in order to play popular racing games (e.g., Need for Speed II and Power Boat Racer). The results showed that patients using these devices were able to reach fitness goals as indicated by results of a submaximal oxygen consumption test (VO2/kg) and heart rate monitoring. Unfortunately, this study did not include a control group of patients who were asked to engage in the activity with the device without a video game interface. This would have helped to more precisely define the causal effects of the video game in achieving the observed results. In a more recent study, a commercially available video game Need for Speed was used in conjunction with an add-on exercise hand crank device (ergometer) called the GameCycle to control movements in the games (Widman, McDonald, & Abresch, 2006). Patients were adolescents with spina bifida, a congenital malformation of the spinal cord. These patients had mobility impairments associated with their disease that did not allow them to participate in most mainstream sports. The game intervention focused on an area of physical activity for the patient population that they could engage in and combined it with the video game play to improve their motivation to engage in physical activity. The 4-month homebased video game– exercise intervention showed that most patients were able to reach levels of intensity training consistent with guidelines set forth by the American College of Sports Medicine for the general population (i.e., at least 50% of VO2 reserve or 50% of heart rate reserve). Patients in the study who did not meet this standard had the highest baseline strength values and reported that the intervention was not physically challenging. Closer inspection of this group revealed that these patients were already physically fit. This suggests that the intervention was effective for patients who needed it the most. Subjective ratings of the intervention also revealed that virtually all patients found exercising on the GameCycle to be easy, enjoyable, and physically challenging. A similar study comparing a standard ergometer with the GameCycle (ergometer combined with a video game) found that wheelchair athletes who exercised with the GameCycle and accompanying video games showed increased intensity of training compared with controls (Fitzgerald & Cooper, 2004). An interesting finding was that each group’s reported perceptions of exertion levels did not differ. The studies above demonstrate that video games have the potential to positively influence physical activity in populations of medical patients, especially those with physical impairments. In recent years, a new generation of commercial games has been developed that explicitly requires mainstream audience of users to be physically active as part of game play. Although studies have linked video game play with obesity (Vandewater, Shim, & Caplovitz, 2004), video games that accompany wireless video game console systems (e.g., the Nintendo Wii) and certain accessories (e.g., the dance pad with Dance Dance Revolution) have been shown to significantly increase energy expenditure among players (Graves, Stratton, Ridgers, & Cable, 2008; Lanningham-Foster et al., 2006). Although the energy expenditure may not be as great as engaging in an authentic version of the sports simulated in the games (e.g., boxing, tennis, and bowling), these video games provide alternative activities for individuals concerned about video games as a sedentary activity. In fact, these games are among the most popular video games on the market. The Nintendo Wii Fit game, in which players engage in strength, balance, and aerobic activities, has topped the charts as the best-selling console game (Orry, 2009). Dance Dance Revolution was a chart-topper as well (Konami Digital Entertainment—America, 2005). The use of commercially available video games to increase physical activity challenges a prevailing assumption that playing video games is a sedentary activity. The positive effects of these games stand in contrast to concerns that excessive gaming is related to negative outcomes such as repetitive stress injuries (Mirman & Bonian, 1992). In most of these studies, specialists supervised the therapeutic use of the games. In addition, the patients were probably engaged in the games in a way that was representative of average players of games who do not play in excess to the point of physical injury. SPECIAL ISSUE: VIDEO GAMES IN HEALTH CARE 115 Tailor-Made Games for Health As the general popularity of video games grew and it was clear that video games could be used to engage patients in their care, video games were made specifically to address issues in health care. These games built on past research that showed that video games were effective as a distraction for pain, nausea, and anxiety. They also built on past research evidence that video games were powerful motivators for people to engage in active behaviors. Whereas commercial games were used to increase compliance in physical therapy, the new tailor-made games were used to increase compliance with other treatment directives by delivering healthrelated information, modeling positive health behaviors, and providing opportunities for players to vicariously practice engaging in positive health behaviors for specific patient groups. Burn pain. Building on the power of