The Psychological Effects of Playing Exergames: A Systematic Review

Exploring the Psychological Effects and Physical Exertion of Using Different Movement Interactions in Casual Exergames That Promote Active Microbreaks: Quasi-Experimental Study

BACKGROUND

Prolonged sedentary behavior, such as sitting or reclining, has consistently been identified as a stand-alone risk factor for heightened cardiometabolic risk and overall mortality. Conversely, interrupting sedentary periods by incorporating short, active microbreaks has been shown to mitigate the negative effects of sedentary behavior. Casual exergames, which mix elements of casual gaming with physical activity, are one prospective intervention to reduce sedentary behavior because they require physical exertion. Casual exergames have shown promise in fostering emotional and physical advantages when played in specific circumstances. However, little research exists on how different types of movement interactions impact the psychological effects as well as the physical exertion of playing casual exergames.

OBJECTIVE

The primary aim of this work was to explore the psychological effects and physical exertion of playing casual exergames lasting 2 minutes. More precisely, the investigation focused on comparing upper body and full body movement interactions. In addition, the work examined variations in body positions, considering both standing and seated positions during upper body movement interactions.

METHODS

Two casual exergames were developed and investigated through 2 quasi-experimental studies. In study 1, we investigated how players' perceptions of control, exertion, and immersion were affected by using upper body as opposed to full body exergame controllers when playing casual exergames. In study 2, we investigated differences in positive affect, performance, enjoyment, and exertion when playing casual exergames with upper body movement interactions in seated and standing positions.

RESULTS

Study 1 showed that perceived control was significantly higher for upper body movement interactions than for full body movement interactions (P=.04), but there were no significant differences regarding perceived exertion (P=.15) or immersion (P=.66). Study 2 showed that positive affect increased significantly for both standing (P=.003) and seated (P=.001) gameplay. The participants in the standing gameplay group showed slightly higher actual exertion; however, there were no differences between the groups in terms of positive affect, perceived exertion, enjoyment, or performance.

CONCLUSIONS

Casual exergames controlled by upper body movement interactions in seated gameplay can produce similar psychological effects and physical exertion as upper body movement interactions in standing gameplay and full body movement interactions. Therefore, upper body and seated casual exergames should not be overlooked as a suitable microbreak activity.

Single or Multiplayer Mode? Examining the Effects of Exergames in Improving Physical Health and Well-Being Among Older Adults

Objective: This study assesses the impact of single-player and multiplayer exergaming modes on improving exercise intentions, reduction of fear of falling, and emotional well-being among older adults, primarily from low socioeconomic status (SES) backgrounds-a group often underrepresented in exergame research. Method: We engaged 48 participants, primarily from low-SES communities in Singapore for a 4-week community-based exergaming intervention. Participants were divided into four groups as follows: (1) conventional exercise alone, (2) exergames alone, (3) exergames with a health coach, and (4) exergames with a peer. Using two-way repeated-measures ANOVA, we analyzed the effects of these interventions. Results: The findings revealed that all exergaming modes positively influenced exercise intentions, fear of falling, and emotional well-being to varying extents. Notably, exergaming with a health coach significantly improved participants' exercise intentions and emotional well-being, underscoring the value of expert guidance in motivating and supporting older adults in adopting healthier lifestyles. Exergaming with a peer was most effective in reducing fear of falling, highlighting the importance of social support and peer interaction in addressing physical health concerns among this population. Conclusion: This study emphasizes the potential of tailored exergame interventions incorporating various social interactions to improve health outcomes for older adults, contributing to more inclusive health promotion strategies.

Energy Expenditure Validation of an Exergame Platform: Ring Fit Adventure Use in Adults with Overweight and Obesity

Objective: This study aims at comparing the energy expenditure (EE) and heart rate (HR) data from Ring Fit Adventure (RFA) with those from indirect calorimetry (COSMED) and a heart rate monitor (Polar FT7). A secondary goal is to evaluate self-reported enjoyment and perceived effort levels. Materials and Methods: Thirty participants (age = 21.8 ± 2.2; body mass index = 31.8 ± 4.4) were recruited for two laboratory visits. The first visit involved baseline measurements. In the second visit, participants performed a 55-minute ad libitum exercise session with the RFA in adventure mode with moderate difficulty. During this session, EE, HR, perceived effort, and enjoyment of physical activity were recorded. Results: Although no statistically significant overestimation of EE was found between the RFA and the metabolic cart, two-way analysis of variance results show a main effect of condition (RFA vs. Polar FT7) on HR (122.8 ± 20.1 bpm and 129.0 ± 18.6 bpm; P = 0.007; ᶯp2 = 0.235). Based on comprehensive statistical evaluations, including the mean absolute percent error, intraclass correlations, typical error of measurement, and limits of agreement, the data suggest that the RFA provides reliable estimates for EE and HR. Overall, participants enjoyed the game considerably (71.3 ± 5.9/80 arbitrary units), and their reported perceived exertion was low. Conclusion: This study underscores that the RFA values are relatively accurate and precise, and thus it can be safely suggested for individuals with overweight and obesity to adopt an active lifestyle.

Effects of exergames on student physical education learning in the context of the artificial intelligence era: a meta-analysis

Whether the application of exergames in physical education (PE) courses can significantly improve student performance in PE learning is still controversial. This review explores the promoting effect of exergames on student PE learning and the conditions in which the effect of exergames can be maximized. Based on the PICOS method, two researchers independently searched the ProQuest database, EBSCO database, Web of Science (WoS) database, PubMed database, Chinese National Knowledge Infrastructure (CNKI) database, Wanfang database, and VIP database, evaluated the literature quality using the Cochrane system evaluation manual, and performed a meta-analysis of the included literature. A total of 16 randomized controlled trials involving 2962 subjects were included in this study. The meta-analysis showed that exergames effectively improved student performance in PE learning (SMD = 0.45, 95% CI: 0.27-0.63, P < 0.00001). Subgroup analysis indicated that better results could be achieved when exergames were introduced in small kindergarten classes and continued for 1-2 months.

Exercise-based gaming in patients with multiple sclerosis: A systematic review and meta-analysis

Background

Multiple sclerosis presents a significant burden, with balance disturbances impacting patients' daily living. Conventional therapies have been supplemented with technological advancements like virtual reality (VR) and exergaming, providing engaging, multisensory rehabilitation options.

Objective

This study aimed to synthesize evidence on exergaming's role in multiple sclerosis treatment, particularly to evaluate the impact of exergaming on cognitive, motor, and psychological outcomes in patients with multiple sclerosis.

Methods

A systematic review and subsequent meta-analysis design were employed. An extensive search was conducted up to June 2023 across five electronic databases - Web of Science, Scopus, PubMed, Cochrane, and EMBASE. The data extraction process from the selected studies was conducted independently. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool 1 (ROB1) and the National Institutes of Health (NIH) assessment tool. Continuous outcomes were consolidated as mean differences (MD) with 95% confidence intervals (CIs). Meta-analyses were performed using RevMan ver. 5.4.

Results

Out of 1,029 studies, 27 were included for meta-analysis. There were no significant differences in cognitive outcomes between the exergaming and the no-intervention group or the Conventional Physiotherapy and Rehabilitation interventions (CPRh) subgroups. However, the Symbol Digit Modalities Test (SDMT) showed a statistically significant difference in favor of exergaming in the no-intervention subgroup (MD = 5.40, 95% CI [0.08, 10.72], p = 0.05). In motor outcomes, exergaming only demonstrated better results in the 6-minute walking test compared to the no-intervention group (MD = 25.53, 95% CI [6.87, 44.19], p = 0.007). The Berg Balance Scale score in both studied subgroups and the Timed Up and Go (TUG) test in the no-intervention group favored exergaming. In terms of psychological outcomes, the Beck Depression Inventory did not reveal any significant differences, while the Modified Fatigue Impact Scale (MFIS) score favored exergaming in the CPRh subgroup.

Conclusion

Exergaming shows promise for enhancing cognitive and motor functions, motivation, adherence, and quality of life in MS patients, which is beneficial for nurses. It can be tailored to individual preferences and easily conducted at home, potentially serving as a viable alternative to traditional rehab programs, especially during relapses. However, further research is necessary to fully understand its optimal and lasting benefits.

Exergaming: A Good Exercise Option During the Coronavirus Pandemic

The purpose of this study was to evaluate Wii sports programs as a potential physical activity solution to increasing inactivity among young adults and potentially improving the immune system. An evaluation was done on five Wii Sports games, including tennis, baseball, bowling, golf, and boxing. Measures included caloric expenditure and metabolic equivalents (MET) expended. A total of 16 subjects participated in two interactive video game sessions that took place over a 14-day period, in which their caloric expenditure (based on metabolic equivalents and rate of perceived exertion [RPE]) was compared with accepted reference values associated with playing the actual sports. Results showed that Wii sports were associated with higher MET values than published norms for other actual sports, and all Wii sports showed caloric expenditure that was four to ten times higher than traditional sedentary gaming. In conclusion, the results justify the integration of interactive video-gaming technologies into future fitness programs targeted toward young adults and, consequently, decrease the risk of metabolic syndrome and obesity.

Effects of Playing Exergames on Quality of Life among Young Adults: A 12-Week Randomized Controlled Trial

Objective: The purpose of this paper is to investigate whether playing exergames can enhance quality of life among young adults and it examines the potential moderators. Methods: A 12-week randomized controlled trial was conducted. Quality of life was measured using the short-form 36-item version (SF-36) scale. All the participants were between 20 and 24 years old in Taiwan. Participants in the intervention group (n = 55) were asked to play exergames for 12 weeks, three times a week and 30 minutes at a time, while participants in the control group (n = 62) did not play exergames. The changes in the scores on quality of life between the beginning and the end of the 12-week trial were calculated. Independent t-tests were used to analyze the differences. Results: The intervention group participants experienced an enhanced quality of life in terms of physical functioning, role-physical (role limitations due to physical health), general health, and social functioning. Moreover, the intervention group participants who were not enthusiastic about exercisers experienced an enhanced quality of life in physical functioning, role-physical, and general health. The intervention group participants who attempted to control their weight experienced enhanced general health, vitality, and mental health. Conclusion: Playing exergaming could contribute to users' quality of life in terms of both physical and mental health.

Development of a Novel Home-Based Exergame With On-Body Feedback: Usability Study

BACKGROUND

With more than 1.4 billion adults worldwide classified as physically inactive, physical inactivity is a public health crisis leading to an increased risk of cardiometabolic diseases. Motivating and engaging training strategies are needed to tackle this public health crisis. Studies have shown that exergames, games controlled by active body movements, are potentially usable, attractive, and effective tools for home-based training. The ExerCube (by Sphery Ltd) has been developed as a physically immersive and adaptive functional fitness game. The development of a home-based version of the ExerCube could increase accessibility, reduce barriers to exercise, and provide an attractive solution to improve physical and cognitive health.

OBJECTIVE

The aim was threefold: (1) to develop a usable home-based exergame system, (2) to evaluate the usability and training experience of the home-based exergame and its early-stage on-body feedback system, and (3) to identify avenues for further user-centered design iterations of the system.

METHODS

A total of 15 healthy participants (mean age 25, SD 3 years) completed 2 laboratory visits consisting of four 5-minute exergame sessions. In each session, the on-body feedback system provided a different feedback modality (auditory, haptic, and visual feedback) to the participant. Following the second visit, participants completed a range of assessments, including the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), the Flow Short Scale (FSS), the Immersive Experience Questionnaire (IEQ), and a rating of perceived exertions (RPEs) both physically and cognitively. Participants answered questions regarding the on-body feedback system and completed a semistructured interview.

RESULTS

Usability was rated as acceptable, with a SUS score of 70.5 (SD 12). The questionnaires revealed medium-to-high values for the training experience (FSS: 5.3, SD 1; PACES: 5.3, SD 1.1; IEQ: 4.7, SD 0.9. Physical (mean 4.8, SD 1.6) and cognitive (mean 3.9, SD 1.4) RPEs were moderate. Interviews about the on-body feedback system revealed that the majority of participants liked the haptic feedback and the combination of haptic and auditory feedback the best. Participants enjoyed the distinct perceptibility, processing, and integration of the exergame and its supportive and motivating effect. The visual feedback was perceived less positively by participants but was still classified as "potentially" helpful. The auditory feedback was rated well but highlighted an area for further improvement. Participants enjoyed the training experience and described it as motivating, interactive, immersive, something new, interesting, self-explanatory, as well as physically and cognitively challenging. Moreover, 67% (n=10) of the participants could imagine exercising at home and continuing to play the exergame in the future.

CONCLUSIONS

The home-based exergame and its early-stage on-body feedback system were rated as usable and an enjoyable training experience by a young healthy population. Promising avenues emerged for future design iterations.

The Effects of Exergames on Physical and Psychological Health in Young Adults

Objective: This study aims to examine the effects of Kinect-based exergaming on physical (balance and reaction time) and psychosocial health factors (mental well-being and subjective happiness level) in young adults. Materials and Methods: A total of 22 men aged between 18 and 40, who play sedentary videogames at least once a week, were randomly divided into 2 groups to participate in either a Kinect-based exergame program (experimental group, n = 11) or to continue playing sedentary videogames without making any changes (control group, n = 11). The Kinect-based exergame program, including three exergames (Kinect Adventure: Reflex Ridge, Dance Central 3, Kinect Sports: Volleyball), was implemented with the experimental group for 5 weeks, three times a week, and 45 minutes per session. Balance and reaction time were assessed using SportKAT® 4000 Kinesthetic Ability Trainer and FitLight Trainer™ devices, respectively. To measure mental well-being and subjective happiness level, scales with proven psychometric qualities, whose validity and reliability studies were conducted, were used. Results: Results of the study showed statistically significant improvement for the experimental group on the measures of reaction time [t(10) = -4.69, P = 0.001], subjective happiness [t(10) = 8.94, P = 0.000], and mental well-being [t(10) = 4.62, P = 0.001]. In addition, the difference between the groups in reaction time [t(20) = 1.66, P = 0.01], right leg static balance [t(20) = -2.96, P = 0.008], mental well-being [t(20) = 2.77, P = 0.012], and subjective happiness levels (U = 0.50, P = 0.000) was found to be statistically significant in favor of the experimental group. Conclusion: The findings suggest that Kinect-based exergaming positively supports adults' reaction time, mental well-being, and subjective happiness.

Motivators and Barriers to Physical Activity among Youth with Sickle Cell Disease: Brief Review

Purpose: Health disparities for minority groups include a low rate of physical activity and underserved urban minority youth with chronic disease are among the least active population segments, as exemplified by sickle cell disease (SCD). “Exercise prescriptions” for youth with chronic diseases need to be evidence based and align with psychologic motivators and barriers. This scoping review sought evidence for psychosocial motivators or barriers to physical activity (PA) in youth with SCD and other chronic disease that could be relevant to SCD. Methods: Five databases were searched for studies on urban minority youth published between 2009 and 2022. Results: Keyword searching yielded no papers on SCD and PA motivation and barriers. Adding health-related quality of life (HRQL) in SCD found eleven relevant papers. Widening the search to chronic disease in minority youth resulted in a total of 49 papers. Three thematic categories and seven sub-themes emerged. PA barriers added by chronic disease include fear of triggering disease complications, negative relationships due to disease limitations on performance in sports, and lack of suitable environment for PA that accommodates the chronic disease. PA motivators are similar for youth without chronic disease: self-efficacy, autonomy, positive relationships with peers and parents and coach/teacher. Conclusion: Direct descriptions of PA motivations and barriers to PA in SCD are limited to fatigue and fear of sickle vaso-occlusive pain. The PA barriers and motivators found for urban youth with chronic disease overlap with themes in healthy adolescents from underserved minorities. Community-based interventions could strengthen PA motivators (self-efficacy, autonomy, positive relationships with peers and parents and coach/teacher) but need disease accommodations to overcome the barriers (fear of triggering disease complications, environmental limitations, and negative relationships). Evidence-based exercise prescriptions might incorporate educational modules to overcome disease stigma and misconceptions. Prospective studies of PA motivators and barriers could improve HRQL in SCD.

The Effects of Health Consideration on Exergaming Behavior in College Students: A Structural Equation Perspective

Purpose: Exergaming play is associated with positive health benefits and increased engagement in physical activity outcomes in players. Research also indicates that factors such as enjoyment and entertainment drive users' exergame activities. However, despite advances in the area, little is known about whether health consideration and physical activity impact college students' exergaming behavior. Method: A cross-sectional online survey of open-ended and fixed questions was completed by 403 college students (Mage = 20.02, SD = 2.3; Range: 17-35; 73.2% female) from a large southwestern university. Descriptive analyses and structural equation modeling techniques were used to draw insights from the data. Results: Among the participants, nearly 87.6% of them reported participating in exergaming behavior. Both measurement and structural models showed good model fits. Health consideration (Std.β = .30, p < .01) and leisure-time physical activity (Std.β = .28, p < .01) were positively associated with exergaming behavior while health consideration was not significantly associated with leisure-time physical activity (Std.β = .05, p = .38). The mediation analysis revealed that the indirect effect from health consideration to exergaming behavior through leisure-time physical activity was not statistically significant (Std.β = .01, p = .38). Leisure-time physical activity could not mediate the relationship between health consideration and exergaming behavior. Conclusions: By pointing out the important role of health consideration and physical activity in college students' exergaming play, findings of this study can help exergame developers and gamification interventionists to design more effective programs and, in turn, facilitate positive intervention outcomes.

Acute Effects of Heart Rate-Controlled Exergaming on Vascular Function in Young Adults

Objective: Acute and regular moderate-intensity endurance exercise (MIEE) is known to positively affect vascular function. The present study assessed if an exercise session in an innovative exergame called the ExerCube can induce similar vascular reactions as an MIEE session. Materials and Methods: Twenty-eight healthy recreationally active participants (13 females and 15 males; aged 24.8 ± 3.9 years; with body mass index 23.2 ± 2.3 kg/m²) completed an exergaming session (EGS) in the ExerCube (25 minutes) and an MIEE session on a treadmill (35 minutes, 65%-70% of maximal heart rate [HR]) in a randomized order. Both before and throughout the 45 minutes after the training sessions, pulse wave velocity (PWV), total peripheral resistance (TPR), stroke volume (SV), and HR were recorded. The study was approved by the Research Ethics Board of the Martin-Luther-Universität Halle-Wittenberg (Medical Faculty of the Martin-Luther-Universität 2019-177). Results: There were different hemodynamic responses to both types of exercises. PWV was significantly decreased 45 minutes after the EGS (P < 0.001). No significant changes were detected after MIEE (P = 0.109). TPR was significantly lower after both exercise sessions (P < 0.01). Only the EGS resulted in a significant decrease in SV 15 minutes after exercise (P < 0.001). The HR was significantly (P < 0.05) higher after both exercise sessions. After the EGS, the increase in HR was still significantly higher (P = 0.011) 45 minutes after the session. The interaction effects revealed significant differences in PWV (15 minutes, P = 0.035; 30 minutes, P = 0.004; and 45 minutes, P < 0.001), favoring the EGS. Conclusion: The EGS seems to induce a relevant exercise stimulus that can modulate vascular function. Therefore, this exergame may present an effective tool for prevention of cardiovascular diseases.

Acute effects of exergame-based calisthenics versus traditional calisthenics on state-anxiety levels in young adult men: a randomized trial

Purpose

This study compared the acute effects of an exergame-based calisthenics (EXG) session versus a traditional calisthenics (TC) session on state anxiety levels in healthy adult men, and compared the mean heart rate, number of repetitions performed, enjoyment, and affective valence reported by the participants between sessions.

Methods

Thirty-six young adult men performed two 30-min sessions of physical exercise in random order (EXG and TC). The same exercise protocol was used for each session; however, the TC session was guided by an exercise science professional. State anxiety was assessed before and immediately after each session. Heart rate was monitored during the sessions. Enjoyment and affective valence were assessed immediately after the sessions. In addition, the number of repetitions performed was recorded.

Results

There was no significant interaction between sessions (EXG vs. TC) and time (pre vs. post-session) (p = 0.102), no significant effect of session (p = 0.587), and no significant effect of time (p = 0.121). Participants presented a higher mean heart rate (+ 3.5%, p = 0.020) and number of repetitions performed (+ 43.7%, p < 0.001) in the TC session compared with the EXG session. There was no difference in enjoyment (p = 0.804) and affective (p = 0.195) valence between the EXG and TC sessions.

Conclusion

The EXG and TC sessions did not reduce state anxiety levels. Nor did they increase enjoyment or affective valence in healthy young adult men. However, the TC session evoked a higher mean heart rate and higher training volume than the EXG session.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11332-021-00841-9.

Adaptive High-Intensity Exergaming: The More Enjoyable Alternative to Conventional Training Approaches Despite Working Harder

Objective: The purpose of this study was to assess psychological and physiological responses to an exergaming session in the ExerCube (EX) and compare them with the responses of a moderate endurance run (ER). Materials and Methods: Twenty-eight healthy adults (13 women) aged 24.8 ± 3.8 years took part in this study. The first test day, participants performed a graded exercise test on a treadmill to determine maximal heart rate (HR) and lactate levels. The following test days 2 and 3, the participants completed an EX session and an ER on a treadmill in a randomized counterbalanced order. HR, rate of perceived exertion (RPE), and lactate levels were assessed during both sessions. After the sessions, the participants completed the "Physical Activity Enjoyment Scale" and the "Flow Short Scale." Results: The analysis of variance revealed that enjoyment (P = 0.036), flow (P = 0.042), RPE (P = 0.005), as well as mean and peak HR (P < 0.001) during the EX session were significantly higher compared with the ER. Gender did not affect the differences between the two conditions for mean HR (P = 0.61), maximal HR (P = 0.122), RPE (P = 0.862), flow (P = 0.376) nor enjoyment (P = 0.867). During the EX session, the lactate levels of all participants exceeded the individual lactate threshold (LT). During the ER, lactate values remained below the LT. Conclusion: The ExerCube presents both a physiological relevant exercise stimulus and a joyful gaming experience. Despite the higher exercise intensity achieved during the EX session, enjoyment was significantly higher compared with the ER. Therefore, the EX can be a promising and appealing tool to facilitate physical activity. Trial registration: ISRCTN registry, ISRCTN43067716, April 14, 2020. Trial number: 38154.

Does Dynamic Tailoring of A Narrative-Driven Exergame Result in Higher User Engagement among Adolescents? Results from A Cluster-Randomized Controlled Trial

Physical activity interventions for youth are direly needed given low adherence to physical activity guidelines, but many interventions suffer from low user engagement. Exergames that require bodily movement while played may provide an engaging form of physical activity intervention but are not perceived as engaging to all. This study aimed to evaluate whether dynamic tailoring in a narrative-driven mobile exergame for adolescents played in leisure settings, can create higher user engagement compared to a non-tailored exergame. A cluster-randomized controlled trial assessed differences in user engagement between a dynamically tailored (based on an accelerometer sensor integrated in a T-shirt) and non-tailored condition. In total, 94 participants (M age = 14.61 ± 1.93; 35% female) participated and were assigned to one of the two conditions. User engagement was measured via a survey and game metric data. User engagement was low in both conditions. Narrative sensation was higher in the dynamically tailored condition, but the non-tailored condition showed longer play-time. User suggestions to create a more appealing game included simple and more colorful graphics, avoiding technical problems, more variety and shorter missions and multiplayer options. Less cumbersome or more attractive sensing options than the smart T-shirt may offer a more engaging solution, to be tested in future research.

Educational and Social Exergaming: A Perspective on Physical, Social, and Educational Benefits and Pitfalls of Exergaming at Home During the COVID-19 Pandemic and Afterwards

Physical inactivity and coronavirus disease 2019 (COVID-19) signify two pandemics with negative physical, mental, and economic consequences. Younger and older people have not reached the recommended physical activity level for years. Societal restrictions due to COVID-19 additionally reduce opportunities for physical activity, and they increase social isolation. Here, we outline how playing exergames with others (social exergaming) at home could foster physical and mental health and promote communication and discussions on exergaming. Accordingly, we highlight the educational and social benefits of exergaming at home and delineate the concept of Educational and Social Exergaming (EASE). We outline specific benefits and pitfalls of exergaming regarding its physical and nonphysical effects, including educational values of discussing exergaming experiences and related topics. Moreover, we discuss the relevance of practical guidelines for educational and social exergaming at home as well as prospects for future research. Overall, educational and social exergaming could alleviate several detrimental effects of both pandemics on the health and well-being of people of all ages.

A Bowling Exergame to Improve Functional Capacity in Older Adults: Co-Design, Development, and Testing to Compare the Progress of Playing Alone Versus Playing With Peers

Background

Older people often do not meet the recommended levels of exercise required to reduce functional decline. Social interaction is mentioned by this cohort as a reason for joining group-based exercises, which does not occur when exercising alone. This perspective shows that exergames can be used as motivational resources. However, most available exergames are generic, obtained from commercial sources, and usually not specifically designed or adapted for older people.

Objective

In this study, we aim to co-design and develop a new exergame alongside older participants to (1) tailor the game mechanics and optimize participants’ adherence to and enjoyment of exercise; (2) test the participants’ functional capacity, motivation, and adherence to the exergaming program; and (3) compare these scores between those who played alone and those who played with peers.

Methods

We conducted a co-design process to develop a new exergame adapted to older people. For user testing, 23 participants were divided into 2 groups to play individually (alone group) or to compete in pairs (with peers group). They played the game twice a week, resulting in 21 exergaming sessions. We assessed the participants’ General Physical Fitness Index (GPFI) before and after the user testing. We also administered questionnaires about the gaming experience and exercise adherence with its motivators and barriers.

Results

We introduced a new bowling exergame for Xbox with a Kinect motion sensor that can be played in single or multiplayer mode. For the GPFI measurements, the sample was homogeneous in the pretest (with peers group: mean 40.5 [SD 9.6], alone group: mean 33.9 [SD 7.8]; P=.11). After the exergame testing sessions, both groups had significant gains (with peers group: mean 57.5 [SD 8.7], P=.005; alone group: mean 44.7 [SD 10.6]; P=.02). Comparing the posttest between groups, it was found that the group in which participants played with peers had better outcomes than the group in which participants played alone (P=.02). Regarding the gaming experience and exercise adherence, both groups recognized the benefits and expressed enthusiasm toward the exergame.

Conclusions

The findings suggest that the developed exergame helps in improving the functional capacity and adherence to physical exercise among older people, with even better results for those who played with peers. In addition to leading to more appropriate products, a co-design approach may positively influence the motivation and adherence of participants.

Personalized Exergames Language: A Novel Approach to the Automatic Generation of Personalized Exergames for Stroke Patients

Physical rehabilitation of stroke patients is based on the daily execution of exercises with face-to-face supervision by therapists. This model cannot be sustained in the long term, due to the involved economic costs, the growing number of patients, and the aging population. Remote rehabilitation tools have emerged to address this unmet clinical need, but they face the double challenge of motivating patients and ensuring an effective remote rehabilitation. In this context, exergames allow patients to play while performing repetitive therapeutic tasks in a safe and ecological environment. This work proposes the design of Personalized Exergames Language (PEL), a language whose sentences can be processed via software in order to automatically generate exergames. The definition of exergames through PEL, guided by an effective methodology of the design and generation of personalized exergames, will include both game mechanics and the necessary metrics to monitor, guide, and adapt the rehabilitation of each patient. The integration of authoring tools are considered to visually guide the therapist when designing exergames. A study has been carried out with stroke patients and therapists from a hospital and two community centers, in order to evaluate several exergames, automatically generated using PEL, in terms of usability, understanding, and suitability.

Effect of practice exergames on the mood states and self-esteem of elementary school boys and girls during physical education classes: A cluster-randomized controlled natural experiment

Reduced physical exercise can impact children's mental health. Use of active electronic games can help promote psychological health. Physical education (PE class) uses different resources, methods, and contents to promote student health. We investigated the effect of exergames on the mood and self-esteem of children and compare it that of with traditional PE classes. From a sample of 213 children (7-11 years old), 140 from 10 classes of the fourth and fifth grades of elementary school (59 boys, 81 girls; mean age 9.41±0.48 years), allocated to an experimental group (EG; n = 68; five clusters) and a PE group (PE; n = 72; five clusters), participated in this experimental controlled study. The EG practiced exergames during three 40-minute classes, and the PE group held three routine curricular PE classes. Brunel's Mood Scale and Rosenberg's Self-Esteem Scale were applied. Repeated measures ANOVA identified differences between sexes and groups. The main results of the EG demonstrated reduced tension in girls (p <0.05; ES: 0.62; 95% CI: 0.17-1.05). Regarding sex comparisons, anger was lower in girls (F: 4.57; p <0.05; ES: 0.61; 95% CI: 0.11-1.11) in the EG. Vigor was higher in girls in the EG than in those in the PE group (F: 5.46; p <0.05; ES: 0.56; 95% CI: 0.12-1.01). The main results of the PE group indicated increased self-esteem in boys (p <0.05; ES: 0.58; 95% CI: 0.08-1.07) and reduction of girls' mental confusion (p <0.05; ES 0.58; 95% CI 0.15-1.06). Thus, exergames impact boys' and girls' self-esteem and mood, as well as traditional physical education classes. Further study on exergames in schools is essential, with long-term effects on physical and mental health. Exergames bring interesting, varied content, technology, and innovation that can increase the attractiveness of physical education.

Analysis of the applicability and utility of a gamified didactics with exergames at primary schools: Qualitative findings from a natural experiment

One of the main objectives of Physical Education in elementary schools is to encourage motivation so that the subject enhances academic performance and the practice of physical exercise. Didactic research should evaluate the effectiveness of educational methods to know if they are applicable, useful, and in what sense. Exergames are digital motor games that aim to stimulate players' motor skills. Gamification refers to the use of game-based elements in nongame contexts to motivate actions. This research evaluates a gamified exergaming intervention, designed to improve children's academic performance by focusing on understanding applicability and usefulness. A natural experiment was set up in schools according to a mixed methods design. The qualitative data herein reported were collected during a natural experiment with a nonrandomized controlled design. The qualitative research design was used with field notes, an open-questions questionnaire, individual semi-structured interviews and focus group interviews. Eight teachers and 417 students took part. A content analysis was chosen as the methodological orientation. The facilitators were the realism of their didactic design and their adaptability to different educational contexts. The main barriers were the required materials and facilities. Teachers and students' attitudes were very positive, although future use was inconclusive. These findings may imply that this study is one of the few to provide positive evidence for educational gamification. The "Mechanics-Dynamics-Aesthetics" gamification model and the "Just Dance Now" exergame may be applicable and useful for didactics in Physical Education, but all the participants' suggestions need to be considered to improve teaching interventions.

Let the Body'n'Brain Games Begin: Toward Innovative Training Approaches in eSports Athletes

The phenomenon of eSports is omnipresent today. International championships and their competitive athletes thrill millions of spectators who watch as eSports athletes and their teams try to improve and outperform each other. In order to achieve the necessary cognitive and physical top form and to counteract general health problems caused by several hours of training in front of the PC or console, eSports athletes need optimal cognitive, physical and mental training. However, a gap exists in eSports specific health management, including prevention of health issues and training of these functions. To contribute to this topic, we present in this mini review possible avenues for holistic training approaches for cognitively, physically and mentally fitter and more powerful eSports athletes based on interdisciplinary findings. We discuss exergames as a motivating and promising complementary training approach for eSports athletes, which simultaneously combines physical and cognitive stimulation and challenges in an attractive gaming environment. Furthermore, we propose exergames as innovative full-body eSports-tournament revolution. To conclude, exergames bring new approaches to (physical) eSports, which in turn raise new topics in the growing eSports research and development community.

Interactive video game-based approaches improve mobility and mood in older adults: A nonrandomized, controlled tri̇al

BACKGROUND AND PURPOSE

Recently, technology-based approaches have become more frequently used in the field of rehabilitation. The aim of this study was to evaluate the effectiveness of interactive video games on mobility, general mood, and quality of life and compare them with physical activity approaches in older adults.

METHODS

Ninety-one residents of a nursing home were assessed and 58 volunteers who met the criteria were included in the study. Participants in Group I (n = 16) participated in a 30-min exercise program using the "Nintendo Wii Fit Plus" twice a week for 8 weeks. Group II (n = 14) participated in a physical activity program consisting of a bicycle ergometer and treadmill for the same duration. Participants were assessed pre- and post-intervention for functional mobility, general depression, and quality of life. The "Wilcoxon Signed-Rank" test was used to compare the pre- and post-treatment outcomes. The Kruskal-Wallis analysis of variance (post hoc Tukey's HSD test) was used to evaluate differences between the groups.

RESULTS

and Discussion: Post-intervention, the scores in the Berg Balance Scale increased significantly for GI and GII compared to the control group (p = 0.001, p = 0.002) Timed Up and Go Test improved for GI (p = 0.001) and 10-Meter Walk Test improved for GI (p = 0.003). Although there was a significant change in Hamilton depression score for GI and GII (p < 0.005), between-group differences were not significant.

CONCLUSIONS

Both programs demonstrated significant improvement in in all parameters. However, video-based program was more effective than physical activity, especially in mobility and balance parameters.

The Psychological Effects of Exergames for Children and Adolescents with Obesity: A Systematic Review and Meta-Analysis

The systematic review and meta-analysis were conducted to analyze the psychological effects of exergames for children and adolescents with overweight or obesity. In August 2018, the electronic databases searched were PubMed, Scopus, Web of Science, SPORTDiscus, Science Direct, CINAHL, and PsycINFO. The eligibility criteria were defined according to the population, intervention, comparison, outcome, and study design. In relation to the population, only studies with children or adolescents with overweight or obesity and without any other comorbidities were analyzed. Only publications in English were considered. Nine studies were selected. The comparisons identified were in relation to weight, type of activity, and play style versus control and preintervention. The magnitude of effect size suggests that the practice of exergaming has a small effect on psychological outcomes. Furthermore, cooperative games produced greater attraction to the game (g = 4.71, 95% confidence interval [CI] = 3.23-6.19) and greater intrinsic motivation (g = 5.29; 95% CI = 3.68-6.90). It was verified that self-esteem (standard mean difference [SMD] = 0.37; 95% CI = 0.09-0.66), and self-efficacy (SMD = 0.42; 95% CI = 0.06-0.79) improved after playing an exergame. This systematic review and meta-analysis suggest that exergames may be effective in improving psychological aspects of children and adolescents with overweight or obesity. Given the limited number of studies, it is essential to increase scientific research in this area.

Comparison of the effects of two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis: A randomized controlled trial

BACKGROUND

Balance disorders, fatigue, and walking impairments are the most common symptoms of multiple sclerosis (MS), which lead to a decrease in quality of life. To cope with these disability-increasing symptoms, it is important to select and regularly apply appropriate rehabilitation approaches. In recent years, virtual reality approaches have been suggested as a potentially useful tool in rehabilitation. Exergaming systems are used in the treatment of symptoms associated with MS, but there are few randomized controlled studies investigating the efficacy of these systems.

OBJECTIVE

To investigate and compare the effects of exercise training with two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis (PwMS).

METHODS

Forty-seven volunteer PwMS were included in the study and randomized to the group I (Nintendo Wii Fit), group II (Balance Trainer), and group III (control group). The participants in the study groups underwent an exercise program under the supervision of a physiotherapist on 2 days a week for 8 weeks. Outcome measures were the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Six-Minute Walk Test (6MWT), Fatigue Severity Scale (FSS), and Multiple Sclerosis International Quality of Life Questionnaire (MusiQol), which were performed before and after the treatment.

RESULTS

Forty-two participants completed the study protocol. All parameters evaluated in group I and II showed statistically significant improvement after treatment. Changes in all outcome measures were found to be superior in group I compared with group III. Similarly, all measures except the 6MWT were found to be superior in group II compared with group III. Changes in BBS and MusiQol were found to be superior in group I compared with group II.

CONCLUSION

In comparison with no intervention, exergaming with Nintendo Wii Fit and Balance Trainer improves balance, increases functionality, reduces fatigue severity, and increases quality of life in PwMS.

Motivational strategies and approaches for single and multi-player exergames: a social perspective

BACKGROUND

Exergames have attracted the interest of academics, practitioners, and designers, in domains as diverse as health, human-computer interaction, psychology, and information technology. This is primarily because exergames can make the exercise experience more enjoyable and entertaining, and in turn, can increase exercise levels. Despite the many benefits of exergames, they suffer from retention problems. Thus, the objective of this article was to review theories and game elements that have been empirically examined or employed in an attempt to make exergames more motivating so people engage in sustained physical activity (duration of physical activity) in a repeating pattern over time (frequency of physical activity).

METHODOLOGY

A literature search and narrative review were conducted.

RESULTS

Five major theories and elements were prevalent in the exergaming literature: (1) self-determination theory, (2) gamification, (3) competition and cooperation, (4) situational interest, and (5) social interaction. These theories and elements are important for encouraging long-term play and show promise for designing exergames to promote sustained engagement and motivate physical activity. We discuss their strengths and weaknesses throughout the paper.

CONCLUSIONS

The long-term effectiveness of exergame interventions is unclear mainly because of the limited amount of long-term studies. Better metrics are also needed to evaluate this effectiveness. We also identified particular attention to social factors and group dynamics, such as multi-player exergames and more effective player matchmaking strategies for increasing social connectedness, as a key area of future research.

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.

Heavy screen users are the heaviest among 10,000 children

This cross-sectional study examined the associations of recreational screen time (viewing TV programs on any screen-based device and computer use, performed while sitting) with body mass index (BMI) categories and waist-to-height ratio (WHtR) tertiles in 10,228 children (mean age 11.1 years, SD 0.8). We categorized the children into Light, Medium and Heavy TV viewers and computer users, and into Low, Medium and High exercise groups. Compared with Light TV viewers, Medium (OR: 1.30, 95% CI: 1.11–1.52, when adjusted for age, sex, language, sleep duration and exercise) and Heavy (OR: 1.57, 95% CI: 1.34–1.83) TV viewers had a higher risk of being overweight. Similarly, Heavy computer users had a higher risk of being overweight (OR: 1.42, 95% CI: 1.21–1.67). We observed interactions between exercise and TV viewing (p = 0.012) or computer use (p = 0.010). However, Heavy TV viewers had a higher risk of being overweight in all exercise groups. The associations of TV viewing and computer use were similar with BMI and WHtR. To conclude, heavy sedentary screen time is associated with overweight and central adiposity in children. Moreover, heavy TV viewers have a higher risk for overweight and central adiposity, regardless of weekly exercise duration.

Virtual Reality-Based Exercise with Exergames as Medicine in Different Contexts: A Short Review

There is enough evidence that, nowadays, the sedentary lifestyle is one of the major health problems worldwide, linked to many chronic diseases, including mental comorbidities, systemic hypertension, metabolic dysregulation, and cancer. Although health societies recommend engagement to physical activities, there is an overwhelming number of people remaining sedentary, even knowing the health benefits of regular exercises. One of the main factors that justifies this scenario is the lack of motivation, which is a barrier to people intended to start new habits for health. Considering this previous information, new alternatives for exercises may help people engage in a healthier lifestyle. Technology has contributed to this with devices that allow movements based on virtual reality approaches, including the exergames. These are games available even in commercial devices, as video-games, that allow people to work with different physical components. Furthermore, exergames add cognitive gain through its dual-task characteristic. Moreover, due to the combination of these benefits, they are feasible to acquire, and easy to use. Exergames are not only a potential strategy to reduce sedentary lifestyle but also a good method to improve health gains and rehabilitation in different populations and pathological conditions: older adults, stroke survivors, and Parkinson's disease. In this review, we aim to demonstrate some conditions that literature supports the intervention with exergames due to its physical and cognitive benefits. Furthermore, at the end of this review, we also explore the neurobiological mechanisms behind virtual-reality based exercises.

Exergaming for Children and Adolescents: Strengths, Weaknesses, Opportunities and Threats

Exergaming, or active video gaming, has become an emerging trend in fitness, education and health sectors. It is defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). Since exergaming is becoming more popular, claims have been made on the usefulness of exergaming. It has, for example, been entitled as being "the future of fitness" by the American College of Sports Medicine, promoting PA and health in children and adolescents. However, research also suggests that long-term engagement in exergaming is difficult to achieve, and there is a noticeable reservation towards exergaming by parents, teachers and caregivers. To provide an overview and to outline the future directions of exergaming, the aim of this review was to critically illustrate the strengths, weaknesses, opportunities and threats of exergaming to promote PA and health in children and youth. The available evidence indicates that exergaming has the potential to improve health via an increase in PA. However, it seems that this potential is frequently underexploited, and further developments such as customized exergames are needed.

Comparison of a 12-Week Whole-Body Exergaming Program on Young Adults: Differentiation in Flexibility, Muscle Strength, Reaction Time, and Walking Speed Between Sexes

This study aimed to investigate the effects of exergaming on flexibility, muscle strength, reaction time, and walking speed of adults within sex differences. Fifty-four individuals participated in a 12-week exergaming program. Three 30-min sessions were conducted each week. Baseline and post-intervention assessments were done using the sit-and-reach and bend-over tests for flexibility, hand-held dynamometer for muscle strength, auditory and visual reaction time machine for reaction time, and 5-meter walk test for walking speed. There were no significant changes in the sit-and-reach, bend-over test, and auditory-visual reaction time for either gender ( p > .05) with the intervention. Walking speed and muscle strength improved after exergaming in both sexes ( p < .05). The study showed that the video gaming intervention led to significant and equal improvements in muscle strength and walking speed for both sexes; however, it had no impact on flexibility and auditory-visual reaction time.

A 12-week randomized controlled pilot study of dance exergaming in a group: Influence on psychosocial factors in adolescent girls

Dance exergaming, which involves playing an interactive video game that requires the player to make upper and lower body movements by dancing to music, may provide a social physical activity experience that positively impacts psychosocial health. The objective of this randomized controlled study was to examine the effects of group-based dance exergaming on adolescent girls' psychosocial health including enjoyment, subjective health, perceived peer support, and health-related quality of life. Forty-one adolescents with overweight/obesity were randomly assigned to a 12-week dance exergaming intervention or to a control group. Peer support, subjective health, and health-related quality of life (HRQOL) were assessed pre- and post-intervention, and intervention participants rated enjoyment after each exergaming session. Repeated measures analysis of covariance models controlling for age and baseline body mass index were used to examine condition differences. Results indicated that subjective health improved in the exergaming condition more than control (p = .02). Ratings of peer conflict after the intervention were significantly different by condition (p = .01), with peer conflict stabilizing in the exergaming group and worsening in the control group. There was no difference by condition for HRQOL. Enjoyment remained high throughout the intervention. In summary, group exergaming improved subjective health, stabilized peer conflict, and provided an enjoyable physical activity experience for overweight adolescent girls.