The Use of digital games to enhance the physical exercise activity of the elderly : a case of Finland

According to the World Health Organization (WHO), population ageing is a global phenomenon, which brings both challenges and opportunities for society. The current longer expected lifespan can create opportunities for the elderly to contribute in many ways to their families and communities. However, it greatly depends on their quality of life, which is affected by many factors, including physical and functional health, social well-being, and cognitive abilities. The WHO (2012) states that physical health is one of the indicators for the elderly’s quality of life, and it declines with increasing age. Participation in regular physical exercises can help the elderly improve their physical and mental health, and this has been aided by the use of modern technologies to promote the elderly’s physical and functional health. Of these latest technologies, digital games have shown promise to improve and enhance the elderly’s physical activities through fun and engaging gameplay. The literature highlights that some commercial games in the market (e.g. Microsoft Kinect- Sports and Nintendo Wii Sports games) have the potential to improve the elderly’s physical health such as gait, balance, and fall prevention. However, researchers argue that these commercial games are not designed specifically for the elderly and their physical exercise activities. They state that most commercial games are not user-friendly for the elderly whose functional and physical abilities are limited due to their advanced years. The literature points out that more studies need to be undertaken to understand the usability and usefulness of digital games for physical exercise activities so that game designers can create elderly-friendly digital games in the future. In Finland, the government has been focusing on promoting healthy ageing and increasing home care services for the elderly. In recent years, Finnish researchers have used digital games to promote older Finns’ healthy and active ageing. The existing literature, whilst showing the potential of digital games for elderly Finns’ physical health, also acknowledges further research is needed particularly in the context of Finland. Thus, in this study, we aimed at investigating digital games to specifically assess their applications for older Finns’ physical activities, focusing on the quality of users’ experiences, and their reported ease of use and perceived usefulness. We used the mixed methods approach, which applies both qualitative and quantitative research methods. The study design included four stages: requirements gathering, analysis and design, prototyping, and evaluation. Firstly, we conducted pre-studies to elicit users’ requirements. This was followed by the analysis of the resulting data to identify trends and patterns, which fuelled ideas in the brainstorming game design and development phases. The final product was a digital game-based physical exercise called the Skiing Game. We then evaluated the Skiing Game in Finland with 21 elderly Finns (M=7, F=14, Average Age =76). By using questionnaires, observation, and interviews, we investigated user experiences, focusing on the game’s usability, and usefulness for enhancing the physical activity and wellbeing of the elderly. We also conducted a comparative test of the Skiing Game in Japan with 24 elderly Japanese participants (M=12, F=12, Average Age = 72) to further understand non-Finnish elderly users’ experiences. The findings from the usability study of the Skiing Game in Finland demonstrated that elderly Finns had a positive experience in the gameplay, and their motivation was noticeably high. It also confirmed that elderly Finns have a genuine interest in digital game-based exercises and strong intentions to play digital games as a form of physical exercise in the future. Although prior to the study most of them had negative views and misconceptions about digital games, after the gameplay their attitudes were decidedly positive. They acknowledged that whilst playing digital games could be an alternative way of exercising for them their use would primarily be when they don’t have access to their usual non-digital physical exercise. The Japanese usability of the Skiing Game showed that the elderly Japanese people also had positive user experiences in playing digital games, and also intend to use them in the future. Similarly, after playing the game they reported that their attitudes towards digital games become positive, and indicated playing digital games could be an alternative way of exercising. Although the comparison of the two studies suggests that the elderly Finns had relatively more positive experiences whilst playing the Skiing Game, compared to their Japanese counterparts, in general, both groups had a positive experience in the gameplay and showed interest in digital games as an alternative exercise. Based on the usability lessons learned from these two studies, recommendations for practitioners and designers regarding improvements in game design and development are made in this report. Implementing these modifications into future designs and further development of digital games for the elderly will improve their commercial viability and user uptake. The findings from this study can provide valuable insights, particularly for Finnish policymakers and healthcare practitioners who are keen to introduce digital games into the aged-care sector in Finland. The studies have also provided valuable insights into the optimal methods for introducing Finnish digital games to international markets, in particular, digital games tailored specifically for the physical exercise needs and motivations of the elderly. By taking into consideration the limitations of the study, we provide our future studies and further improvements of the game to be conducted

Can exergaming improve mental health of university students?

The academic, financial, and social pressures that emerge when adults begin university may lead them to encounter mental health challenges (American College Health Association [ACHA], 2016). In Ontario, 46.2% of university/college students have reported ‘excessive’ stress whereas 64.5% report ‘overwhelming’ anxiety (ACHA, 2016). One approach that may be useful for enhancing mental health is exergaming which uses motion-sensor technology requiring players to move their bodies to complete the videogame sessions (Huang et al., 2017). However, studies focused on the effectiveness of exergaming for improving mental health of university students are scarce in number and limited in scope. The overall purpose of this dissertation was to examine the role of exergaming in relation to mental health reported by university students. In Study 1, a synthesis of published intervention research using exergaming to change well-being – a psychological concept affiliated with mental health – reported by adults was conducted. Results from Study 1 indicated that less than 50.0% of the coded studies - using either multi- or single-group (pre-post-test) research designs - reported enhanced well-being as a function of exergaming. In Study 2, the link between the amount and intensity of exergaming behaviour per week and mental health reported by university students was evaluated. Results from Study 2 indicated that university students who reported more frequent exergaming behaviour during a typical week displayed lower anxiety and stress plus higher flourishing and vitality. In Study 3, the contributions of exergaming to mental health of university students were investigated using an experimental research design that compared exergaming against other physical activity behaviours and self-management approaches. Results from Study 3 showed that ‘exergamers’ did not present higher or lower mental health scores compared against ‘traditional’ exercisers but displayed less stress and anxiety when compared against pet therapy, as well as, higher vitality plus lower stress and anxiety compared to ‘non-exercisers’. The results from these studies make it apparent that exergaming may not offer anything ‘unique’ as a stimulus beyond more traditional modes of exercise, but it fosters mental health of university students

Balance Board-based System for Fall Prevention in Older Adults

O aumento da qualidade de vida no século passado fez crescer a esperança média de vida que levou ao envelhecimento da populção. Com esta mudança, problemas relacionados com a idade são cada vez mais comuns. Um destes problemas são as quedas as suas graves consequências nos idosos. Como a idade deteriora sistemas biológicos que intervêm no mantimento do equilíbrio, quedas tornam-se mais frequentes e mais severas. Os programas de prevenção de quedas contém vários métodos que se complementam. Um deles é o exercício que melhora o equilíbrio em adultos mais velhos, diminuindo assim o risco de queda, assim como também o fortalecimento da massa muscular, atenuando as consequências das quedas. No entanto, é difícil motivar os idosos para praticar exercícios saudáveis de forma regular.Foi demonstrado que novos e acessíveis equipamentos que captam movimentos trazem maior motivação à fisioterapia ao introduzir ambientes descontraídos e divertidos. Um destes, a Balance Board da Nintendo Wii (WBB), usa quatro sensores de pressão que medem o centro de pressão (COP) de um utilizador e foi provado que este cálculo é útil para ajudar terapeutas a analisar o progresso de um paciente. Muitos destes aparelhos foram criados para propósitos de entretenimento, criando exergames que são jogos de vídeo em que o jogador precisa de fazer exercício para jogar. Orientados à terapia, exergames podem ser mais motivantes para os pacientes que métodos tradicionais de reabilitação para os pacientes.O principal objectivo desta dissertação é estudar a relação entre seniores e exergames interactivos de modo a proporcionar uma solução para a sua falta de motivação para a práctica regular de exercício. É também pretendido explorar as capacidades da WBB para avaliar automaticamente o equilíbrio do jogador, através de métricas relacionadas com o COP para ajudar a monitorização dos pacientes. Uma aliança entre técnicas de desenvolvimento de jogos com exercícios para a prevenção de quedas poderá motivar idosos devido à combinação entre o prazer de jogar jogos de vídeo e a necessidade de promover o equilíbrio.Dois exergames interactivos foram desenvolvidos. Estes jogos requerem o uso da WBB para realizar exercícios retirados de programas para a prevenção de quedas, como o Otago Exercise Programme ou o Fitness and Mobility Exercise (FAME), como também de escalas de avaliação do equilíbro, como a Berg Balance Scale. Enquanto os séniores jogos, o sistema usa as capacidades da WBB para seguir o COP e calcula métricas para a avaliação do equilíbrio usadas por fisioterapeutas, nomeadamente a velocidade média e oscilação total do COP. Com estes dados, é possível gerar gráficos de grande utilidade que podem ajudar terapeutas com a análise, que são o caminho, amplitude ao longo do tempo e mapa de frequência do COP.O sistem foi avaliado a duas sessões de teste com um total de 17 seniores voluntários, onde estes tiveram oportunidade de interagir com os jogos. Apesar de a maior parte deles não ter compreendido totalmente a mecânica e lógica do jogos à primeira tentativa, todos afirmram que gostaram da experiência, gostariam de jogar regularmente e que os exergames os motivam para fazer exercício. A solução desenvolvida pode encaminhar os adultos para a prática de exercício regular e potencialmente diminuir do risco de queda enquanto ao mesmo tempo oferece aos fisioterapeutas um meio para monitorizar o equilíbrio dos seus pacientes.The increase in quality of life over the past century led to the growth of life expectancy, which turns population increasingly older. With this change, age related problems are more common. One of these problems is falls and their grave consequences. As age degrades biological elements that control body balance, falls become more frequent and more severe. Fall prevention programes usually integrate several complementary methods. One of them is exercise that improves balance in older adults, decreasing fall risk, but also strengthens the body, mitigating fall consequences. However, motivating seniors to do healthy exercises is difficult.Recent affordable motion sensing devices have been shown to bring motivation as they turn physiotherapy sessions into entertaining and engaging interactive environments. One of those, the Nintendo Wii Balance Board System (WBB), uses four pressure sensors that measure the user's center of pressure (COP) which computation has been proved to be useful in helping the therapists evaluate their patient's balance. Many of these devices were created with entertainment purposes through exergames, which are video games where the player needs to do exercise to play. When oriented to therapy, exergames can be more motivating for patients than traditional rehabilitation methods.The main objective of this dissertation is to study the relation between older adults and interactive exergames to provide a solution for their poor motivation towards regular exercise practice. In addition, the WBB capabilities are explored in order to evaluate the player's balance automatically through COP related metrics, which can help supervisors monitor patients. An alliance of game development techniques with fall-prevention exercises may motivate older adults as it combines the pleasure of playing video games with the need to promote balance.Two interactive exergames were developed. These games require using the WBB to perform exercises that are part of the main fall-prevention programs, such as Otago Exercise Programme or Fitness and Mobility Exercise (FAME), and balance assessment scales as well, such as Berg Balance Scale. While the senior plays the game, the system uses the WBB capabilities to track the COP and compute balance assessment metrics used by physiotherapists, namely the COP's mean velocity and total oscillation. This data can be further processed and COP's path, amplitude over time and frequency maps can be generated.The system was evaluated with two separate set of tests with a total of 17 volunteers, in which they had the chance to interacted with the games. Although most of them did not fully understand the games' mechanics and logic t their first attempt, all of them stated they enjoyed the experience, would like to play regularly and that the exergames motivated them to do exercise. The developed solution can hopefully lead seniors to increase the practice of physical activity and eventually decrease fall risk while providing physiotherapists a mean to monitor the evolution of balance of their patients