Effects and regulatory factors of exergaming on glucose and lipid metabolism in children and adolescents: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Glucose and lipid metabolism are critically linked to the health outcomes of children and adolescents. Exergaming interventions represent a promising approach to promote physical activity engagement in this population. However, the effects of exergaming on glucose and lipid metabolism remain controversial. This systematic review aimed to synthesize and update the evidence on this topic. OBJECTIVE This meta-analysis aimed to evaluate the effects of exergaming on glucose and lipid metabolism in children and adolescents compared with control conditions, and to examine potential moderators of these metabolic outcomes. METHODS Following the PRISMA 2020 guideline, we searched PubMed, Web of Science, Scopus, Embase, and the Psychology and Behavioral Sciences Collection (EBSCO) from inception to October 2025. Standardized mean differences (Hedges g) were pooled using random-effects models. Subgroup analyses and meta-regression were conducted to examine potential moderators(eg, sex, age, BMI, and intervention type). Study quality was assessed using RoB 2, ROBINS-I and the PEDro scale, and the certainty of evidence was rated using the GRADE approach. RESULTS Ten trials (N=732) were included. Exergaming showed no significant pooled effects on glucose or insulin. For lipid outcomes, exergaming was associated with a small reduction in LDL-C (Hedges g −0.27, 95% CI −0.47 to −0.07; P=.008; I²=19%), whereas no significant overall changes were observed for TC, TG, or HDL-C. Exploratory subgroup and meta-regression analyses suggested that sex and intervention type may be associated with variability in effects, but these findings should be interpreted cautiously given the limited number of studies. The overall certainty of evidence was low. CONCLUSIONS Exergaming may modestly reduce LDL-C in children and adolescents, but evidence does not support consistent improvements in other glycemic or lipid outcomes. Given the low certainty of evidence and limited data for effect modification, larger, well-designed trials with clearly reported exercise dose and metabolic endpoints are needed to confirm these findings and to identify subgroups most likely to benefit. CLINICALTRIAL OSF Registries 10.17605/OSF.IO/64FUS.