Improving Psychosocial Well-Being of Older Adults Through Exergaming: The Moderation Effects of Intergenerational Communication and Age Cohorts

Facing the Next "Geriatric Giant"-A Systematic Literature Review and Meta-Analysis of Interventions Tackling Loneliness and Social Isolation Among Older Adults

OBJECTIVES

Loneliness and social isolation are associated with adverse health outcomes, especially within the older adult population, underlining the need for effective interventions. This systematic review and meta-analysis aims to summarize all available evidence regarding the effectiveness of interventions for loneliness and social isolation, to map out their working mechanisms, and to give implications for policy and practice.

DESIGN

Systematic literature review and meta-analysis.

SETTING AND PARTICIPANTS

Older adults (≥65 years).

METHODS

A systematic search was conducted in MEDLINE, PsycINFO, and CINAHL for studies quantitively or qualitatively assessing effects of interventions for loneliness and social isolation in older adults, following predefined selection criteria. Risk of bias as well as small study effects were assessed and, wherever appropriate, information about effect sizes of individual studies pooled using random-effects meta-analyses. Sources for between-study heterogeneity were explored using meta-regression.

RESULTS

Of n = 2223 identified articles, n = 67 were eventually included for narrative synthesis. Significant intervention effects were reported for a proportion of studies (55.9% and 50.0% for loneliness and social isolation, respectively) and 57.6% of studies including a follow-up measure (n = 29) reported sustained intervention effects. Meta-analysis of n = 27 studies, representing n = 1756 participants, suggested a medium overall effect of loneliness interventions (d = -0.47; 95% CI, -0.62 to -0.32). Between-study heterogeneity was substantial and could not be explained by differences in study design, year of publication, outcome measures, intervention length, participant demographics, setting, baseline level of loneliness, or geographic location. However, non-technology-based interventions reported larger effect sizes on average (Δd = -0.35; 95% CI, -0.66 to -0.04; P = .029) and were more often significant. Qualitative assessment of potential intervention mechanisms resulted in 3 clusters of effective components: "promoting social contact," "transferring knowledge and skills," and "addressing social cognition".

CONCLUSIONS AND IMPLICATIONS

Interventions for loneliness and social isolation can generally be effective, although some unexplained between-study heterogeneity remains. Further research is needed regarding the applicability of interventions across different settings and countries, also considering their cost-effectiveness.

Effect of group play therapy as holistic geriatric interventional modality on feelings of loneliness among older people: A randomized control trial

AIM

Previous research has identified loneliness as a significant social stressor among the older adult population, and highlights the scarcity of empirical research on the efficacy of group play therapy as a method for addressing loneliness in this demographic. This study aimed to explore the impact of group play therapy on reducing feelings of loneliness among older individuals.

METHODS

A randomized clinical trial was carried out in 2018 on 60 older adult participants from two governmental health centers in Mashhad, Iran. The intervention group received adult-centered play therapy for 12 sessions over 6 weeks, with each session lasting 60 min. The therapy protocol combined traditional and modern games, structured into three stages: warm-up, working and closing. The University of California, Los Angeles (UCLA) scale was used to measure feelings of loneliness at baseline and after the intervention. Data analysis was carried out using SPSS version 21.

RESULTS

There was a significant decrease in feelings of loneliness in the intervention group compared with the control group (P < 0.001). Additionally, a significant difference in feelings of loneliness was observed within the intervention group between baseline and follow up (P < 0.001).

CONCLUSIONS

Group play therapy, involving a combination of traditional and modern games, can reduce feelings of loneliness among older adults. This method can promote healthy aging and improve mental health issues, such as loneliness, among older people. These findings can be utilized in healthcare centers and nursing homes for older adults. Geriatr Gerontol Int 2024; ••: ••-••.

Interventions for loneliness in older adults: a systematic review of reviews

Loneliness in older persons is a major risk factor for adverse health outcomes. Before the COVID-19 pandemic led to unprecedented isolation and hampered programs aimed at preventing or reducing loneliness, many interventions were developed and evaluated. However, previous reviews provide limited or conflicting summaries of intervention effectiveness. This systematic review aimed to assess previous review quality and bias, as well as to summarize key findings into an overarching narrative on intervention efficacy. The authors searched nine electronic databases and indices to identify systematic reviews of interventions to reduce loneliness in older people prior to the COVID-19 pandemic; 6,925 records were found initially. Of these, 19 reviews met inclusion criteria; these encompassed 101 unique primary intervention studies that varied in research design, sample size, intervention setting, and measures of loneliness across 21 nations. While 42% of reviews had minimal risk of bias, only 8% of primary studies appraised similarly. Among the 101 unique articles reviewed, 63% of tested interventions were deemed by article author(s) as effective or partially effective. Generally, interventions that included animals, psychological therapies, and skill-building activities were more successful than interventions focused on social facilitation or health promotion. However, interventions that targeted multiple objectives aimed at reducing loneliness (e.g., improving social skills, enhancing social support, increasing social opportunities, and changing maladaptive social cognition) were more effective than single-objective interventions. Future programs should incorporate multiple approaches, and these interventions should be rigorously tested.

OLDER ADULTS' SUBJECTIVE WELL-BEING EXPERIENCING THE EXERGAME "I AM DOLPHIN"

The objective of this study was to understand older adults' perceptions of the connections between an exergame intervention, "I Am Dolphin," and their subjective well-being. Researchers conducted three focus groups with 14 older adults who participated in the exergame feasibility study. The semi-structured focus groups were transcribed, coded, and analysed using deductive and inductive techniques. Three themes were constructed related to playing the exergame and participants' subjective well-being: 1) elevated mood (through scheduled activity, immersion, and socialization), 2) feelings of achievement (especially following frustration and competition), and 3) perceived cognitive or physical changes. These findings will help researchers better understand how exergames may relate to the well-being of older adults. Future investigators could use these findings to create and implement new exergame interventions.

Virtual reality-based exercise interventions on quality of life, some balance factors and depression in older adults: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The objective of this study was to investigate the impact of virtual reality-based exercise on the quality of life, some balance variables, and depression among older adults aged 60 years or older.

METHOD

We systematically searched five electronic databases.

RESULTS

Twenty-seven articles met our inclusion criteria. Meta-analysis revealed that exercise using virtual reality had a significant positive effect on overall quality of life (p = 0.05), mental (p = 0.001) and physical component scores (p = 0.01), social relation (p = 0.0002), psychological health(p = 0.01), physical health(p = 0.04), and environmental health (p = 0.04). Additionally, depression significantly improved following virtual reality-based exercise (p = 0.01). However, there were significant improvements in the balance berg scale (p<0.00001) and ABC scale (p<0.00001) but not in timed-up-and-go(TUG) or 8-foot-up-and-go(8-FUG).

DISCUSSION

Virtual reality-based exercise has a positive impact on various aspects of quality of life, BBS and ABC scores, and depression. More studies with larger sample sizes and less heterogeneity in design and assessments are required.

The effectiveness of digital gaming on the functioning and activity of older people living in long-term care facilities: a systematic review and meta-analysis

BACKGROUND

The population is aging globally. Older people living in long-term care facilities have many functional impairments, such as mobility problems and depression. Digital games and so-called exergames can offer a motivating and entertaining way to maintain older people's physical activity and thus their ability to function. However, previous studies have reported conflicting results about the effects of digital gaming and have focused on community-dwelling older people.

OBJECTIVE

To identify, critically appraise, and synthesize evidence about the effectiveness of digital games on older people's physical, psychological, and social functioning and physical and social activity in long-term care facilities.

METHODS

Five databases were systematically searched, and relevant studies were screened. Fifteen randomized-controlled trials and quasi-experimental studies (total N = 674) were included in meta-analysis.

RESULTS

All digital games used in interventions were exergames. Meta-analysis showed that exergame interventions have a statistically significant large effect on physical functioning [number of studies (N) = 6, standardized mean difference (SMD) = 0.97, p = 0.001] measured by Timed Up and Go or Short Physical Performance Battery and self-assessed physical activity (N = 3, SMD = 1.20, p < 0.001) and medium effect on social functioning (N = 5, SMD = 0.74, p = 0.016) compared to alternative intervention or no intervention. Social activity was not measured in any study.

CONCLUSIONS

The results are encouraging that exergames effectively increase the functioning and activity of older adults living in long-term facilities. Successful implementation of such activities requires the competence of nursing staff and rehabilitation professionals in digitalization.

"I can't escape!": Avoidantly attached individuals' conflict resolution and relationship satisfaction before and during the COVID-19 lockdown

Increased time spent together and the lockdown resulting from the COVID-19 pandemic may have created new scenarios for marital conflict. We analyzed how home confinement affects avoidantly attached individuals': (a) resolution strategies to cope with couple conflict, (b) perception of partner's resolution strategies, and (c) overall relationship satisfaction. The sample comprised 549 individuals, divided into two subsamples: (a) the confined group, individuals confined with their partners (n = 275); and (b) the comparison group, coupled individuals from a dataset collected before the pandemic (n = 274). Results indicate that the proposed model works in different contexts (non-confinement and confinement situations), but there are some significant differences in the magnitude of some of the relationships between the variables, being stronger in the confinement group than in the comparison group. In the confined group, in individuals with avoidant attachment, withdrawal was associated with lower relationship satisfaction and a higher demand partner perceived to a higher extent than in the comparison group. This might explain the lower satisfaction with the relationship of the confined group. The different conflict resolution strategies of the couple mediated between avoidant attachment and relationship satisfaction in both groups (confined and comparison). It is concluded that individuals' attachment orientation is a key factor in how individuals experienced their close relationships during the confinement.

Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources

BACKGROUND

Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community.

OBJECTIVE

This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults.

METHODS

A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources.

RESULTS

The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services.

CONCLUSIONS

A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources.

The association between information and communication technologies, loneliness and social connectedness: A scoping review

Older adults are at a higher risk of loneliness, compared to other demographics. The use of Internet Communication and Technologies (ICTs) among older adults is steadily increasing and given ICTs provide a means of enhancing social connectedness suggests they may have positive effects on reducing loneliness. Therefore, the aim of this scoping review was to examine the research that explores how ICTs may be implicated in mitigating loneliness and increasing social connectedness among older adults. After the examination of 54 articles, we identified three major themes within the literature: (1) ICTs were associated with a reduction in loneliness and increase in wellbeing. (2) ICTs promoted social connectedness by facilitating conversations. (3) Factors such as training, self-efficacy, self-esteem, autonomy, and the design/features, or affordances, of ICTs contribute toward the associations between ICT use and wellbeing. The heterogeneity of methodologies, statistical reporting, the small sample sizes of interventional and observational studies, and the diversity of the experimental contexts underline the challenges of quantitative research in this field and highlights the necessity of tailoring ICT interventions to the needs and contexts of the older users.

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.

Do healthy habits regulate the relationship between psychosocial dysfunction by COVID-19 and bidimensional mental health?

COVID-19 has affected mental health and well-being. Lifestyles are relevant to understand the impact of psychosocial dysfunctions. The objective was to examine the role of healthy habits in the relations between psychosocial dysfunction and psychological well-being/distress during COVID-19. Participants completed measures of psychosocial dysfunction, healthy habits, life satisfaction, well-being, depression, and anxiety symptoms. Psychosocial dysfunction was associated with distress symptoms, while health habits were associated with well-being. Healthy habits were mediators: greater psychosocial dysfunction was associated with less healthy habits, which in turn were associated with lower overall well-being, and greater depression. Programs addressing healthy habits can be of great utility.

Impact of Exergames on the Mental Health of Older Adults: A Systematic Review and GRADE Evidence Synthesis

Exergames, which combine digital games and physical exercise, have become a popular alternative to traditional exercise programs and are increasingly used in the health domains. This study aimed to provide a systematic review to synthesize existing studies on the use of exergames for the mental wellbeing of healthy older adults, aggregating the collected data to identify effect size. We performed a Systematic Review and Grading of Recommendations, Assessment, Development, and Assessment (GRADE) evidence synthesis. We performed the search in the following databases: MEDLINE®, CINAHL®, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, and Cochrane® Central Register of Controlled Trials from the first record until October 2021. Randomized controlled trials using exergames as an intervention were included. A total of 10 articles published between 2009 and 2021 were selected. Most studies used the Nintendo Wii® as the exergame in the intervention program. Interventions ranged from 6 to 12 weeks, with 8-week programs being most frequent. It was possible to observe a positive effect on mood, the reduction of apathy, anxiety and depression, self-esteem, and affection.

Comparison of long-term effects of exergaming (Xbox one kinet) and companionship programs on attitude towards dementia and the older adults among adolescents: a quasi-experimental longitudinal study

Background

Many studies have been performed on the use of intergenerational programs to improve the negative attitudes and misunderstandings of adolescents toward older people with dementia. However, the findings of these studies are inconclusive. The aim of this study was to compare the long-term effects of exergaming (Kinect) and companionship programs on attitudes toward dementia and the elderly among adolescents.

Methods

A quasi-experimental longitudinal design was used. A total of 200 adolescents aged 12–18 years old were recruited from nine schools in northern Taiwan. The adolescents were assigned to five different groups, namely, a 5-week exergaming group, a 5-week companion group, an 8-week exergaming group, an 8-week companion group, and a control group, using a single blinding procedure. Data collection was performed pretest, post-test and at 1, 3 and 6 months after the post-test. The long-term effects of the two programs (i.e., exergaming and companionship) were analyzed using a generalized estimating equation.

Results

Regarding attitudes toward dementia, the 8-week exergaming group had a significantly better attitude than the control group at the 6-month follow-up (p < 0.001). Similarly, the results of the 8-week companion group also showed a significantly improved attitude compared with the control group at the 6-month follow-up (p = 0.041). Regarding attitudes toward the elderly, the 8-week exergaming group had a significantly better attitude than the control group at the 6-month follow-up (p < 0.001). The 8-week companion group had a similar effect on better attitude compared with the control group at the 6-month follow-up (p = 0.016). Furthermore, the 5-week companion group showed a significant improvement compared with the control group at the 6-month follow-up (p = 0.004).

Conclusions

Spending companionship time with older adults is beneficial for improving the attitudes of adolescents toward the elderly. Furthermore, exergaming improves the attitudes of adolescents toward both dementia and older adults.

Trial registration

Chinese Clinical Trial Registry: ChiCTR2100053003. Retrospectively registered on 07/11/2021.

A systematic review of the impacts of intergenerational engagement on older adults' cognitive, social, and health outcomes

BACKGROUND

Intergenerational engagement could benefit health and wellbeing within an ageing population. This systematic review evaluated the impacts of intergenerational engagement on cognitive, social, and health outcomes in healthy older adults and older adults with mild cognitive impairment.

RESEARCH DESIGN AND METHODS

Comprehensive literature searches were undertaken, with records filtered according to pre-registered criteria. Study quality was formally assessed, and a narrative synthesis of the findings produced.

RESULTS

Forty-four studies were reviewed. Regarding quantitative evidence, 4 out of 8 studies found significant intergenerational engagement effects on cognitive outcomes, 15 of 24 on social outcomes, and 21 of 31 on health-related outcomes. Qualitative evidence was also important for understanding perceived impacts and experiences of intergenerational programmes. Only 11 studies fully met criteria for high quality research, of which the majority focused on social outcomes.

DISCUSSION AND IMPLICATIONS

There are a range of potential benefits of intergenerational engagement, most notably regarding anxiety, generativity, cross-age attitudes, and physical activity. However, heterogeneity in programme context, sample design, dosage, and duration indicate that more research is required to enable wider implementation and generalisability. Scientific rigour in both quantitative and qualitative research should also be employed as far as possible, to provide the highest quality evidence.

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.

Interventions to reduce social isolation and loneliness during COVID-19 physical distancing measures: A rapid systematic review

BACKGROUND

A significant proportion of the worldwide population is at risk of social isolation and loneliness as a result of the COVID-19 pandemic. We aimed to identify effective interventions to reduce social isolation and loneliness that are compatible with COVID-19 shielding and social distancing measures.

METHODS AND FINDINGS

In this rapid systematic review, we searched six electronic databases (Medline, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews and SCOPUS) from inception to April 2020 for systematic reviews appraising interventions for loneliness and/or social isolation. Primary studies from those reviews were eligible if they included: 1) participants in a non-hospital setting; 2) interventions to reduce social isolation and/or loneliness that would be feasible during COVID-19 shielding measures; 3) a relevant control group; and 4) quantitative measures of social isolation, social support or loneliness. At least two authors independently screened studies, extracted data, and assessed risk of bias using the Downs and Black checklist. Study registration: PROSPERO CRD42020178654. We identified 45 RCTs and 13 non-randomised controlled trials; none were conducted during the COVID-19 pandemic. The nature, type, and potential effectiveness of interventions varied greatly. Effective interventions for loneliness include psychological therapies such as mindfulness, lessons on friendship, robotic pets, and social facilitation software. Few interventions improved social isolation. Overall, 37 of 58 studies were of "Fair" quality, as measured by the Downs & Black checklist. The main study limitations identified were the inclusion of studies of variable quality; the applicability of our findings to the entire population; and the current poor understanding of the types of loneliness and isolation experienced by different groups affected by the COVID-19 pandemic.

CONCLUSIONS

Many effective interventions involved cognitive or educational components, or facilitated communication between peers. These interventions may require minor modifications to align with COVID-19 shielding/social distancing measures. Future high-quality randomised controlled trials conducted under shielding/social distancing constraints are urgently needed.

Exergaming as a Community Program for Older Adults: The Effects of Social Interaction and Competitive Information

This study examined how different types of social interaction and competitive information in exergaming affect older adults' motivation and attitude toward playing exergames. A 2 (time: pre- vs. posttest) × 3 (social interaction: play alone vs. play with peer vs. play with youth) × 2 (competition: competition informed vs. noncompetition informed) mixed experiment was conducted with 319 Singaporean older adults over 6 weeks through a three-way analysis of variance. Social interaction was found to significantly affect the changes of extrinsic motivation over time, while competitive information affected intrinsic motivation significantly. The results showed significant three-way interaction effects between time, social interaction, and competitive information on older adults' extrinsic and intrinsic motivations. The changes of attitude over time were not affected by either social interaction or competitive information. The findings contribute to aging research and advance the knowledge of potential factors that promote the effective implementation of exergames for community older adults.

Staying Physically Active During the Quarantine and Self-Isolation Period for Controlling and Mitigating the COVID-19 Pandemic: A Systematic Overview of the Literature

The COVID-19 pandemic has created an unprecedented worldwide public health concern. Characterized by rapid and high frequency human-to-human transmission, the World Health Organization has recommended implementation of public health measures, including isolation of all suspected infectious individuals for a 14-day quarantine period, while governments have introduced "social distancing" and "lock-downs" of varying severity to curtail COVID-19 spread. Recent COVID-19 research further suggests there are major sleep problems and psychological disorders (e.g., stress, anxiety, depression) associated with the reduction of movement and activities, as well as the reduced social interaction. There have been no studies examining the effect of physical activity at home during such periods of isolation. However, based on previous research, potential tactics to overcome these negative effects include home-based exercise, exergaming, dancing to music, and participation in yoga. Adults should accumulate at least 150 min of moderate-intensity and at least 75 min of vigorous-intensity of activity divided in to 5-7 sessions per week. This training volume could be reduced by 30% for children and adolescents if replaced by recess or active play in and around the home. Additionally, exercises should be adapted to the fitness level of the participant and a progressive model of intensity and training volume should be utilized, preferably monitored by telephone applications and wearable sensors.

Effects of 4 Weeks of Active Exergames Training on Muscular Fitness in Elderly Women

Gallardo-Meza, C, Simon, K, Bustamante-Ara, N, Ramirez-Campillo, R, García-Pinillos, F, Keogh, JWL, and Izquierdo, M. Effects of 4 weeks of active exergames training on muscular fitness in elderly women. J Strength Cond Res XX(X): 000-000, 2020-To analyze the effects of 4 weeks of an active exergames training program on muscular fitness in older women, 2 groups of community dwelling physically active subjects were formed by block-design randomization. One was deemed the control group (CG, n = 37; age 68.1 ± 3.3 years), and a second group completed 4 weeks of an active exergames training program (ExG, n = 35; age, 69.2 ± 3.7 years). Training included active exergames (Wii Fit Plus) performed on the Wii Balanceboard, 2 sessions per week. The exergames required mainly balance-related movements, such as leaning forward, leftward, and rightward, also requiring isometric squat positions and explosive leg extension. A supervisor-to-subject ratio method of 2:1 was used. An intensity-based individual progressive overload was applied. There were no significant (all p > 0.05, d = 0.01-0.07) baseline differences between-groups for all dependent variables. For the ExG, significant improvements were observed in static balance right leg test (Δ75.5%, d = 0.89), static balance left leg (Δ33.7%, d = 0.57), timed up-and-go test (Δ14.8%, d = 0.85) and sit-to-stand velocity test (Δ83.8%, d = 1.62). For the control group, trivial to small decrements in performance were observed across all tests (Δ -2.1 to -8.4%, d = -0.08 to 0.32). Group × time interactions were observed for the static balance right and left leg, timed up-and-go test, and the mean velocity achieved in the 5-repetition sit-to-stand test (all p < 0.001; d = 0.33-0.60). In conclusion, exergames training improves muscular fitness in older women. These results should be considered when designing appropriate and better exercise training programs for older women.

Exergames as Coping Strategies for Anxiety Disorders During the COVID-19 Quarantine Period

The COVID-19 outbreak has led to wide-scale self-isolation, as a result of the quarantine period recommended by the World Health Organization. Consequently, people's mental health, including their anxiety levels, may be becoming impaired. To cope with the situation, the exergame appears to be an enjoyable easy-to-use tool for reducing social isolation, as well as an interesting mode of home-based exercise for tackling anxiety disorders and sedentary behavior. This article critically appraises the opportunities and challenges exergames present for the prevention and treatment of anxiety disorders in a home-based environment during the COVID-19 quarantine period.

The effects of exergames on anxiety levels: A systematic review and meta-analysis

There are currently many different approaches to performing exergames and there is still no consensus as to whether exergames are able to reduce anxiety levels, as well as whether exergames provide greater reductions on anxiety levels when added to traditional forms of clinical interventions. Therefore, the aim of the present systematic review and meta-analysis was to access data from studies that evaluated the effects of exergames on anxiety levels in humans. PubMed, Scopus and Cochrane databases were searched up to 22 February 2019. Inclusion criteria were acute and chronic (short-term and long-term interventions) studies which evaluated the effects of exergames in anxiety levels as primary or secondary aim. Of the 1342 studies found, 17 and 10 were included in qualitative analyses and meta-analyses, respectively. The within-group analysis found that exergames (standardized mean difference [SMD]: -0.57 [95% Confidence interval (CI): -0.86 to -0.28], P < .001) and usual care (SMD: -0.21 [95% CI: -0.34 to -0.08], P = .002) resulted in significant improvements on anxiety levels. However, the between-group meta-analysis on the effects of control interventions vs exergames (SMD: 0.02 [95% CI: -0.55 to 0.60], P = .939) found no significant difference between groups in anxiety levels reductions. There was also no significant difference (SMD: -0.04 [95% CI: -0.32 to 0.25], P = .805) between usual care vs exergames plus usual care interventions in anxiety levels reductions. Although exergames demonstrated within-group improvements in anxiety levels across different clinical populations, it was not greater than the effects from non-exercise interventions. Also, given the paucity of studies, small sample sizes, different research designs, and different population investigated, the existing evidence is insufficient to support the advantages of usual care supplemented by exergame intervention over usual care standalone in anxiety levels reduction.

Affective Game Planning for Health Applications: Quantitative Extension of Gerontoludic Design Based on the Appraisal Theory of Stress and Coping

User retention is the first challenge in introducing any information and communication technologies (ICT) for health applications, particularly for seniors who are increasingly targeted as beneficiaries of such technologies. Interaction with digital technologies may be too stressful to older adults to guarantee their adoption in their routine selfcare. The second challenge, which also relates to adoption, is to supply empirical evidence that support the expectations of their beneficial outcomes. To address the first challenge, persuasive technologies such as serious games (SGs) are increasingly promoted as ludic approaches to deliver assistive care to older adults. However, there are no standards yet to assess the efficacy of different genres of games across populations, or compare and contrast variations in health outcomes arising from user interface design and user experience. For the past 3 decades, research has focused either on qualitative assessment of the appeal of digital games for seniors (by game designers) or on the quantitative evaluation of their clinical efficacy (by clinical researchers). The consensus is that interindividual differences play a key role in whether games can be useful or not for different individuals. Our challenge is to design SGs that retain their users long enough to sustain beneficial transfer effects. We propose to add a neuropsychological experimental framework (based on the appraisal theory of stress and coping) to a Gerontoludic design framework (that emphasizes designing positive and meaningful gaming experience over benefit-centric ones) in order to capture data to guide SG game development. Affective Game Planning for Health Applications (AGPHA) adds a model-driven mixed-methods experimental stage to a user-centered mechanics-dynamics-aesthetics game-design cycle. This intersectoral framework is inspired by latest trends in the fields of neuroimaging and neuroinformatics that grapple with similar challenges related to the psychobiological context of an individual's behaviors. AGPHA aims to bring users, designers, clinicians, and researchers together to generate a common data repository that consists of 4 components to define, design, evaluate, and document SGs. By unifying efforts under a standard approach, we will accelerate innovations in persuasive and efficacious ICTs for the aging population.

To Each Stress Its Own Screen: A Cross-Sectional Survey of the Patterns of Stress and Various Screen Uses in Relation to Self-Admitted Screen Addiction

BACKGROUND

The relationship between stress and screen addiction is often studied by exploring a single aspect of screen-related behavior in terms of maladaptive dependency or the risks associated with the content. Generally, little attention is given to the pattern of using different screens for different types of stressors, and variations arising from the subjective perception of stress and screen addiction are often neglected. Given that both addiction and stress are complex and multidimensional factors, we performed a multivariate analysis of the link between individual's subjective perceptions of screen addiction, various types of stress, and the pattern of screen usage.

OBJECTIVE

Using the media-repertoires framework to study usage patterns, we explored (1) the relation between subjective and quantitative assessments of stress and screen addiction; and (2) differences in stress types in relation to subjective screen addiction and different types of needs for screens. We hypothesized that interindividual heterogeneity in screen-related behavior would reflect coping differences in dealing with different stressors.

METHODS

A multifactorial Web-based survey was conducted to gather data about screen-related behaviors (such as screen time, internet addiction, and salience of different types of screens and related activities), and different sources of stress (emotional states, perceptual risks, health problems, and general life domain satisfaction). We performed group comparisons based on whether participants reported themselves as addicted to internet and games (A1) or not (A0), and whether they had experienced a major life stress (S1) or not (S0).

RESULTS

Complete responses were obtained in 459 out of 654 survey responders, with the majority in the S1A0 (44.6%, 205/459) group, followed by S0A0 (25.9%, 119/459), S1A1 (19.8%, 91/459), and S0A1 (9.5%, 44/459). The S1A1 group was significantly different from S0A0 in all types of stress, internet overuse, and screen time (P<.001). Groups did not differ in rating screens important for short message service (SMS) or mail, searching information, shopping, and following the news, but a greater majority of A1 depended on screens for entertainment (χ²₃=20.5; P<.001), gaming (χ²₃=35.6; P<.001), and social networking (χ²₃=26.5; P<.001). Those who depended on screens for entertainment and social networking had up to 19% more emotional stress and up to 14% more perceptual stress. In contrast, those who relied on screens for work and professional networking had up to 10% higher levels of life satisfaction. Regression models including age, gender, and 4 stress types explained less than 30% of variation in internet use and less than 24% of the likelihood of being screen addicted.

CONCLUSIONS

We showed a robust but heterogeneous link between screen dependency and emotional and perceptual stressors that shift the pattern of screen usage toward entertainment and social networking. Our findings underline the potential of using ludic and interactive apps for intervention against stress.

The Social Effects of Exergames on Older Adults: Systematic Review and Metric Analysis

Background

Recently, many studies have been conducted to investigate the effects of exergames on the social well-being of older adults.

Objective

The aim of this paper is to synthesize existing studies and provide an overall picture on the social effects of exergames on older adults.

Methods

A comprehensive literature search with inclusive criteria was conducted in major social science bibliographic databases. The characteristics of exergames, participants, methodology, as well as outcome measurements were extracted from the relevant studies included in the review. The bibliometric and altmetric outreach of the included studies were also investigated.

Results

A total of 10 studies were included in the review, with 8 studies having used the Nintendo Wii platform. Most of the studies recruited healthy older adults from local communities or senior activity centers. Three groups of social-related outcomes have been identified, including emotion-related, behavior-related, and attitude-related outcomes. A metric analysis has shown that the emotion-related and behavior-related outcomes received high attention from both the academic community and social media platforms.

Conclusions

Overall, the majority of exergame studies demonstrated promising results for enhanced social well-being, such as reduction of loneliness, increased social connection, and positive attitudes towards others. The paper also provided implications for health care researchers and exergame designers.

Exergames Designed for Older Adults: A Pilot Evaluation on Psychosocial Well-Being

OBJECTIVE

Exergames are increasingly been used in the primary healthcare domain for older adults who are 65 years and above. However, most of the exergames on current market are not designed for the aging population. The current study introduced five new exergames developed for elderly and evaluated their benefits.

METHODS

Five new exergames were developed by researchers from Finland, Singapore, and Japan, in which the game topics, difficulties, and user interface were designed particularly for older adults. A between-group pilot study was further conducted to evaluate their psychosocial effects by comparing to traditional exercise and care-as-usual program, with a sample of 30 community-dwelling older adults in Singapore.

RESULTS

Results showed that exergame group had significantly higher exercise enjoyment over other two groups. Exergame group has lower self-efficacy than other two groups, although it was not statistically significant. Significant subgroup difference was detected in neither life satisfaction nor loneliness across the three groups.

CONCLUSION

The study highlighted the effect of fun and entertainment elements on the psychosocial effect of exergames and called for simpler interactive systems and easier exergame tasks for the older adults.

Benefits and Factors Influencing the Design of Intergenerational Digital Games: A Systematic Literature Review

The main purpose of this paper is to review the benefits and factors to be taken into consideration for the design of intergenerational digital games. We conducted a systematic in Scopus, Web of Science, PsicInfo, Pubmed and Science Direct, finally including 16 empirical studies written in English. The identified benefits were found to fall into four main categories, i.e., (1) reinforcing family bond, (2) enhancing reciprocal learning (3) increasing understanding of the other generation and (4) reducing social anxiety. According to the literature, two types of factors are important to take into consideration: player-centric and game-centric factors. We identified the nature of the interactions between older (55–81 year-olds) and younger players (4–22 year-olds), their motivations to play digital games and the difference in abilities as the main player-centric factors to take into account when designing intergenerational games. The most relevant game-centric factors were found to be goal-related and space-related forms of interaction. To gain more insight into how specific benefits of playing digital games are related to a type of game, gender or age of the participant, additional empirical studies (comparative analyses), that take these factors into account are needed.