**7. Games and physical health**

Physical literacy (a certain degree of fitness, behaviors, knowledge, and skill related to physical activity) can undoubtedly be affected by the game practice. Some research concludes that the degree of physical activity can indeed play an important role when dealing with important diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers. In this way, compared with other factors of poor health, physical inactivity and smoking or obesity would have a similar impact [52]. Besides, sedentary activities during adolescence have been correlated with suicidal behavior [53].

Quotidian activities nowadays include video gaming, which is mainly associated with sedentariness. This way, video game practice becomes a problem because of obvious consequences and links to eyestrain, myopia, obesity, and related diseases, which can already be tackled by several advised interventions for improving people's health, particularly for children and adolescents [54]. The aforementioned vision complications got increased by extended computer or digital device use, resulting from digital reading during virtual classes [55].

It is important to emphasize that gamification is not implicitly depending on the use of screens. New development in technology has also explored audio interaction and content that can be transferred through intelligent virtual assistants (IVAs) with considerable advantages since they are mainly independent to screen use even if in some cases they can be complementary to augmented reality technologies [56].

Even if video gaming is not exactly the same as television watching, in terms of sedentariness, they are virtually very close. Considering this fact, important research finding an increased risk for low bone mineral content in male adolescents who watched television more than 3 hours per day [57] acquires even more importance since now, both of the activities contribute to increasing negative health effects.

Specifically dealing with non-transmissible diseases such as coronary heart disease and diabetes, important recommendations point to physical activities' regular practice in order to decrease the incident rates [58]. Besides, after surgical revascularization, remaining high rates of low-density cholesterol and low rates of high-density cholesterol are associated with long-term cardiac death [59].

Focusing on another scope, overexposure to screens can in fact have a serious impact on young children. Emotional problems, anxious/depressive symptoms, somatic complaints, social withdrawal symptoms, attention problems, and aggressive behaviors have been reported in young children spending more time on touch screen devices [60].

In a more serious context, suicidal ideation is mentioned to come to fruition into actual attempts within a year, which highlights the importance of addressing poor physical activity, since it is a factor for more likely suicidal ideation [53].

As alternatives, sports video gaming and active game practice come on stage. Sports video gaming support on physical activity has been highlighted based on similar domains of activity even if the awareness of physical activity importance has not been verified [61]. What is more, active game practice, active virtual reality games specifically, has been reported to provoke moderate-to-vigorous physical activity without increases of motion sickness [62] even if in some cases experts have advised cardiac patients against its practice, due to important demands on anaerobic metabolism [63].

### **8. The importance of instructional design**

Research has revealed gamification is not effective per se. Its success would instead be linked to the effective design of gamified interventions, mainly including serious games and game-based learning. There is then, an increasing number of literature analyzing the theoretical foundations behind gamification in a number of contexts, mainly considering motivation, behavior, and learning theories. This literature deals with fragmented context albeit a synthesis of them may lead to a portrayal of basic principles for gamification design [64].

Gamification design's most effective elements then include competitive game elements and digital feedback. This way, constructive implementation of gamification is proven to lead to high-order skills development [50]. Additional research has also stood up the fact of game elements such as rewards, competition level, and other related elements do not automatically raise engagement and motivation. In lieu, psychological theories need to be involved in granting quality outcomes. Among these theories, self-determination and goal-setting theory would be outlined together with a user-centered design perspective [5].

Combining all these elements, suitable teaching training not only in gamification but also in other trendy methodologies such as flipped classroom, adaptive learning, inquiry-based learning, and more will allow the implementation of multiple digital pedagogies in an interdisciplinary approach aiming to make things easier for granting the students comfort ensuring this way their engagement in the learning process [65].

Beyond educational research, gamification design is even reaching the manufacturing sector because of its high success rates, which has been replicated even if such replication is not yet clearly explained by the use of gamification as a technique or as a new and novel tool [66].

### **9. Game-related addictions**

It is also important to mention the serious implications linked to the abuse of games. Research has shown Internet Addiction Disorder, Internet Gaming Disorder,

#### *Perspective Chapter: Gamification – Pros and Cons DOI: http://dx.doi.org/10.5772/intechopen.109262*

and Mobile Phone Addiction in children as well as some evidence linking it to Attention Deficit Hyperactivity Disorder [12].

Along the same line, several types of behaviors and impulse control disorders have been already mentioned [13]. Among them, the most closely related to game addiction would be cyber-relationship addictions, when online relationships are the focus of the disorder; net compulsions, when the addiction is about online gambling or shopping online, and computer addiction, when the disorder is about obsessive game playing properly called. Nevertheless, as [14] highlights, addiction to the Internet happens when individuals are involved in an alternative reality allowed by the Internet. This fact should be distinguished from other behaviors that might not be directly related to the Internet since the behavior could happen in other conditions/places and not exclusively on the Internet.

When analyzing academic performance, excessive internet use has been reported as a cause of school burnout [15] even before the CoVid-19 pandemic when the use of technology was exponentially increased because of the lockdown.

From the interpersonal point of view, relationships between parents and their teens play a decisive role in Problematic Internet Use, and they can significantly contribute either to reducing or increasing PIU [16, 67].

Additionally, there are scientific evidence of Internet addiction, compulsive computer use, and video game excessive use associated with subjective distress, functional impairment, and other psychiatric disorders [68]. This scientific evidence has led even to the inclusion of both gambling disorder and gaming disorder into the ICD-11 (Internet Classification of Diseases – World Health Organization), which confirms the urgency of analysis of these behaviors.

Fortunately, these preoccupations have not gone unnoticed as shown by several attempts to identify and explain Internet addiction and similar behaviors (e.g., the Internet Addiction Test, whose validity has been researched by [69]; the Adolescent Pathological Internet Use Scale, researched by [70]; the Chinese Internet Addiction Scale, [71]; and the Compulsive Internet Use Scale, [72], among others).

### **10. Conclusions**

Changes in society involving increasing exposure to screens, media, and video games support the election of gamification for improving learning outcomes. These changes were exponentially increased by CoVid-19 Pandemic Lockdown. Motivation levels, autonomy, and academic outcomes can significantly benefit from this innovation. Nevertheless, this is not an option that could be taken lightly, evidence of the growing number of disorders related to the abuse of technology and games highlights the importance of the appropriate design and guidance in order to lead to the best result and avoid negative effects such as impact on health and propensity to addictions.

### **Acknowledgements**

The authors would like to thank Mauro Ocaña, The Department of Human and Social Sciences at Armed Forces University, and Armed Forces University.

## **Conflict of interest**

The authors declare no conflict of interest.
