The digital revolution belongs to a new techno-economic paradigm that has led to the development of a gaming sector with a commercial and entertainment aim [1]. Since the 1970s, this has led to the creation of different genres of video games played using an audiovisual device to interact with a virtual environment under defined rules, conditions, and complexity levels [2]. Such games became part of popular culture, and researchers gradually saw them as potentially useful for academic learning [3]. Studies reported positive effects of practicing entertainment video games on cognitive functions and abilities that promote school achievement [4,5]. The literature also emphasized that video games that embed a pedagogical aim, thus considered serious games, proved useful for sustaining learning activity over time and promoting learning success [6]. Moreover, manufacturers have developed active video games, also known as exergames, for entertainment and educational purposes. Although sharing characteristics with conventional video games, exergames require locomotion and movements of bodily segments, not limited to the use of keyboards, joysticks, or other portable controllers [7]. These video games are thus likely to encourage physical activity, and as a result, to have a significant influence on health but also school achievement [8], which remains to be further examined.

From the outset, authors have argued that exergames may influence health by favoring physical training and a positive attitude toward physical activity [9]. Consistently, studies showed that exergaming generally elicits, at least in the short term, positive emotions [10-12] and well-being [13,14] in children and adolescents. Other studies showed that the eventual decline over time in the appeal of a given exergame [15] can be avoided by specific practice modalities [10]. Furthermore, the literature reported that such influence on interest may favor energy expenditure [16]. Accordingly, studies found that exergaming may reduce perceived exertion [17], promote intense efforts [18], and have a positive impact on physical fitness [19,20]. On the other hand, the attractiveness of practicing an exergame might favor the repetition of the tasks to be performed when exergaming, thus learning these tasks, as authors have long considered repetition to be a key element of learning [21,22].

Most studies examined the possible influence of exergaming on motor learning outside the school context, and especially fundamental motor skills learning. These encompass “balance/stability skills” (eg, 1-foot balance), “object control skills” (eg, throwing), and “locomotor skills” (eg, jumping), rooted in physical fitness (eg, coordination), and form a basis for learning and performing different types of physical activity [23-25]. Mastery of these motor skills is thus likely to encourage long-term commitment to physical activity, with all its attendant health benefits [26,27]. Interestingly, reviews and meta-analyses highlighted that exergaming may develop balance and postural stability [23,28]. A meta-analysis also found a positive influence of exergames involving actions, such as catching or kicking, on performance in a test assessing object control skills [25]. On the other hand, although a few experimental results suggested the possible influence of exergaming on locomotor skills in children and adolescents [29,30], reviews and meta-analyses found that such findings require confirmation [23]. Especially, whether exergaming might develop general motor coordination (ie, the ability to coordinate several limbs and the whole body [31] as a basis for locomotor skills [23]) remains, to our knowledge, to be clarified.

Furthermore, the influence of exergaming on school achievement has been little studied to date, although studies emphasized that active learning, which links movement and learning, may be a promising way to reduce sedentary behavior while improving academic performance [32,33]. Two recent studies reported a positive influence of practicing exergames with math content on motivation and learning in the areas involved by the exergames, which is in line with the literature on serious games [6]. One of these studies found a positive influence on motivation in math, but not on math achievement, and on physical literacy level [34]. The other study found that exergaming, based on ball throws to hit points after identifying them in a Cartesian coordinate system, increased the performance of a paper-and-pencil task of identifying points in such a coordinate system, as well as the accuracy of ball throws at a target [35]. A 2013 study also reported the influence of practicing a nonmathematical exergame, based on aerobic dance, not only on children’s performance in a 1-mile run, but also on math scores on the Utah Criterion-Referenced Test [36]. The last result thus suggests that practicing an exergame might positively influence school achievement beyond the areas that this exergame targets, which requires further investigation, as such a possibility would be of great pedagogical interest.

This result might be due to the influence of exergaming on executive functions reported in the literature [13,37], as these functions include working memory, attentional flexibility, inhibitory control, and higher-level functions such as reasoning, planning, and problem-solving [38]. However, the explanation seems insufficient, as meta-analyses found that training a cognitive function such as working memory generally leads to progress only in tasks similar to those used in the training [39,40]. Another explanation might lie in the development, thanks to exergaming, of spatial ability, that is, a component of intellectual ability [41] and a predictor of math achievement [42]. A meta-analysis found a correlation between video game skill and spatial ability, but no training influence of video game playing on spatial ability [43]. However, another meta-analysis found that spatial ability may be improved by training, with possible transfer effects [44]. Interestingly, studies found that the practice of physical activities in which the processing of spatial information is decisive (eg, wrestling [45] and dance [46]) may improve mental rotation, that is, a component of spatial ability that allows one to rotate the mental image of an object [47,48]. Other studies showed that mental rotation training may positively influence math achievement [49]. More results suggested the existence of links among mental rotation, general motor coordination, and math achievement, particularly in arithmetic [50-52].

The literature led us to consider that dance-based exergaming (DEx), without explicit math content, could influence mental rotation, general motor coordination, and math achievement. Our study, therefore, aimed to clarify this possible influence in adolescent students.

This study differed from previous studies that examined whether exergames based on math problems and ball-throwing may favor math achievement, physical activity, and ball-throwing accuracy [34,35]. Instead, our study focused on DEx as potentially practiced during physical education (PE) lessons, but also during school periods without formal teaching, or as part of the preparation for a school event. This aimed to examine whether such practice may favor school achievement, as suggested by a previous study that showed a positive influence of exergaming based on aerobic dance on the performance of both an endurance run and a math test [36]. Compared with this study, our study had the distinction of focusing on a dance-based exergame selected as being well-suited to train mental rotation and whose practice was organized to scaffold this training.

The main objective of this study was to determine the influence of this DEx practice on mental rotation efficiency, general motor coordination, and math achievement in an experimental group (EG). This was done by comparison with a control group (CG) involved in precision ball-throwing exergaming (TEx), using a pretest-posttest design. Students’ intensity levels of physical activity during exergaming and the situational interest [53] that this practice generated in them were also measured to monitor their involvement.

This study focused on 2 groups, EG and CG, comprising students aged 13-16 years from a regular secondary school based in Switzerland (Canton of Vaud). A total of 56 students (27 girls and 29 boys) participated in the entire study; EG consisted of 30 students (15 girls and 15 boys) with a mean age of 14.0 (SD 0.7) years, and CG consisted of 26 students (12 girls and 14 boys) with a mean age of 14.2 (SD 0.9) years.

Two qualified PE teachers, with experience in teaching (10 years) and familiarity with their school’s Lü exergaming system, participated in the study (implementation of the exergaming sequences). One was the regular PE teacher for the 2 classes forming EG, and the other for the 2 classes forming CG.

We constituted the EG from 2 classes of the school where the experiment took place, and the CG from 2 other classes of this school. On this basis, the inclusion criteria were no known contraindications to physical activity and, for harmonization purposes, no known or presumed special educational needs; thus, not meeting one or more of these criteria led to the a priori exclusion from the study.

In the enrollment stage (January 2023), 72 students were eligible to participate in the study, 37 as potential EG individuals, and 35 as potential CG individuals. These numbers were likely to decrease depending on consent to participate and then, due to a series of requirements relating to the different phases of the experiment (from February to April 2023): pretests (presence), exergaming (participation in the 5 planned exergaming sessions), and posttests (presence). Among the individuals meeting these criteria, compliance (vs noncompliance) with instructions during testing was the final selection criterion.

Based on preliminary data, a sample size calculation, using the pwr package in R software (version 4.5.2; R Foundation for Statistical Computing), indicated that 21 participants per group would be required to achieve 90% power (α=.05, effect size of 0.5) to detect differences in the primary outcomes of the study. Consequently, EG (n=30) and CG (n=26) were deemed acceptable for the study. However, it should be noted that since power calculations were performed for the primary outcomes, other outcomes may have been underpowered.

The study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000. In accordance with local procedure, the project for this pilot interventional study was submitted to the research coordination committee of the host university (University of Teacher Education, Lausanne, Canton of Vaud, Switzerland). This committee approved the project (RCC-pro ID 767) without requiring further submission to the Cantonal Commission for Ethics in Human Research. Subsequently, this project has been integrated into the university’s research project repository.

We also obtained official authorization to implement the study in schools located in the Canton of Vaud and selected 1 secondary school for the study due to its exergaming facilities. We presented the project to the school’s headteacher, who agreed to its implementation. The teachers involved in the experiment, the parents of the students, and the students completed written informed consent forms gathered prior to data collection, which gave them the option to withdraw their consent at any time. No specific compensation was provided for participation in the research. The data were anonymized and stored on a secure university computer. In addition, we have verified that no images that could identify the study participants were used in the study (including in the manuscript and multimedia appendices).

Before the experiment, each sequence was tested with other students than those forming the EG and CG. This enabled the teachers involved in the study to perfect their use of the Lü Üno system, as DEx and TEx included elements (content, practice options) that they needed to explore further. This also led to adjusting the sequences for subsequent implementation.

The experimenters conducted a noninstrumented observation of each of the 5 DEx and TEx sessions implemented (Figure 1) to enable comparison between the observed session and the planned session regarding content, teacher intervention, and participant activity.

For confirmation purposes, during sessions 3 and 5 of DEx and TEx, the experimenters measured the intensity levels of physical activity achieved by each EG and CG participant (Figure 1). The examined variables were (1) the moderate and vigorous intensity levels, expressed in seconds and percentage of time activity, and (2) MVPA, expressed similarly to the moderate and vigorous intensity levels. Given the exergaming characteristics in DEx and TEx described above, we expected EG to be more involved than CG in vigorous-intensity activity, and CG more involved than EG in moderate-intensity activity, as the musical tempo in DEx was to be increased during session 3 and remain at peak in session 5, whereas no such activity peaks were planned in TEx.

Directly after sessions 3 and 5, the experimenters assessed the situational interest of each EG and CG participant to control for possible between-group differences likely to have influenced participants’ activity (Figure 1). The measurement of interest, as conceived in the field of educational psychology [57], is well-suited to examine the closeness and sustainability of a person’s relationship to learning depending on the content to be learned [58]. The triggered situational interest in a person depends on the present situation and personal characteristics [53]. This may lead to maintained situational interest, eventually allowing the gradual stabilization of interest. Interestingly, studies also showed that situational interest may influence physical activity intensity levels and energy expenditure during physical activity [59].

During both pretests and posttests (Figure 1), the EG and CG participants performed a mental rotation test and math tests at the beginning of 2 separate math lessons. On the days these tests were administered, no specific physical activity was performed beforehand (PE classes or otherwise) to promote harmonization of testing conditions. The participants performed a sprint race during the 1-period PE lesson (45 minutes) of the week, and a locomotion circuit during the 2-period PE lesson (90 minutes).

The experimenters also asked science and math teachers in classes of the EG and CG participants not to provide any specific training on mental rotation and the mathematical content covered in the pretests and posttests during the experiment.

The EG and CG students, as well as the teachers involved in the study, were informed of the main lines of the study but were left unaware of any expected results. DEx and TEx sessions have been designed separately, each by a group including the researchers and the PE teacher who would teach the sequence (either to EG or to CG).

Statistical analyses were performed without missing data, due to sampling procedures (see “Sampling Procedures” subsection above) using IBM SPSS Statistics (version 30.0.0.0; 171). On this basis, the normality of the numerical variables was preliminarily checked, and the internal reliability of the situational interest scales was evaluated using Cronbach α coefficients.

Multivariate analysis of variance (MANOVA) tests were performed to compare the intensity levels of physical activity in EG and CG during sessions 3 and 5 of DEx and TEx. The scores for each intensity level considered were specified as dependent variables and the group condition (EG vs CG) as a fixed factor. Similarly, MANOVA tests were done to examine possible differences between EG and CG in scores for each of the 3 situational interest factors measured after sessions 3 and 5.

For each variable measured at pretest and posttest, analysis of covariance (ANCOVA) tests were performed using a generalized linear model approach [71]. The model included basically the posttest score as the dependent variable, the group (EG vs CG) as a fixed factor, and the pretest score as a covariate; in the event of a between-group difference regarding a situational interest variable, it was planned to add the variable as a covariate. Beyond data normality, variance homogeneity, heteroskedasticity, and regression homogeneity were checked; on such a basis, ANCOVA was computed either on untransformed data or on ranks, using the same method for the computations [71,72].

For all the analyses, partial eta squared (η_p²) provided an index of effect size characterizing the effect as small, medium, or large, depending on whether the value of η_p² was between 0.01 and 0.06, between 0.07 and 0.14, or >0.14, respectively [73]. Contrast analyses were applied in the case of significant results.

The different stages involved in forming the groups, which resulted in the selection of 30 students (15 girls and 15 boys) for EG (mean age 14.0, SD 0.7 years) and 26 students (12 girls and 14 boys) for CG (mean age 14.2, SD 0.9 years), are presented in Figure 4.

This pilot interventional study aimed to verify whether DEx, involving mental rotation to perform different types of locomotion and interlimb coordination, may influence (1) mental rotation efficiency, (2) general motor coordination, and (3) math achievement (quantity comparisons, simple and complex additions, and multiplications) in an EG of adolescent students (Multimedia Appendix 6). This was done using a pretest-posttest design, including a CG involved in TEx and monitoring physical activity intensity levels and situational interest.

Noninstrumented observation suggested that the sessions proceeded as planned. This was corroborated by physical activity monitoring (Table 1), which also showed that MVPA timed values approached one-third of the daily 3600 seconds recommended for beneficial effects on adolescent health [54], that is, from 1137 (31.6%) seconds to 1372 (38.1%) seconds. The monitored amounts of moderate and vigorous physical activity were consistent with the expectations based on the planned sequences, which suggested that situational interest did not impede the physical activity required by DEx and TEx [59]. Only the scores for the triggered situational interest factor in session 5 significantly differed between groups, with a higher score in EG than in CG (large effect size), possibly due to the choice of the DEx and TEx activities and how they were perceived by the participants [58] (Table 2). ANCOVAs were performed controlling for this variable, considering the possible influence of situational interest on energy expenditure [59], thus exergaming task repetition and related learning [22].

The main ANCOVA results showed an advantage for EG after DEx over CG after TEx on mental rotation efficiency, the number of correct simple additions performed, and the error rate in complex addition (medium to large effect sizes). No other statistically significant ANCOVA results were found.

Although our study helps to fill a gap in the literature concerning the possible influence of exergaming on academic performance, it is not without its limitations. One limitation is linked to the implementation of scientific research in a school environment. Notably, this did not allow us to allocate students randomly between EG and CG. Possible generalization of the results should also be questioned, especially as these results might depend on features of the exergaming sequences implemented, of the school of implementation, and of the students involved in the sequences. Confirmation of our results should also be sought using larger samples. Especially, in this pilot study, no formal correction for multiple comparisons was applied to the ANCOVA tests since applying strict corrections could have increased the risk of type II errors, given the sample size, the number of factors, and related outcomes [85]. Larger samples would also be needed to clarify the extent to which the selected DEx and TEx activities may modulate our results, by controlling for physical activity (eg, varying the levels of physical activity intensity in 2 or more DEx sequences, as well as in 2 or more TEx sequences), and situational interest [59]. Furthermore, larger samples would allow for proper examination of possible gender differences in the influence of exergaming on spatial abilities and math performance, ideally taking age into account [86,87]. Longer sequences than those used in this study could also be implemented for confirmation purposes [22].

The results of this study encourage us to clarify whether mental rotation training through exergaming may influence math achievement. These results also encourage further investigation to determine if the influence of exergaming on the performance of arithmetical tasks is limited to tasks requiring procedural strategies for calculation. This also raises the question of whether such influence might depend on age, gender, or math experience. Analysis of task repetition and participants’ experience when exergaming might be useful in clarifying these points. Moreover, this study found no evidence of an effect of exergaming on general motor coordination, but a slight improvement in general motor coordination scores was observed in both exergaming sequences considered. This encourages further research to clarify the possible influence of exergaming on general motor coordination and its potential links to mental rotation training during exergaming. It would also be of interest to assess the potential added value of specific exergaming features (eg, avatar demonstration or options for managing exercise variety and progression) in achieving the effects observed in our study [88]. Teacher interventions directly linked to such features could complementarily be considered [23]. This assessment might be done by comparison with a conventional physical activity.

The possible benefits of exergaming in schools have been little studied to date, except in relation to promoting physical activity and health [20]. Especially, no studies have yet been conducted to determine whether a given exergaming sequence may positively influence mental rotation, general motor coordination, and math achievement. For the first time, to our knowledge, our study provides support for the possibility that the same DEx sequence without math content may have a positive influence, in the same adolescent students, on performance in a mental rotation test and in tasks of addition. The results of this study encourage complementary investigations, especially to delimit the possible influence of practicing an exergame on math achievement and determine to what extent such influence might depend on mental rotation training, and possibly motor coordination training, during this practice. However, these results suggest that it would be appropriate to integrate exergames into an active learning approach at school, to promote both PE and math outcomes.