Experimental Design to Systematically Develop a Knowledge Base for Effective Games for Health

Commercial exergames for rehabilitation of physical health and quality of life: a systematic review of randomized controlled trials with adults in unsupervised home environments

Background

Commercial exergames are widely available tools that can support physical rehabilitation at home. However, the effects of the unsupervised use of commercial exergames in home environments are not yet clear. Hence, we provide a systematic review on the effects of unsupervised commercial exergaming at home on adults' physical health (RQ1) and quality of life (RQ2). We also scrutinize adults' experiences with exergaming at home regarding participant support, adherence, and adverse outcomes (RQ3).

Methods

We searched Web of Science, PsycINFO, PubMed, Embase, and CINAHL for peer-reviewed randomized controlled trials with adults in need of rehabilitation. Overall, 20 studies (1,558 participants, 1,368 analyzed) met our inclusion criteria. The quality of evidence was assessed with the Cochrane risk of bias tool.

Results

Effects of unsupervised commercial exergaming at home on physical health were higher in seven studies and similar in five studies regarding the respective comparison or control conditions; eight studies reported non-significant findings. Of the 15 studies that also examined effects on quality of life, improvements were higher in seven studies and similar in two studies regarding the respective comparison or control conditions; results were non-significant in six studies. Participant support consisted of setup of the exergaming system, instructions, training, and contact with participants. Adherence was high in eight studies, moderate in six studies, and low in one study. Adverse outcomes related to exergaming were found in four studies and were at most moderate. Concerning the quality of evidence, six studies were related to a high risk of bias due to outcome reporting bias or ceiling effects in the primary outcome. Additionally, 10 studies yielded some concerns, and four studies were related to a low risk of bias.

Discussion

This systematic review summarizes promising evidence that the unsupervised use of commercial exergames can support and complement rehabilitation measures in home environments. Still, future studies based on larger samples and using more recent commercial exergames are needed to obtain more high-quality evidence on the effects of different exercise prescriptions. Overall, considering the necessary precautions, the unsupervised use of commercial exergames at home can improve the physical health and quality of life in adults with needs for physical rehabilitation.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341189, identifier: PROSPERO, Registration number: CRD42022341189.

The Role of Physical Education and Sports in Modern Society Supported by IoT—A Student Perspective

The COVID-19 pandemic in recent years and the massive presence of information technology generate one of the biggest challenges facing humanity, namely the technological challenge. In this context, educational technologies have a positive impact on the correct and effective teaching and learning of physical education and sports (PES), with a great positive impact on future sustainable higher education (HE). Thus, various innovative techniques could be of interest, such as the use of social networks and fitness sites, e-learning platforms, computer games, and telephone applications involving video analysis and age-specific images of students and the skills taught. This study aims to establish the main means used by technology, through which it can improve the teaching, learning, and practice of PES. This paper demonstrates the positive effects of technology on the PES field in modern society through a regression model, applied to data collected from 260 students from 2 Romanian PES Universities. The pedagogical and educational elements of our model also highlight the role of technology as a facilitator of knowledge, functioning as a tool that comes to the aid of specialists in the PES field.

Situational interest impacts college students' physical activity in a design-based bike exergame

BACKGROUND

Active videogames or exergames have been used as an innovative way to promote physical activity (PA) among various populations. A player's interest in active videogames is associated with the fun and entertaining nature of the games and may trigger situational interest, thus increasing engagement. The goal of this study was to examine the impact of situational interest dimensions on college students' PA when playing the design-based bike exergame Greedy Rabbit (Vescape, Berlin, Germany).

METHODS

Sixty undergraduate students (age: 20.8 ± 1.3 years, mean ± SD, 18-25 years old; 51.7% males) were recruited from the kinesiology department of a university located in the southern region of Belgium. The participants were assigned to an experimental group (n = 41) or a control group (n = 19) based on an incremental cycling test. Students in the experimental group engaged in 1 session of Greedy Rabbit (Vescape) while students in the control group engaged in 1 session of a placebo version of Greedy Rabbit (Vescape). The length of the sessions ranged from 24 min to 31 min.

RESULTS

Results for the control group indicated that the players' PA metrics (cadence: F(19, 360) = 1.43, p = 0.11; heart rate: F(19, 360) = 1.16, p = 0.29; oxygen consumption: F(19, 360) = 0.83, p = 0.67) were stable during the exergame. Results for the experimental group demonstrated the effects of time on the players' PA metrics and revealed significant associations between the change in the players' situational interest dimensions and PA metrics (cadence: F(19, 800) = 26.30, p < 0.01; heart rate: F(19, 800) = 19.77, p < 0.01; oxygen consumption: F(19, 800) = 10.04, p < 0.01).

CONCLUSION

An approach using a design-based exergame may be a relevant strategy for promoting levels of PA that yields positive health-related outcomes among college students.

Design of a Digital Game Intervention to Promote Socio-Emotional Skills and Prosocial Behavior in Children

In emergency contexts such as the COVID-19 pandemic, mental health risk factors affect children and may affect behavioral and emotional problems including anxiety, self-blame, emotional disturbance, and stress. Preventive measures are crucial to address these health risks. Research highlights strength-based factors, such as socio-emotional skills and prosocial behaviors, as important for childhood development and socio-emotional wellbeing. Yet, the initial evidence base shows mixed effectiveness and insufficient behavior change theory application into socio-emotional and prosocial digital game interventions. Additionally, few interventions are designed with a clear process to convert theory into practical game solutions and very limited guidance on the digital game development process exists. This study describes the Intervention Mapping Protocol (IMP) and theory application in the design of a digital game intervention which aims to strengthen social-emotional skills development and promote prosocial behavior in 8–11-year-old children. The method systematically describes the steps of the IMP process in detail to guide future theory-based game design. The results explain the final digital game prototype that was co-designed with continuous input and insights provided by stakeholders and feedback from children. This paper contributes to our understanding of theory application in the design of digital game interventions focused on health and behavior change and provides much needed guidance on how theory and stakeholder input can be incorporated into a final game design.

Gamified Text Messaging Contingent on Device-Measured Steps: Randomized Feasibility Study of a Physical Activity Intervention for Cancer Survivors

BACKGROUND

Physical activity can confer diverse benefits on cancer survivors. Unfortunately, many cancer survivors are not sufficiently active. The efficacy of physical activity interventions for this population may be increased by grounding them in Self-Determination Theory (SDT). Combining game design elements with wearable technologies may be a useful and scalable approach to targeting SDT constructs to promote cancer survivors' physical activity.

OBJECTIVE

The primary aim of this study is to evaluate the feasibility and acceptability of Steps2Health, a physical activity intervention for cancer survivors. It also aims to investigate the effects of the intervention on motivation, physical activity, and step count.

METHODS

We randomized 78 insufficiently active cancer survivors to an experimental or comparison group. All participants received a physical activity tracker. The experimental group participants also received a set sequence of multimedia messaging service messages that were triggered in real time by meeting predetermined cumulative step count totals. Messages presented information about a virtual journey and included photographs and vivid descriptions of locations to increase autonomous motivation. Additional messages targeted perceptions of relatedness (eg, role modeling) and competence (eg, facilitating mastery experiences). We administered pre- and postintervention surveys and conducted 15 individual interviews to evaluate the intervention. We performed directed content analysis of qualitative data and conducted mixed effects linear modeling to investigate participants' changes in motivation, self-reported physical activity, and device-measured step counts.

RESULTS

There was minimal loss to follow-up (3/78, 4%), the device wear rate was high (2548/3044, 83.71% of days), and technical problems with messaging based on real-time step counts were limited. Our qualitative data analysis revealed 3 overarching themes: accessibility, autonomous motivation, and relatedness. Participants successfully navigated the technological aspects and game design elements of the intervention. Participants found messages targeting autonomous motivation and competence or self-efficacy to be enjoyable and compelling, but one feasibility criterion for participant engagement (response rate to text messages) was not met. Messages targeting relatedness were less highly rated than the messages targeting autonomous motivation and competence or self-efficacy. During the intervention, both groups increased their motivation for physical activity (B=0.16; 95% CI 0.01 to 0.30; P=.04; d=0.49), and assignment to the experimental group was associated with increased self-reported leisure activity score (B=10.78; 95% CI 3.54 to 18.02; P=.005; d=0.64). The experimental group had greater increases in daily step counts over time (B=322.08; 95% CI 54.01 to 590.15; P=.02; d=0.28).

CONCLUSIONS

This study supports the feasibility of using real-time game design elements to target SDT constructs and increase cancer survivors' physical activity. Overall, our findings support the acceptability of the Steps2Health intervention, but fostering active participant engagement and targeting relatedness may present additional challenges. Steps2Health may help cancer survivors increase their physical activity levels.

Descriptive Normative Nutrition Messages to Maximize Effect in a Videogame: Narrative Review

Messages containing descriptive norms have been manipulated and tested for effects on dietary intake in a number of studies. The effects have been mostly small or nonexistent. This narrative review analyzed the structural elements of the nutrition messages most likely related to effectiveness. Elements examined included the following: source, similarity of source to the participant, reference group, identification with or evaluative significance of the reference group, delivery, salience, background, tailoring, gain-loss framing, and whether an assessment of the group norm was conducted before designing the descriptive norm message. Most studies incorporated few of the reviewed structural elements, and message manipulations appeared weak. Controlled, systematic studies are needed to examine the effect of the structural elements, singly and in combination, on behavior and its mediators. Videogames are designed to be delivered in the same way to players; therefore, they offer a controlled environment for extensively and systematically manipulating structural elements of messages and examining the resulting behavioral effects. How this might be accomplished was described. Experimental research was identified as being necessary to delineate the individual and combined element effects, thereby contributing to the body of literature on videogame design and effectiveness.