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

Investigating the Finnish Elderly People’s Attitudes and Motivation towards Digital Game-Based Physical Exercises

Attitudes and motivation towards physical exercises play a vital role for elderly people’s adherence to exercise. In recent years, digital games have been used to enhance elderly people’s experiences in physical exercises. However, there is a limited number of studies regarding elderly people’s attitudes and motivation towards digital game-based exercises. In this study, we aim at investigating the Finnish elderly people’s attitudes towards physical and digital game-based exercises, as well as their motivation in the gameplay. Furthermore, we intend to investigate if digital games can be an alternative way of exercising for elderly people. We conducted a user experience test of the “Skiing Game” with 21 elderly participants in Finland. We applied both qualitative (e.g. interview) and quantitative (e.g. questionnaires) methods to collect data from the participants. Then, we analyzed the data by using SPSS and Nvivo. The findings show that the Finnish elderly people’s attitudes towards physical exercises are more positive than digital game-based exercises. However, their attitudes towards digital games have become more positive after the gameplay. Their in-game and post-game user experiences were moderately positive. Their motivation to play digital game-based exercises was moderately high after the gameplay. Their feedback towards the Skiing game was positive. They recommend that digital game-based exercises can be an effective way of exercising. Based on these findings, we recommend that digital games are promising to be used as an alternative way of exercising for the Finnish elderly people. The discussion in this study can help researchers gain insights about using digital games for promoting elderly people’s participation in physical exercises

Gamified Solutions in Healthcare - Testing Rehabilitation Games in Finland and Asia

This paper presents a comprehensive summary of the Gamified Solutions in Healthcare (GSH) research project, which is a joint research project between Turku University of Applied Sciences and the University of Turku. The goal of the project is to promote exercise, social inclusiveness and enhance quality of life, aiming at developing new services and effective activity solutions for the elderly through gamification. During the research project elderly people were included in the development and testing of games so that they could be used for more than just entertainment purposes. According to all of our tests elderly enjoy playing exergames, and digital games can be an effective way to enhance the quality of life of the elderly. In the case studies it was observed that the players where motivated while playing but motivation should also be maintained throughout the gameplay. The elderly gave overall positive feedback for the idea of using digital activity games for exercising. </div

Lessons Learned from Two Usability Studies of Digital Skiing Game with Elderly People in Finland and Japan

Physical decline is associated with old age. Engagement in regular physical exercises can help elderly people improve their physical functionalities, as well as cognitive abilities. Among modern technologies, digital games have the potential to promote elderly people’s engagement in physical exercises through fun and enjoyable gameplay. Although commercial digital games show promise, most of them are not designed for elderly people. The literature also suggests that more studies need to be undertaken to understand the usability and usefulness of digital games for elderly people. Hence, in this study, we designed and developed a digital game-based Skiing activity for elderly people. Then, we evaluated it with the Finnish and Japanese elderly participants in Finland and Japan to investigate their feedback towards the usability and usefulness of the game. The findings from both studies show that digital games are useful for promoting elderly people’s engagement in physical activities. While digital games are promising to be used as an alternative solution for promoting the Japanese elderly participant’s physical activities, the Finnish elderly participants recommend to use it when they don’t have access to non-digital physical exercises. The lessons learned from this study can help researchers and practitioners gain insights into game design and development for elderly people and their physical activities.</p

Rehabilitative Games for Stroke Patients

Stroke is one of the major problems in medical and healthcare that can cause severe disability and death of patients especially for older population. Rehabilitation plays an important role in stroke therapy. However, most of the rehabilitative exercises are monotonous and tiring for the patients. For a particular time, they can easily get bored in doing these exercises. The role of patient’s motivation in rehabilitation is vital. Motivation and rehabilitative outcomes are strongly related. Digital games promise to help stroke patients to feel motivated and more engaged in rehabilitative training through motivational gameplay. Most of the commercial games available in the market are not well-designed for stroke patients and their motivational needs in rehabilitation. This study aims at understanding the motivational requirements of stroke patients in doing rehabilitative exercises and living in a post-stroke life. Based on the findings from the literature review, we report factors that can influence the stroke patients’ level of motivation such as social functioning, patient-therapist relationship, goal-setting, and music. These findings are insightful and useful for ideating and designing interactive motivation-driven games for stroke patients. The motivational factors of stroke patients in rehabilitation may help the game designers to design motivation-driven game contexts, contents, and gameplay. Moreover, these findings may also help healthcare professionals who concern stroke patient’s motivation in rehabilitative context. In this paper, we reported our Virtual Nursing Home (VNH) concept and the games that we are currently developing and re-designing. Based on this literature review, we will present and test out the ideas how we can integrate these motivational factors in our future game design, development, and enhancement