Can Dance Exergames Boost Physical Activity as a School-Based Intervention?

The Effects of Active Video Games on Health-Related Physical Fitness and Motor Competence in Children and Adolescents with Healthy Weight: A Systematic Review and Meta-Analysis

(1) Background: Poor levels of physical fitness and motor skills are problems for today's children. Active video games (AVG) could be an attractive strategy to help address them. The aim was to investigate the effects of AVG on health-related physical fitness and motor competence in children and adolescents with healthy weight. (2) Methods: Randomized and non-randomized controlled trials investigating the effects of AVG programs on health-related physical fitness and motor competence were included. Two different quality assessment tools were used to measure the risk of bias. Twenty articles met the inclusion criteria and the variables of interest were body mass index (BMI), body fat, cardiorespiratory fitness (CRF), muscular fitness and motor competence. (3) Results: AVG interventions seem to have benefits in BMI when lasting longer than 18 weeks (SMD, -0.590; 95% IC, -1.071, -0.108) and in CRF (SMD, 0.438; 95% IC, 0.022, 0.855). AVG seems to be a promising tool to improve muscular fitness and motor competence but the effects are still unclear due to the lack of evidence. (4) Conclusions: AVG seem to be an effective tool for improving some components of health-related physical fitness and motor competence in healthy-weight children and adolescents, but the effect on some fitness components needs further research. Therefore, AVG may be included as a strategy to improve health.

Assessment of Active Video Gaming Using Adapted Controllers by Individuals With Physical Disabilities: A Protocol

Background

Individuals with disabilities are typically more sedentary and less fit compared to their peers without disabilities. Furthermore, engaging in physical activity can be extremely challenging due to physical impairments associated with disability and fewer opportunities to participate. One option for increasing physical activity is playing active video games (AVG), a category of video games that requires much more body movement for successful play than conventional push-button or joystick actions. However, many current AVGs are inaccessible or offer limited play options for individuals who are unable to stand, have balance issues, poor motor control, or cannot use their lower body to perform game activities. Making AVGs accessible to people with disabilities offers an innovative approach to overcoming various barriers to participation in physical activity.

Objective

Our aim was to compare the effect of off-the-shelf and adapted game controllers on quality of game play, enjoyment, and energy expenditure during active video gaming in persons with physical disabilities, specifically those with mobility impairments (ie, unable to stand, balance issues, poor motor control, unable to use lower extremity for gameplay). The gaming controllers to be evaluated include off-the-shelf and adapted versions of the Wii Fit balance board and gaming mat.

Methods

Participants (10-60 years old) came to the laboratory a total of three times. During the first visit, participants completed a functional assessment and became familiar with the equipment and games to be played. For the functional assessment, participants performed 18 functional movement tasks from the International Classification of Functioning, Disability, and Health. They also answered a series of questions from the Patient Reported Outcomes Measurement Information System and Quality of Life in Neurological Conditions measurement tools, to provide a personal perspective regarding their own functional ability. For Visit 2, metabolic data were collected during an initial 20-minute baseline, followed by 40 minutes of game play. The controller (balance board or gaming mat) played was randomly selected. A set of games was played for 10 minutes, followed by 5 minutes of rest, and then another set of games was played for 10 minutes, followed by rest. Quality of game play was observed and documented for each set. During rest, the participant completed questions regarding enjoyment. Following the same procedures, the participant then played the two sets of games using the other version (off-the-shelf or adapted) of the controller. The entire procedure was repeated during Visit 3 with the controller that was not played.

Results

Enrollment began in February 2016 and ended in September 2016. Study results will be reported in late 2017.

Conclusions

We hypothesized that the adapted versions of the Wii Fit balance board and gaming mat would produce greater quality of game play, enjoyment, and energy expenditure in persons with mobility impairments compared to off-the-shelf versions.

Trial Registration

ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6qpPszPJ7)

Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning?

BACKGROUND

Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP.

METHODS

Sixty-eight English-speaking, adult volunteers (n = 17 games) from communities around Hershey, Pennsylvania, and Lexington, Kentucky, played a conversation card game about end-of-life issues. Readiness to engage in 4 ACP behaviors was measured by a validated questionnaire (based on the transtheoretical model) immediately before and 3 months postgame and a semistructured phone interview. These behaviors were (1) completing a living will; (2) completing a health-care proxy; (3) discussing end-of-life wishes with loved ones; and (4) discussing quality versus quantity of life with loved ones.

RESULTS

Participants' (n = 68) mean age was 51.3 years (standard deviation = 0.7, range: 22-88); 94% of the participants were caucasian and 67% were female. Seventy-eight percent of the participants engaged in ACP behaviors within 3 months of playing the game (eg, updating documents, discussing end-of-life issues). Furthermore, 73% of the participants progressed in stage of change (ie, readiness) to perform at least 1 of the 4 behaviors. Scores on measures of decisional balance and processes of change increased significantly by 3 months postintervention.

CONCLUSION

This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within 3 months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.

Conversation Game Effectively Engages Groups of Individuals in Discussions about Death and Dying

BACKGROUND

Discussions about end-of-life (EOL) values, wishes, and beliefs are critical for effective advance care planning (ACP). New strategies are needed to engage individuals in EOL conversations.

OBJECTIVE

The study objective was to test the feasibility of using a conversation game to engage individuals in EOL discussions.

METHODS

This study used a mixed-methods approach. Participants played a conversation game that prompts players to answer and discuss 20 questions about death, dying, and EOL care. Participants completed pre- and postgame questionnaires and participated in postgame focus groups. Subjects were 70 healthy volunteers (18 groups of families, friends, or strangers). Demographics, emotional state, and perceived relational closeness were measured using preintervention questionnaires. Postintervention questionnaires measured conversation satisfaction, realism, self-rated quality, and emotional state. Postgame focus groups evaluated players' experiences playing the game.

RESULTS

Using a seven-point Likert scale (1 = low score, 7 = high score), players rated game conversations as satisfying (mean [M] = 6.1, SD = 0.9), realistic (M = 5.6, SD = 0.8), and of high quality (M = 5.7, SD = 0.9). There were no negative effects on emotional state immediately postgame (M = 1.3, SD = 0.5). A thematic analysis of participants' experiences (n = 55) revealed that (1) playing the game was an enjoyable, positive experience; (2) a game is a good framing for EOL discussions; and (3) there were mixed opinions about ideal game group composition.

CONCLUSIONS

This study established that healthy volunteers enjoyed engaging in a two-hour discussion about EOL issues when framed as a game. The game experience was a positive, satisfying, and enjoyable activity for participants. Further studies are needed to determine if health games can promote effective ACP.

Building a Better Mousetrap (Exergame) to Increase Youth Physical Activity

Although exergames have been demonstrated to induce moderate levels of physical activity (PA) if played as designed, there is conflicting evidence on use of exergaming leading to increased habitual PA. Exergames have increased PA in some home and school studies, but not others. Exergames have been used in community centers to good effect, but this has not generally been validated with research. PA from exergames may be enhanced by innovative use of sensors, "fun"-enhancing procedures, tailored messaging, message framing, story or narrative, goal setting, feedback, and values-based messaging. Research is needed on PA-enhancing procedures used within exergames for youth to provide a firmer foundation for the design and use of exergames in the future.

Are field-based exergames useful in preventing childhood obesity? A systematic review

Exergames have started to find their way into field-based settings, such as schools, communities and homes, as a possible solution to curbing physical inactivity and childhood obesity. However, a clear view of the effects of field-based exergaming on children's obesity-related outcomes is lacking. Hence, a systematic review on this topic is warranted. This review synthesizes the impact of field-based exergames on children's physical and psychosocial outcomes. A total of 34 articles conducted in field-based settings were identified from 104 peer-reviewed publications that investigated the effects of exergames. Upon screening, these articles met the inclusion criteria and a high inter-rater agreement for inclusion was reached between the authors. The effects of field-based exergames on children's habitual physical activity (PA) and obesity-related outcomes (e.g. weight loss, body composition) remain unclear due to design problems, measurement issues and other methodology concerns. In addition, exergame is appealing to children, although strategies are warranted to sustain their interests. In summary, exergames are desirable as a promising addition to promote PA and health. Professionals may integrate exergames at field settings to promote a physically active lifestyle among children with the goal of curbing childhood obesity.

Gaming, Adiposity, and Obesogenic Behaviors Among Children

Videogames in general have been maligned for causing obesity because of their inherent sedentariness, whereas exergames have been both maligned for requiring low levels of activity and extolled for requiring physical activity to move game play along. The intensity and duration of physical activity resulting from exergame play have shown varying results, and they have been explored for use in obesity treatment and prevention, primarily among children. Other videogames have been developed and tested to help children change their diet and physical activity practices with various outcomes. As a field of inquiry, we are in the earliest stages of understanding how, or under what circumstances, videogames can influence all these behavioral and health outcomes. To deal with these complexities, we have assembled a group of investigators who have made important, but diverse, contributions to this research agenda and asked them to address five key child obesity-related issues in a Roundtable format. Brief biosketches are presented at the end of this article.

Disentangling Fun and Enjoyment in Exergames Using an Expanded Design, Play, Experience Framework: A Narrative Review

With exergames (as with physical activity in general), more intense and longer-duration game play should accrue more health benefits. Exergames, however, appear to be played for relatively short durations, often at medium or lower intensities. Ostensibly games are played for fun or enjoyment. Enhancing the fun or enjoyment experienced during exergame play should enhance the intensity and duration of physical activity, and thereby the health benefits. Research, reviewed herein, indicates fun and/or enjoyment in games are inherently laden with psychosocial, physiological, and embodiment substrates. Physical activity may also have separate or closely related psychosocial, physiological, and embodiment enjoyment substrates. Research is needed to integrate these levels of experience and to identify the game mechanics that enhance, and even maximize, the fun or enjoyment experienced in exergames, to thereby increase the health benefit.