Designing for movement quality in exergames: Lessons learned from observing senior citizens playing stepping games

-Background: Exergames are increasingly used as an exercise intervention to reduce fall risk in elderly. However, few exergames have been designed specifically for elderly, and we lack knowledge about the characteristics of the movements elicited by exergames and thereby about their potential to train functions important for fall risk reduction. Objective: This study investigates game elements and older players' movement characteristics during stepping exergames in order to inform exergame design for movement quality in the context of fall preventive exercise. Methods: Fourteen senior citizens (mean age 73 years ± 5.7, range 65 - 85) played 3 stepping exergames in a laboratory. Each of the exergames was described with respect to 7 game elements (physical space, sensing hardware technology, game graphics and sound, model of user, avatar/mapping of movements, game mechanism and game narrative). Five movement characteristics (weight shift; variation in step length, speed, and movement direction; visual independency) were scored on a 5-point Likert scale based on video observations of each player and each game. Disagreement between raters was resolved by agreement. Differences in scores for the 3 exergames were analyzed with a multivariate one-way ANOVA. Results: The Mole received the highest sum score and the best score on each of the 5 movement characteristics (all p values <0.0005). LightRace scored the lowest of the 3 exergames on weight shift and variation in movement direction (both p values <0.0005), while DanceDanceRevolution scored lowest on step length variation and visual independency (p < 0.03 and p < 0.0005, respectively), and lower than The Mole on speed variation (p < 0.05). The physical space players used when exergaming and the on-screen representation of the player, affected movement quality positively as indexed by multiple weight shifts and variation in stepping size, direction, and speed. Furthermore, players' movements improved when playing speed-affected game progression and when the game narrative was related to a natural context. Conclusion: Comparing differences in game elements with associated differences in game movement requirements provides valuable insights about how to design for movement quality in exergames. This provided important lessons for the design of exergames for fall-preventive exercise in senior citizens and illustrates the value of including analyses of movement characteristics when designing such exergames

Step-based Exergames Used in Balance Training for Seniors : A Usability Study

This study explores the potential of the use of step-based exergames in balance training for senior citizens. Three exergames were tested and evaluated by healthy senior citizens to provide a basis for further development and use of these types of exergames.\newline Three mini games were chosen for evaluation; SilverFit and &quot;the Mole&quot; mini game, Your Shape and the &quot;Light Race&quot; mini game, and a modified version of Dance Dance Revolution for PC. The reason for the choice of exergames to be evaluated, was that all of three games require the player to perform a step-based movement that can potentially improve the player&apos;s balance. To collect data to evaluate these exergames, there were two main phases of research conducted. Firstly, 14 individual sessions of usability tests were conducted with senior citizens. Secondly, a focus group session with domain experts in human movement science was held. \newline The aim of the first phase was to evaluate which of these three selected exergames, was most preferred by the senior user-group and what game elements that contributed positively and negatively to the seniors&apos; motivational factors and preference of game. The aim of the second phase was to explore the aspect of success-factors and requirements that exists for the use of exergames in balance-training from domain experts&apos; point of view.\newlineIn the usability tests that were conducted, 14 healthy senior citizens each played the three selected games in a balanced order, and was asked to give their opinions and preferences afterwards. A card-ranking session and System Usability Scale forms filled out after every game-play showed that it was the SilverFit game that was the most preferred game by seniors. The seniors were also asked what elements that they found important in a game like this for them to take it into use. Through a qualitative analysis of the data form the usability tests, it was found that a challenging of level of difficulty, mastery of game aims, high-scores and progression, entertaining concept, and multi-player functionality are game elements that are important factors if senior citizens are going to use exergames at a regular basis.\newlineAfter conducting all usability tests, one focus group session was held with two domain experts in the field of human movement science. These experts established that the success criteria for use of exergames in balance training with seniors are fun, safety, shifting of bodyweight, independent use, full-body movement and challenging game-play. SilverFit: &quot;the Mole&quot;, Your Shape: &quot;Light Race&quot;, and a modified version of Dance Dance Revolution were all evaluated on the basis of recordings from the usability tests. In terms of the criteria established, experts found that SilverFit was the most suitable game, although not optimal, due to the lack of progression in the game.\newlineAfter conducting two phases of research and data collection, it can be concluded from this study that new exergames need to be developed specifically intended for regular balance-training for senior citizens

Designing for movement quality in exergames: Lessons learned from observing senior citizens playing stepping games

Background: Exergames are increasingly used as an exercise intervention to reduce fall risk in elderly. However, few exergames have been designed specifically for elderly, and we lack knowledge about the characteristics of the movements elicited by exergames and thereby about their potential to train functions important for fall risk reduction. Objective: This study investigates game elements and older players' movement characteristics during stepping exergames in order to inform exergame design for movement quality in the context of fall preventive exercise. Methods: Fourteen senior citizens (mean age 73 years ± 5.7, range 65 - 85) played 3 stepping exergames in a laboratory. Each of the exergames was described with respect to 7 game elements (physical space, sensing hardware technology, game graphics and sound, model of user, avatar/mapping of movements, game mechanism and game narrative). Five movement characteristics (weight shift; variation in step length, speed, and movement direction; visual independency) were scored on a 5-point Likert scale based on video observations of each player and each game. Disagreement between raters was resolved by agreement. Differences in scores for the 3 exergames were analyzed with a multivariate one-way ANOVA. Results: The Mole received the highest sum score and the best score on each of the 5 movement characteristics (all p values <0.0005). LightRace scored the lowest of the 3 exergames on weight shift and variation in movement direction (both p values <0.0005), while DanceDanceRevolution scored lowest on step length variation and visual independency (p < 0.03 and p < 0.0005, respectively), and lower than The Mole on speed variation (p < 0.05). The physical space players used when exergaming and the on-screen representation of the player, affected movement quality positively as indexed by multiple weight shifts and variation in stepping size, direction, and speed. Furthermore, players' movements improved when playing speed-affected game progression and when the game narrative was related to a natural context. Conclusion: Comparing differences in game elements with associated differences in game movement requirements provides valuable insights about how to design for movement quality in exergames. This provided important lessons for the design of exergames for fall-preventive exercise in senior citizens and illustrates the value of including analyses of movement characteristics when designing such exergames