A Game-Based, Physical Activity Coaching Application for Older Adults: Design Approach and User Experience in Daily Life

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Meaningful learning: motivations of older adults in serious games

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

The use of co-design in developing physical activity interventions for older adults: a scoping review

BACKGROUND

Promoting physical activity (PA) participation in older adults is important for preserving quality of life and functional independence. Co-design has been shown to increase engagement of end-users in health-related policies and interventions. This scoping review aimed to examine how co-design has been used to develop PA interventions for older adults.

METHODS

We searched MEDLINE, EMBASE, AMED, and CINAHL. Peer-reviewed primary research studies that met the following criteria were included: had at least one participant aged ≥60 years involved in the co-design process and the intervention was delivered to individuals whose mean age was ≥60, used co-design methodologies, and any form of PA. After duplicate removal, two or more independent reviewers completed title and abstract and full text screening. Data were extracted from the included studies according to study aims.

RESULTS

Of the 29 included studies, 12 different terms were used to describe co-design with variable operational definitions that we consolidated into five proposed components. Fifteen studies engaged users in a consultative way, 13 studies using collaboration, and one study engaged end-users in consumer-control. No studies involved end-users in the dissemination phase. Further, no studies directly measured the effectiveness of the co-design process. Five categories of barriers and facilitators to co-design were identified including frameworks and methodologies, logistics, relationships, participation, and generalizability.

CONCLUSIONS

There is a large degree of variability in how co-design is used to develop PA interventions for older adults. Our findings can be used by researchers to improve rigor and standardization in this emerging field.

TRIAL REGISTRATION

osf.io/vsw2m.

Designing Personalized Persuasive Game Elements for Older Adults in Health Apps

The use of gamification elements in health apps has been shown to promote healthy behaviors. However, one-size-fits-all gamification strategy does not have the best persuasive effect. Therefore, the aim of this paper was to determine how to select personalized game elements for older adults and use them in health education app design. Firstly, based on the DMC model, the Kano model was used to identify the demand attributes of game mechanisms, and three gamification mechanisms (winning, feedback and reward) preferred by the elderly were selected. Secondly, the corresponding gamification elements were selected by the focus group method, and nine virtual products were generated. Thirdly, the virtual products were rated and conjointly analyzed to obtain the relative importance of gamification mechanisms and the utility values of gamification elements, and a comparative analysis was conducted on four characteristics of older adults: age, gender, personal income, and education. The results obtained the best combination of gamification elements chosen by the elderly under different classifications. Finally, design guidelines on persuasive gamification elements were developed based on the characteristics of older adults, and a modified gamification model was proposed. The results of this study provide suggestions and guidelines for the design of persuasive gamification in health education apps, which will help improve the satisfaction of older adults with health apps.

Measurement of Adherence to mHealth Physical Activity Interventions and Exploration of the Factors That Affect the Adherence: Scoping Review and Proposed Framework

BACKGROUND

Mobile health (mHealth) is widely used as an innovative approach to delivering physical activity (PA) programs. Users' adherence to mHealth programs is important to ensure the effectiveness of mHealth-based programs.

OBJECTIVE

Our primary aim was to review the literature on the methods used to assess adherence, factors that could affect users' adherence, and the investigation of the association between adherence and health outcomes. Our secondary aim was to develop a framework to understand the role of adherence in influencing the effectiveness of mHealth PA programs.

METHODS

MEDLINE, PsycINFO, EMBASE, and CINAHL databases were searched to identify studies that evaluated the use of mHealth to promote PA in adults aged ≥18 years. We used critical interpretive synthesis methods to summarize the data collected.

RESULTS

In total, 54 papers were included in this review. We identified 31 specific adherence measurement methods, which were summarized into 8 indicators; these indicators were mapped to 4 dimensions: length, breadth, depth, and interaction. Users' characteristics (5 factors), technology-related factors (12 factors), and contextual factors (1 factor) were reported to have impacts on adherence. The included studies reveal that adherence is significantly associated with intervention outcomes, including health behaviors, psychological indicators, and clinical indicators. A framework was developed based on these review findings.

CONCLUSIONS

This study developed an adherence framework linking together the adherence predictors, comprehensive adherence assessment, and clinical effectiveness. This framework could provide evidence for measuring adherence comprehensively and guide further studies on adherence to mHealth-based PA interventions. Future research should validate the utility of this proposed framework.

Effects of Gamified Smartphone Applications on Physical Activity: A Systematic Review and Meta-Analysis

INTRODUCTION

This systematic review and meta-analysis aims to examine the impacts of standalone gamified smartphone application-delivered interventions on physical activity.

METHODS

Web of Science, Scopus, PubMed, PsycINFO, and ACM Digital Library were searched for publications that were published between January 1, 2008 and August 31, 2021. Eligibility criteria were RCTs or single-arm pre-to-post interventions delivered by standalone gamified applications and targeting physical activity. Study-specific results were analyzed using random-effects meta-analysis, with a standardized mean difference. Meta-regressions, subgroup analyses, and sensitivity analyses were performed. PRISMA guidelines were followed, and the Grading of Recommendations Assessment, Development and Evaluation system was used to determine the strength of the evidence.

RESULTS

A total of 19 studies with 24 gamified applications were eligible, and 16 studies were included in the meta-analysis. Standalone gamified applications had a small-to-moderate effect on physical activity in both the between-group RCTs (n=12 applications, standardized mean difference=0.34, 95% CI=0.06, 0.62, I²=72%, p<0.01; Grading of Recommendations Assessment, Development and Evaluation: moderate) and the within-group pre-to-post interventions (n=18 applications, standardized mean difference=0.38, 95% CI=0.17, 0.59, I²=74%, p<0.01; Grading of Recommendations Assessment, Development and Evaluation: very low). Leave-one-out sensitivity analyses sustained the main effects with lower heterogeneity (I² of 31.0% and 47.8%, respectively).

DISCUSSION

Using gamified smartphone applications as standalone interventions may increase physical activity. Future research could investigate the impacts of gamified applications on physical activity by isolating the role of specific single or clustered groups of application features.

The Effects of mHealth-Based Gamification Interventions on Participation in Physical Activity: Systematic Review

BACKGROUND

It is well known that regular physical exercise has associated benefits; yet, participation remains suboptimal. Mobile health (mHealth) has become an indispensable medium to deliver behavior change interventions, and there is a growing interest in the gamification apps in mHealth to promote physical activity (PA) participation. Gamification could use game design elements (such as points, leaderboards, and progress bars), and it has the potential to increase motivation for PA and engagement. However, mHealth-based gamification interventions are still emerging, and little is known about the application status and efficacy of such interventions.

OBJECTIVE

This systematic review aims to investigate gamification apps in mHealth for improving PA levels and simultaneously summarize the impact of gamification interventions on PA participation.

METHODS

We searched PubMed, Scopus, Web of Science, Embase, CINAHL (EBSCO host), and IEEE Xplore from inception to December 20, 2020. Original empirical research exploring the effects of gamification interventions on PA participation was included. The papers described at least one outcome regarding exercise or PA participation, which could be subjective self-report or objective indicator measurement. Of note, we excluded studies about serious games or full-fledged games.

RESULTS

Of 2944 studies identified from the database search, 50 (1.69%) were included, and the information was synthesized. The review revealed that gamification of PA had been applied to various population groups and broadly distributed among young people but less distributed among older adults and patients with a disease. Most of the studies (30/50, 60%) combined gamification with wearable devices to improve PA behavior change, and 50% (25/50) of the studies used theories or principles for designing gamified PA interventions. The most frequently used game elements were goal-setting, followed by progress bars, rewards, points, and feedback. This review demonstrated that gamification interventions could increase PA participation; however, the results were mixed, and modest changes were attained, which could be attributed to the heterogeneity across studies.

CONCLUSIONS

Overall, this study provides an overview of the existing empirical research in PA gamification interventions and provides evidence for the efficacy of gamification in enhancing PA participation. High-quality empirical studies are needed in the future to assess the efficacy of a combination of gamification and wearable activity devices to promote PA, and further exploration is needed to investigate the optimal implementation of these features of game elements and theories to enhance PA participation.

Mobile health applications for older adults: a systematic review of interface and persuasive feature design

OBJECTIVE

Mobile-based interventions have the potential to promote healthy aging among older adults. However, the adoption and use of mobile health applications are often low due to inappropriate designs. The aim of this systematic review is to identify, synthesize, and report interface and persuasive feature design recommendations of mobile health applications for elderly users to facilitate adoption and improve health-related outcomes.

MATERIALS AND METHODS

We searched PubMed, Embase, PsycINFO, CINAHL, and Scopus databases to identify studies that discussed and evaluated elderly-friendly interface and persuasive feature designs of mobile health applications using an elderly cohort.

RESULTS

We included 74 studies in our analysis. Our analysis revealed a total of 9 elderly-friendly interface design recommendations: 3 recommendations were targeted at perceptual capabilities of elderly users, 2 at motor coordination problems, and 4 at cognitive and memory deterioration. We also compiled and reported 5 categories of persuasive features: reminders, social features, game elements, personalized interventions, and health education.

DISCUSSION

Only 5 studies included design elements that were based on theories. Moreover, the majority of the included studies evaluated the application as a whole without examining end-user perceptions and the effectiveness of each single design feature. Finally, most studies had methodological limitations, and better research designs are needed to quantify the effectiveness of the application designs rigorously.

CONCLUSIONS

This review synthesizes elderly-friendly interface and persuasive feature design recommendations for mobile health applications from the existing literature and provides recommendations for future research in this area and guidelines for designers.

Using Participatory Design Methods to Explore Changes in the Self-Efficacy of Students with Visual Impairments After Playing Exergames

Objective: To explore changes in task/scheduling self-efficacy in children with visual impairments after playing exergames, using the participatory design (PD) method to guide students with visual impairments to engage in the design and test of exergames. Materials and Methods: A pre-/post-test was used with two experimental groups (nine high school students with visual impairments aged 18-21, nine junior high school students with visual impairments aged 14-17). Data were analyzed by an independent-/paired-sample t-test to assess changes in task/scheduling self-efficacy of different groups after gameplay. Data of three dimensions (psychological emotion, physical activity, and social interaction) were collected through texts, participative observations, live notetaking, and video recordings. These dimensions provide opportunities for children with visual impairments to improve their self-efficacy. Results: Exergames helped children with visual impairments to improve their task and scheduling self-efficacy. It confirmed that exergames can be useful to promote their psychological emotion, enhance levels of positive physical activity, and increase social opportunities to improve self-efficacy. Conclusion: Participants of various ages who engaged in exergames reported an improvement in both task and scheduling self-efficacy in terms of psychological emotion, physical activity, and social interaction. The PD approach may be useful in the design of products for people with visual impairments and may ultimately be helpful in supporting the social and physical needs of people with disabilities.