task was to find the missing figure that could logically complete the picture among the eight suggested options. The test consisted of 24 experimental trials with increasing difficulty. The number of correct answers was scored.

Mental flexibility.

The test from Experiment 1 in Monsell et al., 2003 [ 35 ] was adapted to assess mental flexibility skills. The exact same task was used by Green et al. (2012) [ 36 ] to study action video gamers’ mental flexibility skills. In this test, participants were presented with four types of stimuli (blue squares, red squares, blue circles, or red circles). The task was to classify each stimulus according to its shape (square or circle) or its color (blue or red). The stimuli were displayed successively on a background composed of eight parts, defined by eight equally spaced circle radii. The horizontal radii of the background were thickened to indicate the location of the task switch. Above the horizontal radii, participants classified the stimuli as circle or square (shape condition), whereas under the horizontal radii, participants classified the stimulus as red or blue (color condition). Therefore, the task to be performed was cued by location on the screen, changing every four trials. In the shape condition, participants used the left middle or index finger to press the “Q” key or the “S” key on a computer keyboard to give their answer. In the color condition, they used their right index or middle finger to press the “L” key or the “M” key. As soon as a participant responded by pressing a key, the next stimulus was presented counterclockwise in the next locus.

The test was composed of 32 training trials and 128 experimental trials. The trials in which the instruction changed (i.e., first trials above and below the horizontal radii) corresponded to the switching condition, whereas the trials in which the instruction remained the same corresponded to the non-switching condition. Thus, the switching condition represented 25% of the trials. Accuracy (i.e., proportion of correct answers) and reaction time were recorded in both switching and non-switching conditions. The differences between the accuracy and the reaction times in both switching and non-switching conditions were then computed.

A computerized version of the Tower of London test [ 37 , 38 ] was used to assess planning skills. Boot et al. (2008) [ 39 ] used the same test to examine the relationship between video gaming and planning skills. In this test, participants were presented with a board with three pegs and three colored balls. The balls could be moved by clicking on the pegs and applying the following rules: No more than three balls could be placed on the biggest peg, no more than two balls on the middle peg, and no more than one ball on the smallest peg. The task was to reproduce a specific arrangement of the balls, which was presented at the top right-hand corner of the screen, with the smallest possible number of moves and within 60 seconds. The task included a training trial and 12 experimental trials. The number of correctly reproduced arrangements was scored.

Visual working memory.

A computerized version of the Corsi block-tapping task was used to measure visual working memory skills [ 40 ]. A similar version of the task was used by Hazarika and Dasgupta (2020) [ 41 ] to examine the neural correlates of action video gaming in visual working memory tasks. Participants were presented with nine dark blue squares, of which some randomly flashed in bright orange, in a specific order. In the forward condition, participants were required to reproduce the sequence by clicking on the same blocks in the same order, whereas in the backward condition, they were required to reproduce the sequence in reverse order. Both conditions included two training trials and two experimental trials for each sequence length, ranging from two to nine flashing blocks in the forward condition and from two to eight flashing blocks in the backward condition. Participants were informed that the sequence length would increase gradually. When they failed both trials of the same sequence length, the condition ended. The span (i.e., the longest sequence correctly reproduced) was then scored.

Verbal working memory.

The shortened version of the operation span task was used to assess verbal working memory skills [ 42 ]. A similar task was used to assess the relations between action and real-time strategy gaming and verbal working memory skills [ 43 ]. In this test, participants were required to remember letter sequences, and as a distractor task, to judge whether arithmetic operations were correct. After each operation-letter sequence, participants were asked to recall the letters in the correct order. The test was composed of two training trials and six experimental trials (two trials for each letter sequence length, ranging from four to six letters). An absolute score (i.e., the number of letter sequences correctly recalled) was recorded.

Visuospatial processing.

Peltier and Becker’s (2016) [ 44 ] visual search task was adapted to assess visuospatial processing skills. A similar task was used in Hubert-Wallander (2011) [ 45 ], assessing the visuospatial skills of action video gamers. During this test, participants were required to determine whether the figure included the letter “T” among a set of distractors (letter “L”). Participants were asked to press the “M” key or the “Q” key on a computer keyboard to give their answers. A fixation cross was displayed for 500 ms before each trial. The letters were randomly rotated from their upright positions by 0°, 45°, 90°, 135°, 180°, 225°, 270°, or 315°. The task included two training trials and 24 experimental trials (4 trials– 2 target absent, 2 target present trials–for each set size– 10, 15, 20, 25, 30, or 35 letters). The number of correct answers and the reaction time were recorded.

Player profiles

Participants’ play times were assessed using two self-reported questions: “How often do you play video/board games?” and “On average, how many hours do you play video/board games per week?” The given responses ranged on a 6-point Likert-type scale from “Never” to “Several times a day” to the first question, and responses were given in hours to the second question. The answer to the first question was used to control the answer to the second question (e.g., participants who answered “Never” to the first question and did not answer “0 hours” to the second were excluded).

Participants’ favorite video and board game genres were recorded using the alternative choice question “Choose your favorite video/board game genre." Responses were chosen from a list of common video game genres (e.g., first-person shooters, multiplayer online battle arenas, and puzzle games) and common board game genres (e.g., party games, abstract games, and quiz games). The most played games were also recorded through the open-ended question "What video game have you played the most in the last 6 months?"

The participants were all tested online from October 2021 to March 2022. They first completed the Raven matrices, Monsell, Tower of London, Corsi block-tapping, operation span, and visual search tasks, and then completed the gaming experience and demographics questionnaire, which lasted approximately 45 minutes. Because the study was conducted online, quality controls were applied to the data. Participants’ time spent on each cognitive task, responses to attention check questions between each test, and feedback reported at the end of the study were assessed. Thus, any participants who completed the study in less than 20 minutes, those who reported being distracted, those who had any cognitive disorders, or those who engaged in drug use were excluded.

Statistical analyses were performed using R [ 46 ]. For all cognitive tests, outlier reaction times to correct responses were detected and removed for each participant using three median absolute deviations around the median reaction time [ 47 ]. Outliers were also detected based on the visualization of the frequency distributions of correct responses. This was done using histograms [ 48 ].

For all statistical tests, we used an alpha level of .05. We conducted regression modeling to examine how participants’ overall play time and game-specific play times (i.e., time spent playing video games vs. time spent playing board games) were related to cognitive performance. Because no theory suggests that the relationship between play time and cognitive functioning is strictly linear, we decided to compute generalized additive models (GAMs) [ 49 ]. GAMs capture the non-linear aspects of and the variations in a relation based on flexible, smoothing splines. These splines correspond to the sum of multiple basis functions, each multiplied by a coefficient to fit the data and create the overall shape of the relation. We used the mgcv package in R to compute the GAMs. First, we tested the relation between all cognitive scores and overall play time. Second, we computed multivariate GAMs to test the relations between all the cognitive scores and game-specific play times and to determine the specific predictors of cognitive performance.

The assessed cognitive functions have been shown to be affected by aging (for a review, see Harada et al., 2013 [ 50 ]) and education level (for a review, see Lövdén et al., 2020 [ 51 ]). Participants’ ages ranged from 18 to 59 years, and their highest degrees ranged from none to a doctoral degree. Thus, we decided to control for participant age and education level. All predictor variables (i.e., time spent playing video games and time spent playing board games) and control variables (i.e., age and education level) were entered into smoothing splines in the multivariate GAMs.

Relation between overall play time and cognitive performance

GAMs were computed to assess the relation between all the cognitive measures and overall play time. The estimated degrees of freedom (edf), the p-values, and the coefficients of determination (R 2 ) are reported in Table 1 .

https://doi.org/10.1371/journal.pone.0283654.t001

The overall play time was significantly related to the number of correct responses in the Raven matrices test, the number of correctly reproduced arrangements in the Tower of London test, the forward span in the Corsi block-tapping task, and the number of letter sequences correctly recalled in the operation span task. In addition, the overall play time was significantly and linearly related to the difference between the non-switching and switching reaction times in the Monsell task, the backward span in the Corsi block-tapping task, and the number of correct responses and the reaction time in the visual search task.

Relation between game-specific play time and cognitive performance

Multivariate GAMs were performed to test whether the time spent playing video games and the time spent playing board games significantly predicted cognitive measures. The time spent playing board games was found to be significantly related to age (edf = 3.865, p < .001) and education level (edf = 4.366, p = .004). Considering these significant relations and the literature on cognitive aging and education, it was necessary to control for participant age and education level. In Model 1, only age and education level were entered into the analysis. In Model 2, all predictor variables (i.e., time spent playing video games, time spent playing board games, age, and education level) were entered into the regression equations simultaneously. These analyses provided an estimate of the additional variance explained by play times when controlling for age and education level. The models’ coefficient of determination (R 2 ) and predictors’ estimated degree of freedom (edf) are reported in Table 2 .

https://doi.org/10.1371/journal.pone.0283654.t002

As expected, age was found to be a significant predictor of all assessed cognitive functions. Education level was found to be a significant predictor of all cognitive performance, except mental flexibility. Controlling for age and education level, the time spent playing video games significantly predicted the number of correct responses in the Raven matrices test, the difference between switching and non-switching reaction times in the Monsell task, the number of correctly reproduced rearrangements in the Tower of London task, the forward and backward spans in the Corsi block-tapping task, the number of letter sequences correctly recalled in the operation span task, and the reaction times in the visual search task (see Fig 2 ).

Note. Plots with 95% intervals.

https://doi.org/10.1371/journal.pone.0283654.g002

More specifically, mental flexibility and visual working memory skills were found to be linearly related to the time spent playing video games. The more the participants played, the lower their switching cost and the higher their backward visual span (see Fig 2B and 2E ). Similarly, fluid intelligence skills were found to increase, along with video game time, especially after 10 hours of gaming per week (see Fig 2A ). Planning skills and verbal span were also found to increase with video game time, but this positive relation reached a limit between 10 and 20 hours of video gaming per week (see Fig 2C and 2F ). However, visuospatial processing speed was found to increase (i.e., lower reaction times) as video game time increased, reaching a limit around 20 hours of gaming per week and then decreasing in more intensive gamers (see Fig 2G ).

Playing practice specifically explained 5.7% of the variance in the visual forward span and 3.6% in the visual backward span, 2.8% of the variance in planning, 2.7% in mental flexibility, 2.2% in visuospatial processing skills, 2% in fluid intelligence, and 1.7% in verbal working memory. However, controlling for age and education level, the time spent playing board games was not related to any cognitive measures.

Given the wide popularity and cognitive benefits of video and board games, the current study aimed to elucidate the relationship between playing practices and cognitive abilities. Until now, players were mainly defined according to a minimum play time and a specific game type, which is not representative of real playing practices. Therefore, we overcame the dichotomous definition of players by examining whether the benefits of play were explained by the overall play time or specific playing activities. To accomplish this, we assessed the relationships between the participants’ overall and game-specific play times and six main cognitive abilities. Our results demonstrated significant relationships between overall play time and cognitive performance and revealed the important implications of video game practice time in cognitive functions.

The GAMs revealed that overall play time was related to all the assessed cognitive performances. In line with our hypothesis, the overall play time predicted fluid intelligence, mental flexibility, planning, visual and verbal working memory, and visuospatial performance. We noted positive non-linear relations between play time and planning skills, verbal span, and forward visual span, as well as positive linear relations between play time and backward visual span and visuospatial processing skills. Regarding reaction times, we noted negative linear relations between play time and mental flexibility and visuospatial processing speed. Therefore, our results showed positive relations between overall play time and both accuracy and efficiency.

Considering mental flexibility, we found only a negative linear relation between the overall play time and the difference between the non-switching and switching reaction times. The more the participants played, the higher their efficiency became, but their accuracy did not show a similar increase. This is in accordance with Dye et al.’s (2009) [ 52 ] findings showing that gamers responded faster to several switching tasks without losing accuracy. Overall, our findings are in line with the recent literature on the cognitive benefits of play [ 3 , 4 ]. Most importantly, we showed a positive relationship between play time and cognitive performance.

Using GAMs allowed for the consideration of the individual diversity of play time (e.g., 0–48 hours per week in our sample). Indeed, the dichotomous categorization of players based on minimum play time often fails to capture the current diversity of playing practices. Moreover, on a theoretical level, a consensus has not yet been reached on the minimum play time required for someone to be defined as a player. In recent studies, players have not had equal play time, and non-players are sometimes casual players, playing up to 8 hours per week [ 3 ]. Therefore, our findings showed the importance of considering play time as a continuous variable to determine the benefits of play on cognitive abilities. We confirmed the relationship between play and cognitive functions, and most importantly, we demonstrated the not necessarily linear nature of this relationship.

The implications of game-specific play times for cognitive performance were detailed via multivariate GAMs. The analyses showed that age was a significant predictor of all assessed cognitive functions, and education level was a significant predictor of all cognitive measures except mental flexibility. These results are consistent with numerous studies showing that cognitive functions are affected by age [ 50 ] and education level [ 51 ]. Comparing this model with age and education level as predictors and a model with age, education level, time spent playing video games, and time spent playing board games as predictors, playing practice was found to significantly explain 1.7% to 5.7% of the variance in different cognitive performance.

Video game practice time was found to uniquely predict all assessed cognitive abilities. In line with recent literature, video game practice was related to mental flexibility, visuospatial processing, and visual working memory skills [ 6 , 18 ]. The time spent playing video games was negatively and linearly related to the difference between non-switching and switching reaction times in the mental flexibility task. Thus, video game practice time positively predicted the limited cost of task switching on players’ efficiency. However, the time spent playing video games was non-linearly related to visual search task reaction times. Playing video games predicted higher efficiency in visuospatial processing tasks but not necessarily higher accuracy, only for gamers playing up to 20 hours a week. This is in line with the literature showing that gamers respond faster to visuospatial tasks without losing accuracy [ 53 ]. However, this relation seems to reverse when playing video games more than 25 hours a week. In addition, the time spent playing video games was positively related to the visual forward and backward spans. Interestingly, the analyses also revealed that the time spent playing video games predicted fluid intelligence, planning and verbal working memory skills.

Few studies exist on the relationship between video gaming and fluid intelligence, planning and verbal working memory [ 10 , 54 ]. However, recent literature has shown that board gamers demonstrate higher fluid intelligence [ 30 ], planning [ 55 ] and verbal working memory performance [ 31 ]. Indeed, we found that the time spent playing board games was significantly related with fluid intelligence (edf = .2.283, p = .002) and verbal working memory skills (edf = 3.720, p = .020). However, after controlling for age, education level, and video game practice time, the associations between board gaming and fluid intelligence and verbal span were no more significant in GAM analyses. Thus, by comparing the cognitive contributions of video games and board games in the same statistical model, something that has not been done in previous studies, our results highlight the specific relationship between video gaming and fluid intelligence and verbal working memory skills.

The unique implications of video game practice in cognitive functions, even after controlling for age, education level, and board game practice time, could be explained by unique game features. Indeed, compared with board games, video games imply real-time dynamics, such as real-time decision making, which have a great potential to enhance cognitive abilities. Playing video games often leads to a high level of arousal. Gamers are mainly required to maintain and manipulate information from multiple sources and to make rapid decisions. They also need to use their attention skills in a flexible manner by switching between distributed and focused attention. These features could help develop attention and mental flexibility skills [ 20 , 56 ]. Moreover, video games offer various environments, avoiding full task automatization and fostering new strategies and learning [ 20 ]. Gamers can also take advantage of increasing difficulty levels that are adapted to their skills, and they can gather immediate informative feedback, which allows them to adapt their behavior and strategies. Finally, video games are intrinsically rewarding and fun, and these characteristics have been shown to yield cognitive enhancement [ 57 ]. Further investigations are now required to define which game features particularly explain the cognitive benefits of video games.

A current issue has to do with the structural similarities existing between games’ mechanisms and cognitive tests. Some authors highlighted that the relationship between gaming and cognitive abilities may only demonstrate the training of specific behavioral responses to stimuli that are shared between games and cognitive tasks (e.g., the requirement for rapid responses to a first-person shooter game and reaction times to a go/no-go task) [ 3 , 58 ]. However, some studies showed that video gaming can enhance other cognitive skills and activities involving these cognitive functions. Thus, interpreting the relationship between video gaming and cognitive functions based on structural similarities only is challenging. For example, children’s reading speed and accuracy significantly increased after playing Rayman Raving Rabbids action mini games, which could be explained by the significant enhancement of their visuospatial and phonological processing skills [ 59 , 60 ]. Similarly, playing Unreal Tournament 2004 and Angry Birds significantly enhanced undergraduates’ verbal working memory and mental rotation skills, which could explain the significant improvement in their geometry performance [ 61 ]. Therefore, the benefits of video gaming on cognitive abilities cannot be attributed solely to structural similarities between the games and the cognitive tasks.

Board game practice time was not found to predict any of the assessed cognitive abilities. These findings did not confirm our hypothesis of differential relationships between game-specific play times and cognitive abilities. The significant relationship between board game practice time and cognitive measures was no longer significant when age and education were controlled. Indeed, board game practice time was significantly related to age and education level. More educated participants and those aged 30 to 40 years spent more time playing board games. Thus, board game practice seems to represent a specific category of the population, capturing age and education level. Therefore, it is difficult to confirm the specific effect of board games on cognitive functions [ 4 ]. The already demonstrated effects in the literature may be due solely to the participants’ age and education. Therefore, an interventional study is needed to determine whether cognitive benefits related to board games exist and how much practice time per week would be needed to achieve this effect. These studies could be conducted with younger participants to control for age and education effects.

Our analyses did not reveal a concomitant implication of video games and board games in terms of cognitive performance. Thus, the common features of games, such as that they are rewarding and fun experiences, do not seem to be sufficient to explain cognitive performance. Once again, these findings highlight the importance of identifying the unique game features involved in the association between play and cognitive functions. Further studies will need to consider game specific features and play times to fully understand the cognitive benefits of play.

Limitations and perspectives for future research

Although the current study offers novel findings on the association between play time, game type, and cognitive functions, some limitations must be noted. As a first limitation, the participants completed the study online, which allowed a large sample to be recruited. Although the data were checked, and any incomplete data were excluded, participants’ engagement and motivation can be questioned. Recent studies have noted that online participants are not necessarily inattentive during the tasks, but they are more likely to be distracted (e.g., in using their mobile phones, talking to another person in the room, etc.) [ 62 ]. Thus, a recommendation for ensuring online participants’ motivation and engagement is to provide informative feedback about their performance [ 63 ]; we did this for each task, but it may not have been sufficient.

The second limitation lies in the concerns regarding whether bias existed in the self-reported measures of play time. Some studies have shown that players tend to under-report their time spent playing video games [ 64 ] and to over-report their genre-by-genre gaming time [ 65 ]. To our knowledge, no similar study has assessed bias in the measures of time spent playing board games. Thus, there is currently no way to know whether video game and board game times are biased in the same way. A solution to ensure that play time is accurately measured is to use online measures. In video games, this could correspond to the play time recorded in video games’ servers [ 64 ]. A similar measure could be implemented for board games using diary-based reports or timed play sessions [ 17 ].

A third limitation is the use of a dichotomous game-type approach. Although we considered play time as a continuous variable, playing practice was still defined according to a game-type dichotomy (i.e., video games vs. board games). This approach allowed us to compute cognitive predictors while controlling for game-specific play times and gave first results on the comparison of video and board games’ cognitive implications. However, future studies will be needed to build on our findings according to game subtypes (e.g., action games, strategy games, etc.) and obtain evidence on the game-specific features mediating cognitive enhancement. Finally, given the correlational nature of our analyses, we demonstrated the existence of linear and non-linear relations between overall and game-specific play times and cognitive performance. However, our results cannot account for the causality of the cognitive benefits of play. Thus, future training studies will be necessary to determine the causal relations between play and cognitive abilities. As discussed above, these studies will have to implement training based on different play times and different game features to specify the effects of play on cognitive functions.

Given the global popularity of playing practices and the concerns about intensive gamers’ health, it is important to examine the implications of play time and game type on cognitive functions. Our findings are in line with the recent literature showing that playing is beneficial for cognitive functions; moreover, the findings demonstrate that play time predicts players’ cognitive performance. It seems that video games affect cognitive performance more than board games do, which has never been demonstrated in previous studies. The unique features of this main game type surely explain its specific relationship with cognitive functions. Video games seem to have a greater potential for overall cognitive enhancement because they involve processing various types of information and adapting strategies dynamically and in real time. Future studies on play and cognitive functions will need to account for individual differences among players by considering their play times and the specific features of the games they play.

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Systematic review article, a systematic literature review of analytics for adaptivity within educational video games.

• 1 Department of Clinical Psychology, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
• 2 LEAD Graduate School and Research Network, University of Tübingen, Tübingen, Germany
• 3 Leibniz-Institut für Wissensmedien, Tübingen, Germany
• 4 Chair of Psychology of Learning with Digital Media, Faculty of Humanities, Institute of Media Research, Chemnitz University of Technology, Chemnitz, Germany

Research has shown that serious games, digital game-based learning, and educational video games can be powerful learning instruments. However, experimental and meta-research have revealed that several moderators and variables influence the resulting learning outcomes. Advances in the areas of learning and game analytics potentially allow for controlling and improving the underlying learning processes of games by adapting their mechanics to the individual needs of the learner, to properties of the learning material, and/or to environmental factors. However, the field is young and no clear-cut guidelines are yet available. To shed more light on this topic and to identify common ground for further research, we conducted a systematic and pre-registered analysis of the literature. Particular attention was paid to different modes of adaptivity, different adaptive mechanisms in various learning domains and populations, differing theoretical frameworks, research methods, and measured concepts, as well as divergent underlying measures and analytics. Only 10 relevant papers were identified through the systematic literature search, which confirms that the field is still in its very early phases. The studies on which these papers were based, however, show promise in terms of the efficacy of adaptive educational games. Moreover, we identified an increased interest in the field of adaptive educational games and in the use of analytics. Nevertheless, we also identified a clear lack of common theoretical foundations as well as the application of rather heterogenous methods for investigating the effects of adaptivity. Most problematic was the lack of sufficient information (e.g., descriptions of used games, adaptive mechanisms), which often made it difficult to draw clear conclusions. Future studies should therefore focus on strong theory building and adhere to reporting standards across disciplines. Researchers from different disciplines must act in concert to advance the current state of the field in order to maximize its potential.

Introduction

Digital game-based learning is becoming a powerful tool in education (e.g., Boyle et al., 2016 ). However, several open issues remain that require further research in order to optimize the use of game-based learning and educational video games. One unique characteristic of digital learning games is the wealth of data they produce, which can be acquired and used for (learning) analytics and adaptive systems. Adaptive learning environments are part of a new generation of computer-supported learning systems that aim to provide personalized learning experiences by capitalizing on the generation and acquisition of knowledge and other types of data regarding learner’s cognitive capabilities, knowledge levels, and preferences, among other factors (e.g., Mangaroska and Giannakos, 2019 ).

Adaptive learning is characterized by an adaptive approach to learner’s individual needs and preferences in order to optimize learning outcomes and other learning-related aspects, such as motivation. While the idea of adaptive learning is not new (e.g., mastery learning as discussed by, Bloom, 1968 ) and has received strong support from researchers in educational psychology ( Alexander, 2018 ), it is surprising how few systematic studies are available on adaptive learning with digital technologies and game-based learning in particular. For instance, a recent review of adaptive learning in digital environments in general found evidence of the effectiveness of adaptivity ( Aleven et al., 2016 ). However, in this review, only one study was identified as having used an educational video game, thus demonstrating the lack of research currently being performed on adaptive learning in the domain of game-based learning.

Most entertainment games are pre-scripted and therefore have static (game) elements such as, content, rules, and narratives ( Lopes and Bidarra, 2011 ). While “fun” is the locus of attention in entertainment games and has been investigated in learning games as well ( Nebel et al., 2017c ), educational games serve additional purposes, as they need to convey learning content appropriately to learners. According to Schrader et al. (2017) adaptivity in educational games can be defined as “a player-centred approach by adjusting game’s mechanics and representational modes to suit game’s responsiveness to player characteristics with the purpose of improving in-game behavior, learning processes, and performance” (p. 5). Hence, finding the right balance between the learner’s skills and the challenge levels of the games is a critical issue, especially as the perceived difficulty and inferred feedback after facing a task could influence learning outcomes (e.g., Nebel et al., 2017b ). Researchers agree that educational video games could utilize adaptivity to optimize knowledge and skills acquisition (e.g., Lopes and Bidarra, 2011 ; Streicher and Smeddinck, 2016 ). Potentially, all elements of a game can become adaptive elements ( Lopes and Bidarra, 2011 ). For instance, gameplay mechanics, narrative and scenarios, game content and its objectives, etc., all can contribute to offer and personalized and individualized gaming and learning experience.

It seems natural for learning material to be adapted to individual needs and preferences. In analogue learning settings, this can be achieved by individualized support from educators, teachers, etc.; in multiplayer games, social processes can trigger similar processes ( Nebel et al., 2017a ). For single-player games, however, there are several different ways to acquire the data needed to identify user’s needs or preferences (for a review see Nebel and Ninaus, 2019 ) and to change the learning environment accordingly (for a review see Aleven et al., 2016 ). Numerous studies have demonstrated that data or analytics gathered during play can be used to successfully detect various cognitive (e.g., Witte et al., 2015 ; Appel et al., 2019 ), motivational (e.g., Klasen et al., 2012 ; Berta et al., 2013 ), and emotional (e.g., Brom et al., 2016 ; Ninaus et al., 2019a ) states of users (for a review see Nebel and Ninaus, 2019 ). The analytics used in such studies range from simple pre-test measures and self-reports to more complex process measures utilizing (neuro-)physiological sensors (for a review see Ninaus et al., 2014 ; Nebel and Ninaus, 2019 ). Consequently, the current systematic review aims to identify if and how such analytics have been used to realize adaptive learning in games. In particular, we wanted to investigate the use of adaptive learning in educational games by utilizing analytics to adapt learning content to the skill level or cognitive capability of the player/learner.

While games theoretically offer many opportunities for adapting their content (e.g., visual presentation, narrative, difficulty), many factors usually need to be considered when implementing adaptivity. These factors include which analytics are used and what as well as how content is actually being adapted by the game or its underlying algorithms. Accordingly, frameworks for adaptive educational games are often guided by two questions (c.f., Shute and Zapata-Rivera, 2012 ): First, what to adapt: Which analytics and data are utilized to implement adaptivity and which elements are adapted (e.g., feedback, scaffolding, etc.)? Second, how to adapt: Which general methods are used to implement adaptivity? While different frameworks of adaptive (educational) games differ in their granularity and their specific design, they share the common goal of providing a generic approach on how to realize adaptivity (e.g., Yannakakis and Togelius, 2011 ; Shute and Zapata-Rivera, 2012 ; Schrader et al., 2017). For instance, Shute and Zapata-Rivera (2012) suggest a four-process adaptive cycle that connects the learner to appropriate educational material through the application of a user model. These generic frameworks are helpful for building adaptive systems, however, they tell very little about their effectiveness. Evaluating adaptive systems with empirical studies is therefore not only informative but absolutely necessary for advancing the field of adaptive educational games. Moreover, as the field of educational psychology aims to improve the theoretical understanding of learning ( Mayer, 2018 ), particular attention should be paid to the theoretical foundations of the adaptation mechanisms being used. This seems to be in contrast to recent trends in learning analytics (e.g., Greller and Drachsler, 2012 ) and game-learning analytics (e.g., Freire et al., 2016 ), which employ rather strong data-driven approaches. Thus, in our research, we focused especially on what is adapted, how adaptivity is implemented, and which analytics are utilized to realize adaptivity in game-based learning. In this latter respect, by identifying the analytics used for adaptivity, we sought to produce a precise overview of successful and less successful approaches in adaptive game-based learning in the interest of identifying practical needs and recommendations. That is, we aimed to provide a systematic overview of the current state of the art of adaptivity in game-based learning by analyzing the ways in which empirical research is currently being conducted in this field of research, which theoretical foundations are being used to realize adaptivity, and what is being targeted by adaptivity.

Description of Research Problem

That learning environments have the potential to act dynamically by gathering user data or pre-test values and responding by altering the learning tasks within a digital environment has been an established fact for decades (e.g., Skinner, 1958 ; Hartley and Sleeman, 1973 ; Anderson et al., 1990 ; Aleven et al., 2009 ). This approach might be particularly relevant in the field of game-based learning, as games are usually considered to involve highly dynamic environments and adaptive learning seems to be a promising avenue by which learning outcomes in digital learning can be enhanced (for a review see Aleven et al., 2016 ). However, the extent to which adaptivity has been implemented in empirical studies using game-based learning has thus far not been systematically documented. Consequently, in the current pre-registered systematic literature review (see Ninaus and Nebel, 2020 ), we pay particular attention to game-based learning environments to uncover the current state of research in this field. An increasing number of studies have demonstrated the use of various analytics to identify different mental states of the users that might be useful for adapting educational games in real time (for a review see Nebel and Ninaus, 2019 ). However, it remains unknown whether these suggested adaptive approaches have actually been implemented and evaluated in game-based learning. Thus, with this systematic literature review, we aim to address this open question by analyzing the current state of the literature. Instead of motivation or personality-based adaptations (e.g., Orji et al., 2017 ), we focused on cognition or performance-based adaptations, as learning theories heavily focus on this perspective (e.g., Sweller, 1994 ; Sweller et al., 1998 ; Mayer, 2005 ) and it allows for a more focused analysis of the current literature. Accordingly, we sought to identify successful (learning) analytics for adapting the game-based learning environment to, for instance, the skill level or cognitive capability of the learner. That is, which data about learners or their context can be utilized for understanding and optimizing learning by adapting the learning environment. Doing so might shed light on which approaches are most successful in adaptive game-based learning and thereby advance the field and provide practical recommendations for researchers and educators alike.

Study Objectives

Taken together, this paper systematically reviews the ways in which adaptivity in game-based learning is realized. For this pre-registered systematic literature, we broadly searched for empirical studies that utilized analytics to realize adaptivity in game-based learning scenarios and educational video games. Based on the previously described research gaps, we were specifically interested in the following three research questions (RQ):

(RQ1) How is research in the field of analytics for adaptation in educational video games currently conducted? For instance, which learning domains and analytics are most popular as well as most successful in this research field, and which empirical study designs are currently being employed to study the effects of adaptive elements?

(RQ2) What cognitive/theoretical frameworks within analytics for adaptation in educational video games are currently used? That is, which theoretical underpinnings are currently being used to integrate, justify, and evaluate analytics in adaptive educational video games?

(RQ3) What types of outcomes are influenced by an adaptive approach? For instance, are the analytics and adaptive mechanisms used for adapting the difficulty of a quiz in a game or is the overall pace of the gameplay altered?

To contribute a precise overview as well as to identify areas for future development in the analytics for adaptation research field, this paper follows the meta-analysis article-reporting standards proposed by the American Psychological Society (2020a) , and the PRISMA checklist ( Moher et al., 2009 ) has been used to ensure the inclusion of all relevant information.

Materials and Methods

Research design overview.

This review can be considered systematic ( Grant and Booth, 2009 ) as it includes clarifications of the research questions and a mapping of the literature. Furthermore, the information generated by the review was systematically appraised and synthesized, and a discussion on the types of conclusions that could be drawn within the limits of the review was included ( Gough et al., 2017 ). A systematic approach was chosen to more fully investigate the range of available research in the field and to produce more reliable conclusions with regard to the research questions. Although all literature reviews should be question-led ( Booth et al., 2016 ), rather specific research questions and an overarching synthesis of the findings demarcate this review from similar approaches, such as scoping reviews ( Arksey and O’Malley, 2005 ; Munn et al., 2018 ). To further enhance methodological integrity, a pre-registration was filed prior to data collection ( Ninaus and Nebel, 2020 ). Finally, the review was conceptualized with a focus on open material by, for instance, providing the developed coding table ( Moreau and Gamble, 2020 ). This, combined with an in-depth description of the approach, should enable future replications of this review, in turn facilitating the systematic identification of additional developments in the field.

Study Data Sources

Researcher description.

Both lead researchers for this study are experts on experimental investigations of learning technologies, such as educational video games, and actively seek to investigate new approaches for enhancing learning processes. Both researchers have published experimental research in this field and were therefore capable of analyzing and systematizing the sample collected for the current study. However, it should be noted that some papers eligible for inclusion in the analysis were authored by the researchers themselves. Additionally, research assistants with experience working with experimental research and publications supported the coding procedure. The team’s affiliation with the field of psychology provided the necessary skills to interpret and evaluate the quality and potential of the measures and frameworks employed as needed for addressing RQ2 and RQ3. That said, given that the overall perspective taken for this work was decidedly psychological in nature, other approaches from relevant fields, such as computer science, received less emphasis.

Study Selection

The following search strategy ( Figure 1 ) was pre-registered ( Ninaus and Nebel, 2020 ) and employed for this review. Using the Frontiers research topic “Adaptivity in Serious Games through Cognition-based Analytics” as a basic foundation ( Van Oostendorp et al., 2020 ), articles that addressed some sort of adaptivity, use of a digital educational game, or use of a variation of analytics, and were based on a learning or cognitive framework, were collected. To identify this research, the Population, Intervention, Comparison, and Outcome (PICO; Schardt et al., 2007 ) approach was used, as it results in the largest number of hits compared to other search strategies ( Methley et al., 2014 ). To address population , labels describing the desired medium (e.g., educational video games) were used. If necessary, quotation marks were used to indicate the search for a specific term instead of a term’s components (e.g., “Serious Games” to prevent a misleading hit for serious ). Regarding intervention , search terms were used that addressed the topics of our research questions, such as adaptivity and analytics. The outcome segment was represented by keywords suitable for capturing the overall cognitive and learning focus of this review (e.g., cognition, learning). Finally, the comparison component could not be applied within this review, as a specific empirical procedure was not pre-defined; instead, this component served as a subject of interest for this review. These considerations led to the following search query:

FIGURE 1 . Study collection flowchart; based on Moher et al. (2009) .

(Adaptivity OR Adaptive OR Adjustment) AND (“Serious Games” OR DGBL OR GBL OR “Educational Videogames” OR “Game Based Learning” OR Simulations) AND (Analytics OR Analytic) AND (Cognitive OR Cognition OR Memory OR Brain OR Learning).

Furthermore, the search engines were adjusted to search within the title, abstract, or keywords of the articles. A quick analysis of the field was conducted to identify the most useful bibliographic databases in line with the psychological and empirical focus the review. As a result, the following databases were used: Association for Computing Machinery—Special Interest Group on Computer-Human Interaction and Special Interest Group on Computer-Human Interaction Play ( dl.acm.org/sig/sigchi ), Elton Bryson Stephens Company Information Services ( search.ebscohost.com ), Web of Science ( webofknwoledge.com ), Scopus ( scopus.com ), and Education Resources Information Center ( eric.ed.gov ). Other databases with a different focus, such as the technology focused IEEE eXplore, were not used as they might result in no substantial results meeting inclusion- or exclusion criteria presented below (e.g., empirical methodology, inclusion of cognitive aspects, measured outcomes on human participants). In addition, an invitation to recommend articles suitable for the review was sent to colleagues and spread via social media. Although the database search was carried out during February 2020, further additions through these additional sources were collected until the end of July 2020.

Altogether, the search returned 496 articles ( Figure 1 ; for the full list of coded articles, see: Ninaus and Nebel, 2020 ). These articles were given an identifier consisting of their database origin and a sequential number (e.g., SCOPUS121). Entries gathered via recommendations and other channels were labeled with OTHER. This ID is used throughout this paper when works within the coding table are referenced. The collection process was followed by the first coding of the articles (see Figure 1 ; Coding I) using the pre-registered coding table columns A1 to A18.2 ( Ninaus and Nebel, 2020 ). During this phase, each entry was coded by one coder and verified by a second coder. When disagreement or uncertainty occurred between these two coders, a third coder was consulted and the issue was discussed until the conflict was resolved. For any remaining uncertainty, the rule of thumb was to include rather than exclude the articles in question. The use of at least two independent coders not only increased data quality but also ensured that none of the authors could code their own papers solely by themselves. The focus of this first coding phase was to ensure the eligibility of the search results. More specifically, only papers that presented outcome measures, were published in English, were appropriate in the context of the research questions, were peer-reviewed, and could be classified as an original research study were included in the review. Furthermore, studies that did not involve digital games, were published prior to 2000, did not document the measures that were used, could be classified as a review or a perspective article, only applied a theoretical or technical framework, or were duplicates from other research results were excluded from the review. In addition, papers for which the full text could not be acquired were excluded as well. The coding procedure was stopped if any of the pre-registered ( Ninaus and Nebel, 2020 ) exclusion criteria or inclusion criteria were met or not met, respectively. For example, the paper WOS32 was published prior to the year 2000 and thus had to be excluded. As a consequence, the columns following the publication year (A6) were not completed.

The rationale for some of these exclusion and inclusion criteria are evident, such as the exclusion of duplicates. However, six criteria should be clarified further: 1) inclusion of outcome measures. For the analysis of RQ3, the papers had to provide detailed insights into the measured outcomes as influenced through adaptive elements. If no outcomes were included (e.g., CHIPLAY1) or could not be interpreted with respect to RQ3 (e.g., WOS87), then this work was excluded; 2) publication language in English. In order for the resulting coding table to be interpretable by both the coders and the potentially broad readership, only those works published in the English language were included in the review. Papers whose abstracts were translated into English but whose main text was not were also excluded (e.g., SCOPUS128); 3) appropriateness for the research question. As complex research questions were abbreviated to short keywords during the database research, the validity of the search results had to be verified. Doing so was crucial, as some keywords generated for the current study have also been used in different, unrelated fields or have ambiguous meanings when not in context. For example, search items such as “Learning” or “Adaptivity” are also used in the field of algorithm research (e.g., EBSCO80); 4) original research study. To avoid redundancies and overrepresentations of specific approaches, only original research studies were included. Additionally, other meta- or review-like publications (e.g., EBSCO40) were excluded, as the current work sought to reach independent conclusions. Because of this, editorial pieces for journals (e.g., EBSCO86) or conferences (e.g., SCOPUS19) were also excluded. As RQ3 required experimentation and/or data collection, theoretical frameworks (e.g., SCOPUS199) or similar publications were omitted as well. Additionally, it was specified to focus on data stemming from human participants, thereby ruling out research using simulations (e.g., WOS42); 5) digital game use . As specifically stated within RQ1 and RQ2, this review addresses educational video games. The focus on digital technology was used to shed light on new approaches to adaptivity and assessment not feasible using other games, such as educational board or card games. Clearly, then, papers in which no game at all was included (e.g., OTHER7) were excluded from the review as well. Similar but not identical approaches to video games, such as simulations (e.g., CHI1), were also omitted to retain the focus solely on games; 6) publication year. Technology continues to rapidly change and evolve. Thus, comparing research on specific properties of technology is especially challenging. To face this challenge, and to remain focused on new developments within the field of adaptivity and assessment, papers published before the year 2000 were excluded. Moreover, although the assessment of study quality is part of many systematic review frameworks (e.g., Khan, 2003 ; Jesson et al., 2011 ), it is also a much debated issue within review research ( Newman and Gough, 2020 ) and was therefore not used as a selection criterion. Study quality was, however, investigated during the full-text analysis.

In cases where certain criteria could not be conclusively determined based on the information presented in article abstracts and/or titles alone, these works were not excluded in the initial step Overall, 33 articles were deemed appropriate for further full-text review (see Figure 1 ; Coding II) or could not be excluded based solely on title or abstract information. Concerning the remaining, excluded articles, 12 were duplicates of other table entries, 70 did not investigate digital games, 49 did not constitute original research, 318 contained no information relevant to the research questions, and 14 were published prior to the year 2000, resulting in an exclusion rate of 93.35% after the initial coding phase.

Subsequent to the initial coding phase, the authors and assistants coded the remaining articles and completed the pre-registered columns B to G, finalizing the coding table for publication alongside this paper. Similar to the initial phase, the second coding procedure was directed by the same criteria described above, excluding or including published works based on a full-text analysis. Consequently, two papers were identified as duplicates, four did not investigate digital games, 10 did not include original research, and six contained no information relevant to the research questions—thus, these 22 articles were also excluded. Ultimately, then, the second coding procedure resulted in the inclusion and coding of 10 papers (2.01% of the complete sample) for subsequent analysis in this systematic literature review ( Table 1 ). One paper (OTHER1 and OTHER2) included multiple experiments and was therefore coded into separate rows in order to investigate the experiments individually. As noted above, three of the sample papers (30.00% of the final sample) were authored or co-authored by the authors of the present review.

TABLE 1 . Reviewed studies.

Papers Reviewed

In addition to the overview table ( Table 1 ), a short summary is presented below, as the final sample was small enough to permit a brief discussion of each paper. The papers will be discussed in no particular order.

Operation ARA: A Computerized Learning Game That Teaches Critical Thinking and Scientific Reasoning (OTHER1 and OTHER2)

The paper by Halpern et al. (2012) includes two separate experiments analyzing the impact of a serious game with respect to scientific reasoning. The authors assessed the student’s level of knowledge with scores on multiple-choice tests and as a form of adaptivity, assigning the students based on this classification into three different tutoring conditions. Within the first experiment, this adaptive approach was accompanied by other adjustments that supposedly support learning and then compared to a control group. The second experiment addressed the tutoring component in more detail. For this, three variations (including the adaptive version) were compared to a control group. Overall, the authors used a pre-post design and a sample size of over 300. As a result, the authors concluded that their game was useful for learning as intended; however, conclusions specifically regarding adaptivity can only be cautiously drawn, as the results were either confounded with other variables or only reached significance for very specific comparisons.

Implementation of an Adaptive Training and Tracking Game in Statistics Teaching (SCOPUS2)

Groeneveld (2014) used a popular approach of difficulty assessment and adaptation (i.e., the Elo-algorithm, e.g., Klinkenberg et al., 2011 ; Nyamsuren et al., 2017 ) to match student’s skills as well as item difficulty in a statistics learning tool. Groeneveld aimed to reach a 75% success rate of solving tasks among the students. The tool was revealed to be useful in a real-life application that included over 400 students. However, no simultaneous control group was implemented and no specific process data on how the adaptive algorithm influenced learning processes could be gathered.

A Pilot Study on the Feasibility of Dynamic Difficulty Adjustment in Game-Based Learning Using Heart-Rate (OTHER11)

Ninaus et al. (2019b) used physiological measurements (i.e., heart rate) to assess player arousal and defined thresholds to adapt game difficulty according to the Yerkes-Dodson Law ( Yerkes and Dodson, 1908 ). Overall, the authors clearly framed their research as a pilot study, justifying the low count of 15 participants for their main experiment. This also explains the lack of dedicated learning measurements. Nonetheless, their results indicated that the adaptive approach resulted in a more difficult, challenging, and fascinating game experience.

Gamification and Smart Feedback: Experiences With a Primary School Level Math App (SCOPUS1)

Based on the theoretical framework of competence-based knowledge space theory ( Doignon, 1994 ; Albert and Lukas, 1999 ), Kickmeier-Rust et al. (2014) built a digital agent that provided feedback in a gamified math-learning environment. When pre-defined thresholds of user skill levels were reached, the agent provided adaptive information. In an experiment that included 40 second-grade students, Kickmeier-Rust and colleagues were not able to determine any statistically significant benefits of their method.

Competitive Agents and Adaptive Difficulty Within Educational Video Games (OTHER12)

In the experiment by Nebel and colleagues (2020), two game versions that additively regulated social competition were compared to a non-adaptive game scenario. The authors based their assumptions on, among other theories, cognitive load theory ( Sweller, 1994 ; Sweller et al., 2011 ). Yet, they did not specify how adaptive variations might interact with the implications from their theoretical foundation. Overall, the experiment demonstrated empirical support for each adaptive game version, with the version including an artificial and adaptive opponent exhibiting significant advantages. However, as the three game versions differed in more than one feature, the results were confounded to a certain degree and, as a consequence, associating certain outcomes to specific properties would be challenging.

Logs Analysis of Adapted Pedagogical Scenarios Generated by a Simulation Serious Game Architecture (WOS57)

Callies et al. (2020) used a Bayesian network to estimate user knowledge and included a planning algorithm to adjust the learning sequence in a real-estate learning simulation with respect to each user. In particular, feedback, challenge, and learning context were adjusted. An evaluation study was conducted, and qualitative considerations supported the feasibility of the chosen approach, although no quantitative information on learning could be evaluated using inferential statistics.

Sensor Based Adaptive Learning—Lessons Learned (SCOPUS11)

This paper reports the findings of ongoing research from the previously discussed paper OTHER11 ( Ninaus et al., 2019b ). However, more details on potential assessment (e.g., body temperature, CO 2 data) and adaptive mechanisms (e.g., alerts, recommendations) were provided alongside preliminary results, which indicated that participants became aware of the adaptation.

Effect of Personalized Gameful Design on Student Engagement (OTHER15)

For this research, Mora et al. (2018) used the SPARC model, previously reported by the lead author ( Mora et al., 2016 ), to gamify software that teaches statistical computing. Within the experiment, users were categorized according to self-evaluations based on the Hexad User Type scale ( Tondello et al., 2016 ) and assigned to four different implementations of rules and rewards. The inferential statistical analysis could not identify significant deviations induced through this approach. Following our rule of thumb (see Study Selection ), we retained this study as part of our final sample even though it was not completely clear whether the focal instrument could be considered a game.

Predicting Learning in a Multi-Component Serious Game (SCOPUS8)

This research by Forsyth et al. (2020) used the same software as that employed in previous experiments (OTHER1 and OTHER2; Halpern et al., 2012 ) with the aim of gaining insights into knowledge formation divided into deep and shallow learning ( Marton and Säljö, 1976 ). For this, students were assigned to different tutoring conditions based on an assessment of prior knowledge with multiple choice tests. The results suggested that some principles, such as generation, might be suitable predictors for learning within the learning environment under study.

Improving Student Problem Solving in Narrative-Centered Learning Environments: A Modular Reinforcement Learning Framework (OTHER13)

Based on theories such as seductive details ( Harp and Mayer, 1998 ) or modular reinforcement learning ( Sutton and Barto, 2018 ), Rowe and Lester (2015) scaffolded adaptive events in microbiology learning and compared them to a non-adaptive version. In summary, the researchers could not identify significant learning improvements with regard to microbiology learning outcomes.

Data-Analytic Strategies

During the second phase of full article screening, the full text of the articles was reviewed to search for information needed to address RQ1 to RQ3 as well as to generate an overview that could be systematized and presented within this paper. For this, a content analysis approach ( Lamnek and Krell, 2016 ) was followed. More specifically, to answer RQ1 to RQ3, frequency analysis ( Lamnek and Krell, 2016 ) was used and necessary categories, such as type of research or significance of research, were created. Through this, quantifiable information, such as whether a specific model was used more frequently than others, could be inferred. The codes for these categories were built using the prior knowledge of the researchers in the field of experimental research (e.g., study types) or as derived verbatim from the articles (e.g., names of specific theories). Where applicable, existing codes within the literature were used. For example, game genre or subject discipline were coded using labels from previous meta-analytic and review-like work ( Herz, 1997 ; Connolly et al., 2012 ). Thus, frequencies could potentially be compared to other reviews in the field. Additionally, other relevant information was narratively systematized and is discussed within the Narrative Content Analysis section. For this, no specific qualitative or quantitative approach was used but was instead reliant on an in-depth discussion and interpretation by the authors, one aligned with the overall aim of this review. In line with the systematic approach, differences were discussed and resolved through consensus.

Methodological Integrity

Several aspects of methodological integrity that needed to be discussed have already been addressed within previous sections (e.g., researcher’s perspective). Following the Journal Article Reporting Standards by the American Psychological Association (2020b) , additional, complementary information was needed. First, to validate the utility of the findings and the general approach to addressing the study problem, a section specifically devoted to this issue is included in the discussion. Second, to firmly base the findings within the evidence (i.e., the papers), the codes should be closely aligned with the sampled literature and sufficient, supportive excerpts should be provided. However, copyright protection of the original articles prevented the inclusion of exhaustive direct quotations. Third, consistency within the coding process was supported by pre-defined entry options that were prepared for several columns within the coding table. This was especially useful during the first coding phase when the general inclusion or exclusion criteria were verified. For example, game type (column A11) was coded as either digital , non-digital , or unknown based on abstract . Similar, appropriateness for the review (A15.1) was coded as 1 = should be considered, 2 = should NOT be considered, or 3 = not sure. When a paper was coded as 3 , the entry was reviewed by a second coder. For the full-text review, such pre-defined entries were less applicable in certain cases, as the codes themselves were of interest in regard to the initial research questions. For example, column B2, What are the used theoretical frameworks? needed to be completed during the review process, as the answer to this question was naturally unavailable prior to the review. Overall, the process of pre-registering the coding table, research method, and research questions ensured a high level of methodological integrity throughout the review. Any deviations or extensions of the a priori formulated research plan (which is not unusual for qualitative or mixed method research; Lamnek and Krell, 2016 ) is clearly indicated throughout the paper. For example, analyses beyond that covering RQ1–3 were included within the Narrative subsections of the results section. Finally, the integrity of research like systematic literature reviews is limited by the integrity of the reviewed material. To ensure basic scientific quality, papers that have not yet undergone peer-review were omitted during the first coding phase. In addition, concerns or potential critical issues were identified within the Papers Reviewed section.

The findings described below were based on the final sample. Unless stated otherwise, phrases such as “20% of the sample” refer to the final studies reviewed, not to the initial sample after the literature search. In addition, percentages are reported in relation to the final coded sample (11) and not in relation to the ultimately included papers or manuscripts (10).

RQ1—How is Research in the Field of Analytics for Adaptation in Educational Video Games Currently Conducted?

The current systematic literature review identified 10 relevant papers in total. One paper included two studies and was therefore considered as separate entries—that is, as two entries in the coding table. To better understand how research in the field of analytics for adaptation in educational video games is currently conducted, we provide a comprehensive overview of the games and methods currently being used before we report the specifics of the actual implementation of adaptivity.

In the identified 11 studies, eight different games were used. That is, the same games or at least the same game environments were used in multiple studies or papers. The game genres used in the studies did not vary considerably, with simulation games (4) and role-playing games (4) being the most popular. The three other studies employed games that did not fit the predefined genres (cf. Connoly et al., 2012 ) and were thus classified as “other.” For instance, in OTHER15, a gameful learning experience was designed using Trello boards and the SPARC model ( Mora et al., 2016 ). OTHER12 utilized a game-like quiz, while SCOPUS1 used a game-like calculation app. However, we must note that even for those games that were classified into a predefined genre, the decision to do so was not always clear cut and was at least debatable, as these games were not always sufficiently described.

The studies and games covered different subject disciplines , with games covering Science being the most popular (4). Mathematics was the subject discipline for two games. Business and Technology were covered by one study each. Moreover, three studies did not clearly fit into any of the predefined subject disciplines: OTHER12 covered general factual knowledge on animals, whereas OTHER11 and SCOPUS11, which used the same game, covered procedural knowledge for emergency personnel. In this context, the studies mostly targeted higher education content (6) and continuing education (3). Primary and secondary school content was targeted by one study each.

In the identified sample of papers, the majority utilized quantitative data (9). Only one study used qualitative data, while two studies used a combination of both. The overall mean sample size of 120.73 could be sufficient to detect differences of medium effect size between two independent samples. For instance, a two-tailed t -test with alpha = 0.05, power = 0.8, and d = 0.5 requires a sample size of 128 according to g*power ( Faul et al., 2007 ). However, the large standard deviation of 120.46 highlights major differences between the individual studies. Furthermore, the studies utilized very different designs, requiring more or less statistical power. To this end, an a priori power analysis could not be identified as a normal procedure within the sample.

Most of the identified studies (8) evaluated their adaptive approach with participants from university/higher education (i.e., university students). Although WOS57 did not report specific information on participants, they were recruited with advertisements on a university campus, which suggests a high likelihood that most of the sample consisted of university students as well. Corresponding with the reported target content (see Games ), one study was performed in primary school and one in secondary school. The majority of studies were conducted in a real-world setting (7). Four studies were performed in laboratory settings. The substantial proportion of studies performed in the field indicates the dominance of an applied approach to the field of adaptive educational video games.

In six of the 11 studies, the authors utilized a control group or control condition to evaluate the effects of adaptivity. However, we should note that in SCOPUS2, the authors also made an attempt to descriptively compare their investigated student sample with data they had on students from previous years using the same system but without adaptive components. This comparison was accomplished only descriptively and, overall, the comparison was not sufficiently described, which led to it being classified as not having used a dedicated control group. In any case, the number of studies utilizing a control group was equivalent to the number of studies that did not, underscoring the urgency of increasing empirical standards in this field of research. However, almost all studies used an experimental or quasi-experimental study design (9). One study was mostly correlational, while another employed a qualitative study design. Furthermore, seven studies only used one measurement point (i.e., post-test measure), while three studies utilized pre- as well as post-test measurements to evaluate their adaptive approach. In SCOPUS1, neither a classic pre- nor post-test was reported, but instead the authors observed primary class children for two learning sessions with or without the adaptive component (i.e., feedback) of the game in question. Only two studies solely used descriptive statistical analyses . One study used a combination of descriptive statistics and correlation but without inferential testing. Hence, the large majority (7) ran descriptive as well as inferential statistical analyses to support their conclusions.

Overall, the general goal of the adaptive mechanism integrated into the games included in the sample was, in most studies, to optimize learning (7). The rest of the studies focused on instigating a change in either a behavioral, motivational, cognitive, or social variable. Hence, there is a clear focus on directly affecting learning in and of itself in the investigated sample of studies. The strategies by which the authors of the studies sought to achieve adaptivity also varied considerably (see also RQ2 on which theoretical frameworks were used). Hence, providing frequencies on the different approaches was not possible. Instead, a few examples are included here to demonstrate the types of approaches used (for more detailed information, see Ninaus and Nebel, 2020 ). For instance, the adaptive mode used in OTHER11 was aimed at keeping the players in the game loop for as long as possible. In contrast, SCOPUS2 sought to maintain the chance of being correct in the game at 75% by adapting the game’s difficulty. Others tried to adapt the feedback provided by the game (e.g., SCOPUS1) or used natural language processing to develop questions that were posed to the players on the basis of their prior knowledge (e.g., SCOPUS8).

To realize adaptivity within a learning environment, different sources of data can be used. Although assessment and adaptivity could be potentially realized using only the game system itself, the majority of the sample (80%) utilized additional surveys and questionnaires. Only two papers could be identified with a potentially less intrusive approach of exclusively utilizing in-game measures. In this vein, only two papers used physiological measures instead of behavioral indicators or survey data to realize adaptivity. Using these data, different adaptive elements were realized in the sample by either between (8) or within (3) subject designs. The vast majority of studies were aimed at adapting the difficulty of the game (8). Two other studies used adaptive scaffolding to optimize the learning outcomes. One other study (WOS57) investigated pedagogical scenario adaptation (i.e., automatically generated vs. scripted). These elements were, in most of the studies, adapted in real time (8), followed by between learning sessions (3). However, this differentiation was not always clear as relevant information was in some instances missing. In seven studies, processing of data was done using a user model. Two studies processed the data without a user model, while another two used the raw data only.

RQ2—What Cognitive/Theoretical Frameworks Within Analytics for Adaptation in Educational Video Games are Currently Used?

Apart from OTHER1, OTHER2, OTHER11, and SCOPUS11, which were either two experiments within the same paper or articles authored by almost identical authors, each experiment used a unique theoretical approach. Thus, frequency analysis would have been ineffectual. Instead, a few examples can be used to illustrate the encountered theoretical approaches. For instance, cognitive load theory (OTHER12), learner models with Bayesian networks (WOS57), competence-based knowledge space theory (SCOPUS1), or modular reinforcement learning (OTHER13) were applied. This indicates emphasis on data-driven methodology or institutional preferences rather than on slowly evolving and unifying theoretical frameworks.

RQ3—What Kind of Outcomes are Influenced Through the Adaptive Approach?

Every game within our final sample was originally intended as a learning game. Additionally, every application within the sample was intended to increase learning outcomes. Other possible combinations—for example, entertainment-focused commercial games used within an educational context or educational games aimed at improving metacognition or motivation—were not observed. Instead, 60% of the papers reported that the adaptive mechanism was mainly intended to increase learning outcomes. One study aimed to improve user experience (SCOPUS11), while another sought to explore motivational aspects (WOS57); the remaining two studies, on the other hand, indicated mixed goals (OTHER11, OTHER15). In sum, learning improvements can be identified as the main target of adaptive approaches. A different distribution can be observed within the report of statistically significant findings: 50% of the final sample revealed significant findings, 10% reported mixed results, and 40% did not generate statistically significant outcomes. For this frequency analysis, however, it should be noted that statistical significance alone neither necessarily indicates a relevant effect size nor confirms a sufficient methodological approach. In addition, the potential threat of publication bias cannot be ruled out. No study, at least, revealed negative outcomes, and even if not statistically significant or mixed, the majority of outcomes were indicated to be positive.

Narrative Content Analysis

Disciplines and publication.

Although the inclusion criteria allowed for the inclusion of research ranging back to the year 2000, the oldest eligible article was published in 2012, with 50% of the final sample being published from 2018 to 2020. This indicates a substantial increase in research interest in the field. Psychology or computer science were identified as the disciplinary affiliation of the primary author for 80% of the articles, with only 20% originating from the field of education. This might indicate a lack of sufficient support through educational research. The final sample contained only research from North America or Europe, raising questions regarding the availability or visibility of research from other productive regions, such as Asia. Similarly, only 50% of the final sample could be gathered through database research, raising concerns about sufficient visibility or insufficient standardized keywords in the research field. This could potentially be explained by the fact that apart from two papers published in the International Journal of Game-Based Learning ( Felicia, 2020 ), all eligible papers were published in different outlets and conferences. This suggests the lack of an overarching community or publication strategy but also indicates that the field addressed by the systematic review remains in its infancy.

Research Strategy and Limitations

Most frequently, the collected articles comprised exploratory research, as only research questions like “Does an online personalized gameful learning experience have a greater impact on student’s engagement than a generic gameful learning experience?” ( Mora et al., 2018 , p. 1926) or open-ended questions were included. For example, formulations such as “The primary research question that the current paper addresses is …[…]” ( Forsyth et al., 2020 , p. 254; emphasis added) entailed unspecified additional observations. Rarely, hypothesis testing research was identified: “Hypothesis 4: Learners playing against adaptive competitive elements demonstrate higher retention scores than players competing against human opponents” ( Nebel et al., 2020 , p. 5). Although exploratory studies are very valuable in early research, their outcomes are subject to more methodological limitations than theoretically and empirically supported hypothesis-testing research. Additional limitations are imposed through frequent applications of quasi-experimental factors using split groups—e.g., “we split the participants into three roughly equal groups based on pretest scores” ( Forsyth et al., 2020 , p. 268)—or with separations based on other sample properties—e.g., “Students belonged to the CAS or CAT group according to the native language recorded in their academic profile” ( Mora et al., 2018 , p. 1928).

Occasionally, the authors used limited statistical methods or reported disputable findings if no significant result could be produced: “[…] the descriptive statistics suggest that personalization of gameful design for student engagement in the learning process seems to work better than generic approaches, since the metrics related to behavioral and emotional engagement were higher for the personalized condition in average” ( Mora et al., 2018 , p. 1932). This was observed even in cases in which the authors were aware of their shortcomings—e.g., “[…] there is a danger of mistaking a correlation for causality […]” ( Groeneveld, 2014 , p. 57)— or if critical methodological difficulties, such as alpha-error inflation, were not considered—“We then computed correlations between all of the measures for the cognitive processes and behaviors (i.e., time-on-task, generation, discrimination, and scaffolding) and the proportional learning gains for the two topics (experimental, sampling) for each of the four groupings” ( Forsyth et al., 2020 , p. 265). However, rarely, the necessary corrections were applied: “[…] Sidak corrections will be applied to the pairwise comparisons between these groups” ( Nebel et al., 2020 , p. 8). In contrast, even for process data for which a myriad of potential comparisons could be made, statistical criteria, such as significance levels, were handled incautiously: “A two-tailed t -test indicated that students in the Induced Planner condition (M = 13.7, SD = 10.9) conducted marginally fewer tests than students in the Control Planner condition (M = 19.5, SD = 14.4), t (59) = 1.80, p < 0.08” ( Rowe and Lester, 2015 , p. 8). Justifications for such methodological issues relied on the goal justifies the means approach: “Although the assumption of independence was violated, the goal of the correlations was to simply serve as a criterion for selecting predictor variables to include in follow-up analyses” ( Forsyth et al., 2020 , p. 265). As a consequence, the validity of the gathered insights are questionable in light of the methods by which they were generated.

Similar to other emerging fields, yet rarely, the sampled studies employed standardized measurements or comparable indicators: “Second, the high success rate in the final exams is reassuring, but can hardly be considered evidence” ( Groeneveld, 2014 , p. 57). However, some authors tried to overcome such methodological issues by pre-testing the measures themselves: “There were two versions of our measure of learning […] Reliability was established using over 200 participants recruited through Amazon Mechanical Turk” ( Forsyth et al., 2020 , p. 263). However, such pre-testing regarding the effectiveness of the learning mechanism or the suitability of the measures themselves was scarce. Some authors discussed this issue a posteriori: “In hindsight, the lack of a condition effect on learning is unsurprizing. A majority of the AESs provided scaffolding for student’s inquiry behaviors, rather than microbiology content exposure, which was the focus of the pre- and post-tests” ( Rowe and Lester, 2015 , p. 7).

Potential for Improvements

Despite severe methodological challenges, the sampled researchers highlighted various areas of improvement within the field. For instance, in cases where the game was not created by the researchers themselves or not specifically for the addressed research questions, limited insights into the different processes were acknowledged: “[…] we cannot disentangle one theoretical process from each other without restructuring the entire game. For these reasons, we acknowledge that our findings may not be as generalizable as we would hope in regards to the literature of the learning sciences” ( Forsyth et al., 2020 , p. 274). Another potential area for improvement was the method of adaptation itself. Often, predefined and global thresholds are used to adjust adaptivity, neglecting potential differences between the users: “Feedback is triggered when a certain pre-defined probability threshold is reached for a skill/skill state” ( Kickmeier-Rust et al., 2014 , p. 40). Rarely, these thresholds are based on other research or pilot studies: “The 5 bpm threshold was defined based on previous pilot tests with the same game” ( Ninaus et al., 2019b , p. 123). In contrast, the thresholds are frequently based on assumptions made by the authors themselves: “Students have, regardless their ability level, a 75% chance of correctly solving a problem, which is motivating and stimulating […]” ( Groeneveld, 2014 , p. 54). In addition to the potential for technical improvements, theoretical work could be enhanced as well, especially as exhaustive motivation regarding the use of adaptive features is not presented but their usefulness is rather assumed or briefly mentioned: “This feature also guarantees learner engagement throughout the duration of the game session” ( Callies et al., 2020 , p. 1196) or “Diverse psychological viewpoints agree that people are not equal, therefore, they cannot be motivated effectively in the same way” ( Mora et al., 2018 , p. 1925). Rarely, full chapters discussing which processes might be influenced through adaptive elements are included: “[…] adaptive mechanisms […] offer several benefits in educational settings. For example, […]” ( Nebel et al., 2020 , p. 3/4); alternatively, references to methodological approaches are included: “[…] Evidence-Centered Design […] requires that each hypothetical cognitive process and behavior to be carefully aligned with the measures. For this reason, we needed to identify general processes or actual behaviors with theoretical underpinnings […]” ( Forsyth et al., 2020 , p. 259).

Recommendations

In addition to potential improvements that were more or less explicitly stated or can only be inferred with sufficient knowledge of empirical research, some authors provided clear recommendations. For example, some authors claimed that data extraction and investigation should be intensified: “Thus, we suggest, as demonstrated in this study, that tools [should] be designed to facilitate data extraction and detect learning patterns” ( Callies et al., 2020 , p. 1196). Furthermore, the complexity of the research field was emphasized: “From our research we learned that quick and easy results are often neither realistic nor meaningful. […] Using user interaction data for learning analytics is also complex and becomes even more challenging when physiological data are used […]” ( Fortenbacher et al., 2019 , p. 197). Within several papers, it was reported that adaptive systems need more time or cases in order to function sufficiently: “[…] for example, students with a very low error rates, with highly unsystematic errors, or students who performed a very small number of tasks, did not received formative feedback because in those cases the system is unable to identify potential problems […]” ( Kickmeier-Rust et al., 2014 , p. 45). As a consequence, their full potential could not be assessed within the corresponding studies. As a potential solution, other researchers used pre-test samples to train their algorithms: “[…] we conducted a pair of classroom studies to collect training data for inducing a tutorial planner” ( Rowe and Lester, 2015 , p. 5). Finally, some authors were aware of methodological limitations and the need for better studies in the future: “Although the results are encouraging, we recognize that they are not the sort of well-controlled studies that are needed to make strong claims […]” ( Halpern et al., 2012 , p. 99) or “However, these results need to be treated with great caution. Future studies with larger sample sizes and more dedicated study designs need to investigate this in more detail” ( Ninaus et al., 2019b , p. 126).

Situatedness

Overall, the studies were overwhelmingly conceptualized within an academic context. The researchers worked within various universities, and their samples frequently included students from such institutions. This, consequently, limited their research perspective (e.g., lack of pedagogical input) as well as related applications (e.g., learning impairments, limited technical equipment). In addition, the authors were frequently affiliated with faculty from the same fields, resulting in scarce interdisciplinary discussions within the final sample.

Despite the numerous research studies demonstrating the potential of determining user states via various analytics relevant for learning (e.g., Klasen et al., 2012 ; Berta et al., 2013 ; Brom et al., 2016 ; Appel et al., 2019 ; Ninaus et al., 2019a ; for a review see; Witte et al., 2015 ; Nebel and Ninaus, 2019 ) and supporting their use for adaptation, few studies have actually followed through with this approach as indicated by the current literature review. Consequently, our aim to identify how such analytics have been used to realize adaptive learning in games was compromised by the low number of existing studies in this area. Nevertheless, the current systematic literature provided valuable insights into the nascent field of adaptive educational video games and its use of analytics.

Overall, the existing research on adaptive educational games appears to be somewhat heterogenous in terms of the conceptual approaches applied. However, we did identify clear patterns concerning game genres and subject disciplines. First, there seems to be a clear focus on simulations or simulation games, as well as on role-playing games. Although we can only speculate as to the reasons for this, it would seem that this pattern is completely in line with the overall field of educational games. In a recent review on the effects of serious games and educational games by Boyle et al. (2016) , simulation games and role-playing games were also the most popular game genres. Likewise, we would argue that simulations might be easier to design than modeling aspects of learning via various game features in such a way that they respond accordingly to the adaptive mechanisms implemented. Moreover, more research is needed to better understand how individual game features affect performance and learning outcomes in general. Importantly, the games in question were not always sufficiently described. That is, it was sometimes unclear which core game loop drove the game and to which genre the game best fit. However, a lack of sufficient details on actual gameplay or of overall information on the games within empirical studies is not unique to the field of adaptive games. As there is no consensus about how to report and describe educational games in the scientific literature, the whole field of serious games or educational games is impacted. The game attributes taxonomy suggested by Bedwell et al. (2012) might serve as one way to achieve consistent reporting standards.

Second, the majority of studies focused mostly on natural sciences, such as math. So-called “softer” disciplines, such as social sciences, were not found in the final sample. In our opinion, these disciplines might be more difficult to operationalize and evaluate. Consequently, implementing adaptive mechanisms within these disciplines is at once more complex and less reliable.

The target audience of the games varied in the investigated sample, from primary and secondary school pupils to university students and vocational training students. Interestingly, however, most of the studies were performed in real-world settings, thus allowing for high ecological validity. Nevertheless, their overall research designs varied tremendously. While most studies employed experimental or quasi-experimental research designs, only three studies evaluated their adaptive mechanisms with pre- as well as post-tests. It was unfortunate that two studies, which constituted 18% of our total sample, used descriptive statistical analyses alone, further emphasizing how the field remains in its early phases. Moreover, the lack of control groups or specific manipulations of individual elements, as well as the absence of process data, in several studies made clear inferences about the impact of the adaptive systems used especially difficult, if not impossible, to generate. However, it should be noted that creating an appropriate control group for studies of adaptive mechanisms is no trivial endeavor, as learning content between adaptive and non-adaptive learning differs by nature.

In most studies, the general goal of adaptive mechanisms was to optimize or improve learning. While a few studies also investigated adaptive mechanisms on behavioral, motivational, cognitive, or social variables, there was a clear focus on learning or knowledge acquisition. This pattern might have originated from the search query we used, as we intentionally focused on cognitive or learning outcomes. More varied was the pattern in which adaptivity was realized. We could not identify a clear trend with regard to the different mechanisms targeted by the implemented adaptivity. The realization of the adaptive approaches, however, was mostly based on surveys or questionnaires. Only four papers used in-game metrics (SCOPUS8 and WOS57) or physiological signals (SCOPUS11 and OTHER11) directly to adapt the games. Thus, there seems to be room for future improvements, especially minding the various methods of assessing process data within games (for a review see Nebel and Ninaus, 2019 ).

Overall, there was no clear or coherent pattern of theoretical or cognitive frameworks used within analytics for adaptation in educational video games. That is, almost all studies used unique theoretical approaches to justify their adaptive mechanisms. It seems that the use of general learning theories was mostly neglected in the identified sample. Only OTHER12 and OTHER13 shared similar ideas based on cognitive load theories (e.g., Harp and Mayer, 1998 ; Mayer, 2005 ). Some of the presented ideas were technologically impressive but lacked a clear theoretical background. We would suggest that interdisciplinary collaborations might overcome this lack of theory-driven research and help to advance the field of adaptive educational games, which in turn might also increase the effectiveness of adaptive mechanisms. Researchers from different fields should act in concert to fully utilize current possibilities in adaptive game-based learning from a technological as well as theoretical perspective. Besides new sensor technologies to make data acquisition easier and learning analytics algorithms that permit deeper insights into the learning process and that can potentially identify misconceptions among learners, a strong theoretical foundation is also required—not only of general learning principles (e.g., Mayer, 2005 ) but also learning domain-specific processes (e.g., embodied learning approaches in mathematics; see Fischer et al., 2011 ).

As mentioned above, all games or studies were aimed at increasing learning outcomes. However, at the same time, not all of these studies actually evaluated learning outcomes alongside user experiences or motivational outcomes. Only about half of the studies found positive effects of adaptation within their evaluated games. At the same time, no negative effects due to adaptivity were reported. That is, many results did not reach statistical significance, which might be attributed to the varying sample sizes used in individual studies. Hence, this literature review cannot make clear conclusions as to the efficacy of analytics for adaptation in educational video games. However, a recent and more general review on adaptive learning technologies in general reached a more positive verdict on the effectiveness of adaptation ( Aleven et al., 2016 ). We therefore remain cautiously optimistic as to the effectiveness of analytics for adaptation in educational video games.

As the current systematic literature review only identified a rather low number of empirical studies, its results needed to be treated with caution as they might not be representative. However, we need to note that identifying only a rather small number of eligible studies is not completely unusual for the field of serious and educational games, in particular when reviewing a subdiscipline of serious games or focusing on specific constructs [c.f. Lau et al., 2017 (9 studies); Eichenberg and Schott, 2017 (15 studies); Perttula et al., 2017 (19 studies)]. Moreover, other recent and more general systematic literature reviews on adaptive learning systems did also only identify a very small number of empirical studies utilizing games or game-like environments (e.g., Aleven et al., 2016 ; Martin et al., 2020 ). That is, our current results seem to be in line with other systematic reviews on adaptive learning systems, suggesting that the field of adaptive educational games and its use of analytics is indeed in its very early phases.

Overall Conclusion

Overall, the presented review contributes a previously lacking overview of and deep exploration into the extant research in the field of analytics for adaptation within educational videogames. Increasing attention to this research area was evident, whereas the overall quantity of relevant experimental research was rather low. In this vein, narrative and frequency analysis could confirm existing opinions about the lack of theory-driven approaches ( Van Oostendorp et al., 2020 ) on a systematic level, although the existence of heterogenous approaches and methodological limitations could prevent further systematization of the dimensions of adaptive systems. This finding, however, is not entirely surprising, not only because of the different disciplines involved but also because some of the contributing research areas struggle with similar challenges themselves. For instance, Human-Computer-Interaction research that investigates video games often encounters substantial methodological and statistical challenges ( Vornhagen et al., 2020 ), whereas educational psychology faces related issues, such as the replication crisis ( Maxwell et al., 2015 ) or infrequent improvements to theoretical frameworks ( Alexander, 2018 ; Mayer, 2018 ). Nonetheless, the results of this review can be used to address these critical issues and improve future empirical research in the field. In addition, the empirical evidence, albeit limited, is promising and could encourage future investigations and practical applications of the resulting adaptive systems. Although positive effects were achieved despite the fact that the researchers often worked without pedagogical, instructional, or educational theories or conducted limited exploratory investigations the highly needed quantity of research simply does not exist yet. This was concluded with reasonable certainty after conducting the systematic review. However, the sample supported only a somewhat superficial systematization and assumption of resulting effects. Therefore, it remains to be seen how such conclusions might change as the field matures and improves. This argumentation holds true for subsequent systematic work in the field. Using this article as a starting point, the pre-registered and open-data information can be used to improve the process and gather more fine-grained insights or even yield different conclusions. Furthermore, future systematic reviews following an identical methodical but different theoretical focus could systematize and contrast important literature in adjacent fields (e.g., Bellotti et al., 2009 ). In addition, different research methods, such as further quantitative or qualitative investigations of the main sample, might enrich the gathered insights. However, in light of the methodological heterogeneity of the current investigation and its small sample size, pursuing such an approach at present is unlikely.

Utility of the Findings and Approach in Responding to the Initial RQs

The approach and its findings can be considered to be successful and insightful with regard to major aspects of the initial research questions. A clear picture of current research was gathered (RQ1), and crucial gaps and heterogenous approaches were clearly identified (RQ2). In this latter respect, the systematic approaches also increased the validity of the conclusions, thereby supporting previous considerations within the field. However, some aspects could not be completely assessed by the pre-registered categories (RQ3), consequently reducing the systematized information collected by this review and its subsequent conclusions. In order to compensate for this limitation, which was discovered after pre-registration, an additional, non-systematic narrative analysis was conducted. Taken together, the approach can be considered fruitful, even though the coding table could be further optimized. In addition, the findings are capable of addressing the initial research questions, even though the answers sometimes contained less information than first assumed during the conceptualization of the review.

Data Availability Statement

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: The datasets (i.e., complete coding tables) for this study can be found in the OSF: https://osf.io/dvzsa/ .

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

The publication of this article was funded by Chemnitz University of Technology.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We want to sincerely thank our student assistants Stefanie Arnold, Gina Becker, Tina Heinrich, Felix Krieglstein, Selina Meyer, and Fangjia Zhai for supporting the initial screening of articles for this review.

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Keywords: analytics, educational video games, serious games, game-based learning, adaptivity, learning, systematic review

Citation: Ninaus M and Nebel S (2021) A Systematic Literature Review of Analytics for Adaptivity Within Educational Video Games. Front. Educ. 5:611072. doi: 10.3389/feduc.2020.611072

Received: 28 September 2020; Accepted: 21 December 2020; Published: 29 January 2021.

Reviewed by:

Copyright © 2021 Ninaus and Nebel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Steve Nebel, [email protected]

† These authors have contributed equally to this work

This article is part of the Research Topic

Adaptivity in Serious Games through Cognition-Based Analytics

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Video games and their associations with physical health: a scoping review

Vincent huard pelletier.

1 Department of Anatomy, Universite du Quebec a Trois-Rivieres, Trois-Rivières, Canada

Arianne Lessard

2 Department of Human Kinetics, Universite du Quebec a Trois-Rivieres, Trois-Rivières, Canada

Florence Piché

Charles tétreau, martin descarreaux, associated data.

bmjsem-2020-000832s001.pdf

The objective of this scoping review is to investigate the possible links between the practice of video games and physical health. It seeks to answer the following question: What are the physical health consequences of playing video games in healthy video game player? and How is it currently investigated?.

A scoping review was conducted to identify observational and experimental studies pertaining to our research question. Retrieved papers were screened using a two-phase method first involving a selection based on titles and abstracts. Then, potentially relevant studies were read and triaged. The final set of included studies was analysed, and data were subsequently extracted. Observational studies and experimental studies were assessed using the appropriate Cochrane Risk of Bias Tool and data were synthetised according to specific physical health and related health behaviours.

Twelve peer-reviewed articles were retained for further analyses. Results of this scoping review suggest preliminary evidence that time spent gaming is associated with some health outcomes indicators. Our results indicate preliminary evidence that increased gaming time is associated with higher body mass index and lower self-reported general health status. There is insufficient evidence to conclude on a possible association between gaming time and physical activity or sedentary behaviours, sleep or fatigue, musculoskeletal pain or dietary behaviours.

The results of this sopping review suggest an association between increased video game playing time and a deterioration in some physical health indicators but available evidence is scarce, precluding from any strong conclusion.

INTRODUCTION

The first-ever publicly released video game was introduced in 1958; it was called Pong and it was a very rudimentary representation of a tennis game. Since then, the video game industry has continued to expand and diversify, gradually moving from arcades to consoles until the arrival of the internet in the mid-1990s. Video gaming is now part of the daily lives of more than 75% of North American households, 1 and revenues of the video game industry now outpace those of the film and online streaming industry. 1 Several types of games are available to meet the needs and desires of a large number of consumers, which explains why there are players in each age group and in both sexes. 1 Over time, a professional scene has emerged and grown in popularity, to the point where electronic sports (eSports), which are defined as video gaming in a competitive environment or settings, 2 now offer salaries comparable to traditional sports and could be included in the 2024 summer Olympic Games. 3 Such rapid development has led educational institutions to implement eSports development programmes that can also provide scholarships to promising students. In the United States, at least 50 colleges have varsity eSport teams under the National Association of Collegiate eSports, and more than 20 offer scholarships to their athletes. 4

Although video gaming and eSport has seen a tremendous growth in popularity in the past decades, studies suggest that these activities may have several negative impacts on psychological and physical health. 5 First, playing violent video games is seen as a desensitising factor to violence in the real world and has been linked to several tragic events such as the Columbine and Sandy Hook massacres by the media and public figures. 6 This relationship, however, may not be causal and playing these types of games may not increase the chances of becoming violent for oneself. 6 Another often-raised problem is that many video game enthusiasts seem to devote a large number of hours to gaming. For instance, in South Korea and Singapore, where video games are ubiquitous in popular culture, many young people are reported to play for more than 20 hours a week. 7 Cultural differences may exist in other parts of the world, but gaming addiction was considered serious enough for the American Psychiatric Association to add video game addiction as a pathology in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 8 However, this addition raises questions, as some authors suggest that the pathology definition and the different behaviours characterising the diagnosis should be clarified. 9

Psychological health is not the only concerning aspect surrounding video game players. Indeed, with the exception of active games, video games are most often played while sitting in front of a screen, using either a cell phone, tablets, a console attached to a television or a computer monitor. Screen time is a major concern for public health organisations, as it has several negative effects. In fact, people who report higher screen time are physically less active, more likely to be overweight 10 and consume significantly more caffeine and calories. 11 12 In addition, sleep quality is often negatively related to screen time, 13 as are some depressive symptoms. However, it remains to be determined if evidence regarding negative consequences can also be observed in video game players. In this study, video gamers are defined as individuals who play video games at least 1 hour per week. 14 They certainly spend some time in front of a screen, but their sessions may be more interactive than passive television viewing. Furthermore, depending on the type of games played, the practice level and their social context, video game players can be classified in various categories. 15 Thus, video gaming is a multi-faceted phenomenon that not only attracts different types of individuals, but that can also provide different types of experience depending on the context. 16 Nowadays, there is no clear consensus with regard to the different physical health indicators and behaviours associated with video gaming played by healthy video games players, as very few studies focused on this topic.

Video games have become an important part of people’s daily lives in a relatively short period of time, and scientific evidence focusing on the impact of gaming, whether it is organised or solitary, are progressively emerging and shedding light on significant public health issues. Given the rapidly growing popularity of gaming and organised eSports and the publicly growing concerns about video game effects on health, 17 the following scoping review focuses on how video game playing impacts on the physical health indicators and behaviours of healthy players.

MATERIALS AND METHODS

A scoping review approach was chosen to undertake this literature review on the physical health of video game players. The scoping review was identified as the most appropriate format for this study, as: (1) the literature on this subject appears to be incomplete, and suggestions could be made to fill existing research gaps, (2) this format allows the extraction of results while taking into account the context of the studies and (3) the scoping review can be used to verify the relevance of conducting a complete systematic literature review. 18 The following five methodological steps have been conducted and will be presented below: (1) identification of the research question, (2) identification of relevant studies, (3) selection of studies, (4) data extraction and (5) gathering, synthesis and presentation of the review’s results. According to the University’s Human Research Ethics Committee policy, a scoping review does not require an IRB certification.

Identifying the research question

In order to address the main objective of the study, which is to increase the broad knowledge about the consequences of video gaming on physical health of healthy video game players, the following research question was developed: What are the consequences of playing video games on physical health indicators and behaviours in healthy video game players, and how is it currently investigated? Since the definition of physical health can be broad and may vary from one study to another, physical health was defined, for this study, as multi‐component construct that refers to health complaints and acute health concerns (notably injuries), but also includes lifestyle choices like commitments to physical activity, nutritious diets and sufficient sleep. 19

Identification of relevant studies

Nine databases (SPORTDiscuss, Academic Search Complete, CINAHL, Cochrane, MEDLINE, PsycINFO, Pubmed, ERIC, APA PsycNET) were searched for articles published between January 1990 and July 2019. For each databases, we used the following keywords: (‘Video game’ OR ‘Computer game’ OR ‘Online game’ AND ‘fitness’ OR ‘musculoskeletal injury’ OR ‘lifestyle’ OR ‘physiological health’ OR ‘physical health’).

Studies selection

To define the inclusion criteria for the articles to be included in this scoping review, the PICO framework was used. 20 Articles that discussed the effect of video games in non-healthy videogame players (with a reported medical diagnosis), as well as articles focusing on active or exergames (like Wii Sports) or the effect of playing video games on violent behaviour were excluded. Finally, studies exploring outcomes not directly related to physical health as well as non peer-reviewed articles, case studies and reviews were excluded.

For each of the subsequent steps, two reviewers (FP & VHP) were involved in the article selection. Whenever reviewers disagreed on the relevance of the articles, a third reviewer (MD) was involved to settle in favour of one or the other. First, articles whose title was clearly irrelevant to our research question were excluded. Abstracts from the remaining articles were then screened and irrelevant studies were further excluded using the same criteria. The last step involved thoroughly reading the remaining articles to select only those that convincingly met the inclusion criteria.

Data extraction

Data from the 11 selected studies were extracted using an Excel form where the following information was compiled (see online annexe 1 ): authors names and year of publication, main objectives of the study, physical health outcomes and main results.

Supplementary data

Gathering, synthesis and presentation of results.

The content of the studies from the Excel form was discussed by the two reviewers (FP & VHP) to highlight relevant information about the consequences of video games on various physical health indicators and behaviours. Studies such as literature reviews discussing physical health and video games that were not part of the final selection were used to compare results and discuss the state of the current evidence on the topic.

Assessment of risk of bias was conducted independently by two authors (AL & MT), using the methodology recommended by Guyatt et al for observational studies. 21 This tool assesses six potential sources of bias: selection bias (inappropriate sampling), performance bias (flawed measurement of exposure), detection bias (flawed measurement of outcome), attrition bias (incomplete follow-up, high loss to follow-up), selective reporting bias (selective, incomplete or absent outcome reporting) and all other sources of bias. All the included studies were assessed for quality. Each item was rated either high, low or unclear risk of bias. For experimental studies, the ‘Revised Cochrane risk-of-bias tool for randomised trials’ was used. 22 Grading of the evidence was conducted for each physical health outcomes and judgement of the strength of the available evidence included risk of bias analyses as well as strength and consistency of associations. 23 24

Descriptive statistics

Of the 2356 papers gathered from the search strategy, 251 abstracts and titles (10.6%) met our inclusion criteria. After the full-text reading stage of our scoping review, the list of articles was considerably shortened and included eleven peer-reviewed articles gathered by the search and one article suggested by an expert (<1%) that were retained for further analyses (see figure 1 ). Of these 12 studies, 10 (83%) had used a cross-sectional design, 25–33 one (8%) had a longitudinal design 34 35 and one (8%) was an experimental randomised cross-over study. 36 Five studies were published between 2005 and 2010, 25 30 31 34 while the remaining seven studies were published after 2010 (see table 1 ). 26–29 33 35 36 With regard to the participants that were investigated, every study included (100%) adolescents, 25–32 34–36 while four (33%) also included adult participants. 27 29 30 33 Concerning the participants' gender, nine studies (75%) examined both men and women, 25 27 28 30–35 while two (16%) only focused on men 29 36 and another study (8%) did not specify the participants’ gender. 26 Finally, the different studies involved participants from various countries or regions of the world (see table 2 ), as six studies (50%) were conducted in Europe, 27–29 32 33 36 five (42%) in North America 25 26 30 34 35 and one (8%) in South America. 31 Finally, seven studies (58%) had a large number of participants (more than 500), 25 27 28 30–33 two had an intermediate number of participants (100–499) 34 35 and three had a low number of participants (less than 100). 26 29 36

Study designs

*Scharrer et al was designed like a randomised experimental study but there were no baseline assessments of outcomes. Therefore, it was considered a prospective cohort study.

Participants and locations

PRISMA flow chart.

Risk of bias assessment

The eleven observational studies 25–35 and one experimental study 36 were assessed for quality. All observational studies had issues regarding detection bias, mostly because homemade questionnaires or non-validated protocols were used to measure outcomes. Three studies 25 26 34 had a high risk of bias, either due to selection, missing data, reporting or measurement bias, such as voluntary participants and non-randomised samples, and incomplete reporting of some outcomes. Nine studies 27–33 35 36 presented a low risk of bias. Table 3 summarises the risk of bias assessment.

Physical health indicators and behaviours

Several key health-related variables were studied in the articles selected in this scoping review. Five studies (42%) investigated sleep or fatigue, 27 29 32–34 four (33%) examined body mass index (BMI), 25 29 30 33 35 four (33%) were interested in general health, 30 32–34 three (25%) considered musculoskeletal pain, 26 28 31 three (25%) investigated levels of physical activity 26 29 33 and three (25%) measured energy intake/expenditure or nutrition. 29 33 36

Assessment tools

A vast majority (83%) of the studies under examination used questionnaires to gather data. 26–35 Of these studies, nine (75%) chose to develop a homemade questionnaire, 25 26 28 30–32 34 35 while two (17%) decided to use a pre-existing and validated questionnaire. 27 29 Only one (8%) study opted to measure a physical health outcome using objective measures. 36 Chaput and colleagues 36 used a direct measurement method to evaluate energy intake and expenditure. Table 4 presents the various assessment tools used in each study and the psychometric properties as reported in the original study.

Outcomes assessment tools psychometric value

BMI, body mass index; MCID, minimal clinically important change score; N/A, not available in the study.

Association between gaming and physical health outcomes

Sleep and fatigue.

Five studies investigated sleep and/or fatigue. 27 29 32–34 From these studies, only one 34 had a high risk of bias but assessment tools and study populations were heterogeneous across studies including sometimes teenagers and young adults and sometimes older adults. One study, 27 with a low risk of bias, reported a weak association between gaming and lack of sleep or level of fatigue while two low risk of bias studies 29 found no association between sleep indicators and gaming time. One study did not specifically address the relationship between gaming time and fatigue. 32 Based on heterogeneity among samples (studies involving either video gamers and eSport athletes) and assessment tools used in these studies, there is insufficient evidence to determine if any association exists between sleep quality, fatigue and video game playing time.

Five studies investigated BMI, 25 29 30 33 35 three of them having a low risk of bias. Two low risk of bias studies 29 30 conducted in teenagers and adult populations found a moderate association between gaming and BMI, one low risk of bias study 33 found a weak association between gaming and BMI, while one low risk of bias study 35 found no association in teenagers. Based on these studies and because of the heterogeneity of studied populations, we conclude that there is preliminary evidence that increasing hours of video game playing is associated with increased BMI in adults only.

General health status

Four studies reported general health status outcomes 30 32 34 and three of them had a low risk 30 32 33 of bias, while the other one had a high risk of bias. 34 One low risk of bias study reported a poorer health status in video game players compared with non-players 30 and one low risk of bias study found a weak negative association between playing time and self-reported health status. 33 Another study 32 indicated that ritualised motives to play video games contributed significantly to health complaints in boys and girls. This latter association, although significant was marginal. Based on these studies and because of the heterogeneity of studied populations, we conclude that there is preliminary evidence that increasing hours of video game playing is negatively associated with general health status.

Musculoskeletal pain

Three studies investigated musculoskeletal pain, 26 28 31 all of them having a low risk of bias. One study 26 reported only descriptive statistics for various musculoskeletal complaints among eSport athletes. One study 28 reported a weak association between gaming time and musculoskeletal pain, while another study 31 concluded that gaming was not associated with back pain, pain in upper limbs or diffuse pain. Given that musculoskeletal pain and complaints were self-reported using non-validated tools and based on two contradictory low risk of bias studies we conclude that there is insufficient evidence to determine if any association exists between time spent playing video games and musculoskeletal pain.

Level of physical activity and sedentary behaviours

Three studies investigated the level of physical activity. 26 29 33 One low risk of bias study 29 reported a moderate negative association between vigorous physical activities while one low risk of bias study reported no association. 33 One high risk of bias study 26 reported only descriptive statistics (40% of the players do not participate in any kind of physical activity). Based on the two low risk of bias studies, there is conflicting evidence that increasing hours of video game playing is negatively associated with physical activity.

Dietary behaviours

Three studies, all with low risk of bias, measured dietary behaviours. 29 33 36 One study 29 reported no difference in energy intake between frequent and non-frequent players while the other study, 36 the only experimental study included in the review, showed that video game playing is associated with an increased food intake, regardless of appetite sensations. Another low risk of bias study found no association between video game playing time and fruit and vegetable consumption. 33 Based on low risk but contradictory and heterogeneous studies, we conclude that there is insufficient evidence to determine if any association exists between time spent playing video games and either energy intake/expenditure or fruit and vegetable consumption.

This scoping review focused on the impacts of video games on physical health indicators and behaviours of healthy video game players. In this study, physical health is defined as a multi‐component construct that refers to health complaints and acute health concerns (notably injuries), but also includes lifestyle choices like commitments to physical activity, nutritious diets and sufficient sleep. Based on the current evidence regarding the effect of screen time on physical health indicators, we hypothesised that increased time spent playing video games would be associated with a deterioration in physical health indicators. After analysing the relatively scarce and recent available evidence on the topic, it is now possible to synthetise the main findings regarding the different health outcomes.

Because of their methodological approach and specific research questions, some articles deserve to be discussed individually. Chaput and colleagues 36 were the only study in this scoping review that used a randomised crossover methodology and is also the only study using direct measurement to measure energy balance. Another study published by Hellström and colleagues 28 investigated the motives to play video games and the association between such motives and various health outcomes. Finally, DiFrancisco and colleagues 26 adopted a more descriptive approach, but opted to measure a population of eSport athlete, which makes it the only study currently addressing physical health outcomes and E-gaming.

Another review in which massively multiplayer online games were studied 37 found ‘inconclusive evidence’ regarding the relationship between regular massively multiplayer online games gameplay and negative consequences to physical or psychosocial health of players, although they found a positive relationship between gaming addiction and worse overall health and sleep quality. The authors also reported that a major limitation of their study was the poor quality of the research in the field of gaming. A systematic review 38 explored the effect of gaming on physical and psychological health among users for the past 20 years. They found that the impact is variable depending on the type of gamer, but that playing more than 5 hours per week was associated with negative outcomes like musculoskeletal injuries, higher BMI and sleeping problems. The latter review included studies either about general and mental health, aggressive and social behaviours and educational benefits but did not assess specific categories of physical health outcomes and only provided broad results and conclusions on these outcomes. Moreover, the authors did not conduct a risk of bias analysis which limits the interpretation and generalisability of their results.

Several physical health indicators and behaviours were identified in the selected articles. The conflicting evidence suggesting a possible negative association between physical activity levels and time spent playing video games, even if preliminary, seems important since physical activity levels are closely related to long-term health indicators, such as blood pressure, diabetes or BMI. 39 40 A recent study exploring associations between sitting time, physical activity and BMI concluded that individuals that spend more time seated (8 or more hours per day) were more likely to have a higher BMI and lower physical activity participation. 41 Given that preliminary evidence also suggest that increasing hours of video game playing are associated with increased BMI in adults, more studies investigating the relationship between video games physical activity, obesity and cardiometabolic health outcomes are warranted. The effect of video game playing on physical activity seems to vary according to the type of video gaming. For instance, preliminary results suggest that 73% of eSports players are able to meet physical activity guideline potentially because of their motivation to stay healthy and enhance their physical capacity. 42 Alternatively, because they require the participants to move their body to progress, as opposed to classic video games or other screen-based activities, 43 exergames seem to momentarily increase light-intensity to moderate-intensity physical activity. Their effect on long-term commitment to physical activity or decreases in sedentary behaviour, however, is less clear. 44 The results and conclusion of this review may have differed if active or exergames would have been included.

One of the major concerns of public health stakeholders is the impact of screen time on population health. When compared with the overall body of evidence related to screen time and physical health, this scoping review suggests that the relative consequences are generally similar to those observed when individuals spend time in front of a screen, regardless of whether they play video games, watch television or interact on social media. A recent review by Hale and Guan investigating screen time and sleep hypothesised that sleep was negatively impacted by screen time. 13 They found that, in 90% of the reviewed studies, sleep was negatively impacted by time spent gaming. Moreover, the physiological and psychological states of arousal caused by the content of the media or resulting social interactions can negatively impact the ability to fall or stay asleep. Finally, the authors reported that prolonged screen light exposure before bed (more than 2 hours) is suggested to alter the circadian rhythm through the suppression of melatonin and affect the quality of sleep. Moreover, a recent study highlighted an inverse association between time spent in front of a screen and moderate to vigorous physical activity. 45

One of the key strengths of this review is the fact that it strictly focuses on video games and no other type of screen-related activities. This distinction can be useful for public health stakeholders to develop and disseminate recommendations to the public; it can also help scientists to identify strengths and weaknesses in the literature. Another relevant contribution of this review is that it isolates the physical component of health and ignore psychosocial outcomes. There is much more evidence regarding the latter outcomes, while physical outcomes such as sleep, physical activity and energy balance are often relegated to a secondary role. Limitations of this review include the sometimes small sample and heterogeneity of the included studies. Indeed, the available evidence regarding the relationship between physical health and time spent playing video games is still limited and most of the studies were published in the last 10–15 years. Also, given the composition of the research team, it was decided that only studies written in French or English would be included for analysis. The impact of such language exclusion is that the number of potentially excluded but relevant publications is unknown. Finally, because original studies included in this scoping review were mostly cross-sectional studies, the temporal relationship between exposure and outcomes as well as other criteria for causation cannot be determined.

Given the aforementioned limitations, future research should include experimental research design using control groups to better understand the mechanisms underpinning the relationship between video games and the deterioration of physical health outcomes. Considering the associations between gaming and physical health indicators, public health stakeholders should continue to encourage the population, especially children and adolescents, to adopt an active lifestyle and promote physical activity. Furthermore, researcher should continue to explore such associations and assess video gaming and health indicators with precise and validated measurement tools. Another possible solution would be to better monitor and organise the practice of video games. Playing within the framework of organised extracurricular activities where children and adolescents could practice video games under the supervision of a trained adult is certainly a promising approach to gaming. A recent study 46 highlighted the potential of eSports as a means of improving life skills such as commitment, cooperation and communication among young athletes as well as a potential catalyst to improve lifestyle habits and physical activity practice, especially among the young people.

This scoping review overviews the few studies exploring the topic of video gaming and physical health. Results suggest preliminary evidence of an association between video game playing time and a deterioration of some physical health indicators and behaviours such as BMI and general health status. Overall, available evidence is scarce and was mostly published recently. More studies are needed to increase our understanding of video gaming effects on physical health and related health behaviours.

Contributors: MD and CT designed the study and the search strategy whereas the selection process, extraction and risk of bias analyses were carried out by VHP, AL and FP. VHP and AL wrote the manuscript, while MD and CT directed the project and reviewed all stages of the study including writing the manuscript.

Funding: The study was funded by the Chaire de recherche internationale en santé neuromusculosquelettique.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• Review Article
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• Published: 12 December 2023

Use of serious games with older adults: systematic literature review

• Bárbara-Mariana Gutiérrez-Pérez 1 ,
• Antonio-Víctor Martín-García 1 ,
• Alicia Murciano-Hueso   ORCID: orcid.org/0000-0003-4351-9307 1 &
• Ana-Paula de Oliveira Cardoso 2  

Humanities and Social Sciences Communications volume  10 , Article number:  939 ( 2023 ) Cite this article

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• Science, technology and society

The aim of this paper is to qualitatively synthesise literature on empirical research into video games and older adults. A total of 108 studies were analysed, with the participation of 15,902 individuals aged over 60. The framework of Search, Appraisal, Synthesis, and Analysis (SALSA) was used, with screening by three independent reviewers and phrase searching and combining search terms. The results indicate a majority of studies with a quantitative approach conducted in the European context in which a total of 125 scales were identified for the assessment of different geriatric aspects related to domains for the improvement of physical health and functional quality, improvement of cognitive, psychological and mental health, and improvement of physical and cognitive functions from a combined approach.

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Introduction.

In increasingly digitised social scenarios, certain groups are at a disadvantage. This is the case for the elderly. At the root of digital exclusion and the various digital divides are issues related to technical aspects and infrastructures, but above all a set of negative beliefs and stereotypes about older adults, which reinforce and amplify the effect of digital exclusion. Some studies suggest that the digital divide affecting this age group can be explained by internal motivational factors. For example, relative deprivation theory holds that relative disadvantage exists when people perceive themselves to be (unjustifiably) disadvantaged or different compared to others in a given situation. The negative stereotype of technological incapacity reinforces the subject’s perception of the difficulty of using certain devices and the avoidance of situations in which they are necessary resulting in the underuse of technology, which contributes to maintaining the digital divide (Mariano et al., 2022 ). The case of video games exemplifies a type of resource traditionally associated with younger people and of little interest to older people.

However, available research suggests that video game-based technology can create opportunities for social connection, helping to alleviate social isolation and loneliness in this age group. For this reason, and in the framework of so-called positive technology, the use of video games ( serious games ) is one of the most current topics generating most interest among the gerontological scientific community, public leaders interested in developing active ageing and community health policies, as well as video game developers and the video game industry as a whole. Despite this interest, serious games are a relatively new field of study that could be described as the use of video games to help users achieve a specific objective through gaming (Barbosa et al., 2018 ). Game-based methods and concepts and gaming technology are thus combined with other ICTs and research areas and applied to a wide scope of domains of use ranging from training, simulation and education to sport and health, or any other relevant social or business topic (Barbosa et al., 2018 ). As a complement to traditional interventions, these digital games can help older adults boost their health by improving their physical condition and coordination skills, combined with greater motivation generated by the game experience and fun while practising. In any case, the purpose of serious games is much more than entertainment —which is still a factor—, seeking to achieve objectives that could be considered as educational and learning in the broadest sense.

As indicated, and despite interest in serious games as a gerontological resource, current knowledge available in this field is still incipient. After a first phase of study, specialised literature shows that most researchers have focused on understanding what type of digital games can be more interesting for older adults. Some studies have verified that most tend to play digital games known as casual (Gigante, 2009 ) and/or educational games. From this starting point, studies have focused on reviewing the effect this type of game could have as a support for cognitive training in gerontological therapy. The idea is to assess how to use video games to help maintain cognitive skills, increase self-esteem, improve coordination or reaction times or also to improve aspects such as spatial awareness, reasoning and mental rotation (McLaughlin et al., 2012 ). In a second phase, researchers are analysing to what extent the use of different types of casual, serious, social and educational games is related to the emotional and social well-being of older adults (Kaufman et al., 2019 ). Aspects such as cooperative and social play are viewed to contribute to improving social interaction and active participation, they also help maintain general cognitive function in older adults, improving social support, integration and social interaction. Finally, video games are also being analysed as mere entertainment, as an e-leisure resource. In this case, this type of resource is understood to also help improve mood, reducing sadness and depression (Nazry and Romano, 2017 ), helping to maintain social networks, and social and community ties in this age group. Despite the rough outline of these areas of interest and research studies, the relative youth of this research field means that there are many gaps and a lack of knowledge on basic aspects regarding the use of digital games for and by older adults, and this is well worth analysing. For this reason, we adopted a systematic review method to examine general literature available on serious games and adults over 60 years old in order to provide an overview of the state of gerontological research into this subject.

AIMS of review

Systematic review is a strategy to search for and select the best evidence published in certain bibliographical sources on a research topic, offering a series of theoretical and practical recommendations on the topic. In this case it was a review of studies published in the last 5 years on serious games and older adults in an attempt to clarify what knowledge is available on the matter. This SLR specifically attempts to clarify the following key questions:

What main objectives are proposed in studies on non-commercial serious games and older adults?

What are the main categories and types of video games and what have they been used for in the studies reviewed?

What are the main instruments and measurement scales used in studies on serious games and older adults? (screening)

What are the main results obtained after using serious games with older adults for socio-educational purposes? (with older adults aged 65 and above)

Search strategy and study selection

Search, Appraisal, Synthesis and Analysis (SALSA) framework was implemented to guarantee the methodological precision of this research (Grant and Booth, 2009 ). The search process was carried out in August 2023. In this phase, firstly, Web of Science (WoS) and Scopus databases were selected to search for literature due to their impact factor and multidisciplinary nature. For the search, a term algorithm was established based on a series of keywords, some of which included the asterisk symbol (‘*’) as a truncation operator: (exergam* OR videogam* OR serious gam*) AND (elder* OR old* OR ageing). This algorithm was applied to field labels corresponding to Title, Abstract and Keywords. Secondly, a series of inclusion and exclusion criteria were established to assess literature based on two perspectives. The first focuses on filters applied during the search process, and the second on criteria to ascertain eligibility of the research studies. The criteria of both perspectives are shown in Table 1 .

Thirdly, based on the research questions, a content matrix was designed as a documentation method and coding of information for the synthesis phase. It included the following coding variables: (a) author(s) «AUT», (b) year of publication «YP», (c) article title «AT», (d) research objective «RO», (c) research methodology «RM», (d) research instrument or test «RIT», (e) selected sample «SS», (f) geographical context «GC», (g) objective of the videogame «OVG», and (h) description of the videogame «DVG». Las variables «RM», «RIT», «SS», «GC» and «OVG» were coded for descriptive calculations (mean, standard deviation and frequency) using the statistical analysis package SPSSv.26 (Licence of *Anonymised*).

To categorise the research instruments or tests used in the studies, as well as the objectives of the video games, three categories were established: (a) physical domain, which covers aspects related to assessment, training and improvement of physical health and functional quality; (b) cognitive domain, encompasses aspects related to the assessment, training and improvement of cognitive, psychological and mental health; and (c) multi-modal domain, including aspects related to the assessment, training and improvement of physical and cognitive functions from a combined approach. A qualitative approach was also applied by means of narrative analysis for the variables «RO» and «DVG» And, fourthly, different objectives and video games presented in the studies selected were described and analysed for the final phase of the SLR, identifying which domains (general and specific) were targeted by each.

As a result of applying the search filter criteria a total of 2608 articles were obtained (WoS n  = 2158; Scopus n  = 450). Due to the high number of pre-selected research, a search for key terms in the title and abstract was executed using conditional formats. In this way, 376 articles were identified (WoS n  = 74; Scopus n  = 302) containing the following terms in one of the two fields: ‘exergam*’, ‘serious gam*’, ‘video gam*’, ‘video gam*’, ‘game”, ‘gaming’. Then, after excluding duplicate studies (generally from the WoS database), a total of 313 articles were identified (WoS n  = 11; Scopus n  = 302). Finally, after applying the eligibility criteria, 205 studies were excluded: 1 did not provide information on the age ranges of the sample; 14 focused on perceptions, usability, feasibility or improvements in the video game without providing information on benefits or impact on participants; 19 did not include older people in their sample; 20 did not provide descriptive or contextual information about the video game or did not study the video game as a video game per se; and 151 investigations did not analyse the video game as a study variable. These included literature reviews or research protocols. Finally, a total of 108 articles were selected for inclusion in the research (Fig. 1 ).

n number of identified studies.

Characteristics of the selected studies

The 108 articles selected were then read in depth. In summary, the main data on the matter subject to analysis appear in Table 2 .

The following information was taken from each of these studies: author(s), year of publication, title, type of study, objectives presented in the article, geographical context, users or participants. Based on these data it is clear that a majority of these research studies were in the European context (51.38%), specifically in Belgium, Czech Republic, France, Germany, Hungary, Netherlands, Poland, Portugal, Spain, Switzerland and United Kingdom; meanwhile, the 20.18% of the studies analysed correspond to the Asian context (Singapore, Malaysia, Thailand, Japan) and 20.18% to the American context.

The set of studies analysed comprises a total of 15,902 participants. It is important to note that the majority of this sample corresponds to the study by Bonnechère et al. ( 2021 ), which included 12,000 people over the age of 60. On the other hand, Table 2 shows that the sample selected in most of the studies is limited to older people. However, four papers were identified that included participants with different age ranges. The research by Brauner and Ziefle ( 2022 ) included a sample of 128 participants, with a minimum age of 16 and a maximum age of 84 years. However, the study does not provide specific information on the age distribution of the participants. Chesham et al. ( 2019 ), Kaplan et al. ( 2018 ) and Qiu et al. ( 2023 ) conducted their studies on heterogeneous samples in terms of age. In the first research, three groups were established: 28 subjects aged 18–31 years, 13 subjects aged 64–79 years and 11 subjects aged 86–94 years. In the second study, the sample included a group of 15 participants aged between 24 and 30 and a second group of 14 subjects aged between 69 and 76. Finally, in the third study, the sample was divided into two age ranges, 17–35 years and 55–70 years, with a total of 18 participants in each group. Chesham et al. ( 2019 ), Kaplan et al. ( 2018 ) and Qiu et al. ( 2023 ) conducted their studies on heterogeneous samples in terms of age. In the first research, three groups were established: 28 subjects aged 18–31 years, 13 subjects aged 64–79 years and 11 subjects aged 86–94 years. In the second study, the sample included a group of 15 participants aged between 24 and 30 and a second group of 14 subjects aged between 69 and 76. Finally, in the third study, the sample was divided into two age ranges, 17–35 years and 55–70 years, with a total of 18 participants in each group. Regarding the minimum and maximum ages included in the samples, as well as the ranges corresponding to this age group, in 22.07% of the studies, the minimum age corresponds to 65 years, while in 18.60% of the investigations, the minimum age of the sample is 60 years. On the other hand, in 7.44% of the studies, there were participants with a maximum age of 80 and 74 years, both of them coinciding in percentage.

In relation to the number of publications per year, Fig. 2 shows that from 2017 to 2021 the publication of research in this line shows a gradual increase, with a slight decrease in 2021. In 2022, the number of publications increased considerably, representing more than 25% of the research analysed. As for the year 2023, the number of published works is lower, corresponding to 10.20% of the selected studies. However, it is important to bear in mind that the publications of the latter year are limited to the first half of the year. In terms of the productivity of the main authors responsible for the papers, there is no clear leadership in this line of research.

Number of publications per year (2017–2023).

What are the main objectives set out in studies on non-commercial and major serious games?

In this section we review only non-commercial video games. In this group, 47.17% are related to the improvement or evaluation of the physical domain (exergames), 30.19% to multi-modal training and 22.64 per cent are associated with cognitive training.

This section only reviews non-commercial video games. In this group, 47.17% are related to improving or assessing the physical domain (exergames), 30.19% to multi-modal training, and 22.64% to cognitive training.

Objective 1: improving physical health, functional quality and quality of life

Physical domain video games are designed for training, improving and assessing different motor and coordination skills; they are the so-called exergames. This type of video game encourages moving the body while using interactive environments with immersive experiences that simulate different feelings of presence. Most exergames included in this domain focus on coordination skills such as combination, balance and space-time perception. (Ayed et al., 2018 ) research the feasibility and effectiveness of exergame prototypes designed for training posture control and balance rehabilitation in older adults. These prototypes, called ‘Reach Game’, ‘Hit-it’ and ‘Watch-Out’, required users to complete coordinated upper and lower limb movements, trunk movements and lateral displacements to achieve the goals set in the games. Similarly, Janhunen et al., ( 2022 ) also present ten exergames custom-designed for older users who needed rehabilitation for post-operative knee replacement. Each exercise included a story explaining the goal of the game and the participants’ body movements, tracked by the Kinect sensor, which acted as a game controller and was translated to the screen to move the avatar. The exercises were performed according to each participant’s mobility limitations. From there, in the research by Janhunen et al., ( 2023 ), they present a programme of 11 personalised post-operative knee replacement surgery games that engage patients in self-directed, personalised therapeutic exercises at home for physical function and pain reduction in older adults following knee replacement surgery. Meanwhile, Brachman et al., ( 2021 ) assess the efficacy of the balance exercise training programme in improving users’ posture control, as well as static and dynamic balance. The seven exergames used were based on virtual reality immersive environments in which players practised static postures, dynamic weight changes, balancing on one leg, leaning in different directions and trunk rotations. Exergame software meant that the difficulty of these movements could be adapted to the individual abilities of each participant.

Continuing with exergames linked with balance and posture control, on one hand, (Soancatl Aguilar et al., 2018 ) conducted a study to research how an ice-skating exergame affects dynamic posture control and balance. To achieve this, the software offers two game modes: one for movement coordination and the other for player resistance. On the other hand, Ellmers et al. ( 2018 ), conducted a study to assess the potential of gamified interventions with video games in reducing discrepancies between perceived balance skills and real skills in older adults. The researchers present a game, ‘Pong’, which is an adaptation of a traditional game. Using a commercial balance platform (Wii Balance Board) and in a virtual reality environment, players must control paddle displacement by maintaining balance. By moving their centre of gravity forward, players moved the paddle upwards, while by moving backwards the paddle moved down. Also using virtual reality, Bukhari et al. ( 2022 ) develop training games that allow participants to interact with a virtual environment to perform different exercise games (target shooting, football head-butts, table tilting, tight rope tension and snowboard slalom) to improve balance, gaze stability and gait performance. Similarly, Yuan et al. ( 2020 ) present a research study to assess the efficiency of gamified interventions with interactive video games on balance in older adults, in this case patients suffering from Parkinson’s with minor to moderate symptoms. This software comprises two tasks: in one, players must take steps in multiple directions guided by illustrated instructions indicating where they must step. This assesses the user’s ability to change their weight, their dynamic and static balance. The other task is to take guided steps towards an objective, assessing coordination skills of orientation and balance.

Dijkstra et al. ( 2018 ), Martins et al. ( 2020 ), Neumann et al. ( 2018 ) and Vorwerg-Gall et al. ( 2023 ) present a study that focuses on the efficiency of exergames in improving balance and also their effect on improving resistance and muscle strength, taking into account the state of the participant’s musculoskeletal system and even the improvement of blood pressure. Dijkstra et al. ( 2018 ) is to assess whether exergames are an effective method for favouring the autonomy and independence of older adults. For this they used ‘Fox Hunting Game’, where the goal is to find the fox avatar three times. The user’s graphic interface is a virtual world with three settings—a street, a museum and a zoo— that the player can move around by walking. The player must indicate which direction their avatar should go by moving their arms. All these movements are recorded and viewed using a motion sensor. The software also allows the user to increase their score by playing mini-games included in the programme. These mini-games are related with reach and grip, balance and squats. As a result, this exergame can train and improve the coordination skills of combination, balance and space-time perception. Finally, there are two game modes (individual and multi-player) making it a social activity.

Martins et al. ( 2020 ) assess the effect of a virtual training programme for balance and muscle strength in older adults. The programme is based on the traditional Otago Exercise Programme. In the study, the researchers assessed the results of three mini-games in the ‘m-OTAGO’ exergames that trained the coordination skills of combination, balance and reaction by completing exercises to bend the knees and move from sitting to standing on two feet, exercises to strengthen the hip and knees, and exercises to lift the calves and toes. These movements are shown in the graphic interface with a penguin avatar in different environments where the player must avoid obstacles and overcome different challenges. Neumann et al. ( 2018 ) assess how a virtual training programme called ‘WeTakeCare-System’ affects certain body functions, as well as performance and quality of life in older adults. This exergame has three games: ‘Sound Movement’, ‘Treasure Hunt’ and ‘Sudoku’. In this case, the activities are used to maintain and improve body functions such as balance, resistance and mobility, focusing on upper and lower limb mobility, preventing risk of falls, balance, resistance and muscle strength.

Alongside them, Vorwerg-Gall et al. ( 2023 ) focus their research on studying virtual reality exercise training games specifically for older people with hypertension. In this way, through a home-based physical exercise programme for older people with hypertension, they manage not only to improve their general physical health but also to contribute to the reduction of blood pressure.

Finally, regarding exergames designed to improve balance and other motor skills, Mugueta-Aguinaga and Garcia-Zapirain ( 2019 ) conduct a study to validate the exergame ‘FRED’. In a subsequent research study, one of the objectives posed by these authors is to assess the efficiency of this exergame in reducing fragility in older adults, improving their independence and quality of life (Mugueta-Aguinaga and Garcia-Zapirain, 2019 ). This video game comprises a sequence of three settings, all with one or more steps in a simplified wine production process. Player movements are detected and recorded with a motion sensor, assessing movement functionality. Depending on what setting the player is in, they must perform lateral body movements, squats, stand on two feet, lift their arms and legs alternately, arm flexion-extension and abduction-adduction, rotate their shoulders, and more. As a result, this exergame encourages players to practice coordination skills of orientation, combination, balance and space-time perception.

A person’s functional and physical quality is another element in maintaining and improving their quality of life. For this reason, Boj et al. ( 2018 ) present an application called ‘HybridPLAY’, which aims to encourage outdoor activity and training. This system transforms outdoor fitness equipment in a digital game interface with a motion detector that links the equipment to a mobile device. The software includes a series of mini-games and the movements detected are transformed into actions such as jumping, running, turning or striking, depending on the mini-game. It is an individual or collaborative exergame, adding a social component to activity and training. Tabak et al. ( 2020 ) carried out a study with the aim of describing the design of a training application to encourage physical activity in daily life and assess older adults’ experiences when using the ‘ActivityCoach’ app. The game presented and included in the app mentioned is ‘WordFit’; it consists of placing words from a starting to an end point. The game’s graphic interface has a board with several tiles with rocks along the route that must be demolished with hammers in order to place the word. Hammers are won when the player meets certain step goals. The objective of the study proposed by Da Silva et al. ( 2021 ) is to design and develop an exergame to promote health and physical activity, and to encourage participants to follow and enjoy the exercises. This exergame, called ‘Boliche virtual’, was designed in collaboration with a group of older adults and includes a multi-player component in order to foster socialisation while participants train. Along these lines, Ruggiero et al. ( 2023 ), designed a health education exergame adapted for adults over 50 years of age with the aim of ensuring the maintenance and improvement of quality of life by complementing didactic education on healthy eating/nutrition with physical activity exercises. The objectives of the health-related game are to provide knowledge, increase motivation, incorporate movement and encourage behaviour change related to healthy eating and physical activity.

Preventing falls and motor rehabilitation are also two aspects that improve functional quality. The first is addressed in a study by Money et al. ( 2019 ) and Ren et al. ( 2022 ). These authors propose three research objectives: to describe a serious game called ‘Falls Sensei’; to assess game usability from the perspective of older adults; and to explore user perceptions on the use of this exergame and to what extent risky behaviours are modified. The exergame takes place in an augmented reality environment with a graphic interface that shows different spaces in a home. Each space is a game level and has between five and nine dangers of falling. As the player moves through each space they must identify the dangers. Ren et al. ( 2022 ) present Envolv, a specific exercise programme to work on fall prevention and balance for older adults. Designed as a feasible strategy to provide therapeutic exercise, it is based on a motion capture system combined with balance training exercise software. As for the second aspect—motor rehabilitation—, the objective of the study by Pereira et al. ( 2019 ) is to assess the efficiency of exergame-based motor rehabilitation training, and also to understand how commitment and social participation affect training. The game has three modes: competitive, coactive and collaborative. The aim is to move the arms to trap balls that fall from the top of the screen. Randriambelonoro et al. ( 2023 ) also designed a gamified multifunctional rehabilitation equipment system called ActivLife to improve the functional capabilities of older adults through physical activation, rehabilitation, mobility, bedside assistance and mental stimulation.

Other examples of arm training exergames are presented in studies by Triandafilou et al. ( 2018 ) and Kaplan et al. ( 2018 ). The objective of the first is to review the feasibility of the ‘VERGE’ system as a physical exercise resource for people who have suffered strokes, including older adults. This system features an augmented reality environment where avatars interact with virtual objects. Meanwhile a study by Kaplan et al. ( 2018 ) present an exergame in which users must control an aeroplane using arm movements in order to pass through rings along the route. Both exergames offer multi-player modes for social interaction. Third, Stamm et al. ( 2022 ) focus on designing a virtual reality game called ViRST VR in which, through interactive tasks on a farm (e.g., rowing, lighting light bulbs, or sorting vegetables), they conduct training sessions to specifically improve pain intensity and severity of chronic pain, functional abilities, and fear avoidance beliefs (kinesiophobia).

Objective 2: improving cognitive, psychological and mental health

One example of this type of serious game is featured in the study by Anguera et al. ( 2017 ). One of the research objectives proposed is to explore how an intervention on the ‘Project EVO’ platform impacts cognitive control, mood and cognitive symptoms of depression in older adults. This platform consists of guiding a character through different environments while overcoming a series of challenges. The player must therefore combine neuropsychological processes of visuomotor and perceptive discrimination. The serious game gets harder as the user progresses through the different environments or levels, adapting to the player’s responses and skills. Another example is the paper by Belchior et al. ( 2019 ), who seeks to compare cognitive improvements caused by the video game ‘Crazy Taxi’ on one hand, and the ‘InSight’ cognitive training system on the other. Crazy Taxi is an immersive driving game in an urban setting. It consists of picking up passengers and taking them to their destination to earn as much money as possible (a higher score requires greater speed and complexity). The game includes complementary settings (‘Crazy Boxes’) to practice different tasks. In line with cognitive training, there are several research studies that present video games that allow the assessment of cognitive aptitude, processing speed and reaction time. Hou et al. ( 2022 ) developed three cognitive computer games: 1) Cognitive Game based on Nostalgia Theory; 2) Whack-a-Mole; 3) Hit-the-Ball. The first one focused on improving memory, attention, executive function and language, while the other two focused on reaction time and processing speed. In turn, Eun et al. ( 2022 ) study a series of cognitive mini-games for computers, smartphones, tablets, and other portable devices designed with artificial intelligence that facilitate older users to feel entertained and immersed in cognitive play voluntarily and to benefit from cognitive training. Ghorbani et al. ( 2022 ) use augmented reality to develop a video game that not only provides cognitive training but also simultaneously examines the mental state of players to slow down the progression of potential cognitive problems and increase the quality of life of the individual. The augmented reality serious game consists of a simulation of everyday life situations with five tasks that are defined to assess different cognitive functions, such as pattern separation and completion, visuospatial and episodic memory, decision-making ability, concentration and overall processing speed by measuring response time.

It is designed to train and improve visual attention and cognitive processing speed. In line with performance and visual capacity, Chesham et al. ( 2017 ) present a serious game puzzle called ‘TMM3 Puzzle Game’. This software is part of study that aims to develop a visual search and pairing task with a video game to them assess the feasibility of the task designed. Based on this objective, the goal of this serious game is to practice, improve and assess visual search capacity in older adults with or without cognitive deterioration in a fun, adaptive and attractive format. ‘TMM3 Puzzle Game’ is designed as a jigsaw board filled randomly with tiles (geometric shapes) in different colours. Each player must match a pattern with a horizontal or vertical sequence of three identical tiles. The matched tiles disappear from the board which is then filled up. Meanwhile, a study by Farzin et al. ( 2018 ) assesses the efficiency of prospective memory training among older adults using ‘Virtual Week Board Game’. This software has a board graphic interface. Each board corresponds to a day of the week and includes different tests. To move forward each day, the user must throw a die, taking decisions and remembering to do some daily activities as they progress. Each virtual day includes eight to ten tasks that include regular (very common), irregular (less common) and timed activities. All activities aim to exercise prospective memory, thus practising and improving older adults’ ability to exercise how they carry out this type of task in the future. Along a similar line, Yu et al. ( 2019 ) assess the efficiency of a software for long-term memory in older adults, in this case people with symptoms of dementia. This serious game is called ‘Memory Matters’ and is a traditional pairing game. Images include objects, food, places, clothing and historical events from the 1930s to the 1960s. It therefore aims to help users recover autobiographical memories. After matching each pair there is a section called ‘Did you know? which is designed to foster memory, reflection and reminiscence. This software also includes a mode to view the images without playing and an option for the user to add personal and family photos. Two modes ‘solo mode’ or ‘social/group mode’, are also available in this serious game for collaborative game experiences. And, precisely in this more social line, is Myosotis FoodPlanet, a video game designed by Zahn et al. ( 2022 ) to promote positive social interactions between players of different generations while playing. Specifically, it is an iPad game that involves two players jointly preparing a Swiss cheese fondue by dragging floating ingredients into a pot. By using a traditional Swiss dish, Myosotis FoodPlanet provides a positive entertaining activity that facilitates intergenerational communication and allows players to find new and exciting access to the memories of older people.

Other examples of serious games in the cognitive domain are ‘Mind Frontiers’ y ‘GRADYS Game’, both types of software are designed to train different neuropsychological processes and skills. In the first case, the serious game is presented by Souders et al. ( 2017 ) who assessed the efficiency of in acquiring and transferring cognitive skills using different gamified tasks. The software is designed to cover three games to exercise inductive reasoning, planning, spatial reasoning skills, cognitive processing speed, switching tasks and working memory. Zając-Lamparska et al. ( 2019 ) conduct a study to assess the effects of virtual reality cognitive training in older adults with and without minor dementia. ‘GRADYS Game’ is a virtual reality-based serious game presented by the authors that comprises four modules inspired by daily activities. The overall goal of this game is to exercise attention, memory, language and visuospatial processing.

Objective 3: improving health from a multi-modal approach

A review of the literature selected identified a series of video games designed to improve physical and cognitive functions from a multi-modal or combined approach, aiming to achieve physical-cognitive interaction between participants. These studies include research by Becker et al. ( 2020 ) whose proposed objective is to present and assess the ‘PDDanceCity’ system as a resource for measuring the functional performance of older adults using physical activity. The system is based on a map of city in the form of a labyrinth. To reach the finish line, players have to complete two-dimensional movements. It is designed to allow users to pass through different settings or points of interest (e.g., museum, monument or cafe) along the way. ‘PDDanceCity’ offers rehabilitation for dual tasks by training the visuospatial function, balance and movement coordination. Meanwhile, the study objective of Chua et al. ( 2019 ) is, on one hand, to review the feasibility and use of virtual reality to detect cognitive deterioration in older adults and, on the other, to assess the system’s capacity to distinguish cognitively intact participants from others with cognitive deterioration. They present the video game ‘RE@CH’, which replicates everyday tasks. This exergame develops seven key activities: (a) open a window with a key and the correct code; (b) make a telephone call by retrieving a predefined 8-digit number; (c) identify famous people, food adverts and a 4-digit lottery number in a newspaper; (d) classify household objects into categories; (e) choose suitable clothing for a specific event; (f) withdraw money from a cash machine; and (g) buy food at a shop. This video game trains motor control, attention, memory, completing dual tasks and executive functions.

In their study, the objective of Li et al. ( 2020 ) is to design a virtual reality-based movement video game to improve various cognitive and physical skills in older adults. ‘Whac-A-Mole’ is a video game with an immersive virtual reality environment simulating a farm. Motion sensors record and replicate limb movements in the game. Players are required to move both arms and legs to feed the animals that appear on the graphic interface, guided by instructions provided by the system. This exercise aims to train static and dynamic posture control, gross and fine motor coordination, as well as neuropsychological processes such as attention, response inhibition and execution of dual tasks. Also relying on virtual reality, Liepa et al. ( 2022 ), present Falling diamonds, a video game developed to improve stability and physical and cognitive fitness, which allows elderly people to train physically and cognitively to avoid falls and thus improve their quality of life. Zangirolami-Raimundo et al. ( 2019 ) use the video game ‘MoviLetrando’ to compare the performance of physically active and sedentary older adults. The aim is to capture pre-established symbols and it takes into account both the player’s number of hits (captures) and speed. The faster the participant can capture the symbol requested, the more symbols will be displayed and, therefore, the higher the final score. Levels and phases evolve according to player performance. Symbols include numbers, vowels, consonants and numerical series, which can be defined individually or as a combination. The stimulus used to display the symbols can be visual, audio or both. With this training exercise, the user practices coordination skills such as reaction and cognitive processes like attention, information processing speed, working memory and response inhibition.

More focused on rehabilitation, there are also examples of video games that combine physical and cognitive training to allow the elderly to improve their condition. These are the cases of video games such as Active Airliness by Beltran-Alacreu et al. ( 2022 ), I Am Dolphin by Drazich et al. ( 2023 ) and SilverFit BV 3D by Müller et al. ( 2023 ). The former consists of a Windows-based application that allows the player to control a virtual aircraft to reach targets by means of head movements. At the end of the exercise, the application stores the achieved and unachieved goals and the trajectory of the plane so that the elderly can improve their rehabilitation through physical and cognitive exercise. The second video game was initially designed to reduce upper limb impairment after stroke but is being applied to older adults without a history of stroke because it can also improve players’ overall cognitive, emotional and physical health. The game is about helping Bandit, a dolphin, to eat fish, jump and avoid being eaten by sharks using a Kinect-based motion sensor remote control. The third game is a television screen-based exercise system recommended for balance training in the physical rehabilitation of older adults, which allows for a puzzle game, a tilt game and a step game called the fox. In this research, they study the impact of this type of exercise game on the cognitive health of the elderly, demonstrating that it inherently increases cognitive activity.

A study by Adcock et al. ( 2020a ) aims to determine the usability of a multi-component exergame and explore its effects on physical and cognitive functions, and cortical activity. In a subsequent study (Adcock et al., 2020b ) aim to assess the effects that multi-modal training using the ‘Active@Home’ exergame has on physical and cognitive functions. This video game simulates a trip around different European countries; as the user follows the route, they complete different activities and exercises inspired by tai-chi, dance and cognitive games. The result is an exergame that can train coordination skills such as coordination, reaction, balance and rhythm, as well as cognitive skills like selective and divided attention, response control, cognitive flexibility and working memory. To ensure challenge and progress, the game has various difficulty levels with more complex and faster movements. Each level of difficulty is associated with a city. The order is predefined and it is advisable to play all the levels in a city before moving to the next and, before moving on, users should train in the level for two sessions.

Alongside this research, Qiu et al. ( 2023 ) study an intergenerational balance training system that allows older and younger people to play together, encouraging social interaction between generations and promoting physical, mental and emotional well-being in older adults. The video game is called Social Balance Ball and allows using three different modes to test the player’s level of social presence as a determinant of the player’s experience: (1) virtual player, (2) mediated human player (i.e. participants played online) and (3) co-located human player (i.e. participants played face-to-face).

Finally, five exergame systems grouping different video games were identified. These include a study by Jirayucharoensak et al. ( 2019 ) whose proposed objective was to review whether a game-based neuro-feedback training system can improve neurocognitive performance in healthy older adults and others with minor cognitive deterioration. The games included in this system (‘Dogsperat’, ‘Penguin’, ‘Both hands draw’, ‘Recall Mem’ y ‘Math’) are designed to train coordination skills such as combination and balance, and neuropsychological processes like memory, executive functions and learning. Meanwhile, (Chu et al., 2021 ) design and develop a cognitive and physical training exergame system for use by older adult’s resident in long-term care homes. ‘MouvMat’ aims to train coordination skills such as combination, reaction and rhythm, as well as cognitive skills like attention, memory, executive function and response inhibition using the games ‘Simons Says’, ‘Memory Pairs’, ‘Scrabble’, ‘Don’t Let the Music Stop’ y ‘Tic-Tac-Toe’. Finally, ‘SureStep’ is presented in a study by Valenzuela et al. ( 2018 ) who propose the objective of exploring experience and use of this system by older adults to reduce the risk of falling. It therefore aims to improve walking, balance, posture control, and also cognitive processes such as working memory, visuospatial skills, completing dual tasks, response inhibition and attention. Fourth, Ferreira et al. ( 2022 ) develop Portable Exergame Platform for Elderly, an augmented reality exergame designed to play four games (Exerpong, Grape stomping, Rabelos and Toboggan) that mobilise physical and mental resources simultaneously to improve reaction times, cognitive flexibility, or verbal fluency in the elderly. Finally, Brauner and Ziefle ( 2022 ) address general physical or cognitive fitness using two different game prototypes to study the similarities and differences between different types of serious games for health care in active and assisted living settings. The first game, Fitness Farm, addresses general fitness, agility, endurance and body control, while the second game, Cook it Right, is designed to promote executive functioning.

What are the main categories or typology of video games and what have they been used for in the studies reviewed?

The 49.07% of the video games analysed were categorised as non-commercial, while 50% were commercial products for recreational purposes (for example, Nintendo Company Ltd o Xbox Network) or designed by companies specialised in other fields (for example, Dividat, Motek o VITAAL Exergame). The remaining 0.93% corresponds to studies that do not specify the name of the video game or its categorisation (Commercial or Non-Commercial), although there is a description.

By observing the general domains for which the video game is used, we can see that they are mostly related to physical capacities (45.37%), followed by video games for the multi-modal domain (Cognitive and Physical) (34.26%), and to a lesser extent video games (serious games) designed exclusively to improve the cognitive, psychological and mental health of older adults (20.37%) (Fig. 3 ).

Aim and purpose of the video game.

The following table (Table 3 ) includes a summary of the different video games analysed in the studies selected.

What are the main measurement instruments and scales (screening) used in studies on serious games?

One of the aspects of interest in this paper is related to the type of instrument used in the studies reviewed in order to evaluate different aspects related to the use of video games. On the one hand, it is of interest to know to what extent the use of video games can be related to the training or improvement of certain cognitive, physical or social elements and, on the other, to establish how these aspects have been measured by researchers. Table 4 shows the relationship between the domain analysed in the studies and the assessment or diagnostic instrument used to obtain the data.

As can be seen (Fig. 4 ), most instruments (52%) seek to measure or assess cognitive, psychological or mental domains; 36.8% of the instruments and/or tests aim to specifically assess physical domains (e.g., balance, posture control, muscle strength, limb movement, etc.). Finally, instruments to simultaneously assess cognitive and physical domains are used less in the studies selected, accounting for 11.2% of the instruments used.

Domains of the assessment instruments used in the selected investigations.

In the case of instruments and tests implemented to measure aspects related to the cognitive, psychological and mental domains, they were grouped into five subcategories: (a) Neuropsychological Assessment, (b) Emotional and Social Health, (c) Cognitive Impairment, (d) Mental Disorder, y (e) Quality of Life. Most instruments assess neuropsychological aspects such as attention; visual, working and verbal semantic memory; visuospatial skills; executive functions; reaction time; and response control, among others, accounting for 66.15% of all tests used. The second group of tests in subcategory Emotional and Social Health, account for 13.85% of the instruments used in the studies selected. These tests aim to assess aspects related to emotional, perceptive, experiential and social components that influence different areas of life of older adults and that have an impact on well-being and quality of life. 9.23 per cent of the instruments were assigned to the Mental Disorder category, which includes those instruments intended to assess the status of disorders such as depression in older people. Subcategory four (Cognitive Impairment) accounts for 7.69% of the instruments used. This type of test aims to assess the cognitive status of people with neurodegenerative diseases such as dementia or Alzheimer’s. Finally, to a much lesser extent, 3.08% of the instruments used in the studies were intended to measure quality of life in older adults (Table 5 ).

From a general perspective, Table 5 presents the instruments or tests that were implemented in 2 or more investigations. In this table, the most frequently used test is the Timed Up-and-Go, which was used in 11 investigations to assess skills related to the physical domain, specifically mobility and balance. The second most applied test is the Montreal Cognitive Assessment - MoCA ( n  = 9), aimed at assessing cognitive skills such as memory, attention, language, visuospatial ability, calculation, abstraction and executive function. As for less frequent instruments or tests, there are tests focused on both the cognitive domain (e.g., Beck’s Depression Inventory, Falls Efficacy Scale-International, Neuropsychiatric Inventory Questionnaire, among others) and the physical domain (e.g., Barthel Index, Senior Fitness Test or Short Physical Performance Battery). These instruments or tests are implemented in at least 2 of the selected studies.

What are the main results obtained after the socio-educational use of digital games with older adults aged 65 and above?

Benefits in the cognitive domain.

The results obtained in the studies reviewed show that the serious games presented are a potentially effective intervention for the overall improvement of the cognitive domain (Anguera et al., 2017 ; Zając-Lamparska et al., 2019 ), highlighting specific benefits in relation to: mood in older adults (Anguera et al., 2017 ; Farzin et al., 2018 ; Yu et al., 2019 ); cognitive processing speed (Belchior et al., 2019 ; Zając-Lamparska et al., 2019 ); memory (Farzin et al., 2018 ; Yu et al., 2019 ); independence and functional capacity (Farzin et al., 2018 ) and improving cognitive memory through social interaction (Yu et al., 2019 ).

Benefits in the physical domain

The studies reviewed yield results that endorse the use of video games to maintain and improve physical condition and general quality of life (Neumann et al., 2018 ), as well as motor rehabilitation processes (Pereira et al., 2019 ; Triandafilou et al., 2018 ;). Specifically to improve physical skills related to: static and dynamic balance (Ayed et al., 2018 ; Brachman et al., 2021 ; Ellmers et al., 2018 ; Martins et al., 2020 ; Yuan et al., 2020 ); posture control (Ayed et al., 2018 ; Ellmers et al., 2018 ; Soancatl Aguilar et al., 2018 ; Yuan et al., 2020 ); fall prevention (Martins et al., 2020 ; Money et al., 2019 ; Yuan et al., 2020 ); functional capacity (Martins et al., 2020 ; Mugueta-Aguinaga and Garcia-Zapirain 2017 , 2019 ; da Silva et al., 2021 ) and social interaction through physical training (Boj et al., 2018 ; Pereira et al., 2019 ; da Silva et al., 2021 ).

Benefits in the multi-modal domain

Based on the effects of the digital games highlighted in some of the studies analysed, we can conclude that they are an option to encourage simultaneous physical-cognitive training (Adcock et al., 2020a ), with positive effects such as maintaining and improving higher cognitive functions (Adcock et al., 2020a , 2020b ; Li et al., 2020 ), as well as specific cognitive functions associated with preventing falls (Valenzuela et al., 2018 ) by improving balance and posture control (Chu et al., 2021 ; Li et al., 2020 ; Valenzuela et al., 2018 ). Other benefits of these studies obtained by implementing serious games are shown in the improvement of attention (Jirayucharoensak et al., 2019 ), working memory (Adcock et al., 2020a ; Jirayucharoensak et al., 2019 ; Li et al., 2020 ); executive control and function (Adcock et al., 2020a ; Jirayucharoensak et al., 2019 ); visuospatial skills (Jirayucharoensak et al., 2019 ; Valenzuela et al., 2018 ); decision-making skills and response inhibition (Adcock et al., 2020a ; Jirayucharoensak et al., 2019 ).

Discussion and conclusion

In this systematic review we delimit and analyse, from a multidisciplinary perspective, research lines related to the use of video games to improve the physical and mental health and, by extension, quality of life of adults aged over 60. Reviewing the studies selected enables us to extract some overall conclusions for the initial questions proposed. Studies in this field have mostly been reviewed from quantitative methodological approaches involving direct participation by older adults, and mainly in European countries. Specifically, and according to the questions posed, the objectives proposed in most studies with video games are related to training and improving physical health and functional quality in older adults. More than half aim to improve the physical health of older adults, training skills such as balance, posture control, muscle strength and walking. Secondly, cognitive health is also addressed from a perspective of training cognitive processes such as memory, attention, response inhibition and executive functions, among others. And finally, we have also identified video games that jointly train both physical and cognitive domains. Indirect to these domains (physical and cognitive), video games also provide benefits for maintaining and improve the social health of older adults as an aggregate value of serious games. However, and despite identifying some video games (see Boj et al., 2018 ; Dijkstra et al., 2018 ; Kaplan et al., 2018 ; Qiu et al., ( 2023 ); Pereira et al., 2019 ; Triandafilou et al., 2018 ; Yu et al., 2019 ; da Silva et al., 2021 ; Zahn et al., 2022 ) designed in multi-player format to encourage social interaction among users, this does not appear to be a clear use for this type of resource in specialised research on the subject to date. Even so, some examples of studies (Faraji and Metz 2021 ; Lin et al., 2022 ; Pageau et al., 2022 ) highlight the idea that social isolation in older adults is a risk factor that significantly reduces their quality of life, so they support the use of video games as a tool for encouraging group activities, integration and social interaction, as well as maintaining a social identity role (Cacciata et al., 2019 ; Di Lorito et al., 2021 ). In particular, the ability of these video games to significantly foster positive intergenerational social interaction between young and old people, and their consequent improvement in long-term psychological well-being, comes to the fore. Thus, previous research in which serious is specifically designed as an intergenerational game (Qiu et al., 2023 ; Zahn et al., 2022 ) stresses the importance of analysing the social dimension of the exergame and recommends that future empirical studies directly compare different game forms to discover the effects of intergenerational interactions. According (Vázquez et al., 2018 ) social health is thus an emerging domain that is gaining greater weight in the design of video games for older adults and this line of research must be expanded. Moreover, very few studies clearly have older adults participating in the process of designing this type of product (one example is the study presented by Da Silva et al. ( 2021 ) which involves a group of older adults in the process of designing and assessing the video game). Some authors emphasise the importance of co-creation as it can favour the participation of older adults, obtaining more effective and useful products adapted to their needs (Martín-García et al. 2021 ) or their empowerment (King et al. 2020 ). Regarding the second research question on type of digital games, similar numbers of video games have commercial and recreational purposes, and educational and social purposes in the broadest sense. As for the third question, we identified a total of 125 geriatric assessment tests used in the studies selected. Finally, the lack of clear evidence based on the data analysed in the review leads to the conclusion that we cannot extract definitive findings on the benefits obtained in using socio-educational digital games, and much less results that can verify their effectiveness compared to other resources or interventions with older adults. We can conclude that this article presents significant contributions that support the interest in the use of serious games in the framework of the so-called positive technology, especially given its potential not only in the video game industry but also in active ageing and community health policies.

Limitations and future lines of research

Results of the systematic review have enabled us to identify and delimit certain aspects of serious games for older adults that can help improve their knowledge and use for social or educational purposes. However, our study is limited by variability in the sample age of the selected research, heterogeneity of the studies analysed, and that the sample size of most studies can been deemed relatively small. Despite considering that a good number of studies have been reviewed, the results obtained still seem very incipient, highlighting the need to strengthen this line of research through various channels. For example, the need to explore new methods that help gain a more in-depth understanding of the usefulness and effectiveness of serious games for use in socio-educational interventions with older adults. This could include controlled experimental tests and it would also be interesting to incorporate more studies with a qualitative approach in their research design. The studies must explore new analysis channels, also examining the roles older adults play in handling this type of technological resource, and their participation in technical and pedagogical design. All with the aim of evaluating whether the use of video games (serious games) helps to improve well-being and quality of life from a comprehensive perspective, covering physical, cognitive and social domains, and providing spaces and experiences for active ageing.

Data availability

All data generated or analysed during this study are included in this published article.

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Acknowledgements

We would like to thank the FCT, the Centre for Studies in Education and Innovation (CI&DEI) and the Polytechnic of Viseu for their support. This research was funded by the FCT—Foundation for Science and Technology (Portugal) through the project Ref. UIDB/05507/2020, and by the Spanish Ministry of Science and Innovation and co-funded by the European Regional Development Fund (ERDF), ERDF A way of making Europe (UE). [Ref. PID2019-107826GB-I00].

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Gutiérrez-Pérez, BM., Martín-García, AV., Murciano-Hueso, A. et al. Use of serious games with older adults: systematic literature review. Humanit Soc Sci Commun 10 , 939 (2023). https://doi.org/10.1057/s41599-023-02432-0

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View of Cartography in Video Games: Literature Review and Examples of Specific Solutions

Kartografie in Videospielen – eine Literaturübersicht und Beispiele spezifischer Ansätze

• Published: 31 March 2022
• Volume 72 , pages 117–128, ( 2022 )

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• Tymoteusz Horbiński   ORCID: orcid.org/0000-0002-9681-6762 1 &
• Krzysztof Zagata   ORCID: orcid.org/0000-0002-9374-1873 1  

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Cartography in video games has rarely been a topic of scientific research. The authors, through a literature review of this issue, intend to draw attention to and emphasize the aspects of a rather specific and still narrow topic in cartography. They focused their literature review on publications that cover games with particular emphasis on video games with regard to cartography. Cartography has played a significant role in video games for a very long time, whether it reveals as the main user interface, mini-map, element of navigation, visual–spatial component or as orientation tool for gamers. However, in scientific research, cartography in video games is discussed in many aspects, such as cognitive cartography, performative cartography, map symbols, spatial knowledge or map design. The authors want to highlight scientific research on cartography in video games, and at the same time show the possibilities of research directions in future. The article also highlights the specific cartographic aspects of video games with techniques of Augmented Reality (AR) and Virtual Reality (VR).

Zusammenfassung

Kartographie in Videospielen war bislang selten ein Thema wissenschaftlicher Forschung. Die Autoren beabsichtigen durch eine Literaturrecherche zu diesem Thema auf die Aspekte eines eher spezifischen und noch engen Themas in der Kartographie aufmerksam zu machen und dieses hervorzuheben. Sie konzentrierten ihre Literaturrecherche auf Veröffentlichungen, die Spiele behandeln, mit besonderem Schwerpunkt auf Videospielen und ihrem Bezug zur Kartographie. Kartographie spielt in Videospielen schon sehr lange eine bedeutende Rolle, sei es als Hauptbenutzeroberfläche, Minikarte, Navigationselement, visuelle Raumkomponente oder als Orientierungshilfe für Gamerinnen und Gamer. In der wissenschaftlichen Forschung wird Kartographie in Videospielen jedoch mit unterschiedlichen Schwerpunkten diskutiert, wie zum Beispiel: Kognitive Kartographie, Performative Kartografie, Kartensignaturen, räumliches Wissen oder Kartendesign. Die Autoren wollen die wissenschaftliche Forschung zur Kartografie in Videospielen hervorheben und gleichzeitig die Möglichkeiten zukünftiger Forschungsrichtungen aufzeigen. Der Artikel beleuchtet auch die spezifischen kartografischen Aspekte von Videospielen mit Techniken der Augmented Reality (AR) und Virtual Reality (VR).

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This paper is the result of research on cartography in video games carried out within statutory research in the Department of Cartography and Geomatics, Faculty of Geographical and Geological Sciences, Adam Mickiewicz University Poznań, Poland.

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Could a video game developer win the Nobel Prize for Literature?

Profesor de Humanidades, IE University

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In October 2016, the Swedish Academy announced that it was awarding the Nobel prize for Literature to the singer-songwriter Bob Dylan for “having created new poetic expressions within the great American song tradition”. The decision sent out shockwaves: for the first time, a musician had received the most prestigious literary award on the planet. It sparked debate , with many questioning the decision and even sarcastic suggestions that novelists could aspire to winning a Grammy.

The controversy fed into much needed debates on the boundary between poetry and song, but the question of what constitutes literature is much broader. Does it mean the same as it did in 1901, when the first Nobel prize for literature was awarded?

High and low culture

These questions date back far beyond 2016. In the late 1950s, a group of professors from the University of Birmingham founded a new interdisciplinary area of study, called cultural studies , in order to ask new questions: What was the role of TV and other mass media in cultural development? Is there a justification for distinguishing high and low culture? What is the relationship between culture and power?

These questions are all still relevant to current debates around literature. Often, the word “literary” is a status symbol, a seal of approval to distinguish “high” culture from more vulgar or less valuable “low” forms of culture. Comics, for example, were not invited to join the club until recently, thanks in part to a rebranding under the more respectable guise of “graphic novels”.

According to the Merriam-Webster dictionary, literature displays “excellence of form or expression and expressing ideas of permanent or universal interest”. It seems that an artist like Bob Dylan can take home the Nobel prize thanks to literature’s defining feature of “excellence of form or expression”, which is not strictly limited to the written word.

But how do we account for other language-based forms of expression? If performed works such as theatre or songwriting can be considered literature, where is the limit?

Word play: text-based video games

According to data from video game data consultancy Newzoo , more than 3 billion people play video games worldwide – almost half of the world’s population. In Spain alone, 77% of young people play videogames , making them a massively relevant form of culture. But what does this have to do with “excellence of form or expression”? To answer this question we have to look back several decades.

When the first video games were developed in the 1950s, two distinct genres emerged: one was action oriented (such as the pioneering 1958 game Tennis for Two ), and the other more text based. The original written games, known as “ interactive fiction ”, were made up exclusively of text, and the player’s job was to read and make decisions that would determine the game’s outcome using a keyboard.

The inclusion of images in adventure games would not arrive until 1980, when Mystery House became the first “graphic adventure” game. These would reach their heyday in the 1990s: famous examples include the first two Monkey Island games (1990, 1991), Day of the Tentacle (1993), Full Throttle (1995), and Grim Fandango (1998), though there were many others. Despite technological advances, these games inherited several features from interactive fiction, including the predominant role of text.

The experience of playing one of these titles is not so different from that of a book: reading, pauses, the possibility of backtracking, and so on. The player spends most of their time in dialogue with various characters in search of information, stories, or even banter and jokes that are irrelevant to the game’s progress, much like footnotes or subplots.

Several classic adventure games even have direct links to literature: The Abbey of Crime (1987) is a Spanish adaptation of Umberto Eco’s The Name of the Rose , while the legendary insult sword fighting of The Secret of Monkey Island was written by science fiction author Orson Scott Card . In Myst (1993), the gameplay itself revolves around two books.

Literature on the screen: “story-rich” games

In more recent years, a new sub-genre of adventure games – known as “story-rich” games – has become popular thanks to independent creators and producers. In Papers, Please (2013), a border policeman in a fictional dictatorial regime deals with terrible moral dilemmas on a daily basis. In Firewatch (2016), players take the role of a forest ranger who investigates a conspiracy by walkie-talkie. In Return of the Obra Dinn (2018), the player must reconstruct a tragedy on the high seas with the help of an incomplete book and a peculiar compass. In all these cases, gameplay and visuals take a back seat to strong narratives.

A quintessential example is The Stanley Parable (2011), where the player takes the role of a worker in a strangely deserted office. They have to explore several corridors while trying unsuccessfully to interact with their surroundings, accompanied by the voice of an enigmatic narrator. Upon reaching a room with two open doors, the voiceover states that Stanley “entered the door on his left”.

The player can choose to follow the instructions or disobey, provoking the wrath of the narrator much like in the denouement of Miguel de Unamuno’s 1914 novel Fog , where the main character speaks directly to the author.

Each decision then opens up new paths leading to dozens of possible endings, similar to a “choose your own adventure” book. Its fragmentary and disordered story – as well as its playful spirit – is reminiscent of Julio Cortázar’s 1963 novel Hopscotch . The experience of playing the game is marked by postmodern literary features – as described by critics like Mikhail Bakhtin or Linda Hutcheon – including metafiction, intertextuality and parody.

One of its creators – Davey Wreden, a critical studies graduate – also created The Beginner’s Guide (2015), a game in which the player moves through levels of failed video games to learn more about their mysterious creator. In one, the player’s task consists solely of wandering through a virtual cave reading the countless comments left there by other frustrated players.

In recent years, the genre of digital or electronic literature has emerged, including books with QR codes, works that can only be read with virtual reality headsets, poetry collections published as apps, and so on. These works are fundamentally based on language, begging the question of why video games cannot also fit into this category.

This debate takes on added relevance today, as digital formats are having an undeniable impact on our reading habits. Just as today we accept oral cultures or popular music as literature, perhaps one day we will do the same with interactive stories like The Stanley Parable . Writing has always tried to break away from established ideas, and we know that literature is not limited to words on paper. Sometimes it pays to disobey the voice in our heads and walk through the door on the right, the one that leads to new, unexplored possibilities.

This article was originally published in Spanish

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Video Games—Cognitive Help or Hindrance?

• 1 Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
• Original Investigation Association of Video Gaming With Cognitive Performance Among Children Bader Chaarani, PhD; Joseph Ortigara, MS; DeKang Yuan, MS; Hannah Loso, PhD; Alexandra Potter, PhD; Hugh P. Garavan, PhD JAMA Network Open
• Letter Notice of Retraction and Replacement Bader Chaarani, PhD; Joseph Ortigara, MS; DeKang Yuan, MS; Hannah Loso, PhD; Alexandra Potter, PhD; Hugh P. Garavan, PhD JAMA Network Open

The increasing time devoted to video gaming by both adolescents and young adults during the past 2 decades has led to a spirited debate about the effect of this pastime on both individuals and societies. Stakeholders in this conversation include the burgeoning electronic gaming industry, video gamers, parents, educators, health care professionals, and governments. China has recently imposed a nationwide rule limiting online video gaming to 3 hours a week to protect youth. In contrast, proponents of video games around the world have claimed both educational and cognitive benefits for participants.

To clarify the impact of video games on personal and societal health, neuroscientists have researched the effects of video gaming on the human brain, an effort that has included many functional magnetic resonance imaging (fMRI) studies. As part of this widening investigation, Chaarani and colleagues 1 studied the neurocognitive ramifications of playing video games by analyzing publicly available fMRI data from the National Institutes of Health–sponsored Adolescent Brain Cognitive Development (ABCD) study cohort. In their analysis, published in this issue of JAMA Network Open , the authors discovered that 9- and 10-year-old children who played at least 21 hours of video games per week demonstrated higher levels of performance on fMRI emotional working memory (n = 679) and response inhibition tasks (n = 800) compared with a group of similarly aged control individuals who did not routinely play video games. Moreover, the patterns of cerebral cortical blood oxygenation level–dependent fMRI activation exhibited during these tasks statistically differed between groups when assessed with a false discovery rate–corrected P value of .05, suggesting differing methods of cerebral function.

This analysis, among the largest reported in the literature, adds to a heterogeneous body of data suggesting that regular video game participation alters cerebral cortical responses to some types of stimuli and may confer certain cognitive advantages. In other fMRI studies of video gamers, improved performance was found in the gamer group in such diverse cognitive domains as visual responsiveness, 2 executive function, 3 and reward system stamina. 4 However, the results of some fMRI studies have been less favorable for video gamers. For example, some fMRI evidence indicates that players of first-person shooter games experience blunted emotional responses to violent stimuli. 5 Despite often conflicting conclusions, 6 the body of evidence that the brains of video gamers may exhibit certain functional variances compared with the brains of non–videogamers, at least when assessed by fMRI, is increasing.

Making any recommendations based on fMRI studies of video gaming is challenging. By the nature of their design, most fMRI studies on this topic fail to establish causality between video gaming and purported brain functional alterations. Some studies may simply be uncovering inherent brain characteristics that lead certain individuals to gravitate toward video gaming. If, in fact, video games are altering neurocognition, the longevity of any cerebral changes induced by this activity remains largely unknown.

An additional concern is that the umbrella term video games includes a wide variety of individual game styles, including abstract tests of visuospatial coordination, fantasy community building, role-playing, virtual vehicular races, and military-style first-person shooter games. Consequently, one must also ask to what degree the specific variety of video games pursued by participants influences cognitive changes. To this point, Chaarani and colleagues 1 reported the number of hours their research participants devoted to video games on a weekly basis; however, the specific makeup of those games remains unknown. Although much research has been directed at the effects of violent video games on the limbic system, other styles of video games have garnered much less interest among researchers.

Another important question that remains unanswered is whether task-based fMRI is a neutral testing mechanism for assessing the cerebral consequences of video games. In many ways, undergoing a task-based fMRI examination is much like playing a video game. Within the confines of the scanner, fMRI participants commonly view various forms of visual stimuli by means of a liquid-crystal display screen or video goggles. Many fMRI tasks require the examinee to respond to these stimuli by pushing buttons on a small handheld device. This testing format may favor video gamers who have spent many hours using a game controller to respond to a variety of stimuli presented on a television screen. Beyond fMRI, many neurocognitive tests are likewise administered using a video-style format. Much more testing certainly needs to be performed on the brains of video gamers without the use of video screens. By doing so, we may come to understand whether the positive or negative cognitive effects of these games have implications beyond the realm of interacting with gaming consoles.

In conclusion, through their analysis of an fMRI data set from large ABCD cohort, Chaarani and colleagues 1 have contributed yet another piece to the puzzle regarding the influence of video gaming on cognitive function and health. Their results suggest a possible benefit to video gaming in the realm of working memory and executive response inhibition. However, large gaps in our knowledge on this topic persist, including such issues as causality, the influence of video game styles, and the impact of any bias introduced by a video-based testing environment. Much future research will be required to address such knowledge deficits before scientific evidence can guide health recommendations or societal policy.

Published: October 24, 2022. doi:10.1001/jamanetworkopen.2022.35729

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Welker KM. JAMA Network Open .

Corresponding Author: Kirk M. Welker, MD, Division of Neuroradiology, Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55902 ( [email protected] ).

Conflict of Interest Disclosures: None reported.

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Welker KM. Video Games—Cognitive Help or Hindrance? JAMA Netw Open. 2022;5(10):e2235729. doi:10.1001/jamanetworkopen.2022.35729

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Teens and Video Games Today

85% of u.s. teens say they play video games, and about four-in-ten do so daily. teens see both positive and negative sides of video games – from problem-solving and making friends to harassment and sleep loss, table of contents.

• Who plays video games?
• How often do teens play video games?
• What devices do teens play video games on?
• Social media use among gamers
• Teen views on how much they play video games and efforts to cut back
• Are teens social with others through video games?
• Do teens think video games positively or negatively impact their lives?
• Why do teens play video games?
• Bullying and violence in video games
• Appendix A: Detailed charts
• Acknowledgments
• Methodology

Pew Research Center conducted this analysis to better understand teens’ use of and experiences with video games.

The Center conducted an online survey of 1,453 U.S. teens from Sept. 26 to Oct. 23, 2023, through Ipsos. Ipsos recruited the teens via their parents, who were part of its KnowledgePanel . The KnowledgePanel is a probability-based web panel recruited primarily through national, random sampling of residential addresses. The survey was weighted to be representative of U.S. teens ages 13 to 17 who live with their parents by age, gender, race and ethnicity, household income, and other categories.

This research was reviewed and approved by an external institutional review board (IRB), Advarra, an independent committee of experts specializing in helping to protect the rights of research participants.

Here are the questions used for this analysis , along with responses, and  its methodology .

There are long-standing debates about the impact of video games on youth. Some credit them for helping young people form friendships and teaching them about teamwork and problem-solving . Others say video games expose teenagers to violent content, negatively impact their sleep and can even lead to addiction.

With this in mind, Pew Research Center surveyed 1,423 U.S. teens ages 13 to 17 about their own video game habits – from how often they play to the friends they’ve made and whether it gets in the way of them doing well in school or getting a good night’s sleep. 1

Key findings from the survey

• Video games as a part of daily teen life: 85% of U.S. teens report playing video games, and 41% say they play them at least once a day. Four-in-ten identify as a gamer.
• Gaming as a social experience: 72% of teens who play video games say that a reason why they play them is to spend time with others. And some have even made a friend online from playing them – 47% of teen video game players say they’ve done this.
• Helpful with problem-solving, less so for sleep: Over half of teens who play video games say it has helped their problem-solving skills, but 41% also say it has hurt their sleep.
• Bullying is a problem: 80% of all teens think harassment over video games is a problem for people their age. And 41% of those who play them say they’ve been called an offensive name when playing.
• Boys’ and girls’ experiences differ: Most teen boys and girls play video games, but larger shares of boys identify as gamers (62% vs. 17%) and play every day (61% vs. 22%). Boys who play them are also more likely to experience positive things from it, like making friends, and more troubling things like harassment.

Jump to read about: Who plays video games | Socializing over video games | Views about video games’ impact | Harassment and violence in video games      

Playing video games is widespread among teens. The vast majority of U.S. teens (85%) say they play them. Just 15% say they never do, according to the survey conducted Sept. 26-Oct. 23, 2023.

In addition to asking whether teens play video games, we also wanted to learn whether they consider themselves gamers. Overall, four-in-ten U.S. teens think of themselves as gamers. Just under half of teens (45%) play video games but do not think of themselves as gamers.

Nearly all boys (97%) say they play video games, compared with about three-quarters of teen girls. There is a substantial gap by gender in whether teens identify as gamers: 62% of teen boys do, compared with 17% of girls. 2

By gender and age

Younger teen girls are more likely than older girls to say they play video games: 81% of girls ages 13 to 14 compared with 67% of those ages 15 to 17. But among boys, nearly all play video games regardless of age. 

Similar shares of teens play video games across different racial and ethnic groups and among those who live in households with different annual incomes. Go to Appendix A for more detail on which teens play video games and which teens identify as gamers.

We also asked teens how often they play video games. About four-in-ten U.S. teens say they play video games daily, including 23% who do so several times a day.

Another 22% say they play several times a week, while 21% play them about once a week or less.

Teen boys are far more likely than girls to say they play video games daily (61% vs. 22%). They are also much more likely to say they play them several times a day (36% vs. 11%).

By whether someone identifies as a gamer

About seven-in-ten teens who identify as gamers (71%) say they play video games daily. This drops to 30% among those who play them but aren’t gamers.

By household income

Roughly half of teens living in households with an annual income of less than $30,000 (53%) say they play video games at least daily. This is higher than those in households with an annual income of $30,000 to $74,999 (42%) and $75,000 or more (39%).

Go to Appendix A to see more details about who plays video games and identifies as a gamer by gender, age, race and ethnicity, and household income.

Most teens play video games on a gaming console or a smartphone. When asked about five devices, most teens report playing video games on a gaming console (73%), such as PlayStation, Switch or Xbox. And 70% do so on a smartphone. Fewer – though still sizable shares – play them on each of the following:

• 49% say they play them on a desktop or laptop computer
• 33% do so on a tablet  
• 24% play them on a virtual reality (VR) headset such as Oculus, Meta Quest or PlayStation VR

Many teens play video games on multiple devices. About a quarter of teens (27%) do so on at least four of the five devices asked about, and about half (49%) play on two or three of them. Just 8% play video games on one device.

Teen boys are more likely than girls to play video games on four of the five devices asked about – all expect tablets. For instance, roughly nine-in-ten teen boys say they ever play video games on a gaming console, compared with 57% of girls. Equal shares of teen boys and girls play them on tablets.  

Teens who consider themselves gamers are more likely than those who play video games but aren’t gamers to play on a gaming console (95% vs. 78%), desktop or laptop computer (72% vs. 45%) or a virtual reality (VR) headset (39% vs. 19%). Similar shares of both groups play them on smartphones and tablets.

One way that teens engage with others about video games is through online platforms. And our survey findings show that teen gamers stand out for their use of two online platforms that are known for their gaming communities – Discord and Twitch :

• 44% of teen gamers say they use Discord, far higher than video game players who don’t identify as gamers or those who use the platform but do not play video games at all. About three-in-ten teens overall (28%) use Discord.
• 30% of teens gamers say they use Twitch. About one-in-ten other teens or fewer say the same; 17% of teens overall use the platform.

Previous Center research shows that U.S. teens use online platforms at high rates .

Teens largely say they spend the right amount of time playing video games. When asked about how much time they spend playing them, the largest share of teens (58%) say they spend the right amount of time. Far fewer feel they spend too much (14%) or too little (13%) time playing them.

Teen boys are more likely than girls to say they spend too much time playing video games (22% vs. 6%).

By race and ethnicity

Black (17%) and Hispanic (18%) teens are about twice as likely than White teens (8%) to say they spend too little time playing video games. 3

A quarter of teens who consider themselves gamers say they spend too much time playing video games, compared with 9% of those who play video games but don’t identify as gamers. Teen gamers are also less likely to think they spend too little time playing them (19% vs. 10%).

Fewer than half of teens have reduced how much they play video games. About four-in-ten (38%) say they have ever chosen to cut back on the amount of time they spend playing them. A majority (61%) report that they have not cut back at all.

This share is on par with findings about whether teenagers have cut back with their screen time – on social media or their smartphone.

Although boys are more likely to say they play video games too much, boys and girls are on par for whether they have ever cut back. About four-in-ten teen boys (39%) and girls (38%) say that they have ever cut back.

And gamers are as likely to say they have cut back as those who play video games but don’t identify as gamers (39% and 41%).

A main goal of our survey was to ask teens about their own experiences playing video games. For this section of the report, we focus on teens who say they play video games.

Socializing with others is a key part of the video game experience. Most teens who play video games do so with others, and some have developed friendships through them.

About nine-in-ten teen video game players (89%) say they play them with other people, in person or online. Far fewer (11%) play them only on their own.

Additionally, about half (47%) report that they have ever made a friend online because of a video game they both play. This equals 40% of all U.S. teens who have made a friend online because of a video game.

These experiences vary by:  

• Gender: Most teen boy and girl video game players play them with others, though it’s more common among boys (94% vs. 82%). Boys who play video games are much more likely to say they have made a friend online because of a video game (56% vs. 35%).
• Race and ethnicity: Black (55%) and Hispanic (53%) teen video game players are more likely than White teen video game players (43%) to say they have made a friend online because of them.
• Whether someone identifies as a gamer: Nearly all teen gamers report playing video games with others (98%). Fewer – though still most – of those who play video games but aren’t gamers (81%) also play them with others. And about seven-in-ten (68%) say they have made a friend online because of a video game, compared with 29% of those who play them but don’t identify as gamers.

Teens who play video games are particularly likely to say video games help their problem-solving skills. More than half of teens who play video games (56%) say this.

Additionally, more think that video games help, rather than hurt, three other parts of their lives that the survey asked about. Among teens who play video games:

• Roughly half (47%) say it has helped their friendships
• 41% say it has helped how they work with others
• 32% say it has helped their mental health

No more than 7% say playing video games has hurt any of these.

More teens who play video games say it hurts, rather than helps, their sleep. Among these teens, 41% say it has hurt how much sleep they get, while just 5% say it helps. And small shares say playing video games has impacted how well they do in school in either a positive or a negative way.

Still, many teens who play video games think playing them doesn’t have much an impact in any of these areas. For instance, at least six-in-ten teens who play video games say it has neither a positive nor a negative impact on their mental health (60%) or their school performance (72%). Fewer (41%) say this of their problem-solving skills.

Teen boys who play video games are more likely than girls to think playing them has helped their problem-solving skills, friendships and ability to work with others. For instance, 55% of teen boys who play video games say this has helped their friendships, compared with 35% of teen girls.

As for ways that it may hurt their lives, boys who play them are more likely than girls to say that it has hurt the amount of sleep they get (45% vs. 37%) and how well they do in school (21% vs. 11%). 

Teens who consider themselves gamers are more likely than those who aren’t gamers but play video games to say video games have helped their friendships (60% vs. 35%), ability to work with others (52% vs. 32%), problem-solving skills (66% vs. 47%) and mental health (41% vs. 24%).

Gamers, though, are somewhat more likely to say playing them hurt their sleep (48% vs. 36%) and how well they do in school (20% vs. 14%).

By whether teens play too much, too little or the right amount

Teens who report playing video games too much stand out for thinking video games have hurt their sleep and school performance. Two-thirds of these teens say it has hurt the amount of sleep they get, and 39% say it hurt their schoolwork. Far fewer of those who say they play the right amount (38%) or too little (32%) say it has hurt their sleep, or say it hurt their schoolwork (12% and 16%).

Teens who play video games say they largely do so to be entertained. And many also play them to be social with and interact with others. Teens who play video games were asked about four reasons why they play video games. Among those who play video games:

• Nearly all say fun or entertainment is a major or minor reason why they play video games – with a large majority (87%) saying it’s a major reason.
• Roughly three-quarters say spending time with others is a reason, and two-thirds say this of competing with others. Roughly three-in-ten say each is a major reason.
• Fewer – 50% – see learning something as a reason, with just 13% saying it’s a major reason.

While entertainment is by far the most common reason given by teens who play video games, differences emerge across groups in why they play video games.

Teens who identify as gamers are particularly likely to say each is major reason, especially when it comes to competing against others. About four-in-ten gamers (43%) say this is a major reason, compared with 13% of those who play video games but aren’t gamers.

Teen boys who play video games are more likely than girls to say competing (36% vs. 15%), spending time with others (36% vs. 27%) and entertainment (90% vs. 83%) are major reasons they play video games.

Black and Hispanic teens who play video games are more likely than White teens to say that learning new things and competing against others are major reasons they play them. For instance, 29% of Black teen video game players say learning something new is a major reason, higher than 17% of Hispanic teen video game players. Both are higher than the 7% of White teen video game players who say the same.

Teens who play video games and live in lower-income households are especially likely to say competing against others and learning new things are major reasons. For instance, four-in-ten teen video game players who live in households with an annual income of less than $30,000 say competing against others is a major reason they play. This is higher than among those in households with annual incomes of $30,000 to $74,999 (29%) and $75,000 or more (23%).

Cyberbullying can happen in many online environments, but many teens encounter this in the video game world.

Our survey finds that name-calling is a relatively common feature of video game life – especially for boys. Roughly four-in-ten teen video game players (43%) say they have been harassed or bullied while playing a video game in one of three ways: 

• 41% have been called an offensive name
• 12% have been physically threatened
• 8% have been sent unwanted sexually explicit things

Teen boys are particularly likely to say they have been called an offensive name. About half of teen boys who play video games (48%) say this has happened while playing them, compared with about a third of girls (32%). And they are somewhat more likely than girls to have been physically threatened (15% vs. 9%).

Teen gamers are more likely than those who play video games but aren’t gamers to say they been called and offensive name (53% vs. 30%), been physically threatened (17% vs. 8%) and sent unwanted sexually explicit things (10% vs. 6%).

Teens – regardless of whether they’ve had these experiences – think bullying is a problem in gaming. Eight-in-ten U.S. teens say that when it comes to video games, harassment and bullying is a problem for people their age. This includes 29% who say it is a major problem.

It’s common for teens to think harassment while playing video games is a problem, but girls are somewhat more likely than boys to say it’s a major problem (33% vs. 25%).

There have also been decades-long debates about how violent video games can influence youth behavior , if at all – such as by encouraging or desensitizing them to violence. We wanted to get a sense of how commonly violence shows up in the video games teens are playing.

Just over half of teens who play video games (56%) say at least some of the games they play contain violence. This includes 16% who say it’s in all or most of the games they play.

Teen boys who play video games are far more likely than girls to say that at least some of the games they play contain violence (69% vs. 37%).

About three-quarters of teen gamers (73%) say that at least some of the games they play contain violence, compared with 40% among video game players who aren’t gamers.   

• Throughout this report, “teens” refers to those ages 13 to 17. ↩
• Previous Center research of U.S. adults shows that men are more likely than women to identify as gamers – especially the youngest adults. ↩
• There were not enough Asian American respondents in the sample to be broken out into a separate analysis. As always, their responses are incorporated into the general population figures throughout the report. ↩

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Alice Munro, Canadian author who mastered the short story, dead at 92

Munro, who won the nobel prize in 2013, acclaimed for blending ordinary lives with extraordinary themes.

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Alice Munro, a Canadian author who was revered worldwide as master of the short story and one of few women to win the Nobel Prize in Literature, has died at the age of 92.

Her publisher said she died at her home in Port Hope, Ont., on Monday evening.

"Alice Munro is a national treasure — a writer of enormous depth, empathy, and humanity whose work is read, admired, and cherished by readers throughout Canada and around the world," read a statement from Kristin Cochrane, CEO of McClelland & Stewart, which is owned by Penguin Random House Canada.

"Alice's writing inspired countless writers too, and her work leaves an indelible mark on our literary landscape."

Munro wrote more than a dozen acclaimed collections over the course of her career, seamlessly blending ordinary people with extraordinary themes — womanhood, restlessness, aging — to develop complex characters with the nuance, depth and clarity most writers can only find in the wider confines of a novel.

In honouring her with the Nobel Prize in Literature in 2013, the Swedish Academy hailed Munro as "master of the contemporary short story," affirming what her peers, critics and readers had proclaimed for years.

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"Alice Munro was one of the world's greatest storytellers. Her short stories about life, friendship, and human connection left an indelible mark on readers. A proud Canadian, she leaves behind a remarkable legacy," read a statement from Prime Minister Justin Trudeau on Tuesday.

"On behalf of the Government of Canada, I offer my condolences to Mrs. Munro's family, friends, and many fans. Her creativity, compassion, and gift for writing will remain an inspiration for generations."

Early years in small-town Ontario

Munro was born Alice Laidlaw in Wingham, Ont., on July 10, 1931. The eldest child of Robert and Anne Laidlaw, she was raised on what she described as a " collapsing enterprise of a fox and mink farm " in the throes of the Great Depression.

An avid reader by 11, Munro was drawn to the work of literary legends Lucy Maud Montgomery and Charles Dickens. She began "making up stories in her mind" after discovering the works of Alfred Tennyson, according to her official Nobel biography.

Alice Munro on the craft of writing

As the eldest child, Munro took on most of the domestic roles in the household after her mother, who had been a schoolteacher, was diagnosed with Parkinson's disease. Though only 12 or 13, Munro said the work gave her "a sense of responsibility, purpose, being important. It didn't bother me at all."

Despite the family challenges, she began writing short stories when she was a teenager. She graduated valedictorian of her high school class in 1949 with a two-year scholarship to the University of Western Ontario in London.

Her first published story, The Dimensions of a Shadow , appeared in Western's undergraduate creative writing magazine, Folio, in the spring of 1950 . Two more pieces followed, with all three receiving praise for their exploration of the lives of girls and women.

It was there that she met and began dating honours history student James Munro. She also noticed Gerald Fremlin, an older student and another contributor to Folio.  Laidlaw and Munro married at her parents' home in Wingham on Dec. 29, 1951. The following year, James gave his wife a typewriter as a 21st birthday present.

The Munros had three daughters — Sheila, Catherine and Jenny — in the early years of their marriage. (Catherine died the same day she was born.) Munro left university when the scholarship money ran out and the family eventually settled in West Vancouver's Dundarave neighbourhood.

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The monotony of the girls' early years was reflected in 1978's The Moons of Jupiter , which described "wives yawning, napping, visiting, drinking coffee, and folding diapers; husbands coming home at night from the city across the water."

"We had become a cartoon couple, more middle-aged in our twenties than we would be in middle age," she wrote.

5 coolest things Alice Munro told CBC about her writing

Devotion to the short story.

Munro later said she devoted her career to the short story medium — regarded by many as notoriously difficult and by others as inferior to the novel — because the demands of marriage and motherhood didn't allow her the time to complete longer works.

In 1963, the Munros moved to Victoria and opened Munro's Books on Yates Street. Munro credits the bookstore, which made a "marvellous" $175 on its first day and is still flourishing, as helping her overcome the writer's block she experienced from her mid-20s to her mid-30s: "The writing ceased to be this all-important thing that I had to prove myself with. The pressure came off."

"Just as she would shape Munro's, Munro's would shape Alice," the shop wrote in a tribute to its founder. "Jim enjoyed recounting his wife's urge to write something better than the 'crappy books' that sold alongside the store's more palatable titles."

Alice Munro remembered at the beloved Victoria book store she co-founded

Munro's first collection of stories, Dance of the Happy Shades , was published in 1968 — two years after she gave birth to her fourth daughter, Andrea. The anthology drew attention from other Canadian literary giants such as Margaret Atwood and earned her comparisons to the famed Russian short story writer Anton Chekhov.

After her marriage ended in 1972, Munro moved back to Ontario. She reconnected with Fremlin — whom she'd shared pages with in Folio back at Western — after he deduced from an interview of hers on CBC Radio in 1974 that she was back in Ontario. The pair married and moved to Clinton, Ont., not far from her hometown in Wingham.

Fremlin, a retired geographer and cartographer, was the one to use the office in the couple's home. Munro opted to write at a tiny desk facing a window overlooking the driveway from the corner of their dining room, according to a 2013 profile . 

Alice Munro amazed by Nobel win

International recognition came after the New Yorker bought its first Munro story, Royal Beatings , in 1977. Munro nurtured a decades-long publishing relationship with the magazine, cementing the Canadian author's status with an elite group of contributors who defined the American publication's celebrated love affair with short fiction .

An unapologetic revisionist, Munro was known to keep reworking stories even after her publisher had sent them back without asking for any changes.

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In one instance , she personally paid financial penalties in order to add an entirely new story and change the voice from first to third person after the printing deadline for Who Do You Think You Are? — a collection of short stories that went on to win Munro the Governor General's Award in 1978.

Munro won a litany of literary honours over the next decades of her career, including two more Governor General's Awards, two Giller Prizes and the Man Booker International Prize. She also received an honorary degree from her alma mater, Western University — the "only such honour" she ever accepted, the school has said .

In mid-2013, shortly after the death of her second husband, Munro told the National Post that she was content with her career and "probably not going to write anymore."

She won the Nobel Prize in Literature that October, becoming the 13th woman to receive the honour.

In an interview with CBC after her Nobel win, Munro said: "I think my stories have gotten around quite remarkably for short stories, and I would really hope that this would make people see the short story as an important art, not just something that you played around with until you'd got a novel written."

Munro's last collection of work, Dear Life , was published in 2012. She introduced the final four stories in its pages, called Finale , as "autobiographical in feeling", if only partly.

"I believe they are the first and last — and the closest — things I have to say about my own life."

ABOUT THE AUTHOR

Senior Writer

Rhianna Schmunk is a senior writer for CBC News based in Vancouver. Over a decade in journalism, she has reported on subjects including criminal justice, civil litigation and climate change. You can send story tips to [email protected].

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With files from CBC Books

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