Background: Although emerging research is demonstrating the potential health impact of exergaming,investigations have primarily been conducted in laboratory settings among small samples with short-term interventions.Information on the effectiveness of exergaming in underserved children’s objective physical activity(PA) in population-based settings is also scarce.Moreover,most empirical studies have only included 1 type of exergame in the intervention.Therefore,this study’s purpose was to investigate the long-term impact of a multigame exergaming intervention among underserved children integrated within school curricula.Specifically,this study examined the effect of exergaming on children’s accelerometer-determined sedentary behavior(SB),light PA,moderate-to-vigorous PA(MVPA),and energy expenditure(EE) over 2 years as compared with regular physical education(PE) classes.Methods: A total of 261 second-and third-grade children(134 girls,127 boys; mean age 8.27 years) were recruited from 2 Texas elementary schools.Children’s pre-test 3-day SB,light PA,MVPA,and EE at school were assessed in the fall of 2012.Participants were assigned to 1 of 2groups:(1) exergaming/PE group(125 min weekly of exergaming-based PA program) and (2) comparison group(125 min weekly of PE).PA(SB,light PA,and MVPA) and EE outcome variables were assessed again in 2013(post-test) and 2014(follow-up).Results: Significant time effects were observed for SB(F(1,162)=25.0,p<0.01,η~2= 0.14),light PA(F(1,162)=9.6,p<0.01,η~2= 0.06),and MVPA(F(1,162)=6.2,p=0.01,η~2= 0.04) but not for EE(F(1,162)=0.63,p>0.05,η~2= 0.004).Subsequent pairwise comparisons revealed significant increases from pre-to post-test for light PA(p<0.01),MVPA(p<0.01),and EE(p=0.02) with no changes in SB(p>0.05).Conversely,significant decreases occurred in light PA(p<0.01) from post-test to follow-up with no differences seen in MVPA(p=0.08) and EE(p=0.06) over the same time period.A significant increase was seen,however,for SB from post-test to follow-up.Conclusion: Exergaming PE can have the same positive effect on children’s light PA,MVPA,and EE as regular PE.More research is necessary to discern how to promote long-term PA participation after conclusion of the intervention.