Activity-promoting gaming systems in exercise and rehabilitation

Commercial activity-promoting gaming systems provide a potentially attractive means to facilitate exercise and rehabilitation. The Nintendo Wii, Sony EyeToy, Dance Dance Revolution, and Xbox Kinect are examples of gaming systems that use the movement of the player to control gameplay. Activity-promoting gaming systems can be used as a tool to increase activity levels in otherwise sedentary gamers and also be an effective tool to aid rehabilitation in clinical settings. Therefore, the aim of this current work is to review the growing area of activity-promoting gaming in the context of exercise, injury, and rehabilitation

Effects of exergaming on health and fitness outcomes for students with disabilities: a meta-analysis

Background: The high prevalence of obesity in America can be attributed to the lack of resources and physical activity for students with disabilities. This meta-analysis presents how current literature on exergaming affects the Health Related Fitness, Skill Related Fitness, and Motor Skills of students with a diagnosed disability. Method: The search strategy for this meta-analysis was to identify previous studies using specific keywords (e.g., Exergaming, Wii-Fit, VR, Physical Education, Adapted Physical Education). Studies were included and sorted based on inclusion and exclusion criteria. Results: Based on 20 studies that met the inclusion criteria, there were increased fitness outs, however not enough studies were found to make conclusive statements about the results. Conclusion: Exergaming has the potential to increase health benefits for students with disabilities, however more data is needed to fully understand the health effects of exergaming

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

Effectiveness and Acceptability of e- and m-Health Interventions to Promote Physical Activity and Prevent Falls in Nursing Homes—A Systematic Review

Age-related decreases in physical activity (PA) and a decline in physical functioning lead to increased fall risk. As falls are a major cause of accidental deaths and hospitalization in older adults, PA promotion and fall prevention are important measures, especially in nursing homes (NH). With advances in information and communication technology, e- and m-health solutions have been developed to positively influence various health-related factors. To date, only little research exists on the implementation of these technologies to promote health in NH. Therefore, the objective of this systematic review was to provide an overview of the effectiveness, acceptability, and feasibility of e- and m-health interventions aimed at promoting PA and preventing falls in NH. Additionally, the effectiveness of such interventions regarding the secondary outcomes physical function, cognitive function, neuropsychiatric symptoms, and psychosocial status was examined. A systematic literature search was performed in five databases and studies published until 15 November 2021, were considered for inclusion. All studies that examined the effectiveness and/or the acceptability and feasibility of e- or m-health interventions in promoting PA and preventing falls in NH, without restriction on language or date of publication, were included in the final synthesis. Of the 1,358 records retrieved, 28 studies were included in this systematic review. Twenty-four studies contained digital exergaming as an intervention or as a part of the intervention, the four additional studies on e-health interventions only examined a small number of outcomes. No m-health intervention study was identified. Data synthesis indicates that exergaming may be effective in reducing the number of falls and fall risk in NH residents. Several significant improvements were also reported regarding secondary outcomes albeit not consistent across studies. No conclusion can be drawn about the effects of exergaming and other e-health interventions on PA, as data is scarce. E-health interventions were mostly reported as feasible and well accepted by NH residents. However, these findings may not be applicable to NH residents with advanced physical and/or cognitive impairments, since they were excluded in many studies. Therefore, more research examining other digital solutions besides exergaming to promote PA in this specific population is critical. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD4202128948

Exergames and motor learning: Systematic review

Distance learning has led to a reflection on the role of physical activity even with children in nursery and primary schools. The traditional physical space combined with online suggests a rethinking of places and teaching-learning processes. Objective: to understand if and in what way active video games were considered and studied before the pandemic and if exergames can represent a useful teaching strategy to reclaim the priority role of physical activity in the education of the student and a tool for combating overweight, obesity, and sedentary lifestyle. Fixed point: exergames must not replace the physical exercise and movement inherent in the physical and motor education curriculum but integrate them

Exergaming (XBOX Kinect™) versus traditional gym-based exercise for postural control, flow and technology acceptance in healthy adults:a randomised controlled trial

Background - The use of exergaming is a potential alternative to traditional methods of balance training, which can be repetitive and somewhat monotonous. The purpose of this study was to assess the effects of exergaming using XBOX Kinect™ versus traditional gym-based exercise with no virtual stimuli (TGB) on postural control, technology acceptance, flow experience and exercise intensity, in young healthy adults. Methods - Fifty healthy active adults (age: 33.8 ± 12.7 years, height: 172.9 ± 11.9 cm, weight: 75 ± 15.8 kg) were recruited; 44 completed both baseline and post-intervention data collection. Participants were randomised (blind card) allocation to one of two groups: (1) received balance training using the XBOX Kinect™ and (2) performed traditional gym-based exercise. Exercises were matched for intensity, duration and movement patterns across groups. All participants completed three, 30-minute, exercise sessions a week for four weeks. Postural sway was measured using a Kistler™ Force platform during unipedal standing. Mean heart rate (HR) and rate of perceived exertion (RPE) were collected during each exercise session to determine and verify that intensity of exercise was matched between groups. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology (UTAUT) and flow experience with the Flow State Scale (FSS). Results - Heart rate was matched between groups and BORG RPE was significantly lower in the Kinect™ group. There were significant between-group differences in postural sway in the medial-lateral direction and CoP. There were also significant differences in technology acceptance between groups for performance expectancy, social influence and behavioral intention, with higher values in the Kinect exercise group. The flow state scale showed significant differences between the groups on several dimensions, with higher values in the Kinect exercise group. Conclusion - Objective physiological demand of exercise (HR) was matched across groups, but the exergaming group perceived it as being less demanding and of lower intensity. This suggests that exergaming may offer an alternative method of rehabilitation exercise through improved concordance. Balance training in healthy adults using the Kinect is both accepted and intrinsically motivating

Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy

Background: There has been a rapid increase in research on the use of virtual reality (VR) and gaming technology as a complementary tool in exercise and rehabilitation in the elderly population. Although a few recent studies have evaluated their efficacy, there is currently no in-depth description and discussion of different game technologies, physical functions targeted, and safety issues related to older adults playing exergames. Objectives: This integrative review provides an overview of the technologies and games used, progression, safety measurements and associated adverse events, adherence to exergaming, outcome measures used, and their effect on physical function. Methods: We undertook systematic searches of SCOPUS and PubMed databases. Key search terms included “game”, “exercise”, and “aged”, and were adapted to each database. To be included, studies had to involve older adults aged 65 years or above, have a pre-post training or intervention design, include ICT-implemented games with weight-bearing exercises, and have outcome measures that included physical activity variables and/or clinical tests of physical function. Results: Sixty studies fulfilled the inclusion criteria. The studies had a broad range of aims and intervention designs and mostly focused on community-dwelling healthy older adults. The majority of the studies used commercially available gaming technologies that targeted a number of different physical functions. Most studies reported that they had used some form of safety measure during intervention. None of the studies reported serious adverse events. However, only 21 studies (35%) reported on whether adverse events occurred. Twenty-four studies reported on adherence, but only seven studies (12%) compared adherence to exergaming with other forms of exercise. Clinical measures of balance were the most frequently used outcome measures. PEDro scores indicated that most studies had several methodological problems, with only 4 studies fulfilling 6 or more criteria out of 10. Several studies found positive effects of exergaming on balance and gait, while none reported negative effects. Conclusion: Exergames show promise as an intervention to improve physical function in older adults, with few reported adverse events. As there is large variability between studies in terms of intervention protocols and outcome measures, as well as several methodological limitations, recommendations for both practice and further research are provided in order to successfully establish exergames as an exercise and rehabilitation tool for older adults.© 2015 Elsevier Ireland Ltd. All rights reserved. This is the authors' accepted and refereed manuscript to the article. Locked until januar 2017-01-01 due to the copyright restrictions

Exergaming as a viable therapeutic tool to improve static and dynamic balance among older adults and people with idiopathic Parkinson's disease: A systematic review and meta-analysis

The use of virtual reality games (known as "exergaming") as a neurorehabilitation tool is gaining interest. Therefore, we aim to collate evidence for the effects of exergaming on the balance and postural control of older adults and people with idiopathic Parkinson's disease (IPD). Six electronic databases were searched, from inception to April 2015, to identify relevant studies. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were used to calculate effect sizes between experimental and control groups. I (2) statistics were used to determine levels of heterogeneity. 325 older adults and 56 people with IPD who were assessed across 11 -studies. The results showed that exergaming improved static balance (SMD 1.069, 95% CI 0.563-1.576), postural control (SMD 0.826, 95% CI 0.481-1.170), and dynamic balance (SMD -0.808, 95% CI -1.192 to -0.424) in healthy older adults. Two IPD studies showed an improvement in static balance (SMD 0.124, 95% CI -0.581 to 0.828) and postural control (SMD 2.576, 95% CI 1.534-3.599). Our findings suggest that exergaming might be an appropriate therapeutic tool for improving balance and postural control in older adults, but more -large-scale trials are needed to determine if the same is true for people with IPD