The potential of virtual reality (VR) and augmented reality (AR) to engage people with physical activity

Introduction: Sufficient physical activity (PA) reduces the risk of non-communicable diseases (NCDs) and improves physical and psychosocial health. The levels of PA in the UK and elsewhere in the world remain low for all age groups. Novel strategies for engaging people in PA are required to tackle the epidemic of inactivity. Virtual reality (VR) and augmented reality (AR) is computer-generated, interactive 3D environments that offer users unique immersive experiences of PA. / Aims: The aim of this mixed-methods, staged research project (vEngage) was to test the potential of VR and AR to engage people in PA. This work was a Medical Research Council (MRC) funded partnership between academic researchers (UCL, Coventry, and Anglia Ruskin Universities) and an industry partner ‘Six to Start’. / Methods: I surveyed and interviewed the users of the world’s most popular running app Zombies, Run! (ZR) (Studies 1 and 2). I then conducted a scoping review in a form of a qualitative analysis of game reviews on popular VR exercise games (exergames) and described positive and negative features, current players of VR exergames report, as important motivators for exergame playing (Study 3). In parallel, the vEngage team set up a steering committee of adolescents (13-17 years) and their parents and interviewed both groups about PA, VR, AR, and exergaming (Studies 4a and 4b). We used the results from these studies to inform our VR exergame intervention (a game called Walls - Study 5) which we developed together with expert games designers Six to Start. / Results: VR is a promising strategy for engaging adolescents in PA but barriers to use remain, including awareness, availability, affordability, and accessibility. The results showed people have a positive attitude to exergaming, with a preference for narratives (engaging story, role-play). This was particularly supported by both ZR studies, where the narrative was the most motivating factor for engagement in PA for all age groups. VR and AR exergaming can distract people from the negative aspects of performing PA such as pain or repetition. / Conclusions: This research project was the first VR study that used principles of co-design in creating a digital VR exergame intervention for adolescents, by engaging adolescents themselves in the exergame design. AR and VR exergaming has great potential to engage a wide range of people in PA and can be particularly useful as means for PA engagement in a time of world pandemics such as the recent Covid-19 pandemic, where gym and fitness facilities are not accessible for unspecified periods of time

OneMile: An Interactive Journey to Wellness for Those with Chronic Illness

Using interaction design, video, and social media to create an application that will encourage people to maintain or improve their quality of life when dealing with a chronic illness. There are many tools, both tangible and online, for people with debilitating illnesses. There are websites and apps that focus on symptom management, medication monitoring or general wellness. The majority of these resources are mainly used for rehabilitation. There is technology used to help people, both healthy and those with an illness, to improve their health–featuring exercise, eating healthy, tips and tricks. Most people with a chronic illness are looking for ways they can be healthy, or ways to maintain their health; they want to be pro-active in their healthy journey. Multiple Sclerosis is one of these chronic illness–the people who have it may be active and mobile and they are looking for something to help them stay motivated and/or to improve their health. They are not looking for something to help with rehabilitation, because most of these people do not need rehab; they want something to encourage them on quest to healthy and wellness. The needs of the target audience (people with MS) would benefit from a combination of mediums that would lend itself to the idea of activities to fully explore all of the potential aspects of a person’s illness and to motivate them to life a healthy life. The purpose of the activities would be so each user could choose exactly what he or she wants and needs to work on. Cognitive exercises, fine motor skill exercises, social connections and suggested physical movement and recipes will help the user stay motivated. Elements of gamification will help create an active environment for the user and allow them to be motivated and excited to pursue wellness in their lives

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

Information technology for active ageing: A review of theory and practice

Active Ageing aims to foster a physically, mentally and socially active lifestyle as a person ages. It is a complex, multi-faceted problem that involves a variety of different actors, such as policy makers, doctors, care givers, family members, friends and, of course, older adults. This review aims to understand the role of a new actor, which increasingly plays the role of enabler and facilitator, i.e., that of the technology provider. The review specifically focuses on Information Technology (IT), with a particular emphasis on software applications, and on how IT can prevent decline, compensate for lost capabilities, aid care, and enhance existing capabilities. The analysis confirms the crucial role of IT in Active Ageing, shows that Active Ageing requires a multidisciplinary approach, and identifies the need for better integration of hardware, software, the environment and the involved actors

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

Active Design – How the built environment matters to mobile games for health

Mobile games for health aim to provide both for an attractive gaming experience and for a positive effect on their users’ wellbeing. Most of these games are context-sensitive, as they take note of the state of the player’s environment and use this information to adapt the game experience. This article points to the limited research available that validates either the physiological effects of playing context-sensitive games for health regularly, or research that focuses on the complex relationship between mobile games, a players’ health and wellbeing, and the (urban) environment in which many of these games are being played. It reviews aspects of health-oriented urban design that has been shown to influence people’s everyday activity patterns including running and cycling. It speculates how “active design” context can also have an impact on how we play mobile games for health and explains how this knowledge can be used to improve such games

Modelling Physical Activity in Virtual Reality Games

This thesis was inspired by the possibility that virtual reality (VR) games, which are designed primarily to be fun, could also provide exercise. It aimed to gain insights about this by exploring whether people can gain beneficial levels of exercise while playing VR games and how they might use VR games for exercise over several weeks. Furthermore, this work also focuses on how the level of physical activity that can be captured during gameplay and how a long-term user model can be created for individual players, as a foundation for supporting the user in gaining personal informatics insights about their exertion as well as being used for personalisation and external recommendation for VR games. The key contributions of this research are: • The first study of a diverse set of commercial VR games to gain insights about the level of actual and perceived exertion players have. • The first long-term study of VR games in a sedentary workplace to gain insights about the ways people utilise it and the levels of exertion they gain. • Based on reflections on the above studies, this thesis presents a framework and guidelines for designing physical activity VR games. • The systematic creation of a user model for representing a person’s long-term fitness and their VR gameplay, exertion and preferences. • A study of the ways that people can scrutinise their long-term personal informatics user model of exertion from VR game play and incidental walking. These contributions provide a foundation for future researchers and industry practitioners to design VR games that provide beneficial levels of exertion and allow people to gain insights into the relative contribution of the exercise from gameplay