This systematic review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, delves into the impact of active video games on adolescents’ energy expenditure. Sifting through 574 manuscripts, 23 studies were analyzed, revealing that short-term engagement in active video games can mirror the energy expenditure of moderate-intensity physical activities (3-6 METs). However, longitudinal studies, extending beyond six weeks, showed no significant long-term effects on energy expenditure or physical activity levels. Notably, sports and dance-themed games were predominant, with boys generally expending more energy than girls. The review highlights the potential of active video games as a supplementary tool to traditional physical activities, despite the methodological diversity that hampers conclusive comparisons. It underscores the necessity for future research to adopt standardized methods, especially in exploring gender disparities and the long-term efficacy of active video games in promoting physical activity among the youth.