ABC News Senior Health and Medical Editor Dr. Richard Besser sat down with Dr. Clyde Yancy, president of the American Heart Association, to ask about the real science behind the health benefits of "active" video games like the Wii, and whether so-called "exergaming" deserves the AHA's stamp of approval, despite research that has linked time playing video games with obesity.
"We can ignore the audience that is engaged with gaming -- a huge audience -- or we can find different ways of engaging that audience," Yancy said. "Certainly there are games within the Nintendo portfolio that are more sedentary, but to their credit they've pioneered physically active gaming."
Still, there are many exercise-linked products -- baseballs, basketballs and other sports equipment included -- that don't have the AHA's logo. The reason, Yancy told Besser, is that the Heart Association's "corporate relationship policy" means that there is a "very deliberate process that must be considered" when determining who gets the AHA's endorsement. Plus, there is no denying the growing popularity of these video games.
"We have to engage consumers and citizens and the public where they are," Yancy said. "The burden of heart disease and stroke is too much."
"The evidence is really inconclusive," said Janet Fulton, an epidemiologist with the U.S. Centers for Disease Control and Prevention. "The amount of activity one achieves from this active gaming is really inconclusive in terms of its benefits on health.
"I believe only boxing kind of hit the mark in terms of being of moderate intensity."
And even the most intense video game has its limits. According to a study in the journal Pediatrics, active gaming is no substitute for real sports and activities. For example, real boxing burns 200 percent more energy than Wii boxing.
"The more logos appear on products that are only tangentially associated with health benefits, the more the public is going to wonder about the appearance of these logos," said David Rothman, president of the Institute on Medicine as a Profession. "Soon rather than later, the public's going to understand that this is a commercial transaction."
According to marketing documents from the AHA, the Association's Heart Check Mark logo is one of the most recognizable and respected labels around. The documents further show that the label is proven to boost sales for products that carry it.
ABC News asked if, as part of the agreement, Nintendo had paid money to the AHA. Yancy said Nintendo did provide a $1.5 million gift over three years in an exclusive relationship.
"Certainly resources have exchanged hands, because it takes quite a bit to launch a new initiative," Yancy told Besser. "And to the credit of our corporate partner, the resources we receive are received for the broad construct of heart health and messaging to use physically active play to increase activity in many sedentary individuals."
As for concerns that the agreement with Nintendo could damage the integrity of the AHA, Yancy said his "greater concern is if we don't engage the millions of people who are physically inactive right now.
"The logo's not for sale. What we're doing is promoting a message that's incredibly important."
Family physicians were split over the AHA's apparent support of the Wii gaming system as a fitness tool. Dr. Andrew Carroll, a Chandler, Ariz.-based family care physician, said that the activity encouraged by the system at least entails more physical engagement than traditional television watching.
"I'm fully for encouraging children and adults to use interactive gaming and activity as a form of encouraging active behavior," Carroll said. "For years, we would sit in front of the 'idiot box' and be fed entertainment or information without interaction. Now exergaming, as well as the ability to chat during such gaming, encourages activity during entertainment as well as socialization to some degree... It's hard to wolf down Cheetos when you have a Wii controller in your hand."
And in its corner, the Wii has a growing body of research that suggests at least some benefits for certain users.
"I think it is appropriate for a specialty organization to recommend a genre of commercially available products which, it believes, have been shown in independent research to be useful," said Dr. Dilip Jeste, director of the Sam and Rose Stein Institute for Research on Aging. "Some studies have reported beneficial effects of exergames in reducing body weight in overweight children, adolescents, and young adults."
Still, some doctors -- Jeste included -- expressed reservations over the idea of the AHA recommending a particular product.
"If a specialty organization believes that there is sufficient evidence of this type, it can recommend exergames as a class of products for specified purposes and in selected populations," Jeste said. "However, it should not recommend a specific product... unless there are independently conducted randomized controlled trials establishing its superiority over other types of exergames."
"I have misgivings for any medical organization giving its stamp of approval to a particular product," said Dr. John Messmer, associate professor of Family and Community Medicine at the Penn State College of Medicine in Palmyra. "I do not see such approval spurring people to exercise. Rather, it will benefit Nintendo's profits more than it will increase activity among Americans, in my opinion."
"Although I think that anything that gets people moving and staying active is good, and these games have accomplished that for some individuals, I think medical organizations need to stay clear of specifically endorsing a product," said Dr. Randy Wexler, assistant professor of Clinical Family Medicine at Ohio State University in Columbus.
And Dr. Neil Brooks, a Vernon, Conn.-based family physician, said he feels certain trade-offs between exergaming and traditional sports participation cannot be ignored.
"It may be argued that [exergaming] results in more calories burned, improved balance, hand eye coordination and other skills," Brooks said. "But how does that compare to the effects of de-socialization, lack of one on one and team competition, the recognition of weaknesses and utilization of strengths?
"I have a hard time picturing a specialty society doing this without severe criticism."
Besser also asked Yancy about a specific product, a drink called Chocolate Moose Attack, which carries the AHA's Heart Check Mark. The drink, Besser said, contains more sugar ounce-per-ounce than Pepsi.
Yancy defended the choices that led to the AHA's decisions on which products carry the Heart Check Mark. "The totality of the product is what we have to evaluate," Yancy said. "Low fat, low sodium. We have to look at the entirely of the package."
In a statement issued last night, the AHA said that it has asked the U.S. Food and Drug Administration to require food manufacturers to disclose the quantity of added sugars on the Nutrition Facts panel. Without that information, the AHA said, its staff is "unable to enforce a criterion for added sugar."