In an age that often feels more divided than ever, video games are enabling us to connect with others in new ways that feel familiar, while providing a path forward to reimagine the intersection of play, the power of communities and the significance of social impact.

A 2008 study found that one out of five casual video game players had a physical impairment of some sort. Advocacy groups, like AbleGamers, a non-profit that helps players with disabilities better enjoy gaming, has worked with developers and publishers to create modified controllers and special technology to assist people with accessibility issues;

Today, some 63% of adult players play with others, often in squads that get together both online or in person. Brought together by servers and matchmaking algorithms, these strangers quickly learn how to work together to achieve a common goal.

The current video game audience is largely split down the middle when it comes to men and women (54% vs 46%). In the US, it covers all political viewpoints and includes Democrats (37%), Republicans (33%), independents (18%) and others (12%). They like different sorts of games but also find they have genres in common, and they regularly play with (and against) people from other countries who might not even speak their native language. These new connections increasingly allow players to put themselves in the shoes of others, helping to foster greater sympathy and compassion.

The current video game audience is largely split down the middle when it comes to men and women (54% vs 46%).

When people engage in play of any kind, they are asked to take on a perspective that might be unfamiliar to them. Video games now provide the platform for this authentic, collaborative play that broadens perspectives and builds new communities by connecting people who may otherwise have never met.

A 2008 international study in 34 medical centers found significantly greater adherence to treatment and cancer-related knowledge among children who played “Re-Mission” compared to children who played a different computer game.

People who play video games, even if they are violent, that encourage cooperation are more likely to be helpful to others while gaming than those who play the same games competitively

More than 70 percent of gamers play with a friend and millions of people worldwide participate in massive virtual worlds

Playing video games may also help children develop problem-solving skills, the authors said. The more adolescents reported playing strategic video games, such as role-playing games, the more they improved in problem solving and school grades the following year

Simple games that are easy to access and can be played quickly, such as “Angry Birds,” can improve players’ moods, promote relaxation and ward off anxiety, the study said. “If playing video games simply makes people happier, this seems to be a fundamental emotional benefit to consider,” said Granic.

possibility that video games are effective tools to learn resilience in the face of failure.

Children’s creativity was also enhanced by playing any kind of video game, including violent games, but not when the children used other forms of technology, such as a computer or cell phone, other research revealed.

A 2013 meta-analysis found that playing shooter video games improved a player’s capacity to think about objects in three dimensions, just as well as academic courses to enhance these same skills, according to the study.

While one widely held view maintains playing video games is intellectually lazy, such play actually may strengthen a range of cognitive skills such as spatial navigation, reasoning, memory and perception, according to several studies reviewed in the article.

Differential structural and functional changes in addicted individuals can be found throughout the reward system.

The late Justice Antonio Scalia, writing for the majority in the 2011 Supreme Court decision, scoffed at the notion that violent video games cause real-world violence.

Despite these limitations, this comprehensive systematic review demonstrates that video games may have potential for improving health in a wide variety of areas, for a variety of sociodemographic groups.

bias was minimized by carefully defining the current selection criteria with specific protocols and examples, and by comparing the assessment of each study completed by two researchers working independently using established measures of inter-rater reliability.

Some measures of quality may be more difficult to achieve when studying a video game as opposed to other types of interventions. For example, only 11% of eligible studies blinded researchers, because researchers were often heavily involved in helping operate and/or facilitate the video games (e.g., when stroke or fracture victims were assisted with rehabilitation).

Almost all of the studies with higher-quality design features reported positive results; this provides reassurance that the current findings of potential health benefits of video games are not simply a consequence of low-quality studies.

, it should not be concluded that it is preferable to have shorter duration of intervention, and future studies should compare interventions of various lengths.

Simultaneously, it will be important to assess the tradeoffs inherent in the use of video games instead of other modalities. For example, estimated calorie expenditure per hour when using a simulator for skiing is likely to be substantially lower than calorie expenditure during actual skiing.

positive results were most frequently reported by studies using video games for physical therapy, psychological therapy, or physical activity.

Although many people associate video gaming with the male gender, 40% of players are now female.

It may be valuable for future RCTs of video games to evaluate whether gender is associated with the efficacy of various video games to improve health outcomes.

no studies in this review were designed for individuals of these ages.

However, this study was unique from these other reviews in three ways. First, it cast a wide net with regard to topic, aiming to discover the various health-related purposes to which video games have been applied, instead of focusing on particular health topics. Second, it was more selective in terms of quality, accepting only studies that met the rigorous criteria of an RCT. Finally, this systematic review is unique in its rigor, having adhered closely to current guidelines related to search criteria, study selection, data extraction, and data synthesis.49

studies conducted to date in this area have generally been of low quality with relatively brief follow-up periods.

It finds that video games have been evaluated for a wide variety of health-related purposes among participants of all ages, most commonly for their ability to train patients and clinicians physically or psychologically.

70% of studies that were less than 12 weeks in duration reported positive primary outcomes, compared to 55% of studies 12 weeks or longer in duration

outcomes were more frequently positive among the studies that were of shorter duration

Including both primary and secondary outcomes, the intervention games that most commonly resulted in positive outcomes were those related to psychological therapy (69%) and physical therapy (59%).

Study outcomes differed by game purpose category (Table 1). For example, only 50% of studies that aimed to improve disease self-management had positive primary outcomes, compared with 67%–100% for all other game types (e.g., physical therapy, psychological therapy, distraction from pain).

studies testing the effect of video games on knowledge or management of asthma exacerbations fulfilled this criterion,29, 30, 42 because such knowledge and/or management skills have been associated with improvements in asthma outcomes.

There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy.

prior to February 2010 were included

enhance the cognitive or physical skills of healthcare providers, such as training surgeons in endoscopic skills

educate individuals about fire and street safety,25 knowledge and self-management of diabetes,26, 27 and self-management of asthma.

an effective vehicle to provide health education

supporting psychotherapeutic treatment,31 improving self-esteem,32 conflict resolution,33 and improving spirometric measurement.

Youth playing these so-called “active” video games

Thus, video game playing is now a phenomenon woven into the fabric of American life.

Today’s video game players defy traditional stereotypes. The average game player is 34 years old; 40% of players are female, and 26% are aged >50 years.4 In 2009, 67% of U.S. households owned either a console and/or a personal computer (PC) used to run entertainment software.

Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes.

This study identified how some games can consistently elicit MVPA over the short term, some key elements of good AVG design, as well as several design limitations. Most children spend more than the recommended time playing video games rather than engaging in outdoor activities. Although outdoor PA is preferable, adding active components to all video games would provide at least adequate levels of PA. Implementation of government policies and a PA rating system would be extremely beneficial given the serious and increasing prevalence of the lack of adequate PA in children.

However, we are not recommending that clinicians advocate playing video games in lieu of outdoor activities, and it should be considered a last-resort effort or a means to augment existing PA levels

participants found playing KF fun, but it is unlikely to be feasible for long-term game play given the lack of content. Offering new AVGs, or the regular addition of new content, may help address these problems and make AVGs more viable as a component of long-term lifestyle change.

The augmented reality game Pokémon GO made great strides in getting a large population of inactive individuals outside and walking.31,32 Unfortunately, this success was short-lived.33 Two studies reported that after ~30-40 days, the number of steps taken was back to pre-game levels,34,35 likely due, in part, to a loss of interest in the game.18

Although playing AVGs has been shown to be effective at eliciting MVPA, their long-term success at modifying behavior to increase PA has proved less so.

, it required players to perform certain actions that they had difficulty doing. The effect of this issue was seen in participants who ended the gaming session early because they could not advance through the game as a result.

This result is important as studies have found that children are not interested in playing games that are either too difficult or too easy for them.30

both AVGs were capable of providing at least MPA in children, especially at the higher difficulty levels.

This study demonstrated that select AVGs successfully elicited MVPA in children and determined that player engagement was important for attaining and maintaining MVPA.

Children are not getting enough PA and spend too much time playing video games.

The majority of participants reported playing games for at least 2-4 hours daily, and a session lasted ~2 hours (Supplemental Table S1C).

active video games (AVGs) can improve PA levels and weight loss in children.

high level of sedentary behavior and lack of proper sleep have serious consequences for both their physical and mental health.4,8

This amount of time far exceeds the recommended maximum of 2 hours of screen time per day,2 while also impacting valuable sleep time3 and healthy dietary behaviors.4

AVGs can provide at least moderate PA and are enjoyable to play, but most popular video games do not incorporate active components.

Full-body movements, player autonomy, and self-efficacy were observed to be important elements of good AVG design.

children spend an average of 1-3 hours/day playing video games.

Overall, there is inconclusive evidence that video games are associated with obesity and, due to the lack of longitudinal studies, virtually no evidence to evaluate if video game play directly contributes to obesity or weight gain in children. On the other hand, there is some (limited) evidence that video game play that involves physical activity can be integrated within behavioral programs to help children to lose weight and attenuate weight gain. Future research should delve into the co-occurrence of video game play with obesogenic behaviors and continue to keep pace with the constantly growing and evolving video game industry to understand the impact of this popular pastime on children’s health.

Is video game play causing childhood obesity, or are children with obesity more likely to play video games, or does video game play cluster with other obesogenic behaviors like higher dietary intake and poor sleep and these behaviors may independently explain observed associations?

Video game addiction has been associated other negative outcomes, including lower school performance and higher substance use in adolescence [76] and problematic gaming behaviors later in life

There is a growing interest in video game play before bedtime due to delaying sleep onset and shortening sleep duration, as youth with shorter sleep duration have been shown to consume more calories [69, 70] and have higher prevalence of obesity

Overall, there is inconclusive evidence that video games directly influence childhood obesity, from both observational and intervention studies. There are multiple opportunities for future areas of research into video game play and its potential effects on childhood obesity, including better capturing quality or content not just quantity of video game play as related to obesity and related behaviors.

Lamboglia et al. (2013) identified nine exergaming studies including eight that measured obesity; two of these studies observed significant reductions in an obesity outcome [22].

Further, a meta-analysis of 35 studies conducted by Gao et al. (2015) indicated that exergames elicited small to moderate increases in intensity based on heart rate above laboratory-based exercises activities such as brisk walking and biking, but exergaming was lower in intensity than laboratory-based running [23].

Three published trials involved health games that researchers developed to promote healthy eating; two of these trials effectively improved eating habits including fruit and vegetable consumption whereas one did not; however, none affected obesity outcomes.

There were inconsistencies in the effectiveness of these interventions to reduce sedentary time: ten trials significantly reduced sedentary time whereas seven did not. Sixteen of the 17 trials reported body weight or body composition as a secondary outcome.

As for physical development, previous evidence has found traditional seated video games to be associated with increased caloric intake [11] and a 2-fold increase in obesity per hour/day played [12].

Overall, there is inconsistent evidence of the relationship between video gaming and obesity, with just over half of articles indicating no significant association between video game play and obesity.

Preliminary evidence indicated that video game play may be related to higher carbohydrate intake [21] and insufficient sleep [20, 39], but this evidence is limited

Gates et al. (2013) found that more boys who were overweight or had obesity played video games/used the internet after school more than 2 hours per day than boys who were normal weight in a sample of First Nation youth in Ontario [27].

Fourteen of the 26 articles (53%) reported no association between video game play and obesity, whereas 12 reported a positive association. No article found an inverse relationship between video game play and obesity. In the 11 articles that assessed duration of video game play in general, seven articles did not find an association in adjusted models [21, 31, 33–35, 37, 43]

Around this time, video games were becoming repurposed to utilize for positive health-related changes, most notably exergames that required the player to engage in upper and/or lower body movement [16]. No longer solely a sedentary pastime, exergaming was investigated in early studies as a genre of video game that indicated promise for improving players’ physical activity levels [17] and consequently reduce body fat and obesity [18].

The majority of adolescents (13–17 years) have smart phones (95%), and 90% report they play video games on a cellphone, console or computer [7].

commercial casinos employ 361,000 employees who earn $17.4 billion in wages and benefits while tribal casinos employ 198,000 employees who earn $9.1 billion of wages and benefits annually.

The gaming industry directly employs 727,000 people in the U.S., with $33.3 billion of wages, salaries, tips, benefits and other labor income. This includes 559,000 jobs on-site at casinos and corporate offices, 17,000 at U.S.-based operations of gaming manufacturers, and 151,000 at businesses providing goods and services to casino patrons during casino trips.

$261.4 billion of output (business sales) 1.8 million jobs with $74.0 billion of labor income (wages, salaries, tips, benefits and other labor income) $40.8 billion of federal, state and local taxes, including $10.7 billion of gaming taxes

providing stable jobs to nearly two million Americans and generating billions of dollars in tax revenue

Gaming contributes $261 billion to the U.S. economy Generates $40.8 billion in tax revenues to federal, state and local governments Supports nearly 1.8 million jobs across the country

The gunman who killed 22 people and injured 24 others at a Walmart in El Paso, Texas, on August 3 made a fleeting reference to video game soldiers, indicating that he was familiar with video violence, and many politicians were quick to blame video games for this and other mass shootings. Yet it seems clear that the El Paso gunman was primarily motivated by ethnic hatred.

In short, playing video games can be fun and a social activity when integrated into a healthy lifestyle that includes plenty of sleep, exercise, and good nutrition, rather than letting the game become your life.

Gaming has also been associated with sleep deprivation, insomnia and circadian rhythm disorders, depression, aggression, and anxiety, though more studies are needed to establish the validity and the strength of these connections. There has also been concern that exposure to the extreme violence that is commonly found in video games can desensitize teens and young adults to such violence, causing emotional problems and even leading to young people committing acts of violence.

Gaming addiction

Vision problems are common complaints of gamers. The most common vision problem is eye strain, which can lead to headaches and poor concentration.

Gaming is also associated with obesity in teens and, plausibly, the same would be shown in adults, if studied. This is due to the obvious phenomenon that if a teen is sitting in front of a screen for hours every day, he or she isn’t getting much exercise.

One common example is carpel tunnel syndrome, which many gamers develop. Carpal tunnel syndrome, often seen in office workers, involves inflammation of a nerve in the wrist, which causes pain and numbness. "Gamer’s thumb," which was previously called "PlayStation thumb" (or "nintendinitis" or "nintendonitis" when Nintendo was popular), occurs when the tendons that move the thumb become inflamed.

Repetitive stress injuries, or overuse injuries, are injuries that come from activities that involve repeated use of muscles and tendons, to the point that pain and inflammation develop. If these injuries are allowed to progress, numbness and weakness can develop, and permanent injury can result. Overuse injuries of the hands and arms are rampant among gamers.

video games have medical applications

There is mixed research that there are some cognitive benefits to gaming, such as better control of one’s attention and improved spatial reasoning, though it isn’t entirely clear how much these benefits extend outside of the video game sphere into the real world.

being entertaining and a fun pastime, gaming can provide a way for people to interact with each other — a virtual community — as they work together toward completing common tasks. Our society suffers from an epidemic of loneliness, and gaming can be a vehicle to connect with others, including otherwise difficult-to-connect-with people in your life, such as kids, grandkids, or (I’ve seen this be quite helpful) with autistic children, who can have challenges with traditional modes of communication.

More than two-thirds of Americans play video games,

Video game addiction is often a symptom of an underlying emotional or psychological issue such as depression or anxiety, and sometimes goes hand in hand with defiance, ADHD, and other conditions.

The American Academy of Pediatrics currently recommends that children should limit “screen time” (time spent playing video games, using the computer, or watching television and movies) to one or two hours a day of “quality programming.”

It is estimated that over 90% of young people in the U.S. play video games, indicating that up to three million could be showing signs of addiction.

Addicted gamers played video games twice as much as casual gamers

The study, which is based on data from a nationwide survey of 1,178 American children and teenagers, aged 8 to 18, found that roughly one in 10 video game players (8.5 percent of American youth) show signs of addictive behavior.

VG use has been linked with reduced recruitment in the ACC, associated with proactive cognitive control and possibly related to reduced attentional skills (Bailey et al., 2010). Likewise, exposure to violent content in VG is associated with lower activity in the dlPFC, interfering with inhibitory control. The same team (Bailey and West, 2013) observed how VG play had beneficial effects on visuospatial cognition, but in turn had negative effects on social information processing. Lastly, VG exposition has been linked to delayed microstructure development in extensive brain regions and lower verbal IQ (Takeuchi et al., 2016).

even short VG training paradigms showed improvements in cognitive control related functions, particularly working memory, linked to changes in prefrontal areas like the dlPFC and the OFC.

VG use has an effect in a variety of brain functions and, ultimately, in behavioral changes and in cognitive performance.

comparisons between gamers and non-gamers are common in VG literature. Nevertheless, there is no consensus on the inclusion requirements for each group and it seems that no scientific criterion has been used to establish a cut-off line. Current dedication to VGs, measured in hours per week, seems to be the most common classification method. Non-gamer groups sometimes are so strict as to exclude any gaming experience, but on other occasions, for the same category, several weekly VG hours are tolerated.

Actually, one of the reasons men do not improve as much as women could be explained by a ceiling effect due to previous exposure to VGs. On the other hand, women with less experience in these activities are able to achieve equal performances in visuospatial skills that reach the same ceiling effect with a short training period. In this respect, Dye and Bavelier comment on the possible effects of lifetime VG exposure since the gender gap in attentional and non-attentional skills is smaller or non-existent during childhood compared to adult life, and the greater development of these skills in male individuals is partially due to games targeting a male audience.

Considering most online VGPs are men and this difference is also observed in addiction cases, they studied the possible factors and observed that lower self-esteem and lower daily life satisfaction are determinant in men, but not women. They attribute these differences to the reasons on why they play VGs: while men declared to play to pursue feelings of achievement and social-bonding, it was not the case for women. This aspect is not new to VG addiction and is shared aspect with other addictions. It is likely that VGs are used as a way to cope with these problems, leading up to the development of the addiction.

gamers have not lost the ability to distinguish real from virtual violence, as Regenbogen et al. (2010*) found, although that also depended on each person's learning history.

It is likely that repeated exposure to violent content will trigger desensitization processes that affect regions linked to emotional and attentional processing, particularly a frontoparietal network encompassing the left OFC, right precuneus and bilateral inferior parietal lobes (Strenziok et al., 2011).

Gamers falling into the addiction category show increased impulsiveness and perseverative errors that are not present in professional gamers and, on a neural level, they differ in GM volumes in the left cingulate gyrus (increased in pro-gamers) and thalamus (decreased in pro-gamers), which together may be indicative of an unbalanced reward system (Sánchez-González et al., 2005; Han et al., 2012b).

VG addiction is understood as an impulse-control disorder with psychological consequences, not unlike other addictive disorders, especially non-substance addictions such as pathological gambling (Young, 1998).

Training older adults in a strategy VG seemed to improve verbal memory span (McGarry et al., 2013)

Despite the observed structural and functional changes in prefrontal areas, executive functions trained in a VG show poor transfer effects as measured with cognitive tasks (Colom et al., 2012; Kühn et al., 2013).

Decreased activation in occipitoparietal regions, associated with the dorsal visuospatial stream (Goodale and Milner, 1992), has also been linked to improved visuomotor task performance, suggesting a reduction of the cognitive costs as a consequence of the VG training, dependent on the training strategy used in the VG (Lee H. et al., 2012).

Non-VGPs, compared to VGPs, showed greater frontoparietal recruitment, a source of selective attention, as task demands increased, showing that habitual gamers have more efficient top-down resource allocation during attentional demanding tasks

There is evidence that VGPs display enhanced performance in a range of top-down attentional control areas, such as selective attention, divided attention, and sustained attention

The rich diversity of methodologies and research goals means that the study of functional brain correlates covers practically all regions of the brain

The aim of this article is to gather all the scientific information referring to neural correlates of VGs and synthesize the most important findings.

as these games continue to proliferate among young people, it is crucial that we better understand both the positive and negative impact that such games may have.

they hypothesize that the specific genre of video games, such as action-adventure, puzzle solving, sports, or shooting games, may have different effects for neurocognitive development,

children who reported playing video games for three or more hours per day did tend to report higher mental health and behavioral issues compared to children who played no video games, the researchers found that this association was not statistically significant, meaning that the authors could not rule out whether this trend reflected a true association or chance.

low activity in visual areas among children who reported playing video games may reflect that this area of the brain may become more efficient at visual processing as a result of repeated practice through video games.

children who played at least three hours of videogames per day showed more brain activity in frontal brain regions that are associated with more cognitively demanding tasks

children who played video games for three or more hours per day showed higher brain activity in regions of the brain associated with attention and memory than did those who never played.

The researchers found that the children who reported playing video games for three or more hours per day were faster and more accurate on both cognitive tasks than those who never played.