Effects of game-based physical education program on enjoyment in children and adolescents: a systematic review and meta-analysis

This research is conducted under the guidance of Cochrane Handbook for the Systematic Review of Interventions [31] and the PRISMA Statement Specification for Systematic Review and Meta-analysis [32].

This research explores six databases, namely Web of Science, PubMed, Embase, EBSCOhost, Scopus and Cochrane. PubMed is primarily adopted to identify medical terms (Mesh). The search period spans from the initiation of database collection until July 25, 2023. Both subject terms and the free word approach are included in the search. The following table consists of many columns. This study firstly focuses on the research object and then emphasizes the intervention strategy. In the third line, the result index is built by connecting the search words using the logical operator “or” inside each group of search terms. Additionally, the search phrases are linked by “or” between each set of search terms. Table 1 displays the whole search words used in the six databases.

Research that meet the following requirements are selected for systematic evaluation: (1) the intervention modality is physical game teaching; (2) the subjects are children and adolescents (3–18 years old); (3) the outcome indicator is the inclusion of enjoyment related MeSH and Entry Terms; (4) the use of a control group; and (5) the articles are written in English.

Researches reach the following standards are omitted from systematic evaluation: (1) the intervention method is not physical game teaching; (2) the experimental subjects are infants, adults, animals, and specific populations (psychiatric patients), etc.; (3) the outcome indicator is the absence of pleasure-related subject terms and free words; (4) no control group is included; (5) the articles are written in other non-English languages; (6) review article; and (7) conference articles.

Upload the relevant literature to Endnote (version X9) for organization. Following this, duplicate results are screened by two authors (MWL and LYM) independently. The screening process include reviewing titles, review articles, conference papers, and animal experiments. Read the abstracts to exclude articles that fail to meet such criteria as study subjects or interventions. Finally, read the full text of selected articles to exclude those that are inaccessible, non-English and does not provide end point indicators. The process involves an initial screening of eligible articles, a discussion of any discrepancy and reaching a consensus with the third author (LJQ). Ultimately, 16 articles are selected for the systematic analysis. Detailed information about these steps are presented in the PRISMA flowchart (refer to Fig. 1).

Three authors (MWL, LYM, and LJQ) extract data from eligible papers in an impartial manner. Any divergence is resolved through discussion until an agreement is reached. The extracted information is then placed in the publications respectively [1]. the extracted information primarily includes the name of the first author and the publication year [2]. the subjects’ features encompass the total sample size, age, and gender [3]. detailed data, like duration, frequency, and cycle, about the teaching process of physical education and sport games are included [4]. the intervention tool employed in the study is a questionnaire or scale designed to measure the degree of pleasure, satisfaction and motivation before and after physical education [5]. the intervention items utilized in the study are game items specifically employed for physical education [6]. the outcome indicators encompass various factors, including the level of pleasure, satisfaction, and motivation before and after physical education and sport activities. Pleasure may be defined as the state of experiencing gratification, enjoyment, satisfaction, delight, or fun [7]. the writers emphasize the importance of significant results.

The Cochrane 5.1 handbook is applied to assess the quality of bias. The evaluation includes one aspect, namely the random allocation procedure and the concealing of allocation schemes. In this research, the evaluation criteria are: 3) participant blinding and outcome assessment, 4) complete outcome data, 5) selective report findings, and 6) bias from other sources. Each criterion is assessed as having either a low risk (an indication for meeting the criterion), a high risk (an indication for not satisfying the criterion), or a medium risk (if not mentioned), with a note explaining the reason for this assessment. Two researchers assesses the article quality independently. Any divergence in their evaluations are solved by discussing with another author. Figure 2 shows the evaluation findings and the detailed information. A sensitivity analysis is conducted whereby each article is systematically removed one at a time. The analysis reveals that the findings are mostly unchanged, which suggests that the results are robust and reliable.

Review Manager 5.3, a statistical software, is applied to merge effect sizes and assess for bias. In this analysis, the indicator continuous variable is incorporated, making the results presented as mean ± standard deviation (Mean ± SD). The I² and Q tests are adopted to evaluate heterogeneity between studies. The fixed-effects model is applied as the I² < 50% or p > 0.1, indicating the studies lack statistical heterogeneity. In contrast, a random-effects model is adopted to evaluate publication bias using funnel plots and to examine the reliability of the findings.

A comprehensive search for 1907 articles in total is conducted. The databases for search are Web of Science (1473 articles), PubMed (33 articles), Embase (75 articles), EBSCO host (154 articles), Cochrane (95 articles), and Scopus (75 articles). All identified articles are uploaded to Endnote (version X9), a reference management software. By examining the article titles, a total of 207 duplicate items are eliminated from further analysis. The articles are uploaded to Endnote (version X9), and after examining the titles, a total of 207 duplicates are removed. The dataset comprises 321 conference papers, 44 review articles, 31 articles with inconsistent subjects, 1 article applying inconsistent measurement tools, 94 articles employing inconsistent interventions, 66 articles featuring different endpoints as determined after reading the full text. 14 articles presenting results deviate from the mean ± standard deviation format. A total of 27 publications without a control group are identified, and 8 articles written in non-English languages are excluded. Additionally, the full texts of 26 articles are incomplete or unavailable. Hence, a final set of 16 eligible articles is included in the meta-analysis.

The analysis encompasses 16 articles, which collectively examines 17 studies. The total sample size has 2181 participants, with 1139 individuals assigned to the experimental group and 1042 individuals assigned to the control group. There were 1096 male participants and 1048 female ones. The age of the samples ranges from 4.9 to 15.62 years. The intervention duration covers from 15 to 90 minutes, with frequencies from 1 to 9 times each week. The intervention cycles span from 2 to 14 weeks. The interventions are concentrated on sports and games programs. The assessed outcome indicators include enjoyment and satisfaction, intervention instruments and major findings. See Table 2 for detailed information.

This research examines the literature about the random assignment process and specifically focuses on six studies that meet the inclusion criteria [20, 22, 23, 26, 28, 33]. The remaining research do not provide details about the randomization process. None of the 17 studies mention whether the allocation is concealed or not in the allocation scheme concealment. In terms of blinding, researchers on the subjects and inform them about the tests. Thus, the subjects are not blinded. Consequently, all 17 studies are deemed to have a high risk. The evaluation of the findings is featured with uncertainty. Two studies had a high incidence of staff turnover as for the completeness of the outcome data [20, 27]. None of the 15 studies shows any subject or data loss, and all of them are considered to have low risk. The included studies show no further selective reporting or biases, and all of them are considered to have low risk of bias.

This research includes outcome indicators for analysis, and the funnel plot demonstrates a distribution that is symmetrical, indicating the absence of publication bias, as seen in the Fig. 3.

The results of this study, including the analysis of 17 studies, show that the adoption of physical education game-based intervention has a beneficial effect on the enjoyment levels of children and adolescents. Such corresponds to the idea offered by Tornero and Capella, 2017, which claims that playing games adjusts to the emotional state of children and adolescents [34]. This advantageous feeling state can further improve their engagement in school sports activities [35, 36]. Physiological studies prove that engaging in physical activity or exercise causes the release of endorphins from the pituitary gland and subthalamus. Endorphins are hormones that induce feelings of calmness and pleasure, enhancing mood and creating an enjoyable experience for children and adolescents during physical education programs, including games [37‐39]. Furthermore, when it comes to content, the teaching of physical education games appears to enhance the enjoyment experienced by children and adolescents to a greater extent than the classes of traditional physical education. In their study, Batez et al. (2021) discovered that adolescents in the experimental group who participated in the Teaching Games for Understanding (mini-volleyball) way experienced a greater sense of satisfaction compared to the control group during the post-test phase [23]. Lopez-Lemus et al. (2023) noticed that analyzing the pre-test and post-test results of both the experimental and control groups revealed that 67 students who were part of the Sport Education (SE)/Teaching for understanding (TGfU) experimental group, specifically focusing on handball, revealed enhancements in-game performance, enjoyment, perceptual skills, and intentions [21]. Similarly, researches on dance movement games and basketball games show superior levels of enjoyment compared to traditional teaching methods [19, 40]. Hence, this research posits that including games into physical education courses may effectively enhance the enjoyment of children and adolescents, making it a recommended approach compared to programmes that do not use games.

This study claims that practicing physical sports might affect enjoyment among individuals of different genders, with boys expressing a greater chance of experiencing enjoyment compared to girls. Research has shown that as they get older boys and girls display unique preferences. In a cultural analysis conducted by Joseph et al., 25 African American women were surveyed regarding their engagement in physical activities. The majority of these women reported positive and enjoyable experiences in childhood, but their feelings were not apparent during their youth [41]. Additionally, female adolescents had a lower frequency of pleasurable meets in physical exercise compared to male adolescents, and they also displayed negative emotions towards engaging in physical activity [42]. Even so, variations in the level of enjoyment based on gender are likely to be impacted by different types of sports games. Girls have a preference for cooperative activities, particularly dancing games [43], whereas boys seem to choose competitive fitness games [44]. In all, both males and females can experience enjoyment in physical education games, still, variations in the level of enjoyment may arise due to factors such as age and the specific type of game. It seems that gender alone is not the sole determinant of enjoyment, and further study is required to identify other contributing factors.

According to this study, teaching physical education games has a major effect on the enjoyable feelings of children below the age of 12. And yet, it does not have a substantial influence on teenagers aged 12 and above. In the opinion of Velez & Garcia, children between the ages of 9 and 12 have better levels of individual feelings of happiness compared to teenagers aged 13 to 17 [45]. Play is an essential element in the development of children’s motor skills and is intrinsically linked to enjoyment, which serves as a motivation for children to engage in physical exercise [46]. According to Bremer et al., a study demonstrated that children between the ages of 6 and 13 with autism who enjoyed their physical education sessions were more likely to engage in other physical activities [47]. Academic competition at school is an important factor that hinders the development of enjoyable feelings in teens, this is mostly caused by the negative effects of stress-induced depression and anxiety [48]. Mangerud found that engaging in physical exercise has an impact on the positive emotions of adolescents with anxiety disorders, including their enjoyment of sports circumstances [49]. As a result, teaching youngsters under the age of 12 physical sports proves to be a more successful method for obtaining enjoyment compared to teenagers aged 12 and above.

The present research offers that applying a physical game lesson beyond a duration of 30 minutes has a favorable impact on the enjoyment of children and adolescents, but less than 30 minutes appears to have little to no effect. This corresponds to the findings of the Gil-Madrona, when children participated in 45 minutes of popular cooperative and cooperative-oppositional games [50]. Physical exercise in children and teenagers increases the release of neurotransmitters including dopamine and (−)-norepinephrine. These substances help to decrease depression and anxiety, leading to increased feelings of euphoria, achievement, and overall well-being, which improve over time [51‐53]. Previous research has shown that children tend to get pleasure from short periods of intense physical activity followed by times of relaxation (similar to outside play), whereas adults may have a preference for lengthier activities [54]. However, Tobin et al. carried out experiments with participants of varying durations and determined that a 12-minute length of time was considered insufficient for players to become fully engaged in the game, thus serving merely as a warm-up period [55]. In addition, another study corroborated these findings by establishing that children exhibited diminished motivation and failed to experience enhanced enjoyment when engaging in sports games for a brief duration of 20 minutes [56]. In the end, engaging in sports games for no less than 30 minutes can lead to improved outcomes and heightened enjoyment for children and adolescents.

The analyses suggested that a teaching intervention based on physical education and games held 1 to 3 times per week is suitable for children and adolescents to experience enjoyment. However, doing more than 3 sessions per week seems unsuitable. Studies indicate a correlation between the frequency of participating in physical activity and experiencing positive emotions [57]. Furthermore, sustaining a proper frequency of physical activity could promote the feeling of Feelings of happiness. For instance, Batez and Gil-Arias both applied the teaching games for understanding (TGfU) approach in a physical education program, results indicated that students’ level of enjoyment somewhat improved when the games were taught twice weekly [23, 58]. However, excessive participation in game activities without sufficient time for rest and recovery can lead to the build-up of lactic acid in the muscles, resulting in increased physical fatigue and negatively impacting the individual’s mood, finally diminishing the enjoyment of the gaming experience [59‐62]. Temporary breaks can effectively facilitate physical recovery during physical education games, it not only promotes bodily rejuvenation but also enhances the enjoyment of children and adolescents [63]. Therefore, it is advisable to offer 1–3 lessons per week to optimise the teaching of physical education games.

This study stated that physical education game teaching interventions lasting between 3 to 6 weeks and more than 6 weeks are ideal for improving the enjoyable outcomes of children and adolescents. Conversely, interventions lasting less than 3 weeks are not advisable. This conclusion is supported by the findings of previous studies. Some curriculum interventions like Zetou et al. designed a 4-week ‘Play and Stay’ tennis teaching programme, Jones et al.’s 6-week Teaching Games for Understanding and Fernandez-Rio et al.’s 9-week Gamification [22, 24, 26]. Findings show an increase in students’ enjoyment, linked to the regular meeting of their intrinsic drive in the physical education classroom. Several studies indicated that short physical procedures lasting only 1 week do not effectively assess the intrinsic motivation of participants [64, 65], thus posing difficulties with stimulating the generation of enjoyable sensations in persons. Moreover, extended periods of physical play may result in decreased intrinsic motivation or boredom in children and adolescents [66, 67]. Fu et al. and Zeng et al. propose that while physical play at first brings joy, enjoyment diminishes over time [33, 68]. In conclusion, children and adolescents should engage in playful activities for a minimum of 3 weeks, while also ensuring that the play program offers a variety of activities and rich content to enhance their enjoyment.