Active video games and other technology-based interventions can promote physical activity participation in children and adolescents, particularly those who are uninterested in traditional sports or lack access to gyms, sports clubs, or safe neighborhood recreational environments. Yet simply placing a game console in a home or school might not be sufficient for changing physical activity behaviors. Rather, social support and opportunities for structured group activity may be important aspects of pervasive health games. We know little, however, about how to design active video games and other technology-based interventions in ways that explicitly allow for the provision of social support by other players as well as “spectators” of the game. Based on the results of a longitudinal study of an active video game used in American schools, this paper contributes design recommendations for features in pervasive health games that explicitly encourage social support