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Espinosa-Curiel IE, Pozas-Bogarin EE, Hernández-Arvizu M, Navarro-Jiménez ME, Delgado-Pérez EE, Martínez-Miranda J, Pérez-Espinosa H. HelperFriend, a Serious Game for Promoting Healthy Lifestyle Behaviors in Children: Design and Pilot Study. JMIR Serious Games 2022; 10:e33412. [PMID: 35522474 PMCID: PMC9123542 DOI: 10.2196/33412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/14/2021] [Accepted: 04/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background The use of health games is a promising strategy for educating and promoting healthy lifestyle behaviors among children. Objective We aimed to describe the design and development of a serious game, called HelperFriend, and evaluate its feasibility, acceptability, and preliminary effects in children in a pilot study. HelperFriend is a vicarious experiential video game designed to promote 3 lifestyle behaviors among young children: physical activity, healthy eating, and socioemotional wellness. Methods Participants aged 8 to 11 years were recruited from an elementary school and randomized to receive a healthy lifestyle behavior educational talk (control) or play six 30-minute sessions with HelperFriend (intervention). Assessments were conducted at baseline (T0) and after the intervention (ie, 4 weeks) (T1). The primary outcome was gain in knowledge. The secondary outcomes were intention to conduct healthy behaviors, dietary intake, and player satisfaction. Results Knowledge scores of intervention group participants increased from T0 to T1 for physical activity (t14=2.01, P=.03), healthy eating (t14=3.14, P=.003), and socioemotional wellness (t14=2.75, P=.008). In addition, from T0 to T1, the intervention group improved their intention to perform physical activity (t14=2.82, P=.006), healthy eating (t14=3.44, P=.002), and socioemotional wellness (t14=2.65, P=.009); and there was a reduction in their intake of 13 unhealthy foods. HelperFriend was well received by intervention group. Conclusions HelperFriend appears to be feasible and acceptable for young children. In addition, this game seems to be a viable tool to help improve the knowledge, the intention to conduct healthy behaviors, and the dietary intake of children; however, a well-powered randomized controlled trial is needed to prove the efficacy of HelperFriend.
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Affiliation(s)
- Ismael Edrein Espinosa-Curiel
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
| | - Edgar Efrén Pozas-Bogarin
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
| | - Maryleidi Hernández-Arvizu
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
| | - Maria Elena Navarro-Jiménez
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
| | - Edwin Emeth Delgado-Pérez
- Centro de Estudios e Investigaciones en Comportamiento, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Juan Martínez-Miranda
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
| | - Humberto Pérez-Espinosa
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
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2
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Schwarz AF, Huertas-Delgado FJ, Cardon G, DeSmet A. Design Features Associated with User Engagement in Digital Games for Healthy Lifestyle Promotion in Youth: A Systematic Review of Qualitative and Quantitative Studies. Games Health J 2020; 9:150-163. [PMID: 31923363 DOI: 10.1089/g4h.2019.0058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
User engagement in digital (serious) games may be important to increase their effectiveness. Insights into how to create engaging games for healthy lifestyle promotion are needed, as despite their potential, not all digital (serious) games are highly engaging. This study systematically reviewed game features that were associated with higher user engagement among youth. A systematic search was conducted in PubMed, Web of Science, CINAHL, and PsycARTICLES databases. Qualitative and quantitative studies were included, if they documented game features associated with youth engagement. Coding of game features was performed using the mechanics-dynamics-aesthetics (MDA) framework. A total of 60 studies met the inclusion criteria and were included in the registered systematic review (No. CRD42018099487). Results showed that various game features were associated with user engagement in digital (serious) games: an attractive storyline, adaptable to gender and age, including diverse (antagonist) characters the user may identify with, high-end realistic graphics, well-defined instructions, which can be skipped, in combination with clear feedback and a balance of educational and fun content. This review underpinned the relevance of investigating engaging game features specifically for youth, as deviations were found with characteristics that are engaging for other populations.
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Affiliation(s)
- Ayla F Schwarz
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Francisco J Huertas-Delgado
- Department of Didactic of Musical, Plastical and Body Expression, La Inmaculada Teacher Training Centre, University of Granada, Granada, Spain
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Ann DeSmet
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.,Research Foundation Flanders, Brussels, Belgium
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Ufholz K, Flack KD, Johnson L, Roemmich JN. Active Videogames to Promote Traditional Active Play: Increasing the Reinforcing Value of Active Play Among Low-Active Children. Games Health J 2019; 9:208-214. [PMID: 31800323 DOI: 10.1089/g4h.2019.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Exercise reinforcement predicts physical activity of children. Repeated exposures of physical activity may increase physical activity reinforcement (incentive sensitization). Active videogame (AVG) play produces light-to-moderate-intensity physical activity. Ideally, AVG play would transition to nonscreen-based active play through incentive sensitization of traditional active play (TAP), providing AVG does not increase sedentary videogame (SVG) reinforcement. Greater autonomy increases motivation toward traditional physical activity, but whether autonomy enhances incentive sensitization has not been studied. Objectives: To determine whether autonomy over AVG play promotes incentive sensitization of TAP or SVG. Methods: Inactive children (ages 8-12; 5th-97th body mass index percentile) were provided with AVG and SVG for 6 weeks and assigned to either a high autonomy (n = 25) or low autonomy (n = 24) group, differentiated by AVG choice and more freedom over amount of play. Both groups played AVG 3 days per week. SVG were played ad libitum. Participants completed an operant responding task to measure the relative reinforcing value (RRV) of AVG versus SVG (RRVAVG vs. SVG) and AVG versus TAP (RRVAVG vs. TAP) at baseline, 6 weeks, and 10 weeks. Results: RRVAVG vs. SVG increased over time (P = 0.056) but did not differ by autonomy or autonomy × time (P = 0.184). RRVAVG vs. TAP decreased over time (P = 0.033) but did not differ by autonomy or autonomy × time (P = 0.73). Conclusion: AVG play does not increase motivation toward SVG and increases motivation to play AVG relative to TAP. Providing higher autonomy did not promote incentive sensitization of play.
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Affiliation(s)
- Kelsey Ufholz
- United States Department of Agriculture, Agricultural Research Service, Grand Forks, North Dakota
| | - Kyle D Flack
- United States Department of Agriculture, Agricultural Research Service, Grand Forks, North Dakota
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky
| | - LuAnn Johnson
- United States Department of Agriculture, Agricultural Research Service, Grand Forks, North Dakota
| | - James N Roemmich
- United States Department of Agriculture, Agricultural Research Service, Grand Forks, North Dakota
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4
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Schwarz A, Mertens L, Simons M, Spook JE, Thompson D, Cardon G, De Bourdeaudhuij I, Chastin SF, DeSmet A. Which Game Narratives Do Adolescents of Different Gameplay and Sociodemographic Backgrounds Prefer? A Mixed-Methods Analysis. Games Health J 2019; 8:195-204. [DOI: 10.1089/g4h.2017.0178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ayla Schwarz
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Lieze Mertens
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Monique Simons
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Jorinde E. Spook
- Department of Communication, Philosophy and Technology, Centre for Integrative Development, Wageningen University, Wageningen, The Netherlands
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | - Sebastien F.M. Chastin
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Institute for Applied Health Research, School of Health and Life Science, Glasgow Caledonian University, Scotland, United Kingdom
| | - Ann DeSmet
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
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5
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Baranowski T, Blumberg F, Buday R, DeSmet A, Fiellin LE, Green CS, Kato PM, Lu AS, Maloney AE, Mellecker R, Morrill BA, Peng W, Shegog R, Simons M, Staiano AE, Thompson D, Young K. Games for Health for Children-Current Status and Needed Research. Games Health J 2015; 5:1-12. [PMID: 26262772 DOI: 10.1089/g4h.2015.0026] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population's diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.
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Affiliation(s)
- Tom Baranowski
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Fran Blumberg
- 2 Division of Psychological and Educational Services, Fordham University Graduate School of Education , New York, New York
| | | | - Ann DeSmet
- 4 Department of Movement and Sport Sciences, Ghent University , Ghent, Belgium
| | - Lynn E Fiellin
- 5 play2PREVENT Lab, Department of Internal Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - C Shawn Green
- 6 Department of Psychology, University of Wisconsin , Madison, Wisconsin
| | - Pamela M Kato
- 7 Serious Games Institute, Coventry University , Coventry, United Kingdom
| | - Amy Shirong Lu
- 8 Departments of Communication Studies and Health Sciences, Northeastern University , Boston, Massachusetts
| | - Ann E Maloney
- 9 Department of Psychiatry, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Robin Mellecker
- 10 Centre for Physical Activity & Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University , Melbourne, Australia
| | | | - Wei Peng
- 12 Department of Telecommunications, Information Studies and Media, Michigan State University , East Lansing, Michigan
| | - Ross Shegog
- 13 Center for Health Promotion and Prevention Research, University of Texas School of Public Health , Houston, Texas
| | - Monique Simons
- 14 Department of Human Geography and Spatial Planning, Utrecht University , Utrecht, The Netherlands
| | - Amanda E Staiano
- 15 Pennington Biomedical Research Center, Louisiana State University , Baton Rouge, Louisiana
| | - Debbe Thompson
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Kimberly Young
- 16 Russell J. Jandoli School of Journalism & Mass Communication, St. Bonaventure University , New York
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6
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Baranowski T, Maddison R, Maloney A, Medina E, Simons M. Building a Better Mousetrap (Exergame) to Increase Youth Physical Activity. Games Health J 2015. [PMID: 26196047 DOI: 10.1089/g4h.2014.0018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Tom Baranowski
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Ralph Maddison
- 2 National Institute for Health Innovation, University of Auckland , Auckland, New Zealand
| | - Ann Maloney
- 3 University of Massachusetts , Worcester, Massachusetts
| | - Ernie Medina
- 4 Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University , Loma Linda, California
| | - Monique Simons
- 5 Department of Health Science and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University , Amsterdam, The Netherlands .,6 Body@Work, Research Center Physical Activity, Work and Health, TNO-VU/VUmc, VU University Medical Center , Amsterdam, The Netherlands .,7 TNO, Expertise Centre Life Style , Leiden, The Netherlands
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7
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Simons M, Brug J, Chinapaw MJM, de Boer M, Seidell J, de Vet E. Replacing Non-Active Video Gaming by Active Video Gaming to Prevent Excessive Weight Gain in Adolescents. PLoS One 2015; 10:e0126023. [PMID: 26153884 PMCID: PMC4496035 DOI: 10.1371/journal.pone.0126023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/26/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of the current study was to evaluate the effects of and adherence to an active video game promotion intervention on anthropometrics, sedentary screen time and consumption of sugar-sweetened beverages and snacks among non-active video gaming adolescents who primarily were of healthy weight. METHODS We assigned 270 gaming (i.e. ≥ 2 hours/week non-active video game time) adolescents randomly to an intervention group (n = 140) (receiving active video games and encouragement to play) or a waiting-list control group (n = 130). BMI-SDS (SDS = adjusted for mean standard deviation score), waist circumference-SDS, hip circumference and sum of skinfolds were measured at baseline, at four and ten months follow-up (primary outcomes). Sedentary screen time, physical activity, consumption of sugar-sweetened beverages and snacks, and process measures (not at baseline) were assessed with self-reports at baseline, one, four and ten months follow-up. Multi-level-intention to treat-regression analyses were conducted. RESULTS The control group decreased significantly more than the intervention group on BMI-SDS (β = 0.074, 95%CI: 0.008;0.14), and sum of skinfolds (β = 3.22, 95%CI: 0.27;6.17) (overall effects). The intervention group had a significantly higher decrease in self-reported non-active video game time (β = -1.76, 95%CI: -3.20;-0.32) and total sedentary screen time (Exp (β = 0.81, 95%CI: 0.74;0.88) than the control group (overall effects). The process evaluation showed that 14% of the adolescents played the Move video games every week ≥ 1 hour/week during the whole intervention period. CONCLUSIONS The active video game intervention did not result in lower values on anthropometrics in a group of 'excessive' non-active video gamers (mean ~ 14 hours/week) who primarily were of healthy weight compared to a control group throughout a ten-month-period. Even some effects in the unexpected direction were found, with the control group showing lower BMI-SDS and skin folds than the intervention group. The intervention did result in less self-reported sedentary screen time, although these results are likely biased by social desirability. TRIAL REGISTRATION Dutch Trial Register NTR3228.
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Affiliation(s)
- Monique Simons
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands
- Body@Work, Research Center Physical Activity, Work and Health, TNO- VU/VUmc, VU University Medical Center, Amsterdam, The Netherlands
- TNO, Expertise Centre Life Style, Leiden, The Netherlands
- * E-mail:
| | - Johannes Brug
- Department of Epidemiology & Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mai J. M. Chinapaw
- Body@Work, Research Center Physical Activity, Work and Health, TNO- VU/VUmc, VU University Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel de Boer
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands
| | - Jaap Seidell
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands
| | - Emely de Vet
- Chairgroup Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Wageningen University and Research Centre Wageningen, Wageningen, The Netherlands
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8
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Verhoeven K, Abeele VV, Gers B, Seghers J. Energy Expenditure During Xbox Kinect Play in Early Adolescents: The Relationship with Player Mode and Game Enjoyment. Games Health J 2015; 4:444-51. [PMID: 26509940 DOI: 10.1089/g4h.2014.0106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE There has been growing interest in the use of active videogames to influence levels of physical activity. Most studies have investigated energy expenditure in general, without taking into account moderating factors such as player mode and game enjoyment. This study therefore examines whether children's energy expenditure and game enjoyment are higher when games are played in a two-player mode than in a single-player mode. MATERIALS AND METHODS Forty-three children from the 7th grade who exhibited an inactive lifestyle engaged in six sports exergames on an Xbox(®) Kinect(®) (Microsoft, Redmond, WA) console. The player mode (single-player or two-player mode) was manipulated (within-subjects design). The primary parameters were "energy expenditure," which was measured with a SenseWear(®) device (Bodymedia Inc., Pittsburgh, PA), and "game enjoyment," which was assessed through self-report. RESULTS On average, Kinect play elicits moderate physical activity (approximately 4 metabolic equivalents of task). Games that are played in a two-player mode elicit more energy than games that are played in a single-player mode. However, this was only the case for simultaneous play (boxing, dancing, and tennis), not for turn-based play (bowling, baseball, and golf). Furthermore, participants generally liked exergaming, regardless of their sex or the player mode. Finally, no significant correlation was found between energy expenditure and game enjoyment. CONCLUSIONS This study has shown that Kinect play elicits physical activity of moderate intensity. Furthermore, Kinect play is generally enjoyed by both boys and girls. Simultaneous play may be the best suited to increase levels of physical activity in early adolescents who exhibit an inactive lifestyle.
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Affiliation(s)
- Katrien Verhoeven
- 1 Department of Health and Well-being, UC Leuven-Limburg , Leuven, Belgium
| | - Vero Vanden Abeele
- 2 e-Media Lab, Faculty of Engineering Technology, KU Leuven , Leuven, Belgium
| | - Brent Gers
- 3 Department of Teacher Education, UC Leuven-Limburg , Leuven, Belgium
| | - Jan Seghers
- 4 Department of Kinesiology, KU Leuven , Leuven, Belgium
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9
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Simons M, Chinapaw MJM, Brug J, Seidell J, de Vet E. Associations between active video gaming and other energy-balance related behaviours in adolescents: a 24-hour recall diary study. Int J Behav Nutr Phys Act 2015; 12:32. [PMID: 25889743 PMCID: PMC4359402 DOI: 10.1186/s12966-015-0192-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Active video games may contribute to reducing time spent in sedentary activities, increasing physical activity and preventing excessive weight gain in adolescents. Active video gaming can, however, only be beneficial for weight management when it replaces sedentary activities and not other physical activity, and when it is not associated with a higher energy intake. The current study therefore examines the association between active video gaming and other energy-balance-related behaviours (EBRBs). Findings Adolescents (12–16 years) with access to an active video game and who reported to spend at least one hour per week in active video gaming were invited to participate in the study. They were asked to complete electronic 24-hour recall diaries on five randomly assigned weekdays and two randomly assigned weekend-days in a one-month period, reporting on time spent playing active and non-active video games and on other EBRBs. Findings indicated that adolescents who reported playing active video games on assessed days also reported spending more time playing non-active video games (Median = 23.6, IQR = 56.8 minutes per week) compared to adolescents who did not report playing active video games on assessed days (Median = 10.0, IQR = 51.3 minutes per week, P < 0.001 (Mann Whitney test)). No differences between these groups were found in other EBRBs. Among those who played active video games on assessed days, active video game time was positively yet weakly associated with TV/DVD time and snack consumption. Active video game time was not significantly associated with other activities and sugar-sweetened beverages intake. Conclusions The results suggest that it is unlikely that time spent by adolescents in playing active video games replaces time spent in other physically active behaviours or sedentary activities. Spending more time playing active video games does seem to be associated with a small, but significant increase in intake of snacks. This suggests that interventions aimed at increasing time spent on active video gaming, may have unexpected side effects, thus warranting caution. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0192-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monique Simons
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands. .,Body@Work, Research Center Physical Activity, Work and Health, TNO- VU/VUmc, VU University Medical Center, Amsterdam, The Netherlands. .,TNO, Expertise Centre Life Style, Leiden, The Netherlands.
| | - Mai J M Chinapaw
- Body@Work, Research Center Physical Activity, Work and Health, TNO- VU/VUmc, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Epidemiology & Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Johannes Brug
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Epidemiology & Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jaap Seidell
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Emely de Vet
- Chairgroup Strategic Communication, Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Wageningen University and Research Centre Wageningen, Wageningen, the Netherlands.
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Straker LM, Fenner AA, Howie EK, Feltz DL, Gray CM, Lu AS, Mueller FF, Simons M, Barnett LM. Efficient and Effective Change Principles in Active Videogames. Games Health J 2014; 4:43-52. [PMID: 26181680 DOI: 10.1089/g4h.2014.0077] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Active videogames have the potential to enhance population levels of physical activity but have not been successful in achieving this aim to date. This article considers a range of principles that may be important to the design of effective and efficient active videogames from diverse discipline areas, including behavioral sciences (health behavior change, motor learning, and serious games), business production (marketing and sales), and technology engineering and design (human-computer interaction/ergonomics and flow). Both direct and indirect pathways to impact on population levels of habitual physical activity are proposed, along with the concept of a game use lifecycle. Examples of current active and sedentary electronic games are used to understand how such principles may be applied. Furthermore, limitations of the current usage of theoretical principles are discussed. A suggested list of principles for best practice in active videogame design is proposed along with suggested research ideas to inform practice to enhance physical activity.
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Affiliation(s)
- Leon M Straker
- 1 School of Physiotherapy and Exercise Science, Curtin University , Perth, Western Australia, Australia
| | - Ashley A Fenner
- 2 School of Psychology and Speech Pathology, Curtin University , Perth, Western Australia, Australia
| | - Erin K Howie
- 1 School of Physiotherapy and Exercise Science, Curtin University , Perth, Western Australia, Australia
| | - Deborah L Feltz
- 3 Department of Kinesiology, Michigan State University , East Lansing, Michigan
| | - Cindy M Gray
- 4 Institute of Health and Wellbeing, University of Glasgow , Glasgow, Scotland, United Kingdom
| | - Amy Shirong Lu
- 5 College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University , Boston, Massachusetts
| | | | - Monique Simons
- 7 Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam , The Netherlands .,8 Body@Work, Research Center Physical Activity, Work and Health, TNO-VU/VU Medical Center, VU University Medical Center , Amsterdam, The Netherlands .,9 TNO, Expertise Centre Life Style , Leiden, The Netherlands
| | - Lisa M Barnett
- 10 School of Health and Social Development, Deakin University , Melbourne, Victoria, Australia
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11
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Simons M, de Vet E, Brug J, Seidell J, Chinapaw MJ. Active and non-active video gaming among Dutch adolescents: Who plays and how much? J Sci Med Sport 2014; 17:597-601. [DOI: 10.1016/j.jsams.2013.10.250] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 10/15/2013] [Accepted: 10/24/2013] [Indexed: 11/26/2022]
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12
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Simons M, de Vet E, Chinapaw MJ, de Boer M, Seidell JC, Brug J. Personal, social, and game-related correlates of active and non-active gaming among dutch gaming adolescents: survey-based multivariable, multilevel logistic regression analyses. JMIR Serious Games 2014; 2:e4. [PMID: 25654657 PMCID: PMC4307820 DOI: 10.2196/games.3092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Playing video games contributes substantially to sedentary behavior in youth. A new generation of video games-active games-seems to be a promising alternative to sedentary games to promote physical activity and reduce sedentary behavior. At this time, little is known about correlates of active and non-active gaming among adolescents. OBJECTIVE The objective of this study was to examine potential personal, social, and game-related correlates of both active and non-active gaming in adolescents. METHODS A survey assessing game behavior and potential personal, social, and game-related correlates was conducted among adolescents (12-16 years, N=353) recruited via schools. Multivariable, multilevel logistic regression analyses, adjusted for demographics (age, sex and educational level of adolescents), were conducted to examine personal, social, and game-related correlates of active gaming ≥1 hour per week (h/wk) and non-active gaming >7 h/wk. RESULTS Active gaming ≥1 h/wk was significantly associated with a more positive attitude toward active gaming (OR 5.3, CI 2.4-11.8; P<.001), a less positive attitude toward non-active games (OR 0.30, CI 0.1-0.6; P=.002), a higher score on habit strength regarding gaming (OR 1.9, CI 1.2-3.2; P=.008) and having brothers/sisters (OR 6.7, CI 2.6-17.1; P<.001) and friends (OR 3.4, CI 1.4-8.4; P=.009) who spend more time on active gaming and a little bit lower score on game engagement (OR 0.95, CI 0.91-0.997; P=.04). Non-active gaming >7 h/wk was significantly associated with a more positive attitude toward non-active gaming (OR 2.6, CI 1.1-6.3; P=.035), a stronger habit regarding gaming (OR 3.0, CI 1.7-5.3; P<.001), having friends who spend more time on non-active gaming (OR 3.3, CI 1.46-7.53; P=.004), and a more positive image of a non-active gamer (OR 2, CI 1.07-3.75; P=.03). CONCLUSIONS Various factors were significantly associated with active gaming ≥1 h/wk and non-active gaming >7 h/wk. Active gaming is most strongly (negatively) associated with attitude with respect to non-active games, followed by observed active game behavior of brothers and sisters and attitude with respect to active gaming (positive associations). On the other hand, non-active gaming is most strongly associated with observed non-active game behavior of friends, habit strength regarding gaming and attitude toward non-active gaming (positive associations). Habit strength was a correlate of both active and non-active gaming, indicating that both types of gaming are habitual behaviors. Although these results should be interpreted with caution because of the limitations of the study, they do provide preliminary insights into potential correlates of active and non-active gaming that can be used for further research as well as preliminary direction for the development of effective intervention strategies for replacing non-active gaming by active gaming among adolescents.
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Affiliation(s)
- Monique Simons
- EMGO Institute for Health and Care Research, Department of Health Sciences, VU University Amsterdam, Amsterdam, Netherlands.
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Simons M, Chinapaw MJM, van de Bovenkamp M, de Boer MR, Seidell JC, Brug J, de Vet E. Active video games as a tool to prevent excessive weight gain in adolescents: rationale, design and methods of a randomized controlled trial. BMC Public Health 2014; 14:275. [PMID: 24661535 PMCID: PMC3987926 DOI: 10.1186/1471-2458-14-275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/13/2014] [Indexed: 11/29/2022] Open
Abstract
Background Excessive body weight, low physical activity and excessive sedentary time in youth are major public health concerns. A new generation of video games, the ones that require physical activity to play the games –i.e. active games- may be a promising alternative to traditional non-active games to promote physical activity and reduce sedentary behaviors in youth. The aim of this manuscript is to describe the design of a study evaluating the effects of a family oriented active game intervention, incorporating several motivational elements, on anthropometrics and health behaviors in adolescents. Methods/Design The study is a randomized controlled trial (RCT), with non-active gaming adolescents aged 12 – 16 years old randomly allocated to a ten month intervention (receiving active games, as well as an encouragement to play) or a waiting-list control group (receiving active games after the intervention period). Primary outcomes are adolescents’ measured BMI-SDS (SDS = adjusted for mean standard deviation score), waist circumference-SDS, hip circumference and sum of skinfolds. Secondary outcomes are adolescents’ self-reported time spent playing active and non-active games, other sedentary activities and consumption of sugar-sweetened beverages. In addition, a process evaluation is conducted, assessing the sustainability of the active games, enjoyment, perceived competence, perceived barriers for active game play, game context, injuries from active game play, activity replacement and intention to continue playing the active games. Discussion This is the first adequately powered RCT including normal weight adolescents, evaluating a reasonably long period of provision of and exposure to active games. Next, strong elements are the incorporating motivational elements for active game play and a comprehensive process evaluation. This trial will provide evidence regarding the potential contribution of active games in prevention of excessive weight gain in adolescents. Trial registration Dutch Trial register NTR3228.
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Affiliation(s)
- Monique Simons
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
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Kempf K, Martin S. Autonomous exercise game use improves metabolic control and quality of life in type 2 diabetes patients - a randomized controlled trial. BMC Endocr Disord 2013; 13:57. [PMID: 24321337 PMCID: PMC3880220 DOI: 10.1186/1472-6823-13-57] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 10/15/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Lifestyle intervention in type 2 diabetes mellitus (T2DM) is effective but needs a special local setting and is costly. Therefore, in a randomized-controlled trial we tested the hypothesis that the autonomous use of the interactive exercise game Wii Fit Plus over a period of 12 weeks improves metabolic control, with HbA1c reduction as the primary outcome, and weight loss, reduction of cardiometabolic risk factors, physical activity and quality of life (secondary outcomes) in T2DM patients. METHODS Participants (n = 220) were randomized into an intervention and a control group. The intervention group was provided with a Wii console, a balance board and the exercise game Wii Fit Plus for 12 weeks. The control group remained under routine care and received the items 12 weeks later. At baseline and after 12 weeks (and for the control group additionally after 12 weeks of intervention) the participants' health parameters, medication, physical activity and validated questionnaires for quality of life (PAID, SF12, WHO-5, CES-D) were requested and compared in a complete case analysis using the Mann-Whitney test and the Wilcoxon signed rank test. RESULTS 80% of participants completed the 12-week study. Patients in the intervention group significantly improved HbA1c (from 7.1 ± 1.3% to 6.8 ± 0.9%; -0.3 ± 1.1%; p = 0.0002) in comparison to the control group (from 6.8 ± 0.9% to 6.7 ± 0.7%; -0.1 ± 0.5%) and also significantly reduced fasting blood glucose (from 135.8 ± 38.9 mg/dl to 126.6 ± 36.6 mg/dl; p = 0.04), weight (from 97.6 ± 19.2 kg to 96.3 ± 18.7 kg; p < 0.001) and body mass index (from 34.1 ± 6.5 kg/m2 to 33.5 ± 6.5 kg/m2; p < 0.001). Daily physical activity increased significantly (p < 0.001). Diabetes-dependent impairment, mental health, subjective wellbeing and quality of life also improved significantly, and the number of patients with depression decreased. Similar improvements were seen in the control group after exercise game intervention. CONCLUSIONS In this trial a low-threshold intervention with the interactive exercise game Wii Fit Plus was able to motivate T2DM patients to improve physical activity, glucometabolic control and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT01735643.
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Affiliation(s)
- Kerstin Kempf
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Hohensandweg 37, 40591 Düsseldorf, Germany
| | - Stephan Martin
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Hohensandweg 37, 40591 Düsseldorf, Germany
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Baranowski T, Adamo K, Hingle M, Maddison R, Maloney A, Simons M, Staiano A. Gaming, Adiposity, and Obesogenic Behaviors Among Children. Games Health J 2013. [PMID: 26196724 DOI: 10.1089/g4h.2013.0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Tom Baranowski
- 1 Baylor College of Medicine , Houston, Texas; and Editor, Games for Health Journal: Research, Development, and Clinical Applications
| | - Kristi Adamo
- 2 Children's Hospital of Eastern Ontario Research Institute , Ottawa, Ontario, Canada
| | | | | | - Ann Maloney
- 5 University of Massachusetts , Worcester, Massachusetts
| | - Monique Simons
- 6 EMGO Institute for Health and Care Research , VU, Body@Work, Amsterdam, The Netherlands .,7 TNO , Leiden and Amsterdam, The Netherlands
| | - Amanda Staiano
- 8 Pennington Biomedical Research of the Louisiana State University , Baton Rouge, Louisiana
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Simons M, Baranowski J, Thompson D, Buday R, Abdelsamad D, Baranowski T. Child Goal Setting of Dietary and Physical Activity in a Serious Videogame. Games Health J 2013. [DOI: 10.1089/g4h.2013.0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Monique Simons
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
- Body@Work, Research Center Physical Activity, Work and Health, TNO-VU/VUmc, VU University Medical Center, Amsterdam, The Netherlands
- TNO, Expertise Centre Life Style, Leiden, The Netherlands
| | - Janice Baranowski
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | | | - Dina Abdelsamad
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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De Vet E, Simons M, Wesselman M. Dutch children and parents' views on active and non-active video gaming. Health Promot Int 2012. [DOI: 10.1093/heapro/das064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Simons M, Bernaards C, Slinger J. Active gaming in Dutch adolescents: a descriptive study. Int J Behav Nutr Phys Act 2012; 9:118. [PMID: 23031076 PMCID: PMC3493303 DOI: 10.1186/1479-5868-9-118] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 09/25/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adequate levels of physical activity are part of a healthy lifestyle and in this way linked to better health outcomes. For children and adolescents, the physical activity guideline recommends at least 60 minutes of moderate-to-vigorous physical activity every day. However, many adolescents are not physically active enough and they spend a lot of their time on sedentary activities (such as video games). A new generation of video games that require body movements to play them, so-called "active games", could serve to increase physical activity in adolescents. The activity level while playing these games is comparable to light-to-moderate intensity physical activity. The current study aims to increase our understanding of 1) the demographic characteristics of adolescents who play active games regularly (≥ 1 hour per week) and non-regularly (< 1 hour per week), 2) time spent on active games, 3) the contribution of active games to daily physical activity and 4) the type and amount of activities being replaced by active gaming. METHODS A cross-sectional survey was conducted in a Dutch internet panel, questioning adolescents in conjunction with one of their parents. A random sample of 320 households (with stratification on gender of the parent and the adolescent, the age of the adolescent and the region of the household) was selected that owned a console or application for active video games and that had a child aged 12 through 16 years. 201 child-parent couples (63% response) completed an internet survey with questions about demographics, physical activity and sedentary behaviour, and gaming behaviour. The questionnaire also contained questions designed to assess whether and how active gaming replaces other activities. Besides descriptive analyses, independent t-test, Pearson's chi-square and Mann-Whitney test (when data were not normally distributed) were used for comparisons between regular and non-regular active gamers. RESULTS Eleven percent of the adolescents with an active game in their household never used the game. There were no significant differences in gender, education level (of adolescent and parent), ethnicity and sedentary behaviour between regular (n = 65) and non-regular active gamers (n = 114). Adolescents' (regular and non-regular active gamers) meantime spent on active gaming was 80 (± 136) minutes a week; this potentially amounts to 11% of total physical activity. When time spent on active gaming was included in the calculation of the percentage of adolescents that met the physical activity guideline, the percentage increased significantly (p < 0.05) from 67 to 73%. According to the adolescents, active gaming mainly replaces sedentary screen time such as TV viewing, internet and non-active gaming. Parental opinions concurred with this appraisal. CONCLUSIONS The results of this study confirm the idea that active gaming may contribute to an active lifestyle in adolescents, primarily because it potentially contributes substantially to time spent on physical activity. Secondly, active gamers indicate that they spent time on active games which they would have spent otherwise on less active activities.
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Affiliation(s)
- Monique Simons
- Body@Work, Research Center Physical Activity, Work and Health, TNO- VU/VUmc, VU University Medical Center, Amsterdam, Netherlands
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
- TNO, Expertise Center Life Style, Leiden, Netherlands
| | - Claire Bernaards
- Body@Work, Research Center Physical Activity, Work and Health, TNO- VU/VUmc, VU University Medical Center, Amsterdam, Netherlands
- TNO, Expertise Center Life Style, Leiden, Netherlands
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