1. Wii and physical health, what relations? A systematic review Adviser: Professor Doutor Ricardo Correia Class 9 Faculdade de Medicina da Universidade do Porto Introdução à Medicina II 2009

2. Summary Introduction Aims Participants and Methods Results References

3. Introduction A new generation of video game consoles enables players to employ active movements in an interaction mode. Consequently, several potential benefits and/or malefits have arouse [1] [2] [3]. According to Graves et al (2008), the activity promoted by new generation console games has a significantly greater energy expenditure when compared to sedentary games, but not as much as the same authentic physical activities. Nintendo Wii, with the Wii Remote, witch contains a sensor able to detect motion and rotation in three dimensions, allows the user to control the game with its own movements [4].

4. Benefits of video games Video games are usually seen as contributors to the epidemic growth of obesity [4]. However, Wii can be used in obesity prevention [3]. Wii has also been used in rehabilitation. Its use has justified the coining of the term “wiihabilitation” by therapists and has been reported to increase patients motivation [5]. The usage of this console has led to improvements on the visual perception process, on the postural control and on functional mobility [6]. Introduction

5. Malefits of video games Injuries from playing the Nintendo Wii have been reported in popular media and physicians have already introduced diagnosis such as “Wiitis” or “Wii shoulder” [7] The use of Wii may cause upper extremity overuse syndrome, delayed-onset muscle soreness (DOMS), and, possibly, acute muscular and myotendinous strain Introduction

6. Aims The aim of our systematic review is to insvestigate and describe the existence of a direct connection between the usage of the Nintendo Wii console and changes on the player’s physical health.

7. Participants and Methods Study Design and Participants Article search and selection Data collection methods

8. Study design and participants Article search Article selection

9. Article Search PubmedScopusISIIEEEACM

10. Pubmed “Wii” AND (("Physical activity"[All Fields] OR "physical effort"[All Fields] OR "physical performance"[All Fields] OR "physical health"[All Fields] OR "cardiovascular health"[All Fields] OR "musculoskeletal health"[All Fields] OR fitness[All Fields]) OR (("rehabilitation"[Subheading] OR "rehabilitation"[All Fields] OR "rehabilitation"[MeSH Terms]) OR "physical therapy"[All Fields] OR "motor rehabilitation"[All Fields]) OR (("obesity"[MeSH Terms] OR "obesity"[All Fields]) OR ("overweight"[MeSH Terms] OR "overweight"[All Fields]) OR ("injuries"[Subheading] OR "injuries"[All Fields] OR "wounds and injuries"[MeSH Terms] OR ("wounds"[All Fields] AND "injuries"[All Fields]) OR "wounds and injuries"[All Fields]) OR ("wounds and injuries"[MeSH Terms] OR ("wounds"[All Fields] AND "injuries"[All Fields]) OR "wounds and injuries"[All Fields] OR "injury"[All Fields]) OR (wii[All Fields] AND ("knee"[MeSH Terms] OR "knee"[All Fields] OR "knee joint"[MeSH Terms] OR ("knee"[All Fields] AND "joint"[All Fields]) OR "knee joint"[All Fields])) OR "acute wiiitis"[All Fields] OR nintendonitis[All Fields] OR "playstation thumb"[All Fields] OR (wii[All Fields] AND ("shoulder"[MeSH Terms] OR "shoulder"[All Fields])))) Wii Physical activity Rehabilitation Weightloss Injuries

11. ISI Refined by: General Categories=( SCIENCE & TECHNOLOGY ) AND [excluding] General Categories=( SOCIAL SCIENCES OR ARTS & HUMANITIES ) AND [excluding] Subject Areas=( THERMODYNAMICS OR TOXICOLOGY OR COMPUTER SCIENCE OR AGRICULTURE OR CHEMISTRY OR EVOLUTIONARY BIOLOGY OR ANTHROPOLOGY OR PHYSICS OR MEDICAL LABORATORY TECHNOLOGY OR ASTRONOMY & ASTROPHYSICS OR BIOCHEMISTRY & MOLECULAR BIOLOGY OR BEHAVIORAL SCIENCES OR GENETICS & HEREDITY OR BIOPHYSICS OR MICROBIOLOGY OR POLYMER SCIENCE OR CRYSTALLOGRAPHY OR DENTISTRY, ORAL SURGERY & MEDICINE OR IMMUNOLOGY OR INFORMATION SCIENCE & LIBRARY SCIENCE OR INFECTIOUS DISEASES OR PHARMACOLOGY & PHARMACY OR METALLURGY & METALLURGICAL ENGINEERING OR CELL BIOLOGY OR REPRODUCTIVE BIOLOGY OR ENERGY & FUELS OR OBSTETRICS & GYNECOLOGY OR FOOD SCIENCE & TECHNOLOGY OR ROBOTICS OR UROLOGY & NEPHROLOGY OR TRANSPORTATION OR MATHEMATICS ) Wii Included in Science & Technology category

12. Scopus TITLE-ABS-KEY(wii) AND (EXCLUDE(SUBJAREA, "COMP") OR EXCLUDE(SUBJAREA, "ENGI") OR EXCLUDE(SUBJAREA, "BIOC") OR EXCLUDE(SUBJAREA, "CHEM") OR EXCLUDE(SUBJAREA, "PHYS") OR EXCLUDE(SUBJAREA, "CENG") OR EXCLUDE(SUBJAREA, "IMMU") OR EXCLUDE(SUBJAREA, "MATE") OR EXCLUDE(SUBJAREA, "MATH") OR EXCLUDE(SUBJAREA, "BUSI") OR EXCLUDE(SUBJAREA, "AGRI") OR EXCLUDE(SUBJAREA, "SOCI") OR EXCLUDE(SUBJAREA, "ENER") OR EXCLUDE(SUBJAREA, "ECON") OR EXCLUDE(SUBJAREA, "EART") OR EXCLUDE(SUBJAREA, "MULT") OR EXCLUDE(SUBJAREA, "ENVI") OR EXCLUDE(SUBJAREA, "PSYC") OR EXCLUDE(SUBJAREA, "DENT") OR EXCLUDE(SUBJAREA, "PHAR") OR EXCLUDE(SUBJAREA, "DECI") OR EXCLUDE(SUBJAREA, "ARTS")) AND (EXCLUDE(EXACTSRCTITLE, "Genitourinary Medicine") OR EXCLUDE(EXACTSRCTITLE, "Sexually Transmitted Diseases") OR EXCLUDE(EXACTSRCTITLE, "British Journal of Venereal Diseases") OR EXCLUDE(EXACTSRCTITLE, "Acta Dermato Venereologica") OR EXCLUDE(EXACTSRCTITLE, "Physiology and Behavior") OR EXCLUDE(EXACTSRCTITLE, "Pediatric AIDS and HIV Infection") OR EXCLUDE(EXACTSRCTITLE, "Journal of the Association of Physicians of India") OR EXCLUDE(EXACTSRCTITLE, "Indian Journal of Medical Microbiology") OR EXCLUDE(EXACTSRCTITLE, "European Journal of Epidemiology") OR EXCLUDE(EXACTSRCTITLE, "Blood") OR EXCLUDE(EXACTSRCTITLE, "American Journal of Industrial Medicine") OR EXCLUDE(EXACTSRCTITLE, "Acta Pathologica Microbiologica Et Immunologica Scandinavica Section B Microbiology")) Wii Included in medical categories

13. ACM and IEEE In this databases our article research was made based on the keywords “Nintendo Wii”.

14. Article selection Selection based on title Selection based on abstract Selection based on full reading of the article

15. Selection based on title

16. We exclude articles that talked about : - Computers -Playstation -Gameboys -Not specifically of Nintendo Wii

17. Selection based on abstract

18. Criteria of inclusion Articles published from 1990 to actuality; Articles published in English, Portuguese, Spanish or French; Articles referring to the impact of the use of Nintendo Wii on physical health; Original articles.

19. Criteria of exclusion Editorials; Articles referring to the psychological impact of Nintendo Wii; Articles referring uniquely to surgical correction of physical problems related to the use of Nintendo Wii. Articles that referred Nintendo Wii technologies and programming system

20. Selection based on full reading of the article

21. Studied Variables Categorical Ordinal Variables Age Group Health Condition Categorical Nominal Variables Weightloss Arterial Pressure Control Sedentarism Avoidance Energy Expenditure Rehabilitation Injuries Numerical Continuous Variables Date Duration of the study

23. Data collection methods Data extraction Studied variables Data synthetizing

24. Selection based on abstract »Total of articles =15

25. Data synthetizing 7 of the 16 articles that were fully read were included The missing article corresponds to one article we found in database that was already included

26. Data synthetizing Article selection based on full reading of the article

27. Results The 7 articles included were published in 2007 and 2008, which brings evidence that this is a very recent issue.

28. Results The 7 articles were found in a wide variety of journals.

29. Results 2 of the 7 final articles did not refer the number of participants 4 of them had 1 participant 1 article was based on results obtained from 11 participants

30. Results Analysing the age group of participants we can see that the studies are only being applied to youngsters with ages from 11-18; Concerning the variables we defined, no articles refered Weightloss and Arterial Pressure Control The analysis of age group and number of participants is showed below and allow us to see that the studies are only being applied to youngsters with ages from 11-18 years old. That way, we suppose that, in the future, researchers will be more worried to search effects of Nintendo Wii in children aged below 11, adults and eldest. Concerning the variables we defined, no articles referred Weight Loss and Arterial Pressure Control, two of them were related with Rehabilitation, one with Sedentarism Avoidance and two of them talked about Energy Expenditure and Injuries.

31. Results From the 7 final articles: 2 articles were related with rehabilitation 1 article was related with sedentarism avoidance 2 articles were related with energy expenditure 2 articles were related with injuries 1 article referred 3 of the variables

32. References 1 - Graves, L.E., Ridgers, N.D., Stratton, G. (2008). The contribution of upper limb and total body movement to adolescents` energy expenditure whilst playing Nintendo. European journal of applied physiology. 104(4); 2 - Graves, L., Stratton, G., Ridgers, N. D. & Cable, N.T. (2007). Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross study. BMJ. 22;335(7633); 3 - Pasch M., Berthouze N., van Dijk B., Nijholt A.(2008). Motivations, Strategies, and Movement Patterns of Video Gamers Playing Nintendo Wii Boxing. Conference of Workshop Paper. EWI-HMI: Human Media Interaction; 4 - Epstein, L. H., Roemmich, J. N., Robinson, J. L., et al, (2008). A viewing and computer use on body mass index in young children, Archives of Pediatrics and Adolescent Medicine, 162(3); 5- Pasch M., Berthouze N., van Dijk B., Nijholt A.(2008). Motivations, Strategies, and Movement Patterns of Video Gamers Playing Nintendo Wii Boxing. Conference of Workshop Paper. EWI- HMI: Human Media Interaction. 6- Epstein, L. H., Roemmich, J. N., Robinson, J. L., et al, (2008). A viewing and computer use on body mass index in young children, Archives of Pediatrics and Adolescent Medicine, 162(3); 7- Bonis, J. (2007). Acute Wiiitis, The New England Journal of Medicine. 356(23):2431-2432 Cowley, A.D. & Minnaar, G. (2008). New generation computer games: Watch out for Wii shoulder. BMJ. 336(7636):110; 8- Nett M. P., Collins M. S. and Sperling J. W. (2008). Magnetic resonance imaging of acute “wiiitis” of the upper extremity. Skeletal Radio. 37- 481-483;

33. AUTHORS: Ana Fraga Ana Cunha Cláudia Melo Irina Ramires Joana Pereira João Maia Marta Antunes Nuno Dias Pedro Pereira Sofia Farinha