Assessing Motivational Differences Between Young and Older Adults When Playing an Exergame.

Background: Currently, exergames are used by different age groups for both recreational and training/rehabilitation purposes. However, little is known about how to design exergames so that they are motivating for specific age groups and health outcomes. Objective: In this article, we compare motivational factors between healthy young and older adults by analyzing their assessments of the same balance training exergame. Materials and Methods: We performed a laboratory-based assessment of a custom-made balance training exergame with 12 healthy young and 10 healthy older adults. Their answers to a semistructured text input questionnaire were analyzed qualitatively. Results: Both age groups were motivated by a combination of intrinsic and extrinsic motivational factors. We found that the young adults tended to be motivated by the game challenge and the in-game reward system (scores). In contrast, the older adults were more motivated by the perceived health effects (both physical and cognitive) and the joy of playing, with less regard for the in-game rewards. Conclusion: The differences in motivational factors that were identified between young and older adults have several design implications. For older adults less effort can be put on designing the in-game reward system and more on showing the player the potential health effects of their play. Furthermore, the competition aspect can be downplayed and more focus placed on simply making the gaming experience itself as joyful as possible

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 in older adults: Use, user experiences, and the relationship between game elements and movement characteristics

NORSK SAMMENDRAG: Exergaming for eldre Bruk, brukervennlighet og forholdet mellom spill elementer og bevegelseskarakteristikker - Etter introduksjonen av det Playstation-baserte spillet Dance Dance Revolution (DDR) i 2004 og Nintendo Wii i 2006, har bruken av videospill som et middel for å fremme fysisk aktivitet økt kraftig i popularitet. Disse bevegelses-kontrollerte spillene, som blir kalt exergames eller trenings spill på norsk, ble raskt anerkjent som et mulig verktøy for å tilby artig og lett tilgjengelig trening i både generell treningssammenheng og spesifikk rehabilitering. Selv om disse spillene har vist seg å ha et stort potensiale, er det fortsatt begrenset kunnskap om bruken og brukervennligheten av disse spillene for eldre, og om de er egnet for å opprettholde fysisk aktivitet, eller til bruk ved opptrening etter sykdom eller skade. Målet med denne avhandlingen er å evaluere bruken, brukervennligheten og forholdet mellom spill elementer og bevegelseskarakteristikker hos eldre, med spesielt fokus på spill som er designet for å ta steg for å få poeng. Resultatene viser at eldre synes at spill er en artig og spennende form for trening, men de påpekte en del mangler i forhold til tilbakemeldinger de fikk fra spillene, samt ønske om gradvis økning av vanskelighetsnivået. Eldre viser også forskjeller i bevegelsene de gjennomfører når de spiller ulike spill på ulike vanskelighetsnivå, noe som illustrerer viktigheten av å se på bevegelsene til spilleren, samt se på de ulike egenskapene som spillene innehar, før man tar i bruk spill i spesifikk trening og rehabilitering for eldre. Økt vanskelighetsgrad kan øke glede og gjøre spillet mer lystbetont, men kan samtidig redusere bevegelseskvalitet. Det er derfor viktig å velge spill ut i fra hva man ønsker at utfallet skal være

Older adults and exergaming – how do they actually move?

Aim: Investigate variation in step and amount of movements in older adults playing step-based exergames. Design: Experimental cross-sectional study. Material: To different studies were performed. In study 1, 20 independent-living older adults ((75.7±5.4 years, 12 women) participated, and in study 2 16 independent-living older 76.5±4.5 years, 8 women) adults and 16 young adults (25±2.1 years, 8 women) participated. Methods: In study 1, participants played 2 step-based exergames, the specially designed game The Mole, and the commercial game LightRace, on 2 difficulty levels. Step and upper-body movements were registered with a 3D-motion capture system. In study 2 all participants played The Mole on 3 difficulty levels. Three tri-axial accelerometers were used to evaluate step and upper-body movements. Results: Older adults had more variation in step movements and greater amount of movement when playing The Mole compared to LightRace. Playing the difficult level of The Mole, older adults displayed less movements compared to easy and medium levels (all p´s>.02), while the young adults had no differences in amount of movements displayed within the three levels. Conclusion: This study illustrates the importance of evaluating the movement’s different exergames and levels within the games prompt when using exergames in exercise and rehabilitation setting

Eldre og exergaming – hvordan beveger de seg egentlig?

Hensikt: Undersøke variasjon i steg og mengde bevegelse hos eldre som spiller stegbaserte exergames. n Design: Eksperimentell tverrsnittsstudie. n Materiale: To ulike studier ble gjennomført. I studie 1 deltok 20 hjemmeboende eldre (75.7±5.4 år, 12 kvinner), og i studie 2 deltok 16 hjemmeboende eldre (76.5±4.5 år, 8 kvinner) og 16 yngre personer (25±2.1 år, 8 kvinner). n Metode: I studie 1 spilte deltakerne to steg-baserte exergames, The Mole og LightRace, på to ulike vanskelighetsnivå. Steg og overkroppsbevegelser ble registrert med et 3D-motion capture system. I studie 2 spilte alle deltakerne The Mole på tre ulike vanskelighetsnivå. Tre tri-aksiale akselerometre ble brukt for å evaluere steg og overkroppsbevegelser. n Resultat: Eldre personer hadde mer variasjon i stegbevegelser og større mengde bevegelse når de spilte The Mole som er spesial designet for eldre, sammenlignet med det kommersielle spillet LightRace. Eldre personer hadde totalt mindre bevegelse når de spilte det vanskeligste nivået av The Mole sammenlignet med lett og medium nivå (alle p>.02), mens yngre deltakere viste ingen forskjell i mengde bevegelse i de tre vanskelighetsnivåene. n Konklusjon: Resultatene i denne studien viser at både type spill og nivå innad i disse spillene påvirker både mengde aktivitet og variasjon i steg. Dette må man ta hensyn til når man bruker exergames i trenings- og rehabiliteringssituasjoner

Systematic Review of Design Guidelines for Full-Body Interactive Games

This paper provides a systematic review of research articles published between 2010 and mid-2018 that have offered design guidelines for full-body interactive games for recreational purposes and physical exercise. From an initial 3562 retrieved database references, 22 articles were found to meet our predefined criteria and were included in the final review. The review of 22 articles resulted in the extraction of 107 design guidelines, which were grouped in 12 different categories: movement elicitation, mapping of movement, explicit movement guidance, player representation and game world, attention, feedback on player performance, player agency and customization, exertion, safety, universal design and social aspects. While the current body of guidelines was found to cover multiple aspects pertaining to the design of full-body interactive games, the conducted review also revealed a number of overarching concerns regarding the present state. Specifically, these concerns relate to (i) the hedonic–utilitarian divide in movement-related design guidelines of relevant literature, (ii) the lack of common structure for specifying guidelines, (iii) the lack of systematic development of guidelines, (iv) the issues related to the validity of the existing guidelines and (v) the limited focus on tangible interfaces in the present state of the art. In conclusion, the current review paints a somewhat questionable picture of the present state of the corpus of design guidelines for full-body games, with relatively large differences in the quality of the guidelines proposed in the individual articles and a lack of reference to already existing guidelines. In the longer run, these quality issues risk watering out the original meaning of the term design guideline and reducing the potential value design guidelines can offer in development of full-body interactive games

The influence of motor tasks and cut-off parameter selection on artifact subspace reconstruction in EEG recordings

Advances in EEG filtering algorithms enable analysis of EEG recorded during motor tasks. Although methods such as artifact subspace reconstruction (ASR) can remove transient artifacts automatically, there is virtually no knowledge about how the vigor of bodily movements affects ASRs performance and optimal cut-off parameter selection process. We compared the ratios of removed and reconstructed EEG recorded during a cognitive task, single-leg stance, and fast walking using ASR with 10 cut-off parameters versus visual inspection. Furthermore, we used the repeatability and dipolarity of independent components to assess their quality and an automatic classification tool to assess the number of brain-related independent components. The cut-off parameter equivalent to the ratio of EEG removed in manual cleaning was strictest for the walking task. The quality index of independent components, calculated using RELICA, reached a maximum plateau for cut-off parameters of 10 and higher across all tasks while dipolarity was largely unaffected. The number of independent components within each task remained constant, regardless of the cut-off parameter used. Surprisingly, ASR performed better in motor tasks compared with non-movement tasks. The quality index seemed to be more sensitive to changes induced by ASR compared to dipolarity. There was no benefit of using cut-off parameters less than 10

Balance training in older adults using exergames: Game speed and cognitive elements affect how seniors play

Falls in older adults are a serious threat to their health and independence, and a prominent reason for institutionalization. Incorrect weight shifts and poor executive functioning have been identified as important causes for falling. Exergames are increasingly used to train both balance and executive functions in older adults, but it is unknown how game characteristics affect the movements of older adults during exergaming. The aim of this study was to investigate how two key game elements, game speed, and the presence of obstacles, influence movement characteristics in older adults playing a balance training exergame. Fifteen older adults (74 ± 4.4 years) played a step-based balance training exergame, designed specifically for seniors to elicit weight shifts and arm stretches. The task consisted of moving sideways to catch falling grapes and avoid obstacles (falling branches), and of raising the arms to catch stationary chickens that appeared above the avatar. No steps in anterior-posterior direction were required in the game. Participants played the game for eight 2 min trials in total, at two speed settings and with or without obstacles, in a counterbalanced order across participants. A 3D motion capture system was used to capture position data of 22 markers fixed to upper and lower body. Calculated variables included step size, step frequency, single leg support, arm lift frequency, and horizontal trunk displacement. Increased game speed resulted in a decrease in mean single support time, step size, and arm lift frequency, and an increase in cadence, game score, and number of error messages. The presence of obstacles resulted in a decrease in single support ratio, step size, cadence, frequency of arm lifts, and game score. In addition, step size increased from the first to the second trial repetition. These results show that both game speed and the presence of obstacles influence players’ movement characteristics, but only some of these effects are considered beneficial for balance training whereas others are detrimental. These findings underscore that an informed approach is necessary when designing exergames so that game settings contribu

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

Experiences of Stroke Survivors and Clinicians With a Fully Immersive Virtual Reality Treadmill Exergame for Stroke Rehabilitation: A Qualitative Pilot Study

Use of VR-games is considered a promising treatment approach in stroke rehabilitation. However, there is little knowledge on the use and expectations of patients and health professionals regarding the use of treadmill walking in a fully immersive virtual environment as a rehabilitation tool for gait training for stroke survivors. The objectives of the current study were to determine whether stroke survivors can use fully immersive VR utilizing modern HMDs while walking on a treadmill without adverse effects, and to investigate the experiences of stroke survivors and clinicians after testing with focus on acceptability and potential utilization in rehabilitation. A qualitative research design with semi-structured interviews was used to collect data. Five stroke survivors and five clinicians participated in the study and tested a custom-made VR-game on the treadmill before participating in individual semi-structured interview. Data were analyzed through thematic analysis. The analysis of the interview data identified two main categories: (1) experiencing acceptability through safety and motivation, and (2) implementing fully immersive VR in rehabilitation. Both stroke survivors' and clinicians enjoyed the treadmill-based VR-game and felt safe when using it. The stroke survivors experienced motivation for exercising and achievement by fulfilling tasks during the gaming session as the VR-game was engaging. The clinicians found additional motivation by competing in the game. Both groups saw a potential for use in gait rehabilitation after stroke, on the premise of individual adaptation to each patient's needs, and the technology being easy to use. The findings from this qualitative study suggest that a fully immersive treadmill-based VR-game is acceptable and potentially useful as part of gait rehabilitation after stroke, as it was positively received by both stroke survivors and clinicians working within stroke rehabilitation. The participants reported that they experienced motivation in the game through safety, engagement and achievement. They also saw the potential of implementing such a setup in their own rehabilitation setting. Elements that enable safety and engaging experience are important to maintain when using a fully immersive VR-game in stroke rehabilitation