The stakes of this question are enormous. More than a quarter of adults and roughly 80 percent of adolescents worldwide fail to meet recommended physical activity levels, and physical inactivity is estimated to cause nearly 50 million new cases of non-communicable disease every year, with projected treatment costs of around 300 billion US dollars between 2020 and 2030. Childhood is widely seen as the most effective intervention point, because motor skill competence and physical activity form a self-reinforcing loop: children who move well tend to move more, and children who move more become better movers. Those who fall behind early can spiral into lifelong inactivity, which is why researchers are increasingly focused on the building blocks known as fundamental movement skills.

Fundamental movement skills are the basic movement patterns that children refine into the specialized actions needed for sports and other physical pursuits. They include locomotor skills such as running and jumping, object control skills such as catching, throwing and striking, and stability skills such as balancing on one foot or walking a beam. Physical education lessons are the traditional venue for teaching them, but the average school delivers only about 60 to 130 minutes of physical education per week, far short of the World Health Organization’s recommendation of at least 60 minutes of moderate to vigorous activity per day. Home-based activity is meant to fill the gap, yet excessive screen time is widely blamed for displacing it, and interventions that simply try to limit screen time have shown little success, partly because they create family conflict, demand parental energy that work and chores already consume, and run up against financial constraints such as lacking safe outdoor spaces.

The research team, led by Oscar O’Brien, proposes a broader conceptual category they call exergamoids: physical activities that involve sensors of physical activity controlling a games technology component of the experience. Exergames, in which players develop their health as they play a complete game, are one subset. Digital gamification of exercise, such as a leveling system layered onto a step counter, is another. The umbrella term is designed to organize a fragmented literature and allow findings to transfer across game types, hardware platforms and settings. What unites exergamoids is a feedback loop in which digital tracking of movement serves as input to a game system, and the game’s output augments the physically active experience, potentially motivating children to practice skills at home that they first learned at school.

To resolve the mixed evidence that has plagued this field, the researchers systematically searched ten databases, including PubMed, APA PsycINFO, SPORTDiscus, IEEE Xplore, ACM Digital Library, Scopus, ProQuest, Web of Science, ScienceDirect and Google Scholar, for studies published between January 2000 and December 2025. After screening 2,882 retrieved records, 545 abstracts, and hundreds of full texts against strict population, intervention, comparison and outcome criteria, they identified 12 studies containing 17 statistically significant comparisons across 28 experimental groups, covering children aged 4 to 12 in school, home and clinical-adjacent settings. The corpus included 22 unique games across four hardware platforms, most of them commercial titles, and the studies varied widely in whether they used researcher-made games with design enhancements, structured physical education sessions or loosely supervised play, and whether children received targeted coaching on movement skills.

The methodological innovation of the study lies in how it handled that variability. Rather than pooling effect sizes, which the authors argue would be undermined by heterogeneity and bias, they applied what they call systematic hypothesis testing, an approach built on set theory and order theory. They generated eleven plausible hypotheses about what causes variability in movement skill outcomes, each defined by mathematical constraints such as whether coaching, activity structure or exergame status has a positive, negative or zero effect. For every hypothesis, they predicted the direction of the outcome for each of the 17 comparisons based on how the experimental groups differed, and then checked whether the observed results matched the prediction. The hypothesis that survived every test was one in which skill improvement is a function of coaching and activity structure, while exergame status itself has exactly zero effect.

That finding is more surprising than it might appear. Many exergames can be operated with sloppy or incorrect movement patterns, since permissive sensors reward effort rather than technique, which has led critics to argue that skills learned in front of a screen will not transfer to the real world. Yet the meta-analysis found no evidence of a differential effect across the temporal, environmental and functional components of movement skill, meaning exergames worked equally well for locomotor, object control and stability skills. The authors draw on dynamic systems theory to explain why: acquiring a movement skill is a search for a correct movement pattern across many degrees of freedom, and what guides that search most effectively is knowledge of performance, the actionable feedback a human coach provides about how to adjust the movement. Simple scores and game rewards, which constitute knowledge of results, do not tell a child how to change their technique, so the accuracy of the simulation matters far less than the quality of the coaching around it.

The analysis also revealed a hierarchy of facilitation. Human-delivered coaching through verbal feedback and live demonstration had a strong effect on skill outcomes, and coaching delivered through digital media, such as skill demonstration videos within the game, also improved results. Activity structure showed a positive contribution as well, though it was not a statistically significant predictor on its own, likely because most studies varied coaching and game status rather than structure in isolation. Unstructured, free-play exergaming sessions consistently underperformed, mirroring broader evidence that unstructured activities are less effective for skill development than planned ones. In practice, the most successful interventions looked like well-run physical education lessons that happened to use a game: teachers selected activities aligned with developmental needs, modeled the skills, cued corrections, and adjusted difficulty for individual children.

The practical implications reach well beyond the school gym. The authors argue that low-barrier exergames, in which cheating produces no better score than playing correctly, deserve recognition as a distinct category, because their permissiveness lets children with imperfect technique participate and stay motivated while a coach fine-tunes the specificity of the activity through praise and goal setting. Exergames can also offer experiences that schools cannot easily provide, from virtual surfing and snowboarding between classes to practicing ball heading in virtual reality, where one study noted children reported reduced fear. They enable training during bad weather, promote exertion through heart-rate-driven game mechanics, and show hints of enhanced benefit for groups that traditional activity often misses, including children with developmental delays and those who skip physical education sessions. Barriers remain, including hardware costs, staff training, IT support and the need to choose games whose movements match the curriculum, but the researchers recommend that teachers and parents treat exergames as a legitimate, freely chosen option rather than a last resort.

Looking forward, the team outlines two frontiers that could push exergames beyond parity with traditional activity. Simulated coaching, in which games assess movement competence, deliver demonstrations and provide cues automatically, could embed the knowledge-of-performance feedback that currently depends on a human presence, making uncoached home play genuinely instructional. Co-teaching systems, in which a game acts as a teaching assistant that adapts around the teacher’s plans rather than displacing them, would require a new layer of interactivity but could draw on evidence that collaborative teaching yields benefits even when the second teacher is less skilled. The authors caution that their analysis operated at the whole-class level, did not examine individual participant characteristics, and could not assess whether small differences emerge in interventions longer than six to eight weeks. Still, their central message is clear: the screen is not the enemy of childhood movement skills. Coached, structured exergaming belongs alongside traditional games as a tool for breaking the spiral of inactivity, at school and at home.

Subject of Research: The effects of exergames on children's fundamental movement skills, examined through a systematic review and meta-analysis of methodological variables such as coaching and activity structure.

Article Title: The Effects of Exergames on Fundamental Movement Skills in Childhood: A Systematic Review and Meta-analysis

Article References: O’Brien, O., Kendrick, C., Ives, B., Yap, M. H., & Henry, J. (2026). The Effects of Exergames on Fundamental Movement Skills in Childhood: A Systematic Review and Meta-analysis. Sports Medicine – Open, 12(1), Article 139. https://doi.org/10.1186/s40798-026-01081-2

Image Credits: AI Generated

DOI: 10.1186/s40798-026-01081-2

Keywords: exergames, exergamoids, fundamental movement skills, children, physical activity, physical education, meta-analysis, motor skill development, coaching, screen time, childhood health, dynamic systems theory

The distinction matters because the two concepts are often grouped together in schools, sports programmes and public-health campaigns. Physical fitness is usually treated as a measurable set of bodily capacities: how far a child can jump, how quickly they can run, how long they can sustain exercise and how well they coordinate movement. Physical literacy is broader and more experiential. It includes whether children enjoy movement, believe they can participate, understand how physical activity fits into their lives and feel able to navigate social and environmental situations that encourage activity. Fitness is therefore largely an outcome-oriented, biophysical concept, whereas physical literacy is a process-oriented framework concerned with engagement and lifelong participation.

The researchers, led by Thibaut Derigny and François Potdevin, recruited pupils from five urban primary schools in France between September and November 2024. Of 633 children invited, 551 received the necessary consent and completed at least part of the assessment process. After 90 children were excluded because of incomplete fitness data, the final analysis included 461 participants—229 girls and 232 boys—with an average age of 7.92 years. The children completed the fitness tests and the physical-literacy questionnaire during the same two-hour physical-education session, under the supervision of teachers, a fitness-test coordinator and a member of the research team.

Fitness was measured using the Diagnoform-Kid protocol, a battery designed for children and widely used in French research. Muscular power was assessed with a standing long jump, speed by measuring how far each child could run in five seconds, endurance with a six-minute 20-metre shuttle test that alternated running and walking, and coordination with a hopscotch task. Each capacity was converted to a score on a 20-point scale. These tests do not measure every aspect of physical capability, but together they capture several core components of performance: force production, rapid movement, sustained cardiorespiratory effort and the ability to control movement.

Physical literacy was assessed with the French-adapted Physical Literacy in Children Questionnaire, or PLC-Quest. The instrument uses 30 pictures, each accompanied by a four-point scale ranging from “not at all like me” to “very much like me.” Twelve items measure the perceived physical dimension, seven the psychological dimension, four the social dimension and seven the cognitive dimension. The physical dimension reflects how children view their movement abilities, while the other dimensions address confidence and motivation, interaction with others and understanding of physical activity. The questionnaire has shown strong test–retest reliability in its French version, although it remains a self-report measure and therefore captures how children perceive themselves rather than providing an entirely objective assessment.

To examine the relationship between the two constructs, the team used structural equation modelling, a statistical approach that can estimate several relationships simultaneously while accounting for measurement error. In the first model, the four fitness tests were combined into an underlying, or latent, overall fitness score, and the four physical-literacy dimensions were combined into an overall literacy score. The association between those two latent variables was substantial: the standardized coefficient was 0.52, with a 95 percent confidence interval from 0.34 to 0.71 and a probability value below 0.001. The model fit the data well, with a Comparative Fit Index of 0.948, a Tucker–Lewis Index of 0.924, a root mean square error of approximation of 0.07 and a standardized root mean square residual of 0.072.

The overall association appeared in both sexes. Among girls, the coefficient linking fitness and physical literacy was 0.30; among boys, it was 0.49. Although the relationship looked stronger in boys, a formal comparison found no statistically significant difference between the groups. The researchers then moved beyond the global scores and modelled each fitness capacity against each physical-literacy dimension. Endurance, strength and speed were each positively associated with the physical dimension of literacy. The strongest of these links was with strength, with a coefficient of 0.22; endurance showed a coefficient of 0.14, and speed 0.11. Coordination, however, was not significantly related to the physical dimension after the other fitness capacities were taken into account.

Strength was the only fitness capacity associated with the psychological dimension of physical literacy, with a coefficient of 0.17. None of the fitness measures showed a significant relationship with the social or cognitive dimensions. That pattern is important because it argues against treating physical literacy as simply another name for motor performance. A child may be able to run farther or jump higher without necessarily gaining the social confidence to join a game, the cognitive understanding to identify opportunities for activity or the motivation to remain active when exercise becomes difficult. The apparent psychological benefit of strength may reflect greater confidence in one’s body, although the cross-sectional design cannot establish that becoming stronger causes higher self-esteem or motivation.

The findings also expose a measurement problem at the centre of the debate. The physical-literacy questionnaire asks children to evaluate abilities related to strength, speed and endurance, while the fitness tests measure those same capacities objectively. The correlation may therefore partly reflect agreement between what children can do and what they believe they can do, rather than a completely independent connection between physical fitness and a wider literacy construct. The researchers caution that the direction of the relationship remains unknown. Fitness may increase confidence and encourage participation, but children who are already motivated, confident and knowledgeable may also practise more often and consequently develop better fitness. The two processes could reinforce one another over time.

Coordination provides another warning against reducing physical literacy to standardized tests. The hopscotch assessment may capture a narrow form of coordination in a controlled setting, while movement coordination in real life depends on changing environments, other people and the demands of play or sport. A child’s ability to adapt movement to a moving ball, a crowded playground or a team activity may not be reflected by a decontextualized task. From an ecological perspective, motor skill emerges through the interaction between an individual and the opportunities offered by their surroundings. The absence of a statistical association in this study therefore does not mean that coordination is irrelevant to physical literacy; it may instead show that the chosen test did not capture the context-sensitive abilities that the broader concept intends to describe.

The authors place the results against a global backdrop of low physical activity among young people. The World Health Organization recommends at least 60 minutes of moderate-to-vigorous physical activity each day for children and adolescents, yet more than 80 percent of adolescents worldwide are reported not to meet that benchmark. Childhood is a critical period for establishing habits that can influence later physical and mental health, but simply prescribing more exercise may not be enough. Programmes that focus narrowly on performance can also produce negative experiences, particularly when children feel judged by timed runs, rankings or comparisons with peers. Earlier work cited by the researchers has linked some forms of fitness testing with reduced self-esteem or unpleasant feelings, suggesting that the way activity is taught may influence whether children continue participating.

For schools and public-health planners, the practical message is not to abandon fitness training but to place it inside a broader educational framework. Activities that develop endurance, strength and speed could be combined with opportunities for choice, cooperation, problem-solving and reflection. Children might learn how to adapt games to different spaces, support classmates with different abilities, understand the health effects of movement and identify forms of activity they find enjoyable. Such an approach would treat fitness as one resource that helps children participate, rather than as the complete definition of successful participation. It could also reduce the risk that physical education becomes a contest in which only the most capable children feel competent.

The study has several important limitations. It was conducted in five urban schools in one country and involved children between six and ten years old, so the results may not apply to rural populations, older children or adolescents. Its cross-sectional design provides a snapshot rather than evidence of cause and effect. Sixteen percent of the initially participating children were excluded because they lacked complete assessment data, potentially introducing selection bias. The fitness tests may not have elicited maximum effort from every young participant, and the PLC-Quest depended on children’s ability and willingness to describe themselves accurately. The researchers also note that the more detailed structural model was saturated, meaning it had no remaining degrees of freedom; its perfect fit indices therefore cannot be interpreted as proof that the model captures the true structure of the data.

Even with those caveats, the results offer empirical support for viewing physical fitness and physical literacy as complementary but distinct. Fitness appears most closely tied to the physical side of children’s self-perceived capability, with strength additionally linked to psychological confidence. The social and cognitive dimensions appear to depend more heavily on family support, peer and teacher relationships, learning opportunities and the environments in which children move. Future longitudinal studies will need to follow children over time to determine whether improvements in fitness lead to greater physical literacy, whether physical literacy drives later fitness, or whether the relationship is genuinely reciprocal. For now, the evidence suggests that the most promising route to lifelong activity is not simply producing fitter children, but helping them become confident, informed and socially supported participants in movement.