Effects of exergames on depression, anxiety, and sleep in adolescents with subthreshold depression: a randomized controlled trial

Subthreshold depression (SD) is highly prevalent among adolescents and increases the risk of developing major depressive disorder. Exergaming, an interactive form of digital physical activity, may enhance engagement and improve adherence compared with traditional exercise, making it a promising approach for adolescent mental-health promotion. This randomized controlled trial investigated the effects of an eight-week exergame intervention on depressive symptoms, anxiety, and sleep quality among adolescents with SD. A total of 51 students were randomly assigned to an exergame group (n = 26) or a control group (n = 25). Participants in the exergame group completed moderate-intensity exergaming for 40 min, two to three times per week, while the control group continued routine school activities. Mental-health outcomes were assessed before and after the intervention using validated self-report questionnaires, including the Self-Rating Depression Scale (SDS), the Self-Rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) for subjective sleep quality. After the 8-week intervention, the exergame group showed significantly greater improvements than the control group in depressive symptoms, anxiety, and sleep quality (all p < 0.05). These findings indicate that exergames are an engaging, feasible, and effective school-based strategy for improving mental health in adolescents with SD. As a low-threshold and scalable digital exercise modality, exergaming may offer meaningful benefits for early intervention and mental-health promotion in youth populations.