children

Article
Evaluating Changes in Perceived Enjoyment throughout a
12‑Week School‑Based Exergaming Intervention
Lisa Röglin 1, * , Oliver Stoll 1 , Kerstin Ketelhut 2 , Anna Lisa Martin‑Niedecken 3 and Sascha Ketelhut 4, *

1 Institute of Sport Science, Martin‑Luther‑University Halle‑Wittenberg, 06108 Halle (Saale), Germany

2 Department of Medical Education and Health, MSB Medical School Berlin, 14197 Berlin, Germany
3 Institute for Design Research, Zurich University of the Arts, 8005 Zürich, Switzerland
4 Institute of Sport Science, University of Bern, 3012 Bern, Switzerland
* Correspondence: [email protected] (L.R.); [email protected] (S.K.)

Abstract: This study assessed whether a high‑intensity exergame represents an enjoyable training
tool for children in the elementary school setting. Furthermore, it evaluated whether gender, body
mass index (BMI), waist‑to‑height ratio (WHtR), fitness level, weekly physical activity level, and gen‑
eral interest in sports moderate perceived enjoyment during the 12‑week intervention. Thirty fifth‑
and sixth‑grade students (10.5 ± 0.7 years; 50% girls) participated in this study. During baseline
assessments, anthropometric measurements and a shuttle run test were conducted. Throughout the
intervention period, the students participated in 15–20‑min exergaming sessions (ES) in the Exer‑
Cube twice a week during school hours. Enjoyment was assessed after an ES in weeks 2 and 12.
Additionally, enjoyment was evaluated after a physical education (PE) class in week 2. The results
reveal no significant changes in enjoyment (p = 0.164) over time. The modest changes over time
were significantly affected by BMI (p = 0.027), WHtR (p = 0.007), and weekly activity level (p = 0.016).
Compared to the PE class, enjoyment was significantly higher during the ES (p < 0.001). None of the
covariates showed a significant effect. Mean HR during the ES reached 87.1 ± 1.9% of students’ indi‑
vidual maximum HR. In conclusion, the ExerCube provides a promising tool for schools to promote
Citation: Röglin, L.; Stoll, O.; enjoyable moderate‑to‑vigorous physical activity.
Ketelhut, K.; Martin‑Niedecken, A.L.;
Ketelhut, S. Evaluating Changes in Keywords: elementary school; exergaming intervention; long‑term psychological effects; moderate‑
Perceived Enjoyment throughout a to‑vigorous physical activity; physical education
12‑Week School‑Based Exergaming
Intervention. Children 2023, 10, 144.
https://doi.org/10.3390/
children10010144 1. Introduction
Academic Editors: Miguel Ángel It is widely accepted that a sufficient amount of physical activity (PA) is a component
Tapia Serrano and Pedro Antonio of a healthy lifestyle in children [1]. Several systematic reviews have consistently demon‑
Sánchez‑Miguel strated the fundamental benefits of regular PA for body composition, physical fitness, and
Received: 22 December 2022
cardiovascular risk profile in children and adolescents [2,3]. Despite the knowledge of the
Revised: 7 January 2023 positive effects of PA, physical inactivity among children and adolescents is a major public
Accepted: 9 January 2023 health concern [4]. Thus, preventive and sustainable interventions to promote PA among
Published: 11 January 2023 children and adolescents are urgently required.
In this regard, schools are often considered to play a pivotal role in developing posi‑
tive PA habits and implementing PA and health programs [5,6] as students spend most of
their day at school [7]. Furthermore, school‑based PA interventions can easily adapt to lo‑
Copyright: © 2023 by the authors. cal needs and resources, which is crucial for the successful implementation of intervention
Licensee MDPI, Basel, Switzerland. programs [5].
This article is an open access article Apart from an appropriate setting, perceived enjoyment during PA is considered a
distributed under the terms and key factor contributing to PA participation and maintenance in childhood [8].
conditions of the Creative Commons
Studies show that enjoyment is the most commonly reported intrinsic motivator for
Attribution (CC BY) license (https://
children to engage in PA [9,10]. Research suggests that PA is perceived as more enjoyable
creativecommons.org/licenses/by/
4.0/).

Children 2023, 10, 144. https://doi.org/10.3390/children10010144 https://www.mdpi.com/journal/children

Children 2023, 10, 144 2 of 15

when children are encouraged to experiment with a variety of novel activities or with vary‑
ing familiar exercises [11,12]. In this sense, schools should incorporate PA programs that
satisfy the need for novelty and stimulate enjoyment.
An innovative and motivating approach to promote PA and increase enjoyment, es‑
pecially in children and adolescents reluctant to engage in PA, can be exergames [13,14].
Exergames combine physical exercise with entertaining video gameplay [15] and are there‑
fore considered an important bridge between players’ enjoyment and PA promotion [13,14].
Because of their exercise‑promoting features, exergames differ from conventional video
games, which are often criticized from a health‑science perspective due to their sedentary
nature [16–18]. Previous studies were able to show that playing exergames increases en‑
ergy expenditure compared to sedentary behaviors [19–23]. Energy expenditure during
exergaming may even be higher than during different forms of PA [24,25].
From a psychological point of view, exergames have been shown to be more enjoy‑
able than traditional exercises, watching television, or playing video games, even in over‑
weight children [26,27]. Research further indicates that exergaming may provoke positive
mood states in students [28]. Due to their popularity among youth [29], researchers and
pedagogics suggest exergames as a tool to engage students within their own digital cul‑
ture and promote a healthy and active lifestyle, especially among those who have become
less interested in conventional PA approaches [8,30–32]. Exergames may provide new and
innovative opportunities for the PE curriculum and/or lunchtime, recesses, or after‑school‑
programs [8].
A previous study by Lwin and Malik [33] showed that exergaming incorporated into
PE classes combined with health messages has a higher potential to enhance PA‑related at‑
titudes and behaviors than regular PE classes, especially in elementary school children. Re‑
search further suggests that school‑based exergaming interventions can be beneficial in de‑
veloping children’s musculoskeletal fitness, improving their cardiorespiratory endurance,
and enhancing activity time [23,34–36].
According to the literature, however, there are substantial differences between ex‑
ergames currently available on the market [37]. Most exergames only induce light to
moderate PA and, thus, do not attain intensity levels required to induce relevant physi‑
ological adaptations [38–41]. Especially, those exergames that are designed for entertain‑
ment and/or do not consider general training principles may not attain activity levels high
enough to induce health benefits [42,43]. Thus, most exergames may provide joyful, active
breaks but should not be recommended to replace PE or school‑based PA programs. Fur‑
thermore, little is known about the long‑term attractiveness of school‑based exergaming
interventions, especially concerning more physically demanding exergames.
It is questionable whether exergames are able to provide enjoyable exercise approaches
in the school setting over time or whether enjoyment fades as soon as the exergaming in‑
tervention becomes a routine.
The present study assessed a mixed‑reality exercise setting, the ExerCube [44], which
provides both an attractive and effective exergame experience for different target
groups [45,46].
According to earlier studies in adults, the ExerCube provides a high‑intensity exer‑
cise stimulus [47] yielding higher scores for flow, motivation, and enjoyment compared to
other exercise protocols regardless of gender and individual performance level [45]. Based
on these results, the present study was conducted to assess whether this exergame also
provides a physiologically relevant but enjoyable exercise experience for children during
a school‑based intervention.
This study aimed to determine whether perceived enjoyment while exercising reg‑
ularly in the ExerCube changes over time and whether gender, body mass index (BMI),
waist‑to‑height ratio (WHtR), and maximal oxygen consumption (VO2 max) as well as
weekly activity level and general interest in sports moderate the possible changes. To pro‑
vide a better understanding of the assessed ExerCube enjoyment scores, the study further
Children 2023, 10, 144 3 of 15

compared the students’ perceived enjoyment during an exercise session in the ExerCube
with that during a regular PE class.

2. Materials and Methods

2.1. Research Setting and Participants
Thirty fifth‑ and sixth‑grade students (10.5 ± 0.7 years; 15 girls) from an inner‑city
elementary school in Berlin (Germany) participated in this study. According to an a priori
power analysis (G*power, version 3.1.; Heinrich Heine University, Düsseldorf, Germany),
a sample size of 15 participants would provide sufficient power (0.8) to detect differences.
A large effect size of 0.4 (Cohen’s f) and an alpha level of 0.05 were assumed.
The school’s principal, teachers, and parents were provided with detailed study in‑
formation. Written parental consent was obtained before participation in the study. Only
students who provided a written informed parental consent form were eligible to partic‑
ipate. Students with health conditions that did not allow unrestricted PA engagement
were excluded.
During the intervention period, the students participated in the regular PE classes
twice a week (in total, 135 min), taught by a certified full‑time PE teacher and held in the
school’s gym. The exergaming sessions (ES) took place in the ExerCube, which was set
up by Sphery Ltd. (Au, Switzerland). in a room located close to the students’ classrooms
(multi‑purpose rooms).
The study was conducted in accordance with the Helsinki Declaration and approved
by the Research Ethics Board of the Medical Center Berlin (2020‑09‑RK1).

2.2. Procedure
The study design consisted of a baseline examination followed by an intervention
period lasting three months. During the baseline examination, anthropometric measure‑
ments, including body mass, height, and waist circumference, were assessed to calculate
the BMI (=body mass (kg)/height (m)2 ) [48] and WHtR (=waist circumference (cm)/height
(cm)) [49]. Habitual PA and sports interest were assessed using selected items of a vali‑
dated questionnaire (Motorik‑Modul‑Physical‑Activity‑Questionnaire for children and ado‑
lescents (MoMo‑PAQ) [50]. Furthermore, the students completed a 20 m shuttle run test
to estimate VO2 max [51]. Trained study staff conducted all measurements under the same
conditions on the school’s premises.
Throughout the three‑month intervention period, the students completed two ES per
week, with each session lasting about 15–20 min. The ES were held during school time
but outside PE classes to guarantee that the intervention would not be conducted at the ex‑
pense of the students’ available exercise time. Together with the respective class teachers,
timetables for each student were developed, supporting regular and consistent participa‑
tion and a smooth process. However, students still had the option to withdraw from the
intervention. Trained study staff supervised the students during the ES. Throughout the
intervention period, perceived enjoyment during the ES was assessed twice (week two and
week 12) using the “Physical Activity Enjoyment Scale” (PACES). Additionally, the same
group of students were asked to complete the PACES at the end of a randomly selected PE
class in the second week. The PE class consisted of various free‑choice sports and move‑
ment games (no exergames as they are generally not part of the school’s PE curriculum),
which are part of the typical content of the curriculum. There were no graded physical
performance tests in this lesson. The order in which the students completed the question‑
naires (after the ES and the PE class) was randomized and counterbalanced.
After the intervention period, we asked the teachers and study staff for feedback using
short, structured interviews.

2.3. The Exergame Setting

The ExerCube by Sphery Ltd. (Au, Switzerland) (Figure 1) is an exergame setting
shaped as an open cube‑like trapeze measuring 9 m2 . The three walls of the ExerCube
 Children 2023, 10, x FOR PEER REVIEW 4 of 15

Children 2023, 10, 144 4 of 15

The ExerCube by Sphery Ltd. (Au, Switzerland) (Figure 1) is an exergame setting

shaped as an open cube-like trapeze measuring 9 m2. The three walls of the ExerCube
project
projectthe virtual
the game
virtual gamescenario and
scenario provide
and an interface
provide for generating
an interface in‑game
for generating actions
in-game [44].
actions
In[44].
contrast to many other exergames, which are played in front of a screen using
In contrast to many other exergames, which are played in front of a screen using a a con‑
troller, the ExerCube
controller, allows
the ExerCube the players
allows to fully
the players to immerse themselves
fully immerse in andin
themselves interact with
and interact
the virtual game scenario through whole‑body movements.
with the virtual game scenario through whole-body movements.

Figure 1. Student playing “Sphery Racer” in the ExerCube by Sphery Ltd. (Au, Switzerland) © Anna
Figure 1. Student playing “Sphery Racer” in the ExerCube by Sphery Ltd. (Au, Switzerland) © Anna
Lisa Martin-Niedecken.
Lisa Martin‑Niedecken.
In the present study, the students played the single-player game experience “Sphery
In the present study, the students played the single‑player game experience “Sphery
Racer,” consisting of a science-fiction inspired virtual racing track. The player’s task is to
Racer,” consisting of a science‑fiction inspired virtual racing track. The player’s task is to
navigateananavatar
navigate avataronona ahoverboard
hoverboardthrough
throughfivefivegame
gamelevels.
levels.The
Theavatar
avatarisiscontrolled
controlledby by
differentmovement
different movementtaskstaskssuch
suchasasjumps,
jumps,punches,
punches,ororsquats.
squats.To Toscore
scorepoints,
points,thethemove‑
move-
ment tasks must be performed as precisely as possible within a restricted
ment tasks must be performed as precisely as possible within a restricted time. Thus, time. Thus, the
game challenges the player not only coordinatively but also conditionally
the game challenges the player not only coordinatively but also conditionally and cog‑ and cognitively
[11]. Throughout
nitively the game,
[11]. Throughout thethe game’s
game, challenge
the game’s is continuously
challenge tailoredtailored
is continuously to the physical
to the
and mental performance of the player.
physical and mental performance of the player.
Theplayer’s
The player’s movements
movements areare tracked
tracked andand incorporated
incorporated into into the game
the game via thevia
HTCtheVive
HTC
Vive tracking system, consisting of two wrist-worn and two ankle-worn
tracking system, consisting of two wrist‑worn and two ankle‑worn trackers. Calibration trackers. Calibra-
attion
the at the beginning
beginning of eachofexergaming
each exergamingsessionsession
ensures ensures that
that the the is
game game is optimally
optimally adjustedad-
justed to the player’s body size. HR is continuously recorded during
to the player’s body size. HR is continuously recorded during the game utilizing an HR the game utilizing
an HR monitor
monitor (PolarOy,
(Polar Electro Electro Oy, Kempele,
Kempele, Finland).Finland).
Moredetails
More detailsabout
aboutthe
theExerCube
ExerCubeare areprovided
providedbybyMartin‑Niedecken
Martin-Niedeckenetetal.al.[44,52].
[44,52].

2.4.
2.4.Measures
Measures
2.4.1.
2.4.1.Anthropometry
Anthropometry
Body
Bodymass
masswas
wasdetermined
determinedtotothe
thenearest
nearest0.1
0.1kgkgwhile
whilethe
thestudents
studentswore
worelight
lightsports
sports
clothes. Height was obtained without shoes to the nearest 0.5 cm. Waist circumference
clothes. Height was obtained without shoes to the nearest 0.5 cm. Waist circumference was
assessed to the nearest 0.5 cm at the umbilical line while the students were standing
was assessed to the nearest 0.5 cm at the umbilical line while the students were standing [53].
All measurements
[53]. were conducted
All measurements using standardized
were conducted measuring
using standardized equipment.
measuring BMI and
equipment. BMI
WHtR were calculated for each student.
and WHtR were calculated for each student.
Children 2023, 10, 144 5 of 15

2.4.2. Enjoyment
A modified version of the PACES [54] consisting of 16 bipolar statements was used
to measure perceived enjoyment during the ES and PE class. On a five‑point bipolar scale,
the students rated how they felt about the exercise they had just performed. The total score
of the questionnaire ranged between 16 and 80, with higher scores indicating higher enjoy‑
ment. A mean score was calculated for each session. Before answering the questionnaire,
the students received standardized instructions and were asked to complete it as truthfully
as possible. The PACES has been widely used in PA and exergaming environments and
is appropriate for children [55]. Furthermore, it has been validated as a reliable and valid
measuring instrument, with good internal consistency between 0.92 and 0.93 [54].

2.4.3. Self‑Reported Habitual Physical Activity and Interest in Sports

Two items of the German version of the MoMo‑PAQ [50] for students were selected
to assess self‑reported weekly PA and students’ general interest in sports. The students
were asked to rate “how interested are you in sports?” using a five‑point bipolar rating
scale from “not interested” to “very interested” (MoMo‑PAQ, section: general PA, item
five). Additionally, the students were asked to state the number of days (0–7) they were
physically active for more than 60 min in a typical week (MoMo‑PAQ, section: general PA,
item four).

2.4.4. Teacher and Study Staff Feedback

After the intervention period, short, structured interviews were conducted with the
study staff and the respective class teachers. The interviews consisted of three questions
assessing their perception of students’ interest, engagement, and motivation during the ES.
The interviews lasted 3–5 min.

2.4.5. Aerobic Fitness

The level of aerobic fitness was assessed using the multistage 20 m shuttle run test.
The shuttle run test is a reliable and standard method to predict VO2 max both in children
and adults [51]. The students were required to run back and forth between two lines, set
20 m apart while keeping a predetermined pace. The pace was set with audio signals
emitted at specific frequencies.
The first stage started at 8.5 km/h and was increased each minute/stage by 0.5 km/h.
The students were instructed to keep running as long as possible, completing as many
shuttles and stages as possible. The test was over when the student was not able to reach
the appropriate lines in the allotted time two consecutive times or when they gave up due
to fatigue.
In order to predict aerobic fitness, the number of fully completed shuttles and stages,
as well as the maximal shuttle running speed, were recorded for each student. Shuttle
running speed and age were used to predict VO2 max according to the model developed
by Leger et al. [51]:

VO2 max = 31.025 + 3.238 × maximal shuttle run speed

− 3.248 × age + 0.1536 (1)
× maximal shuttle run speed × age

2.4.6. Heart Rate

HR was continuously recorded during the ES using a HR monitor (Polar Electro Oy,
Kempele, Finland). Mean HR (HRmean) was calculated for each student by summing up
HRmean of all ES. To determine the percentage of HRmax achieved during the ES, individ‑
ual HRmax was estimated using the formula (HRmax = 208 − 0.7 × age) of
Tanaka et al. [56].
Children 2023, 10, 144 6 of 15

2.5. Data Analysis

IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp. Released 2020, Armonk,
NY, USA) was used to analyze the collected data. The significance level adopted was
p < 0.05. All results are presented as means ± standard deviation.
A regression analysis was conducted to analyze the relationship between the depen‑
dent variable “perceived enjoyment” and the independent variables gender, BMI, WHtR,
weekly activity level, general interest in sports, and VO2 max during an ES at the beginning
of the intervention.
Repeated measures ANOVAs were performed to examine differences in perceived
enjoyment over time and differences in perceived enjoyment between the ES and the PE
class. Additionally, repeated measures ANCOVAs using gender, BMI, WHtR, weekly ac‑
tivity level, general interest in sports, and VO2 max as covariates were conducted.
Because the sample of this study was rather small, normal distribution was assessed
in advance using the Kolmogorov−Smirnov test. The findings suggest that normal dis‑
tribution was violated for a subset of variables/factor combinations. However, as several
studies demonstrate the robustness of ANOVA against violations of the normal distribu‑
tion assumption [57,58], we felt it safe to run the reported analyses to examine possible
interactions. Nevertheless, to further corroborate the robustness of the effects, we addi‑
tionally ran the analyses with a non‑parametric Wilcoxon signed‑rank test. These analyses
reconfirmed the results.
To determine effect size, Cohen’s f (f) was calculated (f > 0.1: small effect; >0.25:
medium effect; >0.4: large effect) [59].

3. Results
All students completed the initial examination. The session attendance rate for the
ES was 97%. Three students were unable to take part in the survey in the second week
of the intervention and were therefore excluded from the analysis. No adverse events oc‑
curred throughout the intervention period. The students’ descriptive and anthropometric
measures are shown in Table 1.

Table 1. Subject’s characteristics.

Item Total (n = 27) Female (n = 14) Male (n = 13)

Height (cm) 148.4 ± 9.2 150.1 ± 10.9 146.5 ± 6.4
Body mass (kg) 46.2 ± 12.8 46.0 ± 14.5 46.5 ± 10.6
Waist circumference (cm) 67.6 ± 10.1 64.8 ± 8.5 70.8 ± 10.8
BMI (kg·m−2 ) 20.7 ± 4.2 20.0 ± 4.3 21.5 ± 3.9
WHtR 0.45 ± 0.06 0.43 ± 0.04 0.48 ± 0.06
VO2 max (mL/kg/min) 44.70 ± 3.5 44.70 ± 3.5 44.74 ± 3.4
Physical activity level
3.6 ± 2.2 3.1 ± 2.1 4.2 ± 2.2
(days/week with over 60 min)
General interest in sports
4.1 ± 0.9 4.0 ± 1.1 4.3 ± 0.8
(1 = no interest; 5 = very interested)
Data are mean ± SD values. Abbreviations: BMI = Body mass index; VO2 max = Maximal oxygen consumption;
WHtR = Waist‑to‑height ratio.

According to the age‑ and sex‑specific BMI percentiles from Coners et al. [48], nine
students (three girls) could be defined as obese (BMI percentiles ≥ 95), and two students
(two girls) could be defined as overweight (BMI percentiles > 85). For the WHtR, eight
students (two girls) reported values within the overweight range (WHtR cutoff of 0.5 [49]).
The regression analysis revealed no significant relationship between perceived en‑
joyment and gender (p = 0.763), BMI (p = 0.113), WHtR (p = 0.231), weekly activity level
(p = 0.967), general interest in sports (p = 0.188), and VO2 max (p = 0.885) during an
ES (Table 2).
Children 2023, 10, 144 7 of 15

Table 2. Effects of gender, BMI, WHtR, weekly activity level, general interest in sports, and VO2 max
on perceived enjoyment during the exergaming session.

Unstandardized Standardized
Variable Std. Error
Coefficient Coefficient
Constant 61.445
Gender 0.881 0.070 2.876
BMI (kg·m−2 ) −0.066 −0.164 0.119
WHtR 54.133 0.534 43.837
Physical activity level
−0.024 −0.008 0.573
(days/week with over 60 min)
General interest in sports
2.026 0.313 1.487
(1 = no interest; 5 = very interested)
VO2max (mL/kg/min) −0.077 −0.040 0.527
R2 0.315
Adjusted R2 0.110
F (df = 6;20) 1.535
Abbreviations: BMI = Body mass index; VO2 max = Maximal oxygen consumption; WHtR = Waist‑to‑height ratio.

The differences in perceived enjoyment over time and between an ES and a PE class
are shown in Figure 2a,b. The mean PACES score during the ES in week two was signif‑
icantly higher than during the PE class in the same week (71.3 ± 6.3 versus 54.6 ± 14.7;
p < 0.001; f = 0.705). None of the analyzed covariates (gender (p = 0.94, f = 0.000), BMI
(p = 0.152, f = 0.100), WHtR (p = 0.461, f = 0.027), weekly activity level (p = 0.957, f = 0.000),
general interest in sports (p = 0.684, f = 0.008), and VO2 max (p = 0.389, f = 0.037) showed
a significant effect on the differences. Furthermore, the analysis revealed no significant
differences in perceived enjoyment (p = 0.164) after two and 12 weeks of intervention. The
mean PACES score changed from 71.3 ± 6.3 in week two to 62.4 ± 14.2 in week 12. A
small effect size (f = 0.073) could be identified for the differences over time. According
to the ANCOVA, the differences in perceived enjoyment between weeks two and 12 were
significantly affected by BMI (p = 0.027, f = 0.227), WHtR (p = 0.007, f = 0.326) and weekly
activity level (p = 0.016, f = 0.265). Gender (p = 0.986, f = 0.000), general interest in sports
Children 2023, 10, x FOR PEER REVIEW 8 of 15
(p = 0.825, f = 0.002), and VO2 max (p = 0.109, f = 0.124) showed no significant effect on the
differences in perceived enjoyment over time.

(a) (b)
Figure
Figure 2.
2. (a)
(a) Perceived
Perceived enjoyment
enjoyment during
during an
an exergaming
exergaming session
session in
in weeks
weeks two
two and
and 12;
12; (b)
(b) Perceived
Perceived
enjoyment during an exergaming session and a PE class in week two. In both figures, the bars show
enjoyment during an exergaming session and a PE class in week two. In both figures, the bars show
the mean Physical Activity Enjoyment Scale (PACES)-scores. The lines represent individual
the mean Physical Activity Enjoyment Scale (PACES)‑scores. The lines represent individual changes.
changes.

During the ES, the students reached an average HRmean of 174.9 ± 3.9 bpm corre-
sponding to 87.1 ± 1.9% of their individual HRmax.
In the feedback interviews, the teachers and study staff consistently reported high
levels of interest, motivation, and engagement of most students throughout the ES. Three
of the four teachers mentioned that even students who were usually unmotivated to par-
Children 2023, 10, 144 8 of 15

During the ES, the students reached an average HRmean of 174.9 ± 3.9 bpm corre‑
sponding to 87.1 ± 1.9% of their individual HRmax.
In the feedback interviews, the teachers and study staff consistently reported high lev‑
els of interest, motivation, and engagement of most students throughout the ES. Three of
the four teachers mentioned that even students who were usually unmotivated to partici‑
pate in PE were highly interested in the ES.

4. Discussion
The purpose of this study was to assess the perceived enjoyment throughout a
12‑week school‑based exergaming intervention in elementary school children. Addition‑
ally, the study determined whether gender, BMI, WHtR, weekly activity level, general
interest in sports, and VO2 max influenced perceived enjoyment over time. Furthermore,
perceived enjoyment between an ES and a normal PE class was compared while consid‑
ering the aforementioned covariates. Based on the present results, the ES represent an
enjoyable and vigorous exercise both for boys and girls irrespective of their physical fit‑
ness level. Thus, this exergame may present an innovative and engaging tool to promote
PA throughout the school day.
Notably, the mean ExerCube enjoyment score did not significantly decrease through‑
out the 12‑week intervention period, although the exercise intensity was relatively high,
reaching 87.1 ± 1.9% of HRmax. This corresponds to vigorous intensity PA according
to the guidelines for exercise testing and prescription of the American College of Sports
Medicine [60]. Interestingly, when we looked at the individual results (Figure 2a), we
were able to detect both increases and decreases in perceived enjoyment over time. Even
when considering the students’ characteristics (e.g., gender, BMI, WHtR), no clear pattern
can be identified. Thus, we cannot make any assumptions about possible reasons for these
differences. Despite this, the ExerCube presents a tool to implement joyful, high‑intensity
PA and keeps most students engaged over a long period of time. The findings are relevant
as a decrease in PA can be observed especially at a prepubertal age and in early puberty,
which is attributed to a lack of perceived PA enjoyment [61].
The results are in accordance with previous research by Sun [62], who reported high
levels of perceived enjoyment during a four‑week school‑based exergaming intervention
in elementary school children using eight different exergames (e.g., Nintendo Wii, Dance
Dance Revolution, or XrBoards). However, the exercise did not reach a moderate to vigor‑
ous intensity in this study. Fu et al. [49] could even show a significant increase in students’
perceived enjoyment during a 12‑week classroom‑based exergaming intervention. Unfor‑
tunately, the authors did not report the exercise intensities of the applied exergames. Lau
et al. [63] could also observe an increase in enjoyment throughout a 12‑week after‑school‑
hour exergaming intervention in 8–11‑year‑old children compared to a control group. How‑
ever, the differences did not achieve statistical significance. Additionally, this study did
not examine the intensity of the 60 min exergaming intervention.
Because studies suggest that enjoyment is associated with higher PA engagement [64],
enjoyable exergames could possibly influence future PA behavior. Furthermore, enjoy‑
ment has been identified as an underlying factor in children and adolescents for main‑
taining their engagement in both PA and PE [65–67]. However, there is still a necessity
to further address the influence of regular school‑based exergaming on PA behavior and
general PA enjoyment.
The sustained enjoyment level throughout the exergaming intervention can be ex‑
plained by the innovative setup and game design. The ExerCube provides an immersive
experience, allowing the players to interact with the audio‑visual gaming scenario through
whole‑body movements. According to Warburton et al. [68], such an immersive experi‑
ence diverts the players’ attention from the physiological cues and increases enjoyment.
Therefore, exergaming may not be primarily experienced as exercise, but as a form of en‑
tertainment [69]. The interactive character of exergames may further distract from negative
Children 2023, 10, 144 9 of 15

thoughts about PA [70,71]. Therefore, exergames could help to motivate particularly those
students who are unwilling to engage in more conventional PA approaches.
A further explanation for the sustained experience of enjoyment throughout the ex‑
ergaming intervention could be related to its digital environment and state‑of‑the‑art tech‑
nology. Because young people devote considerable amounts of their leisure time to screen‑
based activities [72], the integration of exergames into the children’s school routine may
present an enjoyable and culture‑appropriate contrast to the primarily analog curriculum.
Working with, rather than against, preferred digital leisure routines at school can be a
promising approach to promote PA in children. This is supported by the finding that the
ES was significantly more enjoyable than the PE class with none of the covariates (gender,
BMI, WHtR, weekly activity level, general interest in sports and VO2 max) showing a strong
effect. Only two students rated the PE class as more enjoyable than the ES (Figure 2b).
The findings are in accordance with a previous study by Vernadakis et al. [26], who re‑
ported no significant differences between normal‑weight and overweight children in their
enjoyment of exergames, traditional physical activities, and sedentary video games. In
this study, the exergame was the most enjoyable activity, in both normal weight and over‑
weight children.
The appeal of the exergaming intervention in the present study is further supported
by the fact that there were no dropouts.
High adherence levels were also shown by Sheehan et al. [73] during a six‑week school‑
based exergaming program. In this qualitative study, the teachers reported that students’
enthusiasm for the intervention was high, resulting in sustained engagement. Further‑
more, the teachers reported that the students felt proud to have an exergaming opportunity
in their school.
According to feedback interviews, the teachers of the present study also reported
high levels of interest during the exergaming intervention, even among students, who
were usually unmotivated to participate in PE. Low dropout rates were also observed by
Finco et al. [74], who further discovered an increasing interest of students in learning more
about different sports and a healthy lifestyle during a school‑based exergaming
intervention.
Interestingly, Madsen and colleagues [75] found children to have higher dropout rates
when exergaming at home compared to exergaming interventions at school. This under‑
lines that an appropriate setting and intervention design are of great relevance for suc‑
cessfully implementing PA interventions in children. Simply owning an exergame is not
enough to promote PA and provide a public health benefit in children [76].
Another explanation for the sustained enjoyment is the ability of the ExerCube to ad‑
just the game’s challenge according to the player’s physical and cognitive performance.
This guarantees an optimal balance between the game‑related challenge and their skills,
as well as between the movement tasks and the player’s fitness. Consequently, the chal‑
lenge is neither too easy nor too difficult, allowing them to experience success. This is of
relevance as previous research has shown that perceived physical competence is associated
with intrinsic motivation [77] and enjoyment in PA [72] and PE [78,79]. An adaptive game
design, gamification, and gratification can help to evoke perceived physical competence.
According to Csikszentmihalyi’s flow theory, this perceived balance between chal‑
lenge and skills is a precondition for the experience of flow, which is described as the
feeling of being completely focused on a particular activity [80]. Referring to “GameFlow”
research in the context of video gaming [81] and exergaming [82], the flow experience
is regarded as an important determinant of enjoyment in gaming [81,83,84]. The Exer‑
Cube already yielded significantly higher flow scores in adults than traditional training
approaches, as shown in recent studies by Röglin et al. [45] and Martin‑Niedecken and
Schättin [85].
In the present study, the regression analysis revealed no relationship between per‑
ceived enjoyment and gender, BMI, WHtR, weekly activity level, general interest in sports,
and VO2 max during the ES. Therefore, it can be expected that the ExerCube adapts to the
Children 2023, 10, 144 10 of 15

students’ preconditions and represents an attractive exercise for different target groups.
Regarding gender, the findings contrast a study by Sun [62], who reported that boys rated
the exergaming experience as more enjoyable than girls. This is in accordance with re‑
search in video gaming, suggesting that video games are less attractive to girls compared
to boys [86,87]. The fact that gender had no effect on perceived enjoyment during the ES
is an important finding as girls are less physically active than boys [88,89]. Furthermore,
girls are more reluctant to perform PA at higher intensities [90], and generally score lower
on enjoyment in PE class [78]. The ExerCube is an exercise tool that seems to reach boys
and girls alike and thus can help tackle gender disparities. Furthermore, neither general in‑
terest in sports nor VO2 max moderated the minor differences in perceived enjoyment over
time. The findings underline the appeal of the exergame experience for students regardless
of their gender, individual fitness level, and passion for sports. In contrast, BMI, WHtR,
and weekly activity level significantly affected the modest differences in perceived enjoy‑
ment over time. Thus, further research should address how exergames can be tailored and
constantly developed to guarantee persistent engagement in different target groups. Simi‑
larly to normal video games, exergames could also benefit from including regular updates
or expansions to the game to continuously provide new opportunities for exploration.
Furthermore, previous research shows that cooperative and competitive exergaming
conditions result in greater enjoyment and higher motivation compared to single‑player
conditions [91]. Thus, further research should address if the cooperative and competitive
game modes may be an approach to sustain perceived enjoyment even longer.
However, an interesting feature of the single‑player mode is the fact that it adheres
to social distancing and hygiene measures. This could be particularly applicable in times
of pandemics (e.g., COVID‑19). Exercise interventions in the ExerCube can be maintained
even if it is not allowed to perform group exercises or PE classes. This is of relevance, as
research revealed a substantial decrease in PA during the COVID‑19 pandemic, which may
negatively impact children’s and adolescents’ physical and mental health [92,93].

Limitations
The following limitations must be discussed when interpreting the results of the study.
First, the students had no experience with the ExerCube before this study. All students,
however, participated regularly in the PE classes. Thus, the ES could have benefited from
a novelty effect. Recent research discovered that inexperienced players achieve higher
levels of enjoyment than experienced players [94]. However, at least during the 12‑week
intervention period, perceived enjoyment did not decrease significantly.
Second, only one random PE class was chosen as a comparison condition. It is to be
expected that perceived enjoyment may have been affected by the lessons’ content and
the respective exercise intensity, and thus could vary between sessions. However, the stu‑
dents’ exercise intensity during PE class was not assessed. Furthermore, differences in the
duration of the two exercise conditions could have affected perceived enjoyment.
Third, individual HRmax of the students was calculated using the formula of
Tanaka et al. [56]. This calculation only presents a rough estimation of the actual HRmax
and is not specific for the study’s sample.
Another limitation to discuss is the duration of the intervention period. Due to holi‑
days and other school‑related conditions, the intervention took place throughout a 12‑week
period. Therefore, it is not clear if the results hold true for longer intervention periods. Fur‑
thermore, it has not been investigated whether the ES affected general PA enjoyment and
future PA behavior.
Lastly, the target group of this study consisted of fifth‑ and sixth‑grade students. It
cannot be assumed that the results also apply to other grades. Furthermore, the sample
size of this study was rather small, and the study design does not include a control group.
Children 2023, 10, 144 11 of 15

5. Conclusions
The ExerCube provides a promising tool for elementary schools to promote enjoyable
PA among boys and girls with different preconditions during the school day. Therefore,
this exergame can be applied as an appropriate alternative or supplement to traditional ex‑
ercise approaches to promote active routines at school and, thus, healthy lifestyle behaviors
among children. Future studies are required to assess the effects of different exergaming
intervention designs on perceived enjoyment among different target groups. Furthermore,
it should be evaluated whether and to what extent regular school‑based exergaming ses‑
sions affect PA behavior and PA enjoyment in general.

Author Contributions: Conceptualization, L.R., S.K., O.S. and K.K.; methodology, L.R., O.S. and
S.K.; software, A.L.M.‑N.; validation, L.R. and S.K.; formal analysis, L.R. and O.S.; investigation, L.R.,
K.K. and S.K.; resources, K.K. and A.L.M.‑N.; data curation, L.R.; writing—original draft prepara‑
tion, L.R.; writing—review and editing, O.S., S.K. and K.K.; visualization, L.R. and S.K.; supervision,
K.K. and A.L.M.‑N.; project administration, K.K. and O.S. All authors have read and agreed to the
published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki and approved by the Research Ethics Board of the MEDICAL CENTER BERLIN (2020‑
09‑RK1, ethic approval date: 3 September 2020).
Informed Consent Statement: Written informed parental consent was obtained from all subjects
involved in the study.
Data Availability Statement: The data that support the findings of this study are available on request
from the authors.
Acknowledgments: We would like to thank all students participating in this study. Furthermore,
we acknowledge the support of teachers and the school’s principal, without whom this study would
not have been possible. Furthermore, we would like to thank Sphery AG (Au, Switzerland) for pro‑
viding the ExerCube Sphery Racer. Lastly, we would like to thank Frank Brünner for supervising
the exergaming sessions.
Conflicts of Interest: The authors declare no conflict of interest. Sphery AG (Au, Switzerland) pro‑
vided the ExerCube. The funders had no role in the design of the study, in the collection, analyses,
or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
Besides being a Senior Researcher at the Zurich University of the Arts, A.M. is also Co‑Founder and
CEO of the spinoff company Sphery Ltd. that further developed the ExerCube based on the results
of her R&D work. No revenue was paid (or promised to be paid) to A.M., Sphery, or the research
institutions.

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