OBJECTIVE: To assess the quality of evidence for the effects of school active video game (AVG) use on physical activity and health outcomes. STUDY DESIGN: Online databases (ERIC, PsycINFO, PubMed, SPORTDiscus, and Web of Science) and gray literature were searched. Inclusion criteria were the use of AVGs in school settings as an intervention; assessment of at least 1 health or physical activity outcome; and comparison of outcomes with either a control group or comparison phase. Studies featuring AVGs within complex interventions were excluded. Study quality was assessed using the Effective Public Health Practice Project tool. RESULTS: Twenty-two reports were identified: 11 assessed physical activity outcomes only, 5 assessed motor skill outcomes only, and 6 assessed both physical activity and health outcomes. Nine out of 14 studies found greater physical activity in AVG sessions compared with controls; mostly assessed by objective measures in school time only. Motor skills were found to improve with AVGs vs controls in all studies but not compared with other motor skill interventions. Effects of AVGs on body composition were mixed. Study quality was low in 16 studies and moderate in the remaining 6, with insufficient detail given on blinding, participation rates, and confounding variables. CONCLUSIONS: There is currently insufficient evidence to recommend AVGs as efficacious health interventions within schools. Higher quality AVG research utilizing randomized controlled trial designs, larger sample sizes, and validated activity measurements beyond the school day is needed.