Exergaming: Meaningful Play for Older Adults?

Exergaming to Increase Physical Activity in Older Adults: Feasibility and Practical Implications

PURPOSE OF REVIEW

To evaluate the feasibility of exergaming among older adults, focusing on acceptability, demand, implementation, and practicality. Additionally, to offer practical implications based on the review's findings.

RECENT FINDINGS

Exergaming is a safe for older adults, potentially increasing physical activity, balance, cognition, and mood. Despite these possible benefits, barriers such as unfamiliarity with equipment, complex controls, and unclear instructions may challenge older adults in exergaming. Based on the experience of older adults, they found exergaming enjoyable, particularly the social interactions. Exergaming was perceived as physically and cognitively demanding, with technical and safety challenges. Introducing exergaming requires thorough familiarization, including written and video instructions, follow-up support, and home accessibility. To be able to follow improvements during exergaming as well as age-appropriate challenges are important for successful integration into daily life. Based on these findings, an ExerGameFlow model for older adults was developed which provides practical implications for future design of exergames and interventions.

Physical and Affective Physical Literacy Domains Improved After a Six-Week Exergame Exercise Program in Older Adults: A Randomized Controlled Clinical Trial

Introduction: We investigated the effects of an exergames-based exercise program for older adults, and its benefits on their physical literacy (PL) domains, such as physical (mobility skills), affective (motivation and confidence), cognitive (knowledge about physical activity [PA]), and behavioral (daily exertion) when compared with a conventional exercise program and no training (NT) (control). Material and Methods: Forty older adults (mean age 72 years) volunteered and were randomized within three groups-exergame training (ET; n = 15), conventional training (CT; n = 14), and NT (n = 11). ET group performed training sessions based on a commercially available exergame console, while the CT group enrolled in a convention exercise program (aerobic, strength, balance, and flexibility exercises). The training program was conducted three times a week for 6 weeks. The Timed Up and Go Test (TUG), Exercise Confidence Survey (ECS), Motives for Physical Activity Measure-Revised (MPAM-R), Knowledge and Understanding Questionnaire (K&UQ), and total PA tracking (using wearable technology) were used as the study's outcomes. Outcome variables were measured at preintervention (week 0), postintervention (week 6), and at the time of final follow-up (week 9). Results: We observed a reduction in the ET TUG time at postintervention and follow-up. Also, a significant main effect for group and moment of measurement was observed for the Fitness-Health subscore, derived from MPAM-R. The values demonstrated by ET and CT were statistically different (P = 0.01) and a within-group comparison revealed significant differences in the ET from preintervention to both postintervention and follow-up (both, P = 0.01). We did not observe any other significant difference. Conclusion: Our results suggest that a 6-week exergame-based training program may have the potential in improving the physical and affective domains of PL in community-dwelling older adults. The topics related to fitness and health seem to be of interest in this population and programs can make use of them to improve the PL domains.

Meaningful learning: motivations of older adults in serious games

Social sustainability is the generation of significant behaviors through balanced levels of education, learning and awareness so that the population has a good standard of living, achieves self-improvement and supports society. This can be achieved with various strategies, one of which is learning through games, which has gained popularity in recent years due to positive results. This is effectively achieved through serious gaming, which is growing steadily, mostly in education and healthcare. This type of strategy has been typically used in young populations with a transparent interaction with technological processes that facilitate its application. However, one cannot neglect other populations such as the elderly, who may experience a technology gap and may not perceive this type of initiative in the best light. The purpose of this article is to identify the different motivations that can encourage older adults to use serious games to encourage learning processes through technology. For this purpose, different previous research on gaming experiences with older adults has been identified, from which it was possible to categorize a series of factors that motivate this population. Subsequently, we represented these factors by means of a model of motivation for the elderly and, to be able to use it, we have defined a set of heuristics based on this model. Finally, we used the heuristics by means of a questionnaire to evaluate the design of serious gaming for older adults, obtaining positive results for the use of these elements to guide the design and construction of serious games for learning in older adults.

Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study

BACKGROUND

The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants' motivations to adopt these technologies.

OBJECTIVE

This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework.

METHODS

A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S₁-BrainGame, S₂-CarRace, and S₃-Exergame). Each session included an identical sequence of activities (t₁-Baseline, t₂-Picture encode, t₃-Play, t₄-Stroop test, t₅-Play, and t₆-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire.

RESULTS

Session×activity effects were significant on all ambulatory measures (χ²₁₀>20; P<.001) other than cortisol (P=.37). Compared with S₁ and S₂, S₃ was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S₁, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S₃. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (χ²₁>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group.

CONCLUSIONS

Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed.

Lessons Learned from Gamifying Functional Fitness Training Through Human-Centered Design Methods in Older Adults

Background: The design of meaningful and enjoyable Exergames for fitness training in older adults possesses critical challenges in matching user's needs and motivators with game elements. These challenges are often due to the lack of knowledge of seniors' game preferences and technology literacy as well as a poor involvement of the target population in the design process. Objective: This research aims at describing a detailed and scrutinized use case of applying human-centered design methodologies in the gamification of fitness training routines and illustrates how to incorporate seniors' feedback in the game design pipeline. Materials and Methods: We focus on how to use the insights from human-centered inquiries to improve in-game elements, such as mechanics or esthetics, and how to iterate the game design process based on playtesting sessions in the field. Results: We present a set of four Exergames created to train the critical functional fitness areas of older adults. We show how through rapid prototyping methods and multidisciplinary research, Exergames can be rigorously designed and developed to match individual physical capabilities. Moreover, we propose a set of guidelines for the design of context-aware Exergames based on the lessons learned. Conclusion: We highlight the process followed; it depicts 19 weeks of various activities delivering particular and actionable items that can be used as a checklist for future games for health design projects.