8-16-08: I'm posting to my new blog, Exergaming Evangelist now, so please go there for the latest exergaming updates from yours truly. Thanks!

Since our article on the Redlands, CA school district coming out with an experiment to use video games as an alternative option to PE hit the newswire, it's been amazing, but not surprising, to read the negative responses to this idea.

Not surprising, because these are the same criticisms I've heard over the last few years from many in the healthcare and fitness industry whenever I would bring this up at the conferences I attended.

Here is my first post I made in response to Mark, who posted some comments criticizing exertainment in schools.

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Mark brings up some criticisms to this plan, as well as exertainment in general, so I'd like to respond here to show the other side. (I believe I can do that because I'm on the very committee with Sue Buster and others that is planning this--in fact, the whole exertainment idea in the schools is my idea! LOL!)

I will attempt to keept his brief and answers Mark's questions specifically.

1. Does Buster blame video games for childhood obesity? ANS: No...read her quote..."One of the things being blamed for...." She didn't blame it, she made an observation, which just about everyone does. If you read any article--either in the newspaper or scientific literature on pediatric obesity, they will always mention video games (along with TV, Internet, and other so-called "recreational screen time") in the first couple of paragraphs as part of the problem. This was NOT Sue Buster's original idea, nor did she do any studies to back this quote up. She was merely making an observation that is almost common knowledge.

2. "Does Ms Buster also blame food for the obesity problem?" Watch Supersize Me.

3. Mark think "that's insane" to be bringing in these types of video games into the schools. Has he actually played any of these exertainment-based games and hardware? I have...and they get me just as good a workout like I do exercising with more traditional forms of exercise and sport.

Here's the rationale why we are taking this approach. After 12 years working in the trenches overweight adults and kids at Beaver Medical Group, also in Redlands, I have found some major obstacles in getting kids to exercise with our traditional methods. I will list those here, and then show why exertainment is a viable intervention, which, btw, we are currently setting up studies to prove these points.

Also, as an aside, I personally have nothing against our traditional forms of activities. For the last few years, I've organized a kid's triathlon where we've had over 100 kids each year participate--including physically challenged kids.

Our daughter, who is 7 years old, works out on the local swimming team (Redlands Swim Team) swimming 3 days a week for over an hour each (these are full swimming training with a coach barking orders) and on the other 2 days, she does ballet. On the weekends, we either ride our bicycles or run, so she can stay in shape for the next kid's triathlon. She has many medals and ribbons from swim meets and triathlons already--way more than I ever had!

So you see, I am not against these "traditional" forms of physical activity, and support them with our own daughter.

The kids I see through my work, however, are a different story. They are overweight, which makes it difficult for them to participate in these kinds of activities. They usually don't have the skills to do well in these sports.

The proverbial "fat kid" is always picked last on any team-related sports like baseball, soccer, or basketball, thus further depressing their self-esteem and confidence.

A recent study compared the depression levels of overweight kids to those kids going through cancer!

Not only that, many schools are reducing PE time to barely once a week. And just recently, there was a news article about how during recess time, many schools let their kids eat their snacks instead of playing and being active.

We try to encourage kids to be more active by getting outside, playing, going to the park, etc. But as anyone who can read a newspaper, the innocent day and age where we parents used to do those very things is long gone. Most parents don't feel safe letting their kids run all over the neighborhood till the sun set. And let them go to the park unsupervised, what with all the child molestors, kidnappings, and booby trapped parks and playgrounds out there? No way!

The old advice, "Just go outside and play." isn't practical or safe these days, at least in most suburbian areas in this country. Maybe in a rural community in the heart of the farming land can parents do that, but not here in SoCal, even in relatively safe areas outside of the big cities. Parents just don't feel safe letting their kids outside unsurpervised. And with most families having a double-income, they are not home to bring them to the park or play outside. (We're fortunate that my wife works part-time and homeschools so we are able to bring her to the playground and play, under close supervision the whole time.)

Bottomline: It's an uphill battle to motivate the overrweight kid to be more physically active. No matter how we hard we try to encourage them to try these the traditional forms of physical activity, it's either not safe for them, their parents aren't working, or they lack the self-confidence to do those things.

So the path of least resistance: stay inside and play video games where the parent knows they are safe and the kids have a high level of self-esteem doing something they are good at.

Taking a theme from martial arts, instead of trying to fight them and force them to do something that they don't want to do to get a disired outcome (getting more physical activity), why not use what they like to do and get the same outcome? Instead of resisting them, go with the flow.

Exertainment allows them to stay in the medium that they already have (easy access, low cost), they feel good about (usually very good gamers), they can do safely in their own homes with their own friends, and are safe, AND at the same time, get a great physical workout!

Not only that, it has to be sustainable. If you drag a kid to the local soccer league at the local Y and he absolutely hates it because he's out of shape to keep up, the kids pick on him or don't include him because he's not good at it, he'll be dragging his feet everytime his parents try to bring him. He'll be in a foul mood, which will probably drive him to eat more for comfort. How long do you think a parent can keep this up?

But get them a game like DDR or the Eye Toy and all of a sudden, you have your overweight kid playing and getting a great cardio workout, and they're having FUN doing it! Now we're talking about something that they can sustain and do long enough to see the health benefits (weight loss, lower blood sugars, decrease high blood pressure, etc.)

For example, I had a 15 year old boy who didn't like sports, PE, exercise, etc. He was into the arts, and mentioned he like dancing. I asked if he had a game console--he did. So I encouraged him to get the DDR and play it at home.

Two months later, I saw him for his first follow-up and he had lost 16 lbs! I asked what he was doing, and besides reducing his junk food intake, he was playing DDR 4x/wk for 2 hrs. at a time! Why? Because it was FUN. If I had told him to go out and play b-ball or even just walk around his neighborhood for 15 mins., do you think he would've done it? Maybe for a week or 2. Would he keep it up long-term? No. I've seen them relapse time and time again, for a variety of excuses (after 12 years, you hear just about every excuse under the sun).

And that's what is so exciting about exertaintment...that it can overcome just about every excuse for not exercising! This is the first time that I have ever seen an intervention that can do that when it comes to physical activity.

The number one reason why people say they don't exercise, even if they know they should, is "lack of time". But we all know that that isn't really the case, because they have plenty of time to do the things they LIKE to do!

So the real reason people don't like to exercise is because they don't like to do it. And why not? Because exercise is BORING for most people.

Playing games, having fun, in a medium they already feel confident about, is a "sneaky" way to get them to exercise, and maintain an exercise lifestyle.

I could go on and on, and give you more examples of how introducing exertainment-based video game playing has gotten more of our pediatric obese patients moving again, but I'll spare you.

Coming back to the school system, we are not using any public or state funding to do this. There are plenty of grants out there, trying to find innovative and sutatainable interventions to get kids moving and healthy again.

This is being tested to give an alternative to PE. Not only that, since most kids have a PS2 or Xbox at home already, they can easily get the game and continue to play/workout at home, so that working out isn't a once-a-week kinda thing.

Once we get these overweight kids to lose the weight and improve their fitness level, THEN they may be more inclined to try soccer, b-ball, or a kid's triathlon.

We're not replacing these activities, we're trying to meet them where these kids are at, so that they can eventually participate in those activities.

We wouldn't put our 7 year old in AP classes, we'd let her start at 2nd grade level school work. Does that mean I'm trying to replace AP classes or think that it's bad? Of course not--a 7 year old isn't ready for AP classes yet, they have to build up to that point.

The same goes for these overweight kids. Exertainment is like elementary school work for them...it is getting them ready for the traditional forms of activity.

As an aside, we've noticed that most PARENTS of overweight kids are overweight themselves. Do you think that they are inclined to go out and run along side their kids, to play soccer with them, or b-ball, like we do with our daugther? No.

But they can play these video games with their kids, have fun, and get a workout as well! In fact, I've seen where kids are really motivated because they can usually do something better than their parents for a change! By using the scoring system, exertainment games can encourage a healthy competition where you are shooting to beat a high score, and if a kid can get a higher score than their parent, what do you think that'll do for their self-esteem? It's so incredible to watch their joy when they "beat" their parents at one of these exertainment video games. Not too many overweight kids who can beat their overweight parent at any of the traditional sports (though my daughter can easily beat me in the 100 IM in swimming, and has swum over a mile many times whereas I can barely make 100 yds non-stop! Talk about an ego booster for her...fortunately, she's my daughter so I don't mind getting beat by her. ;-)

So I've strayed from rebutting all of Mark's comments, but I hope that you can better understand the rationale for exertainment-based video games.

The best thing to do is play them for yourself, and see kids--especially overweight kids--play them, and compare it to their participation in traditional PE, and you'll be amazed at the difference that will soon be obvious. We've seen that in our clinic with our own Kid Fit class, and now we want to see it happen in our school setting so we can reach a wider range of kids, especially those who are unfit and overweight.

When we did this in our Kid Fit class for the first time this year, we witnessed something we had never seen before in the last 5 years of running this class. We had kids coming EARLY to class and staying later because they wanted to play the games! Instead of our usually drop-out rate over the 4 weeks, we actually INCREASED in attendance over that time! And when we were done, the kids were sad about that, so we encouraged the parents to buy the games for the consoles they already had so they could keep working out at home regularly.

Vidoe games are here to stay. Kids love to play them, and are good at them. Why not use them to get our kids healthy again? Exertainment overcomes all of the obstacles we face in meeting this growing pediatric obesity epidemic. To withhold such an incredible intervention because Johnny should just go outside and play or join the local soccer league is just burying our heads in the sand to what faces these kids.

Ernie Medina, Jr., DrPH
Beaver Medical Group
XRtainment Zone LLC