Examining Motivations to Play Pokémon GO and Their Influence on Perceived Outcomes and Physical Activity

Use of Electronic Ecological Momentary Assessment Methodologies in Physical Activity, Sedentary Behavior, and Sleep Research in Young Adults: Systematic Review

BACKGROUND

Recent technological advances allow for the repeated sampling of real-time data in natural settings using electronic ecological momentary assessment (eEMA). These advances are particularly meaningful for investigating physical activity, sedentary behavior, and sleep in young adults who are in a critical life stage for the development of healthy lifestyle behaviors.

OBJECTIVE

This study aims to describe the use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults.

METHODS

The PubMed, CINAHL, PsycINFO, Embase, and Web of Science electronic databases were searched through August 2022. Inclusion criteria were use of eEMA; sample of young adults aged 18 to 25 years; at least 1 measurement of physical activity, sedentary behavior, or sleep; English language; and a peer-reviewed report of original research. Study reports were excluded if they were abstracts, protocols, or reviews. The risk of bias assessment was conducted using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Screening, data extraction, and risk of bias assessments were conducted by independent authors, with discrepancies resolved by consensus. Descriptive statistics and narrative synthesis were used to identify overarching patterns within the following categories guided by the Checklist for Reporting Ecological Momentary Assessments Studies: study characteristics, outcomes and measures, eEMA procedures, and compliance.

RESULTS

The search resulted in 1221 citations with a final sample of 37 reports describing 35 unique studies. Most reports (28/37, 76%) were published in the last 5 years (2017-2022), used observational designs (35/37, 95%), consisted of samples of college students or apprentices (28/35, 80%), and were conducted in the United States (22/37, 60%). The sample sizes ranged from 14 to 1584 young adults. Physical activity was measured more frequently (28/37, 76%) than sleep (16/37, 43%) or sedentary behavior (4/37, 11%). Of the 37 studies, 11 (30%) reports included 2 movement behaviors and no reports included 3 movement behaviors. eEMA was frequently used to measure potential correlates of movement behaviors, such as emotional states or feelings (25/37, 68%), cognitive processes (7/37, 19%), and contextual factors (9/37, 24%). There was wide variability in the implementation and reporting of eEMA procedures, measures, missing data, analysis, and compliance.

CONCLUSIONS

The use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults has greatly increased in recent years; however, reports continue to lack standardized reporting of features unique to the eEMA methodology. Additional areas in need of future research include the use of eEMA with more diverse populations and the incorporation of all 3 movement behaviors within a 24-hour period. The findings are intended to assist investigators in the design, implementation, and reporting of physical activity, sedentary behavior, and sleep research using eEMA in young adults.

TRIAL REGISTRATION

PROSPERO CRD42021279156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021279156.

Personality profiles and engagement with the augmented reality game Pokémon GO: a cross-sectional study

Background: Since its release in 2016, Pokémon GO™ has achieved not only extensive popularity but has also accrued evidence that it helps to increase physical activity and sense of belonging. Personality traits may explain a differential engagement and fidelity with the game, hence potentially allowing for prediction of different patterns of game engagement as well as its health benefits. Our objective was to compare personality traits between Pokémon GO game players and non-players. Methods: We conducted a cross-sectional study in participants aged 18+ years through an online survey. The following categories of game engagement were defined: active players, occasional players, former players, and never players. Personality was measured with the NEO-FFI inventory that evaluates personality across five domains: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. ANOVA and MANOVA models were performed to test differences in personality traits’ scores. Multivariate regression models were also used to describe specific differences across groups of game engagement. Results: Data from 654 participants, average 28.6 years of age, 75% male, were included in the study. In the ANOVA analysis, we observed differences between the three players' subgroups in openness (p=0.015) and conscientiousness (p=0.032). In MANOVA and multivariate regression analyses, we found that active players presented higher scores in openness and agreeableness, but lower scores in conscientiousness compared to former or non-players. Conclusions: We found evidence that people that actively play Pokémon GO are more likely to be friendlier and more open to new experiences, but also scored less on conscientiousness which is related to discipline. This gives us better insight on how personality may help identification of people and their involvement with activities that demand fulfillment of tasks. These findings could help inform the engagement with health-related behaviors, including physical activity and medication adherence.

How Virtual Reality Technology Has Changed Our Lives: An Overview of the Current and Potential Applications and Limitations

Despite virtual reality (VR) being initially marketed toward gaming, there are many potential and existing VR applications in various sectors and fields, including education, training, simulations, and even in exercise and healthcare. Unfortunately, there is still a lack of general understanding of the strengths and limitations of VR as a technology in various application domains. Therefore, the aim of this literature review is to contribute to the library of literature concerning VR technology, its applications in everyday use, and some of its existing drawbacks. Key VR applications were discussed in terms of how they are currently utilized or can be utilized in the future, spanning fields such as medicine, engineering, education, and entertainment. The main benefits of VR are expressed through the text, followed by a discussion of some of the main limitations of current VR technologies and how they can be mitigated or improved. Overall, this literature review shows how virtual reality technology has the potential to be a greatly beneficial tool in a multitude of applications and a wide variety of fields. VR as a technology is still in its early stages, but more people are becoming interested in it and are optimistic about seeing what kind of changes VR can make in their everyday lives. With how rapidly modern society has adapted to personal computers and smartphones, VR has the opportunity to become the next big technological turning point that will eventually become commonplace in most households.

Selected Behaviors and Addiction Risk Among Users of Urban Multimedia Games

Introduction

The rapid development of technology has led to the transfer of entertainment to the virtual world. Many games and multimedia applications use the so-called augmented reality. With the development of a new technological branch, a new health problem has emerged, which is infoholic addiction, attracting people with the specific functionality that is cyberspace and the virtual world.

Objective

The study aimed to assess health behaviors and the risk of addiction among users of urban multimedia games. Research methodology. The study was conducted among players 1,134 of urban multimedia games—Pokemon GO, in the period March–June 2021. A 990 correctly completed questionnaires were included in the final analyses. The author’s questionnaire was used in the study, which included two standardized measurement scales in the Polish abbreviated version: a questionnaire of emotions and sensations associated with electronic entertainment and a questionnaire on addiction to electronic forms of entertainment. Statistica 13.0 program was used for statistical processing of the data. The probability level was p < 0.05.

Results

The profile of the gamer was identified as male, aged 18–30 years, with secondary education (more rarely higher), not in a relationship, living in a city of more than 100 thousand inhabitants—60.1% of gamers met these criteria. Respondents played urban multimedia games daily (84.7%). About 26.3% of respondents played this type of game 2–3 h a day. In terms of physical fitness, 64.3% of respondents felt that physical fitness had improved as a result of playing multimedia urban games. In terms of mental condition, most of the respondents said that nothing had changed (55.3%). It was observed that 72.3% of respondents had some risk of addiction to urban multimedia games.

Conclusion

Users of urban multimedia games were usually adult men living in big cities. It was also shown that the defined profile of the player was characterized by a higher risk of addiction to electronic forms of entertainment. It was observed that the respondents most often played urban multimedia games every day in a maximum of two-hour sessions. Based on the tools used, it can be concluded that the study group was characterized by a certain risk of addiction to urban multimedia games.

The Effects of Health Consideration on Exergaming Behavior in College Students: A Structural Equation Perspective

Purpose: Exergaming play is associated with positive health benefits and increased engagement in physical activity outcomes in players. Research also indicates that factors such as enjoyment and entertainment drive users' exergame activities. However, despite advances in the area, little is known about whether health consideration and physical activity impact college students' exergaming behavior. Method: A cross-sectional online survey of open-ended and fixed questions was completed by 403 college students (Mage = 20.02, SD = 2.3; Range: 17-35; 73.2% female) from a large southwestern university. Descriptive analyses and structural equation modeling techniques were used to draw insights from the data. Results: Among the participants, nearly 87.6% of them reported participating in exergaming behavior. Both measurement and structural models showed good model fits. Health consideration (Std.β = .30, p < .01) and leisure-time physical activity (Std.β = .28, p < .01) were positively associated with exergaming behavior while health consideration was not significantly associated with leisure-time physical activity (Std.β = .05, p = .38). The mediation analysis revealed that the indirect effect from health consideration to exergaming behavior through leisure-time physical activity was not statistically significant (Std.β = .01, p = .38). Leisure-time physical activity could not mediate the relationship between health consideration and exergaming behavior. Conclusions: By pointing out the important role of health consideration and physical activity in college students' exergaming play, findings of this study can help exergame developers and gamification interventionists to design more effective programs and, in turn, facilitate positive intervention outcomes.

Personalization of Intervention Timing for Physical Activity: Scoping Review

Background

The use of sensors in smartphones, smartwatches, and wearable devices has facilitated the personalization of interventions to increase users’ physical activity (PA). Recent research has focused on evaluating the effects of personalized interventions in improving PA among users. However, it is critical to deliver the intervention at an appropriate time to each user to increase the likelihood of adoption of the intervention. Earlier review studies have not focused on the personalization of intervention timing for increasing PA.

Objective

This review aims to examine studies of information technology–based PA interventions with personalized intervention timing (PIT); identify inputs (eg, user location) used by the system for generating the PIT, the techniques and methods used for generating the PIT, the content of the PA intervention, and delivery mode of the intervention; and identify gaps in existing literature and suggest future research directions.

Methods

A scoping review was undertaken using PsycINFO, PubMed, Scopus, and Web of Science databases based on a structured search query. The main inclusion criteria were as follows: the study aimed to promote PA, included some form of PIT, and used some form of information technology for delivery of the intervention to the user. If deemed relevant, articles were included in this review after removing duplicates and examining the title, abstract, and full text of the shortlisted articles.

Results

The literature search resulted in 18 eligible studies. In this review, 72% (13/18) of the studies focused on increasing PA as the primary objective, whereas it was the secondary focus in the remaining studies. The inputs used to generate the PIT were categorized as user preference, activity level, schedule, location, and predicted patterns. On the basis of the intervention technique, studies were classified as manual, semiautomated, or automated. Of these, the automated interventions were either knowledge based (based on rules or guidelines) or data driven. Of the 18 studies, only 6 (33%) evaluated the effectiveness of the intervention and reported positive outcomes.

Conclusions

This work reviewed studies on PIT for PA interventions and identified several aspects of the interventions, that is, inputs, techniques, contents, and delivery mode. The reviewed studies evaluated PIT in conjunction with other personalization approaches such as activity recommendation, with no study evaluating the effectiveness of PIT alone. On the basis of the findings, several important directions for future research are also highlighted in this review.

Dyadic Effects of Pokémon GO on Physical Activity and Sedentary Behavior in Mothers and Children

Family-based mobile health applications may be an opportunity to increase children's physical activity (PA) levels. Researchers have highlighted Pokémon GO as a potential model for future PA interventions as it integrates PA with social gamification. This study provides descriptive data on Pokémon GO usage among mothers and their children and examines differences in moderate to vigorous PA (MVPA) over time among individuals playing Pokémon GO compared to non-players using a dyadic subsample from a three-year longitudinal study. After the release of Pokémon Go in July 2016, 156 mother-child dyads completed questionnaires about Pokémon Go usage and wore accelerometers continuously for seven days at baseline (Sep 2016), six months, and twelve months. Independent sample t-tests and chi-square tests were used to investigate differences in demographics and daily MVPA by player status cross-sectionally at each time point. At baseline, six mothers and 21 children reported playing Pokémon Go. Baseline demographic characteristics were not associated with player status. Across time, mothers engaged in an average of 21.12 minutes of daily MVPA (SD = 19.7) and children in 29.35 minutes (SD = 18.88). Children's daily MVPA did not differ by player status, but mothers who reported playing engaged in higher daily MVPA (M = 46.84, SD = 38.07) compared to non-players (M = 21.40, SD = 23.31). This naturalistic study lacked power to further analyze changes in MVPA after the release of the game due to lack of engagement with Pokémon GO. Understanding how to design a family-oriented game to bring together gamification, physical activity, and family-based interventions will be important for future public health efforts.

Body surveillance and affective judgments of physical activity in daily life

Affective judgments are one of the strongest predictors of physical activity. Engaging in body surveillance during physical activity is theorized to reduce access to pleasant affective experiences thereby compromising the influence of affective judgments. However, empirical tests of this relationship are lacking. This study examined associations between body surveillance during physical activity and affective judgments (i.e., enjoyment and pleasure) of physical activity. Participants (N = 89; 53 % women, M_age = 20.32 years; SD_age = 1.59) completed an experience sampling protocol for 7 days and provided 7 self-reports/day. Participants reported their body surveillance when engaged in physical activity followed by their affective judgments of physical activity. At the within-person level, participants reported more negative affective judgments during instances when body surveillance was higher than usual. At the between-person level, participants higher in body surveillance reported more negative affective judgments on average. These findings extend correlates of body surveillance to include less favorable affective judgments. Although there is support for targeting affective judgments to promote physical activity, the utility of such efforts may be limited if body surveillance is present. These findings point to a new target for potentially enhancing affective judgements and the promotion of physical activity.

Promoting Physical Activity in Japanese Older Adults Using a Social Pervasive Game: Randomized Controlled Trial

Background

Pervasive games aim to create more fun and engaging experiences by mixing elements from the real world into the game world. Because they intermingle with players’ lives and naturally promote more casual gameplay, they could be a powerful strategy to stimulate physical activity among older adults. However, to use these games more effectively, it is necessary to understand how design elements of the game affect player behavior.

Objective

The aim of this study was to evaluate how the presence of a specific design element, namely social interaction, would affect levels of physical activity.

Methods

Participants were recruited offline and randomly assigned to control and intervention groups in a single-blind design. Over 4 weeks, two variations of the same pervasive game were compared: with social interaction (intervention group) and with no social interaction (control group). In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Changes in the weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity.

Results

A total of 20 participants were recruited (no social interaction group, n=10; social interaction group, n=10); 18 participants remained active until the end of the study (no social interaction group, n=9; social interaction group, n=9). Step counts during the first week were used as the baseline level of physical activity (no social interaction group: mean 46,697.2, SE 7905.4; social interaction group: mean 45,967.3, SE 8260.7). For the subsequent weeks, changes to individual baseline values (absolute/proportional) for the no social interaction group were as follows: 1583.3 (SE 3108.3)/4.6% (SE 7.2%) (week 2), 591.5 (SE 2414.5)/2.4% (SE 4.7%) (week 3), and −1041.8 (SE 1992.7)/0.6% (SE 4.4%) (week 4). For the social interaction group, changes to individual baseline values were as follows: 11520.0 (SE 3941.5)/28.0% (SE 8.7%) (week 2), 9567.3 (SE 2631.5)/23.0% (SE 5.1%) (week 3), and 7648.7 (SE 3900.9)/13.9% (SE 8.0%) (week 4). The result of the analysis of the group effect was significant (absolute change: η²=0.31, P=.04; proportional change: η²=0.30, P=.03). Correlations between both absolute and proportional change and the play activity were significant (absolute change: r=0.59, 95% CI 0.32 to 0.77; proportional change: r=0.39, 95% CI 0.08 to 0.64).

Conclusions

The presence of social interaction design elements in pervasive games appears to have a positive effect on levels of physical activity.

Trial Registration

Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://tinyurl.com/y5nh6ylr (Archived by WebCite at http://www.webcitation.org/761a6MVAy)

Effects of a Personalized Fitness Recommender System Using Gamification and Continuous Player Modeling: System Design and Long-Term Validation Study

Background

Gamification and persuasive games are effective tools to motivate behavior change, particularly to promote daily physical activities. On the one hand, studies have suggested that a one-size-fits-all approach does not work well for persuasive game design. On the other hand, player modeling and recommender systems are increasingly used for personalizing content. However, there are few existing studies on how to build comprehensive player models for personalizing gamified systems, recommending daily physical activities, or the long-term effectiveness of such gamified exercise-promoting systems.

Objective

This paper aims to introduce a gamified, 24/7 fitness assistant system that provides personalized recommendations and generates gamified content targeted at individual users to bridge the aforementioned gaps. This research aims to investigate how to design gamified physical activity interventions to achieve long-term engagement.

Methods

We proposed a comprehensive model for gamified fitness recommender systems that uses detailed and dynamic player modeling and wearable-based tracking to provide personalized game features and activity recommendations. Data were collected from 40 participants (23 men and 17 women) who participated in a long-term investigation on the effectiveness of our recommender system that gradually establishes and updates an individual player model (for each unique user) over a period of 60 days.

Results

Our results showed the feasibility and effectiveness of the proposed system, particularly for generating personalized exercise recommendations using player modeling. There was a statistically significant difference among the 3 groups (full, personalized, and gamified) for overall motivation (F_3,36=22.49; P<.001), satisfaction (F_3,36=22.12; P<.001), and preference (F_3,36=15.0; P<.001), suggesting that both gamification and personalization have positive effects on the levels of motivation, satisfaction, and preference. Furthermore, qualitative results revealed that a customized storyline was the most requested feature, followed by a multiplayer mode, more quality recommendations, a feature for setting and tracking fitness goals, and more location-based features.

Conclusions

On the basis of these results and drawing from the gamer modeling literature, we conclude that personalizing recommendations using player modeling and gamification can improve participants’ engagement and motivation toward fitness activities over time.

mHealth technology for ecological momentary assessment in physical activity research: a systematic review

OBJECTIVE

To systematically review the publications on ecological momentary assessment (EMA) relating to physical activity (PA) behavior in order to classify the methodologies, and to identify the main mHealth technology-based tools and procedures that have been applied during the first 10 years since the emergence of smartphones. As a result of this review, we want to ask if there is enough evidence to propose the use of the term "mEMA" (mobile-based EMA).

DESIGN

A systematic review according to PRISMA Statement (PROSPERO registration: CRD42018088136).

METHOD

Four databases (PsycINFO, CINALH, Medline and Web of Science Core Collection) were searched electronically from 2008 to February 2018.

RESULTS

A total of 76 studies from 297 potential articles on the use of EMA and PA were included in this review. It was found that 71% of studies specifically used "EMA" for assessing PA behaviors but the rest used other terminology that also adjusted to the inclusion criteria. Just over half (51.3%) of studies (39) used mHealth technology, mainly smartphones, for collecting EMA data. The majority (79.5%) of these studies (31 out of 39) were published during the last 4 years. On the other hand, 58.8% of studies that only used paper-and-pencil were published during the first 3 years of the 10-year period analyzed. An accelerometer was the main built-in sensor used for collecting PA behavior by means of mHealth (69%). Most of the studies were carried out on young-adult samples, with only three studies in older adults. Women were included in 60% of studies, and healthy people in 82%. The studies lasted between 1 and 7 days in 57.9%, and between three and seven assessments per day were carried out in 37%. The most popular topics evaluated together with PA were psychological state and social and environmental context.

CONCLUSIONS

We have classified the EMA methodologies used for assessing PA behaviors. A total of 71% of studies used the term "EMA" and 51.3% used mHealth technology. Accelerometers have been the main built-in sensor used for collecting PA. The change of trend in the use of tools for EMA in PA coincides with the technological advances of the last decade due to the emergence of smartphones and mHealth technology. There is enough evidence to use the term mEMA when mHealth technology is being used for monitoring real-time lifestyle behaviors in natural situations. We define mEMA as the use of mobile computing and communication technologies for the EMA of health and lifestyle behaviors. It is clear that the use of mHealth is increasing, but there is still a lot to be gained from taking advantage of all the capabilities of this technology in order to apply EMA to PA behavior. Thus, mEMA methodology can help in the monitoring of healthy lifestyles under both subjective and objective perspectives. The tendency for future research should be the automatic recognition of the PA of the user without interrupting their behavior. The ecological information could be completed with voice messages, image captures or brief text selections on the touch screen made in real time, all managed through smartphone apps. This methodology could be extended when EMA combined with mHealth are used to evaluate other lifestyle behaviors.

Does exergaming drive future physical activity and sport intentions?

We studied how usability and playability of sport exergames affect future intentions of participation in physical activity or actual sport. We employed questionnaires to measure participants' enjoyment, usability, game-experience, and future intentions of physical activity and real sport. We compared the outcomes based on players' gender, previous real-swimming, and exergame experience. Psychological parameters were not different between groups but players without exergame experience enjoyed the game more. Physical activity intentions increased for all participants but not swimming intentions. The limitations of current gaming systems and their effects on players' gaming experience and intentions are discussed.

Virtual Patients in Health Professions Education

Health care professionals must not only have knowledge, but also be able to organise, synthesise and apply this knowledge in such a way that it promotes the development of clinical reasoning. Panels of Virtual patients (VPs) are widely being used in health professions education to facilitate the development of clinical reasoning. VPs can also be used to teach wider educational outcomes such as communication skills, resource utilisation and longitudinal patient care. This chapter will define virtual patients and examine the evidence behind their use in health professions learning and teaching. The chapter will discuss virtual patient design, such as gamification. Finally, the chapter will discuss where this pedagogical innovation is best integrated into assessment and potential barriers to implementation into existing curricula.

Effects of Full Body Exergaming in Virtual Reality on Cardiovascular and Muscular Parameters: Cross-Sectional Experiment

BACKGROUND

In recent years, many studies have associated sedentary behavior in front of screens with health problems in infants, children, and adolescents. Yet options for exergaming-playing video games that require rigorous physical exercise-seem to fall short of the physical activity levels recommended by the World Health Organization.

OBJECTIVE

The purpose of this study was to investigate the effect of a fully immersive virtual reality (VR)-based training system on cardiovascular and muscular parameters of young adults.

METHODS

A cross-sectional experiment design was used to analyze muscle activity (surface electromyography), heart rate, perceived exertion (RPE), cybersickness symptoms, perceived workload, and physical activity enjoyment (PACES) in 33 participants performing two 5-minute flights on a new training device.

RESULTS

Participants' performance of the planking position required to play the game resulted in moderate aerobic intensity (108 [SD 18.69] bpm). Due to the mainly isometric contraction of the dorsal muscle chain (with a mean activation between 20.6% [SD 10.57] and 26.7% [SD 17.39] maximum voluntary isometric contraction), participants described the exercise as a moderate to vigorous activity (RPE 14.6 [SD 1.82]). The majority reported that they enjoyed the exercise (PACES 3.74 [SD 0.16]). However, six participants had to drop out because of cybersickness symptoms and two because of muscle pain due to prior injuries.

CONCLUSIONS

Our findings suggest that fully immersive VR training systems can contribute to muscle-strengthening activities for healthy users. However, the dropout rate highlights the need for technological improvements in both software and hardware. In prevention and therapy, movement quality is a fundamental part of providing effective resistance training that benefits health. Exergaming on a regular basis has the potential to develop strong muscles and a healthy back. It is essential that future VR-based training systems take into account the recommendations of sport and exercise science.

Scoping Review of Pokémon Go: Comprehensive Assessment of Augmented Reality for Physical Activity Change

Pokémon Go™ (PG) is a mobile videogame that requires real-world walking to "catch" augmented reality (AR) virtual creatures. Media attention speculated that extensive physical activity (PA) could result from PG play, which could have public health benefit. Little is known about contextual factors related to PG play and how they may impact play initiation or duration. A systematic search of articles reporting the words PG was conducted with PubMed and Google Scholar. To understand the many possible influences on and outcomes of PG play, a scoping review was conducted by employing a conceptual model to organize the literature. Although large numbers of people started playing PG, these were a relatively small proportion of the relevant populations, but PG may have activated some of those most in need of PA. Diverse factors predicted who initiated PG play, but they tended to emphasize anticipated fun, escapism, nostalgia, social ties, and desire for PA. Environmental factors (e.g., unavailable GPS signals, trespassing laws) limited PG play for some. Diverse factors predicted duration of gameplay, but fun appeared to be prominent. The level of increases in PA from PG among youth and young adults appeared to be small or undetected, and of a relatively short duration (<2 months). Among older adults, however, there were modest increases in PA for up to 7 months post-release. This intensity and duration of increased PA appears to be inadequate to stem the epidemic of obesity but may have mental and social health benefits. Although many adverse outcomes from playing PG were reported, these appear to be low incidence, which should primarily influence PG players to knowingly exercise caution. Many research issues were identified to specify who might play AR games and effective strategies to enhance game design to increase PA.

Effects of Social Interaction Mechanics in Pervasive Games on the Physical Activity Levels of Older Adults: Quasi-Experimental Study

BACKGROUND

The novel genre of pervasive games, which aim to create more fun and engaging experiences by promoting deeper immersion, could be a powerful strategy to stimulate physical activity among older adults. To use these games more effectively, it is necessary to understand how different design elements affect player behavior.

OBJECTIVE

The aim was to vary a specific design element of pervasive games for older adults, namely social interaction, to test the effect on levels of physical activity.

METHODS

Over 4 weeks, two variations of the same pervasive game were compared: social interaction for the test group and no social interaction for the control group. In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity.

RESULTS

A total of 32 participants were recruited (no social interaction=15, social interaction=17); 18 remained until the end of the study (no social interaction=7, social interaction=11). Step counts during the first week were used as the baseline (no social interaction: mean 17,099.4, SE 3906.5; social interaction: mean 17,981.9, SE 2171.1). For the following weeks, changes to individual baseline were as follows for no social interaction (absolute/proportional): 383.8 (SE 563.8)/1.1% (SE 4.3%), 435.9 (SE 574.5)/2.2% (SE 4.6%), and -106.1 (SE 979.9)/-2.6% (SE 8.1%) for weeks 2, 3, and 4, respectively. For social interaction they were 3841.9 (SE 1425.4)/21.7% (SE 5.1%), 2270.6 (SE 947.1)/16.5% (SE 4.4%), and 2443.4 (SE 982.6)/17.9% (SE 4.7%) for weeks 2, 3, and 4, respectively. Analysis of group effect was significant (absolute change: η²=.19, P=.01; proportional change: η²=.27, P=.009). Correlation between the proportional change and the play activity was significant (r=.34, 95% CI 0.08 to 0.56), whereas for absolute change it was not.

CONCLUSIONS

Social interaction design elements of the pervasive game may have some positive effects on the promotion of physical activity, although other factors might also have influenced this effect.

TRIAL REGISTRATION

Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=7274 (Archived by WebCite at http://www.webcitation.org/761a6MVAy).

Correlates of excessive Pokemon Go playing among medical students

BACKGROUND

A new virus "Pokémon GO" is infecting Homo sapiens at an exponential rate. The symptoms include swaying your cell phone in air and focusing in blankness, straying into the unknown in search "Pikachu". In the "Pokedemiological" triad, the host is a medical student, agent is Pokémon GO, and the environment is a chaos of childhood fantasies and peer pressure turning into a vicious cycle of addiction, stress, anxiety, and depression.

AIM

The aim was to study the correlates of excessive playing of Pokemon Go in medical students.

MATERIALS AND METHODS

By purposive sampling, fifty MBBS students who were regularly playing Pokémon GO for more than 2 weeks and equal number of age-and sex-matched students who were not playing any computer games were included in this study with their consent. They were assessed with a pro forma asking information about their habit and the depression, anxiety, and stress scale. Statistical analysis was done using t-test, Chi-square test, and Mann- Whitney U-test.

RESULTS

Reasons for starting to play Pokemon Go included liking the concept (n = 39), peer pressure (n = 8), and free availability (n = 3). Wandering outside their residence alone until way after dark to play the game was reported by 27 players, and six admitted to stopping in the middle of a road to catch a rare pokemon. Twenty-eight players admitted that the game had adversely affected their behavior. Twenty players play much longer than they originally planned, whereas 22 lost track of time while playing the game. The players were under significantly more stress, anxiety, and depression compared to nonplayers.

CONCLUSION

Regular playing of Pokemon Go results in adverse consequences including exposure to dangerous situations, stress, anxiety, and depression.

Go ta catch 'em al or not enough time: Users motivations for playing Pokémon Go™ and non-users' reasons for not installing

Urban exergames are played in the real-world environment using built-in mobile phone sensors. The influence of Pokémon Go on physical activity and sitting time has been examined previously, however limited research has explored motivations for using the application. Thus, the aim of this study was to explore Pokémon Go users’ motivations for using the application, exusers’ reasons for abandoning the game and non-users’ reasons for not installing. After institutional ethical approval, the ‘Physical Activity and Pokémon Go’ questionnaire was developed using Qualtrics^TM and distributed using social media soon after launch in the United Kingdom (baseline). At baseline a total of 461 participants (n=193 male, n=265 female, n=3 transgender) who were predominantly white (n=420) and did not self-report a disability (n=443) completed the questionnaire. Users’ (n=236) were questioned on their motivations for using Pokémon Go and non-users’ provided reasons for not installing. At 3 months a total of 127 participants (n=23 users) completed the questionnaire again and all qualitative data was thematically analyzed. The most commonly reported reason for using Pokémon Go was ‘to have fun’ which was 86% and 83% at baseline and 3 months respectively. The second most frequent reason at baseline was ‘friends were using it’ (58%) and at 3 months was ‘to be outside’ (48%). The least common motivation for using Pokémon Go at both baseline and 3 months was ‘to meet new people’ (8% and 0% respectively). At baseline, social motives and competition were two general themes which encapsulated Pokémon Go users’ motivation for using the application. There were two general themes reported by Pokémon Go users’ as to why they did not think they would use the application in the future. These were application related factors and factors unrelated to Pokémon Go. Non-users reported a range of reasons for not using Pokémon Go, including lack of interest and a lack of time. Safety concerns and risk of adverse events were reported by both users and non-users. This is the first study to thematically analyze motives for using Pokémon Go in which the findings are: 1) future smartphone applications aiming to increase physical activity must ensure that objectives evolve to maintain initial interest and motivation to engage with applications; 2) game developers must consider the required phone storage and capability which could be a barrier to downloading; and 3) concerns of using the application including the safety of users and those around them.

Step Counts of Middle-Aged and Elderly Adults for 10 Months Before and After the Release of Pokémon GO in Yokohama, Japan

Background

Smartphones have been integrated into our society and are expected to serve as tools to improve health outcomes. In the summer of 2016, Pokémon GO, a location-based augmented reality game for smartphones was released; it attracted attention from the perspective of health, especially with its potential to increase physical activity (PA). A few studies have compared objectively measured step counts before and after the release of the game; however, they were conducted over a short study period and evaluated only young people.

Objective

The objective of this study was to confirm whether there was a difference in step counts between middle-aged and elderly players and nonplayers before and after the release of Pokémon GO.

Methods

A total of 46 players and 184 nonplayers aged ≥40 years were matched for sex, age group, and PA level; they were respondents to a questionnaire randomly sent to citizens who were given free pedometers by Yokohama city. Their play status was identified through the questionnaire. To investigate the change in step counts before and after the release of Pokémon GO according to play status, a 2-way repeated-measures analysis of variance was performed. Step counts 1 month before the release of the game were compared with those 8 months after the release. In addition, subgroup analyses according to sex, age group, PA level, and subjective health status were performed.

Results

The mean ages of players and nonplayers were 56.5 (SD 9.9) years and 57.3 (SD 9.6) years, respectively, and the mean baseline step counts of players and nonplayers were 7641.8 (SD 2754.5) and 7903.3 (SD 2674.7), respectively. There was no significant difference in the age and baseline step counts according to a t test (2-tailed). In the analysis of all samples, the interaction between play status and time effect was significant for 3 of 8 months after release. In the subgroup analyses, the interaction was significant for 3 months in men, 7 months in the 55-64-year-old group, 2 months in workers, 4 months in the active group in PA level, and 2 months in participants with subjectively good health. The interaction was significant for only 1 month, at most, in other subgroups.

Conclusions

The present study confirmed a difference in step counts between players and nonplayers before and after the release of Pokémon GO. According to our analysis, step counts were higher until 7 months after the release. The player group maintained their step counts in winter, despite the decrease in step counts of nonplayers. In subgroup analyses, players were more likely to be men, aged <55 years, workers, active, and subjectively in good health.

Pokémon GO Within the Context of Family Health: Retrospective Study

BACKGROUND

Pokémon GO illuminated the potential for mobile phone gaming apps to engage users and promote health. However, much work is needed to fully understand the mechanisms through which digitally supported behavior change interventions operate, particularly for children and families.

OBJECTIVE

The aims of this study were (1) to explore the Pokémon GO user experience from a family perspective and (2) to investigate Pokémon GO within the context of family health.

METHODS

Between January and February 2017, congruent with one of the largest anticipated Pokémon GO updates Gen 2, participants were recruited from parks, word of mouth, and social media to complete a Web-based survey. Participants were surveyed about family characteristics, interest, and experiences playing Pokémon GO and healthy lifestyle beliefs. Using a revised Godin Leisure-Time Exercise Questionnaire, a retrospective pre-post design assessed changes in parent physical activity (PA) before and after playing Pokémon GO.

RESULTS

Self-reported data from 160 parents and 31 children were included in the final analyses (representing 129 parents and 31 parent-child dyads). Gameplay most often occurred between sons aged 10 years or younger and mothers. "Spending time together" was the most cited reason for gameplay by both parents (122/160, 76.3%) and children (24/31, 77%), followed by "it helped me go outdoors" for parents (113/160, 70.1%) and "I am a Pokémon fan" by children (21/31, 68%). Interestingly, open-ended responses indicated that gameplay could trigger both positive and negative emotional parent response. The most cited reason for app disengagement was boredom; conversely, the most cited reason for app re-engagement was in-app events. For parents, there were significant increases in minutes spent in mild (mean 23.36 [SD 66.02]; t₉₇=3.50, P<.001) and moderate (mean 21.76 [SD 53.04]; t₁₃₀=4.70, P<.001) PA per week after playing Pokémon GO. However, child perceptions of parental influence on PA most significantly associated with parents who reported weekly strenuous PA both before (r_s=.514, P=.003) and after (r_s=.536, P=.003) Pokémon GO uptake.

CONCLUSIONS

Pokémon GO transcended traditional understanding of digital health and uniquely reached across generations to engage users. Findings from this study highlight that, for a period of time, Pokémon GO fostered social and physical well-being for children and families through a multifaceted approach.

Gaming behaviour with Pokémon GO and physical activity: A preliminary study with medical students in Thailand

Pokémon GO becomes the most rapidly downloaded mobile application in history. This study aimed to determine the physical activity of medical students, who played Pokémon GO, and the change in their use of Pokémon GO and physical activity over time. An observational study was conducted. Physical activity was measured by using self-administered questionnaires at baseline (phase 0), 1 month (phase 1) and 3 months (phase 2) post-Pokémon GO download. The changes in physical activity (phase 0 to 1 and phase 1 to 2) were analysed using Wilcoxon Signed Ranked test. The trend (3-point analysis) of physical activity from phase 0, 1 to 2 were analysed using Friedman’s test. The relationship between physical activity and time spent gaming was analysed by using Spearman’s rank correlation. Twenty-six participants (mean age 22.04±1.70 years) participated in the study. There was no statistically significant change in physical activity during the three-month period (p = 0.45). Only 11 participants (42.3%) were still playing Pokémon GO 3 months after download. The key reasons for playing game were ‘have fun’ and ‘pass time/boredom’. The most common commuting mode to play the game was walking; some drove a car or motorcycle while playing the game. There was no correlation between physical activity and time spent gaming. This study highlights how the lack of sustainability of the game and the motivation behind using Pokémon GO as a game rather than a physical activity app may have undermined the potential of using the game to improve physical activity. Further studies need to explore the reasons for the lack of sustainability and how to combine fun with behavioural change.

Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration

Background

New mobile health (mHealth) software apps are emerging and are providing the foundation to radically transform the practice and reach of medical research and care. For this study we collaborated with Quit Genius, a cognitive behavioral therapy (CBT) based mHealth app that helps users quit smoking, to explore the effective design of a digital mHealth app; one that delivers important benefits to its users and helps them change their behaviors for a healthier lifestyle.

Objective

The specific aims of this study were to (1) explore the key role of CBT program progress, (2) examine the gamification design app elements that deliver significant benefits (ie, empowerment, well-being, inspiration) to users, (3) explore the effectiveness of these app elements to help users quit smoking or reduce the number of cigarettes smoked, and (4) identify and describe any potential drivers and hindrances arising from the app design elements.

Methods

We developed an online survey and sent an email invitation to 4144 individuals, who had previously or were at the time using the Quit Genius mHealth app, to encourage participation in the study. We matched the online survey data with objective app usage data of the study participants.

Results

A dataset of 190 completed responses was used. At the time of the survey, respondents had completed an average of 60% of the CBT program in the Quit Genius mHealth app. Of the respondents, 36.3% (69/190) noted to have quit smoking successfully after using the Quit Genius app. As for those who remained smokers after using the app (N=121), the number of cigarettes smoked per day was significantly reduced by 59.6%. The ability of the app to enhance users’ hedonic well-being and psychologically empower them in their daily lives was identified as being key in helping users quit smoking. Specifically, the results show that users whose well-being was enhanced through the app were 1.72 times more likely to quit smoking successfully. Moreover, a one-unit increase on a 7-point Likert scale in the app’s ability to empower smokers in their daily lives led to a reduction of cigarettes smoked per day of 53%. The app’s inspiration to users, however, was negatively associated with quitting success and the reduction in cigarette smoked per day.

Conclusions

The findings offer important insights for the effective design of digital mHealth apps. Specifically, we find that perceived psychological empowerment and enhanced hedonic well-being from the mobile solution may be a more impactful way to support the effectiveness of mobile cognitive behavioral therapy for smoking cessation than eliciting strong inspiration.

Pokémon GO and Physical Activity in Asia: Multilevel Study

BACKGROUND

Physical activity has long been considered as an important component of a healthy lifestyle. Although many efforts have been made to promote physical activity, there is no effective global intervention for physical activity promotion. Some researchers have suggested that Pokémon GO, a location-based augmented reality game, was associated with a short-term increase in players' physical activity on a global scale, but the details are far from clear.

OBJECTIVE

The objective of our study was to study the relationship between Pokémon GO use and players' physical activity and how the relationship varies across players with different physical activity levels.

METHODS

We conducted a field study in Hong Kong to investigate if Pokémon GO use was associated with physical activity. Pokémon GO players were asked to report their demographics through a survey; data on their Pokémon GO behaviors and daily walking and running distances were collected from their mobile phones. Participants (n=210) were Hong Kong residents, aged 13 to 65 years, who played Pokémon GO using iPhone 5 or 6 series in 5 selected types of built environment. We measured the participants' average daily walking and running distances over a period of 35 days, from 14 days before to 21 days after game installation. Multilevel modeling was used to identify and examine the predictors (including Pokémon GO behaviors, weather, demographics, and built environment) of the relationship between Pokémon GO use and daily walking and running distances.

RESULTS

The average daily walking and running distances increased by 18.1% (0.96 km, approximately 1200 steps) in the 21 days after the participants installed Pokémon GO compared with the average distances over the 14 days before installation (P<.001). However, this association attenuated over time and was estimated to disappear 24 days after game installation. Multilevel models indicated that Pokémon GO had a stronger and more lasting association among the less physically active players compared with the physically active ones (P<.001). Playing Pokémon GO in green space had a significant positive relationship with daily walking and running distances (P=.03). Moreover, our results showed that whether Pokémon GO was played, the number of days played, weather (total rainfall, bright sunshine, mean air temperature, and mean wind speed), and demographics (age, gender, income, education, and body mass index) were associated with daily walking and running distances.

CONCLUSIONS

Pokémon GO was associated with a short-term increase in the players' daily walking and running distances; this association was especially strong among less physically active participants. Pokémon GO can build new links between humans and green space and encourage people to engage in physical activity. Our results show that location-based augmented reality games, such as Pokémon GO, have the potential to be a global public health intervention tool.