Custom-designed motion-based games for older adults: a review of literature in human-computer interaction

Many older adults, particularly persons living in senior residences and care homes, lead sedentary lifestyles, which reduces their life expectancy. Motion-based video games encourage physical activity and might be an opportunity for these adults to remain active and engaged; however, research efforts in the field have frequently focused on younger audiences and little is known about the requirements and benefits of motion-based games for elderly players. In this paper, we present an overview of motion-based video games and other interactive technologies for older adults. First, we summarize existing approaches towards the definition of motion-based video games – often referred to as exergames – and suggest a categorization of motion-based applications into active video games, exergames, and augmented sports. Second, we use this scheme to classify case studies addressing design efforts particularly directed towards older adults. Third, we analyze these case studies with a focus on potential target audiences, benefits, challenges in their deployment, and future design opportunities to investigate whether motion-based video games can be applied to encourage physical activity among older adults. In this context, special attention is paid to evaluation routines and their implications regarding the deployment of such games in the daily lives of older adults. The results show that many case studies examine isolated aspects of motion-based game design for older adults, and despite the broad range of issues in motion-based interaction for older adults covered by the sum of all research projects, there appears to be a disconnect between laboratory-based research and the deployment of motion-based video games in the daily lives of senior citizens. Our literature review suggests that despite research results suggesting various benefits of motion-based play for older adults, most work in the field of game design for senior citizens has focused on the implementation of accessible user interfaces, and that little is known about the long-term deployment of video games for this audience, which is a crucial step if these games are to be implemented in activity programs of senior residences, care homes, or in therapy

Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial.

This study aimed to investigate the effects of a school-based exergame intervention on anthropometric parameters and physical fitness. Fifty-eight students (10.4 ± 0.8 years; 48% girls) were randomized into an intervention (IG) and a control (CG) group. Both groups participated in regular physical education classes during the three-month intervention period. The IG additionally received a 20-minute exergame intervention twice per week. At baseline and following the intervention period, body mass index (BMI) and waist-to-height ratio (WHtR) were assessed. Furthermore, a sprint test (ST), a countermovement jump test (CMJ), and a shuttle run test (SRT) were performed. Due to prescribed quarantine measures, only 34 students (18 IG; 16 CG) were included in the final analysis. A significant group-time interaction was determined in CMJ performance (p < 0.001; η2 = 0.403), with a significant increase (+2.6 ± 2.4 cm; p < 0.001; η2 = 0.315) in the IG and a significant decrease (-2.0 ± 3.1 cm; p = 0.009; η2 = 0.190) in the CG. Furthermore, ST performance significantly improved in the IG (-0.03 ± 0.08 s; p = 0.012; η2 = 0.180) but not in the CG (0.13 ± 0.16 s; p = 0.460; η2 = 0.017), revealing significant interaction effects (p = 0.02; η2 = 0.157). Significant group-time interaction was observed for the SRT (p = 0.046; η2 = 0.122), with a significant increase (+87.8 ± 98.9 m; p = 0.028; η2 = 0.147) in the IG and no changes (-29.4 ± 219.7 m; p = 0.485; η2 = 0.016) in the CG. Concerning BMI (p = 0.157; η2 = 0.063) and WHtR (p = 0.063; η2 = 0.114), no significant interaction effects were detected. School-based exergaming is a suitable tool to influence students' physical fitness positively

Closing the loop in exergaming - Health benefits of biocybernetic adaptation in senior adults

Exergames help senior players to get physically active by promoting fun and enjoyment while exercising. However, most exergames are not designed to produce recommended levels of exercise that elicit adequate physical responses for optimal training in the aged population. In this project, we developed physiological computing technologies to overcome this issue by making real-time adaptations in a custom exergame based on recommendations for targeted heart rate (HR) levels. This biocybernetic adaptation was evaluated against conventional cardiorespiratory training in a group of active senior adults through a floor-projected exergame and a smartwatch to record HR data. Results showed that the physiologically-augmented exergame leads players to exert around 40% more time in the recommended HR levels, compared to the conventional training, avoiding over exercising and maintaining good enjoyment levels. Finally, we made available our biocybernetic adaptation software tool to enable the creation of physiological adaptive videogames, permitting the replication of our study.info:eu-repo/semantics/publishedVersio

Towards Balancing Fun and Exertion in Exergames: Exploring the Impact of Movement-Based Controller Devices, Exercise Concepts, Game Adaptivity and Player Modes on Player Experience and Training Intensity in Different Exergame Settings

Physical inactivity remains one of the biggest societal challenges of the 21st century. The gaming industry and the fitness sector have responded to this alarming fact by introducing game-based or gamified training scenarios and thus established the promising trend of exergaming. Exergames – games controlled by active (whole) body movements – have been extolled as potential attractive and effective training tools. However, the majority of the exergames do not meet the required intensity or effectiveness, nor do they induce the intended training adherence or long-term motivation. One reason for this is that the evaluated exergames were often not co-designed with the user group to meet their specific needs and preferences, nor were they co-designed with an interdisciplinary expert team of game designers (to ensure a good gaming experience) and sports scientists (for a great training experience). Accordingly, the research results from studies with these exergames are rather limited. To fully exploit the potential of these innovative movement tools and to establish them as attractive and effective training approach, it is necessary to understand and explore both the underlying interdisciplinary theories and concepts as well as possible design approaches and their impact on the game and training experience. This dissertation aims to contribute to a better understanding of well-balanced exergame design. It explores and evaluates how different movement-based control devices, exercise concepts, game adaptations, and player modes influence the attractiveness and effectiveness of exergames. The work provides theoretical and practical contributions to the problem area of effective and attractive exergames. For this purpose, a research and development (R&D) approach with iterative phases was followed. As preliminary work for the contributions of this dissertation, exergames were approached from a theoretical perspective. Underlying multidisciplinary theories and concepts of exergames from relevant fields were analyzed and a generic framework was built, which structured the findings based on three interdependent dimensions: the player, the game controller, and the virtual game scenario. Some commercially available exergames were explored to verify the theory-based assumption that the interposition of technology brings specific transformations in the coupling of perception and action that do not occur in real sports situations. Among other things, the comparative pilot study showed that two different controllers (one gesture-based and one haptic device), which allowed for different physical input, were likely to induce diverse gameplay experiences (e.g., higher feeling of flow and self-location when playing with the haptic device) with differently skilled players. However, certain design-specific differences in the two exergame conditions meant that these results could only be interpreted as a first trend. To overcome the limitations of this preliminary study approach (e.g., unequal game design of the commercial exergames and very sports-specific movement concept), Plunder Planet, an adaptive exergame environment, was iteratively designed with and for children and allowed for a single- and cooperative multiplayer experience with two different controller devices. The user-centered design was further informed by insights from the growing body of related R&D work in the field of exergames. The first study presented in this dissertation compared the subjectively experienced attractiveness and effectiveness of Plunder Planet when played with different motion-based controllers. Besides a generally great acceptance of the exergame, it was found that the haptic full-body motion controller provided physical guidance and a more cognitively and coordinatively challenging workout, which was more highly rated by experienced gamers with fewer athletic skills. The gesture-based Kinect sensor felt more natural, allowed more freedom of movement, and provided a rather physically intense but cognitively less challenging workout, which was more highly rated by athletic players with less gameplay experience. Furthermore, experiments were made with an exploratory adaptive algorithm that enabled the cognitive and the physical challenge of the exergame to be manually adapted in real-time based on the player’s fitness and gaming skills. The first and the second study also compared an adaptive with a non-adaptive single player version of Plunder Planet. It could be shown that the (well-balanced) adaptive version of the exergame was better valued than the non-adaptive version with regard to the experienced and measured attractiveness (motivation, game flow, spatial presence experience, balance of cognitive and physical challenge) and effectiveness (heart rate, physical exertion, balance of cognitive and physical challenge) by differently skilled players. Finally, and contrary to the findings from related work, the results of the third study proved that the specifically designed controller technology could be used as an “enabler”, “supporter” and “shaper” of bodily interplay in social exergaming. Based on these promising findings, the goal became to further explore the effectiveness of exergames, refine the adaptive game difficulty algorithm, and explore further attractiveness- and motivation-boosting design approaches. Therefore, the ExerCube, a physically immersive and adaptive fitness game setting, was developed. It was iteratively designed with and for adults and allowed for cooperatively and competitive exergame experiences. With its physically immersive game setup, the ExerCube combines a mixed version of the advantages of both previously tested controllers. A coordinatively and cognitively challenging functional workout protocol with scalable intensity (moderate to high) was developed and the subjective experience of the ExerCube training was compared with a conventional functional training with a personal trainer. The fourth study showed that the game-based training gave signs of reaching a similar intensity to the personal training, but was more highly rated for flow, motivation, and enjoyment. Based on this exploratory comparison of the ExerCube with a personal trainer session, valuable avenues for further design could be identified. Among other things, it could be proved that the player’s focus during the ExerCube session was more on the game than on the own body. Players experienced stronger physical exertion and social pressure with the personal trainer and a stronger cognitive exertion and involvement with the ExerCube. Furthermore, a refined version of the previously tested adaptive game difficulty algorithm was implemented and automated for the first time for purpose of this study. Again it was shown that the adaptive version had benefits with regard to subjectively experienced attractiveness (motivation, game flow, balance of cognitive and physical challenge) and effectiveness (physical exertion, balance of cognitive and physical challenge) compared to the non-adaptive version. In order to further enhance the gaming experience, experiments were also conducted with sound designs and an adaptive audio design with adaptive background music and sound feedback was implemented. It was found to be a promising and beneficial add-on for a user-centered attractive exergame design. To inform the design of a multiplayer version of the ExerCube, different social play mechanics were explored in the fifth study. This resulted in differently balanced experiences of fun, and in physical as well as cognitive exertion. As the preliminary comparative evaluation of the subjectively experienced effectiveness and attractiveness of an ExerCube session and a personal trainer session could prove the general feasibility of the concept and revealed the first indications of the intensity of the ExerCube’s training concept, the objectively measured effectiveness of a single ExerCube session with a functional high-intensity interval training (fHIIT) with a personal trainer was compared in a final sixth study, and after another design iteration. Again, the subjectively experienced attractiveness of both conditions was assessed. It could be shown that the ExerCube is a feasible training device for training at fHIIT-level. While physical exertion was slightly lower than in the conventional fHIIT condition, the ExerCube condition’s average heart rate values reached the fHIIT threshold and also yielded significantly better results for flow, enjoyment, and motivation. The ExerCube training also resulted in a subjectively experienced higher cognitive load (dual-domain training). To sum up, it can be stated that this dissertation provides valuable and fundamental research contributions to the promising field of exergames as attractive and effective training tools. Furthermore, important contributions to design questions in this field could be developed. Since this field is still relatively unexplored, the work presented creates a sound basis for future R&D work in this area

Feedback control for exergames

The concept of merging exercise equipment with video games, known as exergaming, has the potential to be one of the main tools used in addressing the current rising obesity epidemic. Existing research shows that exergaming can help improve fitness and additionally motivate people to become more active. The two key elements of attractiveness - how much people want to play or use the exergaming system; and effectiveness – how effective the exergaming system is in actually increasing or maintaining physical fitness, need to be maximised to obtain the best outcomes from an exergaming system; we put this forward as the Dual Flow Model. As part of the development of our exergame system we required the use of a heart rate response simulator. We discovered that there was no existing quantitative model appropriate for the simulation of heart rate responses to exercise. In order to overcome this, we developed our own model for the simulation of heart rate response. Based on our model, we developed a simulation tool known as the Virtual Body Simulator, which we used during our exergame development. Subsequent verification of the model using the trial data indicated that the model accurately represented exergame player heart rate responses to a level that was more than sufficient for exergame research and development. In our experiment, attractiveness was controlled by manipulation of the game difficulty to match the skill of the player. The balance of challenge and skills to facilitate the attainment of the flow state, as described by Csikszentmihalyi (1975), is widely accepted as a motivator for various activities. Effectiveness, in our experiments was controlled through exercise intensity. Exercise intensity was adjusted based on the player‟s heart rate to maintain intensity within the limits of the ASCM Guidelines (ACSM, 2006) for appropriate exercise intensity levels. We tested the Dual Flow Model by developing an exergame designed to work in four different modes; created by selectively varying the control mechanisms for exercise workout intensity and game mental challenge. We then ran a trial with 21 subjects who used the exergame system in each of the different modes. The trial results in relation to the Dual Flow Model showed that we developed an excellent intensity control system based on heart rate monitoring; successfully managing workout intensity for the subjects. However, we found that the subjects generally found the intensity controlled sessions less engaging, being closer to the flow state in the sessions where the intensity was controlled based on heart rate. The dynamic difficulty adjustment system developed for our exergame also did not appear to help facilitate attainment of the flow state. Various theories are put forward as to why this may have occurred. We did find that challenge control had an impact on the actual intensity of the workout. When the intensity was not managed, the challenge control modes were generally closer to the desired heart rates. While the difference was not statistically very large, there was a strong correlation between the intensity of the different modes. This correlation was also present when looking at the players‟ perception of intensity, indicating that the difference was enough to be noticed by the subjects

Gyroscope induced force feedback for ball impact simulation in exergames.

A haptic feedback device for simulating batting sport haptics was designed using the resultant gyroscopic effect from rapidly reorienting spinning flywheels and integrated into a custom cricket themed virtual reality exergame. The device was capable of producing impact vibrations and a 0.1 N m torque. A within-subjects user study conducted on 16 participants, and player presence was evaluated using the Presence Questionnaire. The results of the user study were statistically insignificant due to a small sample size (p=0.153), and we were unable to reject the null hypothesis, but visual data analysis was used to identify trends that supported our hypothesis that increase haptic feedback fidelity increases presence in virtual reality batting sports exergames. Due to the statistical insignificance of these results, further research should be conducted to confirm these findings

Development of a wheelchair propulsion laboratory

In rehabilitation, sports, and research, wheelchair users can be tested on a new wheelchair ergometer. That is the most important finding of the thesis “Development of a wheelchair propulsion laboratory”. The Esseda ergometer, a roller system made in Groningen, has been improved and tested in the past few years. The study showed that wheelchair propulsion on the ergometer is comparable to driving overground and that the ergometer is capable of adequately measuring various aspects of wheelchair propulsion. Wheelchair users can be tested on the ergometer in their own personalized wheelchair. The ergometer can be used to observe people in rehabilitation and other wheelchair users, so that straining techniques can be detected and adjusted in time. This is important because more than half of the wheelchair users suffer from overuse complaints in the arms and shoulders. The wrists, elbows, and shoulder joint are often areas of complaint. This has a major impact on the lives of wheelchair users, because these joints are used in almost all daily tasks. The ergometer can also be of value in adapted sports. For example, the propulsion technique and physical condition of athletes can be studied in detail. The ergometer can therefore be a valuable addition to the toolset of clinicians, sports coaches, and rehabilitation researchers. By giving the wheelchair ergometer a central place in the wheelchair propulsion lab, the skills of wheelchair users can be improved, wheelchairs can be fitted, and complaints of overload as a result of wheelchair use can be prevented

Comparative Analysis of The Effects Of Virtual Reality Active Video Game And Controller-Free Active Video Game Play On Physiological Response, Perceived Exertion, And Hedonic Experience

Over 60% of US adults are overweight or obese. Sedentary lifestyles are considered major contributors to the high rates and increasing prevalence of obesity. Physical activity is a critical component in shifting from sedentary lifestyles. Studies indicate that less than half of U.S. adults meet the CDC/ACSM physical activity recommendations. Interactive video games can increase PA, but no study has yet assessed physiologic effort, hedonics, and perceived exertion for playing immersive virtual reality (VR) and controller-free screen-based active video games (AVGs), compared to treadmill walking and resting. We ran 25 subjects (9 female, 16 male) in 10-minute sessions of five conditions. Head Mounted Display VR: Oculus (Fruit Ninja and Boxing), Screen-based AVG: Kinect (Fruit Ninja and Boxing), and Treadmill walking at 3 mph. One, six-condition (Rest, Treadmill 3.0, Kinect Boxing, Kinect Fruit Ninja, Oculus Boxing, Oculus Fruit Ninja) repeated-measures ANOVA was used to examine differences in HRmean. Three, five-condition (Treadmill 3.0, Kinect Boxing, Kinect Fruit Ninja, Oculus Boxing, Oculus Fruit Ninja) repeated-measures ANOVA were used to examine differences in HRpeak, ratings of perceived exertion (RPE) and Hedonics (Liking). Post hoc analyses using pairwise comparisons were used to further assess significant main effects of the condition. A Pearson\u27s product-moment correlation was run to assess the relationship between activity condition HRmean and RPE VR Boxing elicited the greatest physiological effort, producing vigorous-intensity PA. There was no significant difference in average heart rate for the Treadmill, Kinect Fruit Ninja, Kinect Boxing, and VR Fruit Ninja. Thus, the Kinect and VR sport and casual games are comparable to treadmill walking PA levels and qualify as moderate-intensity activity. The VR Fruit Ninja, VR Boxing, Kinect Fruit Ninja were the most enjoyed activities. Despite having the highest Heart rate and the highest self-reported Rating of Perceived Exertion (RPE), VR Boxing was significantly more enjoyable than Treadmill Walking. There was no statistically significant correlation between Activity Condition HRmean and RPE. Both casual and sports VR and AVG activities are enjoyable activities for adults, stimulating moderate-to-vigorous activity through a traditionally sedentary medium. This research extends previous works in active video gaming effects on physiological cost, perceived exertion and hedonics and fills the gap relating virtual reality active video games. The significance of the research outcomes is that this analysis provides a scientifically validated approach to support the establishment of physical activity level goals and guidelines in the development of active video games as a response and/or remedy to address the sedentary lifestyles that are contributing to American and global obesity