See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/260784492

Comparing Energy Expenditure in Adolescents With and Without Autism While

Playing Nintendo Wii Games

Article  in  Games for Health Journal · February 2012

DOI: 10.1089/g4h.2011.0019

CITATIONS READS
24 435

6 authors, including:

Nancy Getchell
University of Delaware
103 PUBLICATIONS   2,783 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Textbooks View project

fNIRs projects View project

All content following this page was uploaded by Nancy Getchell on 14 March 2014.

The user has requested enhancement of the downloaded file.

GAMES FOR HEALTH JOURNAL: Research, Development, and Clinical Applications
Volume 1, Number 1, 2012
ª Mary Ann Liebert, Inc.
DOI: 10.1089/g4h.2011.0019

Comparing Energy Expenditure in Adolescents With

and Without Autism While Playing Nintendo Wii Games

Nancy Getchell, PhD, Dannielle Miccinello, MS, Michelle Blom, BS,

Lyssa Morris, BS, and Mark Szaroleta, BS

Abstract

Objective: Obesity rates are on the rise in individuals with autism spectrum disorders (ASD), which underscores
the importance of finding new ways in which to engage this population in physical activity. We wanted to
explore the energetic expenditure of adolescents with and without ASD while playing Nintendo Wii (Nin-
tendo of America, Inc., Redmond, WA) games compared with more traditional exercise modalities. Specifically,
we wanted to compare energy expenditure (EE) among the different activities and to see which activities lead to
the greatest amount of time classified as ‘‘moderate to vigorous.’’
Subjects and Methods: Two groups of adolescents (15 with ASD [mean age, 17.50 – 2.4 years], 15 without ASD
[mean age, 17.23 – 4.1 years]) participated in 20-minute bouts of walking, running, and playing Nintendo Wii
‘‘Sport,’’ Wii ‘‘Fit,’’ and ‘‘Dance Dance Revolution’’ (DDR) (Konami Digital Entertainment, Inc., El Segundo,
CA). During each session, EE was calculated using an Actical (Mini Mitter Co., Bend, OR) accelerometer. Groups
were compared using multiple t tests.
Results: Both groups expended similar amounts of kilcalories in all activities, except for Wii Fit, in which the
ASD group expended significantly more kilocalories. For the ASD group, EE was greatest in running, followed
by walking, DDR, Wii Fit, and Wii Sport. Walking, running, and DDR all had at least 75 percent of the total time
spent in moderate to vigorous intensity levels.
Conclusion: We suggest videogame systems, such as the Nintendo Wii, may be viable alternative for individuals
with ASD to increase their daily physical activity and help alleviate the growing rates of obesity.

Introduction intervals.8 Being engaged in moderate to vigorous physical

activity (MVPA), a person is working hard enough to in-

T he number of children classified as overweight or ob-

ese has increased exponentially, nearly tripling in the past
25 years.1,2 Reports vary but suggest that children with autism
spectrum disorders (ASD) are at risk for obesity, with a
prevalence of 7–11 percent higher than their neurotypical
(TD) peers.3–5 Weight gain in ASD can be the result of sed-
entary activities and side effects of popular medications. This
constitutes a growing issue as health risks associated with
being overweight include cardiovascular disease, certain
types of cancer, and type 2 diabetes. Furthermore, over-
weight or obese children tend to continue this lifestyle into
adulthood.6,7
In 2008, the Department of Health and Human Services
provided updated ‘‘Physical Activity Guidelines for Ameri-
cans’’ recommending adults with disabilities get at least 150
minutes of moderate- or 75 minutes of vigorous-intensity
aerobic exercise throughout the week in at least 10-minute
crease heart rate, will begin sweating, and possibly have
difficulty completing a sentence.9 It is important to note that
no specifications were provided for children or adolescents
with disabilities; in fact, we do not know about energy ex-
penditure (EE) in different activities between populations that
are typical versus atypical. However, the National Center of
Physical Activity and Disability10 recommended that indi-
viduals with ASD incorporate a variety of activities into their
regimen. These recommendations have been echoed by a
variety of sources.11,12 Although general consensus stresses
the importance of physical activity (PA) on this topic, little
research exists specifically for individuals with ASD (Pan13
and Sandt and Frey14 are two exceptions).
Challenges arise when providing opportunities for PA for
individuals with ASD. First, many traditional activities re-
quire social interactions, which seem difficult and undesirable
for this population.15 Furthermore, individuals with ASD

Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware.

58
ENERGY, ASD, AND NINTENDO WII GAMES 59

may exhibit both fine and gross motor impairments as well hours a week. This allowed students with HFA to become
as the inability to perform complex movements.16,17 For familiar with researchers and provided an opportunity for
example, Dewey et al.16 compared children with ASD, de- them to learn to use the Nintendo Wii games to minimize the
velopmental coordination disorder, and attention deficit hy- effect of learning.
peractivity disorder only and TD children on various motor
skills. Children with ASD were significantly more impaired Procedures
than their cohorts, possibly putting them at a disadvantage
Participants’ height, weight, date of birth, and gender were
for successful participation.
used to program ActiCal (Mini Mitter Co., Bend, OR) accel-
Given the dearth of research within the area of PA and ASD,
erometers. ActiCal accelerometers were attached to a waist
we had two aims. First, we wanted to compare EE between
belt, which was positioned on the participant’s posterior hip.
adolescents with and without ASD during traditional activi-
Participants with HFA completed two or three activities per
ties in which participation is simple and inexpensive and can
week over a 2-week period during their PE class. Participants
be completed individually or with peers—walking and run-
were given rest between assessments in which they did not
ning. Based on previous research, we hypothesized that the
use Wii games or participate in physically taxing activities
group without ASD would have higher EE (in kilocalories) in
during PE. The five activities assessed were walking, running,
running and the same during walking as the group with
and playing three Nintendo Wii games (Wii Sport, Wii Fit,
ASD.18 Second, we wanted to compare EE and MVPA during
and DDR). EE and MVPA were monitored for 20 minutes
Nintendo Wii (Nintendo of America, Inc., Redmond, WA)
during each activity.
games with those during walking and running. Nintendo Wii
Wii Sport was set to beginner level. Participants completed
is an interactive gaming system that incorporates fitness,
the following: Five games of tennis (6.5 minutes), single
motor skills, and hand–eye coordination. In an earlier work,
person bowling (5 minutes), boxing training #2 with balls
parents reported using Wii ‘‘Fit’’ as a means to engage their
(1 minute), boxing training #1 with punching bag (1 minute),
children with ASD in PA.19 Wii Fit, Wii ‘‘Sport,’’ and ‘‘Dance
baseball training home run derby twice (2.5 minutes), and
Dance Revolution’’ (DDR) (Konami Digital Entertainment,
one game the participant chose. Wii Fit was set to interme-
Inc., El Segundo, CA) were chosen. We made no a priori pre-
diate level. Participants completed the following: Sun salu-
dictions related to EE or MVPA during the Nintendo games.
tation yoga move (2 minutes), hula hoop #2 (3 minutes), run
#1 (3 minutes), soccer heading beginner (2 minutes), ski sla-
Subjects and Methods
lom beginner (2 minutes), ski jump (2 minutes), penguin
Overview game (4 minutes), torso twists (1.5 minutes), and 15 repeti-
tions of rowing squats (1 minute). All times are approximate.
EE and time spent in MVPA were monitored for 15 ado-
Song selection and ability level for DDR were selected based
lescents with high functioning autism (HFA) and 15 TD peers
on participants’ previous success.
during 20-minute bouts of running, walking, and participat-
The walk and run portion was completed on an outdoor
ing in various Nintendo Wii games. Multiple t tests were used
track in groups of two or three participants. An investigator
to analyze the data.
walked or ran with the students to provide verbal motivation.
Participants were allowed to jog or walk quickly if they could
Participants
no longer run.
Two groups took part in this research. The first group
consisted of 15 adolescents (17.50 – 2.4 years old; 12 males, Instrumentation
three females) with HFA recruited from the Delaware Autism
Program (DAP) at Glasgow High School, Newark, DE. DAP Noninvasive ActiCal accelerometers were used to monitor
provides services to individuals with an educational diag- EE and MVPA within a custom time interval. ActiCal accel-
nosis of ASD from birth to 21 years. Inclusion criteria for this erometers are valid and reliable for children.20
group were as follows: Ability to run and walk indepen-
dently, ability to communicate, and ability to follow basic Data analysis
instructions. The second group, the TD control, consisted of
SPSS software (SPSS, Inc., Chicago, IL) was used to run
15 counselors (17.23 – 4.1 years old; six males, nine females)
multiple t tests to make group comparisons of the total EE of
from the Delaware Sanford Day Camp (Hockessin, DE). Ex-
the five different activities. All comparisons were made at the
clusion criteria for both groups included the following:
0.05 level.
Musculoskeletal injury prohibiting activity and coexisting
conditions that would impair participation in videogame
playing (e.g., significant visual or hearing impairment). The Results
research received approval from the Institutional Review
Running led to the greatest EE, followed by walking and
Board at the University of Delaware. Parental consent was
Wii games for both groups (Fig. 1). Groups did not differ in
given for TD participants under 18 years of age and HFA
EE during walking, running, or playing Wii Sport or DDR.
participants. TD participants over 18 years of age gave in-
The ASD group had significantly higher EE (t28 = 2.04,
formed consent prior to participation.
P = 0.0002) using Wii Fit. When compared with running, ASD
participants expended 72.1 percent as many kilocalories
Pretesting preparation
during walking, 48.1 percent kilocalories during DDR, 39.4
A month prior to data collection, three investigators vo- percent kilocalories during Wii Fit, and 5.0 percent kilocalo-
lunteered in the DAP physical education (PE) program 8–10 ries during Wii Sport.
60
FIG. 1. Comparison of energy expenditure (in kilocalories)
during traditional and Nintendo Wii forms of physical
activity between autism spectrum disorders (ASD) and
neurotypical control (TD) participants. DDR, ‘‘Dance Dance
Revolution.’’ *Significant difference at the 0.05 level.
The ASD group spent the greatest amount of time engaged
in MVPA during walking (98.5 percent), followed by running
(93.8 percent) and playing DDR (76.4 percent), Fit (32.6 per-
cent), and Sport (25.9 percent). Figure 2 shows the breakdown
of percentage time in sedentary, light, moderate, and vigor-
ous activity for participants with ASD.
Discussion
When engaging in various forms of PA, including Wii
videogames, participants with ASD achieved similar levels of
EE as their typically developing peers. Furthermore, partici-
pants with ASD spent between 25 percent and 98 percent of
time engaged in MVPA. During 20 minutes of DDR, ASD
spent approximately 15 minutes (76 percent) in MVPA,
nearly meeting the daily recommendation for adults with
disabilities.8 Of note is that participants with ASD did not
differ in their EE from their typically developing peers in any
activity except Wii Fit, where they actually expended signif-
icantly more energy.
Videogames may be preferred by individuals with ASD,
who may express a preference for technology-based activities
FIG. 2. Breakdown of energy expenditure (in kilocalories)
for traditional and Nintendo Wii forms of physical activity
for participants with autism spectrum disorders. DDR,
‘‘Dance Dance Revolution.’’
GETCHELL ET AL.
(videogames, browsing the internet, viewing television) over
engaging in traditional PA.21 Parents of children with ASD
report their child’s interest in technology-based activities and
a lack of motivation and interest serve as prime barriers to
participation in PA.19 Therefore, the results of this study
suggest that Nintendo Wii may be a viable alternative to
provide opportunities for PA while incorporating interests of
this population.
Parents have expressed additional barriers hindering their
child with ASD’s participation in PA, including their own
lack of time and energy as well as that lack of supervision and
safety concerns prohibit PA.19 Nintendo Wii can be sub-
stituted for television or computer-based activities keeping
children indoors. The lack of a partner can be overcome by the
individual play option many Nintendo Wii activities offer.
Wii Fit and Sport did not elicit as much time in MVPA as
other activities. However, several possible explanations exist.
First, these activities do not require quick or frequent move-
ment like running, walking, or playing DDR. Also, inter-
ruptions, which did not occur during continuous bouts of
the run, walk, or playing DDR, could have reduced MVPA.
Wii Sport and Fit may be a better option to increase
strength, balance, or coordination. These potential benefits
need to be explored.
Limitations
This study focused on children with HFA and may not be a
clear representation of how all people with ASD will benefit
from Nintendo Wii. Gender discrepancies between the ASD
and control participants existed. The convenience sample
selected for the control group may have included participants
with naturally high levels of PA rather than being represen-
tative of young adults. Extrinsic motivation from the re-
searchers may have influenced MVPA and EE during
running and walking. Therefore, a true representation of EE
and MVPA in these measures may be inflated because of the
support of the researchers to keep the participants with ASD
active.
Future studies
Nintendo Wii is recommended for a broad age range of
consumers; therefore, a greater age range of participants with
ASD can be used in the future to explore if the Nintendo Wii
is beneficial. Participants were given a set amount of time to
use the Wii games. If given more time to play, DDR may be
seen as a beneficial choice to get children with ASD to engage
in MVPA. However, future studies are needed to see if a child
with ASD will remain as physically active and focused for
greater lengths of time. Future studies should explore pref-
erence when given choices between participating in tradi-
tional forms of PA versus Nintendo Wii games. Such
information can be useful for families, PE staff, and PA pro-
gram coordinators to provide the most inviting activities for
participation.
Conclusions
Although providing less EE and MVPA than traditional
exercise, Nintendo Wii offers a choice for adolescents with
ASD to be physically active. Nintendo Wii can increase PA
and also has promise for social, communication, and learning
 ENERGY, ASD, AND NINTENDO WII GAMES
benefits. Playing alongside or against a peer may foster some
degree of interaction. Integrating the Nintendo Wii into the
regimen of the children with ASD can possibly be a tool to
promote PA and proactively combat weigh gain.
Author Disclosure Statement
No competing financial interests exist for any of the au-
thors.
References
1. NHANES Data on the Prevalence of Overweight Among
Children and Adolescents: United States, 2003–2004. CDC
National Center for Health Statistics, Health E-Stat. www
.cdc.gov/nchs/data/hestat/overweight/overweight_child_
03.htm (accessed April 15, 2011).
2. Ogden CL, Carroll MD, Curtin LR. Prevalence of over-
weight and obesity in the United States. JAMA 2006; 295:
1549–1555.
3. Chen AY, Kim SE, Houtrow AJ, Newacheck PW. Prevalence
of obesity among children with chronic conditions. Obesity
2009; 18:210–213.
4. Curtin C, Anderson SE, Must A, Bandini L. The preva-
lence of obesity in children with autism: A secondary data
analysis using nationally representative data from the
National Survey of Children’s Health. BMC Pediatr 2010;
10:1–5.
5. Rosser DD, Frey GC. Comparison on physical activity levels
between children with and without autistic spectrum dis-
orders. Med Sci Sports Exerc 2003; 35(Suppl 1):s76.
6. He XZ, Baker DW. Body mass index, physical activity,
and the risk of decline in overall health and physical func-
tioning in late middle age. Am J Public Health 2004; 94:
1567–1573.
7. Nader PR, O’Brien M, Houts R, et al. Identifying risk for
obesity in early childhood. Pediatrics 2006; 118:594–601.
8. Department of Health and Human Service. Physical Activity
Guidelines for Americans. 2008. www.health.gov/paguide-
lines/guidelines/chapter7.aspx (accessed April 15, 2011).
9. Centers for Disease Control and Prevention. Physical Ac-
tivity for Everyone. 2011. www.cdc.gov/physicalactivity/
everyone/guidelines/adults.html (accessed April 15, 2011).
10. National Council on Physical Activity and Disabilities.
Autism Fact Sheet. 2009. www.ncpad.org/disability/fact_
sheet.php?sheet = 366 (accessed April 10, 2011).
11. Edelson SM. Physical Exercise and Autism. www.autism.
com/families/therapy/exercise.htm (accessed April 10, 2011).
View publication stats
61
12. O’Connor J, French R, Henderson H. Use of physical activity
to improve behavior of children with autism—two for one
benefits. Palaestra 2000; 16:1–5.
13. Pan C. Objectively measured physical activity between
children with autism spectrum disorders and children
without disabilities during inclusive recess settings in Tai-
wan. J Autism Dev Disord 2008; 38:1292–1301.
14. Sandt DR, Frey GC. Comparison of physical activity levels
between children with and without autistic spectrum dis-
orders. Adapted Phys Activity Q 2005; 35:146–159.
15. Rimmer JA, Rowland JL. Physical activity for youth with
disabilities: A critical need in an underserved population.
Dev Neurorehabil 2008; 11:141–148.
16. Dewey D, Cantell M, Crawford SG. Motor and gestural per-
formance in children with autism spectrum disorders, devel-
opmental coordination disorder, and/or attention deficit
hyperactivity disorder. J Int Neuropsychol 2007; 13:246–256.
17. Pope M, Lynch A, Liu T, Getchell N. Motor development in
children with autism spectrum disorders. In: Pelligrino LT,
ed. Motor Skills: Development, Impairment and Therapy.
Hauppauge, NY: Nova Science Publishers; 2010: 287–298.
18. Miccinello DL, Beddingfield KA, Getchell N. Differences in
Physical Activity Between Adolescents With and Without
Autism Spectrum Disorder. Presented at the Midatlantic
American College of Sports Medicine Conference, Novem-
ber 2008, Hershey, PA.
19. Obrusnikova I, Miccinello DM. Parent perceptions of barri-
ers to facilitators of after-school physical activity by children
with autism spectrum disorders. Adapted Phys Activity Q
2012; 29:63–80.
20. Eslinger DW, Adam P, Connor S, et al. Validity of the Actical
accelerometer step-count function. Med Sci Sports Exerc
2007; 39:1200–1204.
21. Obrusnikova I, Cavalier AR. Perceived barriers and facili-
tators of participation in after-school physical activity by
children with autism spectrum disorders. J Dev Phys Disabil
2011; 23:195–211.
Address correspondence to:
Nancy Getchell, PhD
Department of Kinesiology and Applied Physiology
University of Delaware
157 Human Performance Laboratory
Rust Ice Arena
Newark, DE 19716
E-mail: getchell@udel.edu