Elderly Players Research Articles

Experiencing the body as play: Cultivating older adults’ exergame experiences using embodied metaphors and multimodal feedback

Physical activity (PA) is promising in increasing active life for older adults, but its repetitive and fatigue-inducing nature greatly harms older adults’ motivation to participate. Recently, there has been a growing interest in applying exergames to improve older adults’ PA adherence and engagement. To better support body-based interactions, embodied metaphors and multimodal feedback are suggested to ensure effective and meaningful mapping between elderly players’ input actions and exergame responses, but their effectiveness have not been fully investigated. After developing a list of embodied and ontological metaphors based a series of user-centered approaches, two experiments were conducted to investigate how embodied metaphors and multimodal feedback impact older adults'’ playing experience of PA exergames, among fifty-nine and twenty-five older adults, respectively. Regarding the embodied metaphor design, the results indicated that a higher embodiment level significantly and positively influenced the participants’ acceptance behavior in terms of their attitudes toward the exergame, and a higher information richness level demonstrated significantly positive effects on familiarity perception and all aspects of acceptance behavior. For the multimodal feedback design, the results indicated that 3D visual feedback better facilitated the participants’ sense of embodiment and immersion, as well as their acceptance behavior, compared to 2D visual feedback. Furthermore, constant tactile feedback in a continuous-only or continuous-and-augmented way significantly improved the participants’ PA movement performance and sense of embodiment, rather than instant feedback. Accordingly, a list of design guidelines for PA exergame development is proposed, with the possible contributions and limitations of this research addressed.

Cheer for me: effect of non-player character audience feedback on older adult users of virtual reality exergames.

The presence of an audience and its feedback could affect people's performance and experience during an event, especially related to sports such as tennis or boxing. Similarly, in videogames, players' gameplay could be affected if there is an audience and its feedback in response to players' performance in the environment. The inclusion of an audience with non-player characters (NPC) is common in videogames in general. However, there is a limited exploration of the use of an NPC audience in virtual reality (VR) exergames, especially focusing on elderly players. To fill this gap, this work examines the effect of an NPC audience and its associated feedback (with/without) on elderly users of VR exergames. In a user study, we used 120 NPC in a virtual audience. Results showed that the presence of the NPC audience with responsive feedback led to higher performance (with a higher success rate of performing gesture actions, more successful combinations of actions (or combos for short) performed, and more opponent's combos prevented) and better gameplay experience (with higher levels of competence, autonomy, relatedness, immersion, and intuitive controls) of elderly players. Our results can help frame the design and engineering of VR exergames that are targeted at elderly users to help them have an enhanced gameplay experience and improve their health.

Artificial intelligence-based personalized serious game for enhancing the physical and cognitive abilities of the elderly

Recently, therapeutic exercise serious games have been successfully conducted to enhance cognitive decline in dementia and to aid physical rehabilitation. However, these promising results are only possible based on the premise that the elderly players can keep on playing the game with high motivation until they can see the clinical effects. In line with this, this study was conducted to design a digital healthcare application aiming at improving the elderly’s physical and cognitive functions. This study designed the exercise serious game Farming with Artificial Intelligence-(AI-) based personalized systems of difficulty level adjustment and relative scoring to motivate the user to keep playing the game with pleasure while applying a set of gratification and motivation technique. This study also designed a three-month empirical assessment on user satisfaction and performance test. Results of the study showed that all three aspects of immersion, satisfaction, and performance records become higher than other existing games in the market, which proved the suitability and utility of the proposed serious game as a digital healthcare application. Thus, the personalized and playful elements for the exercise games is expected to provide a more motivating and entertaining environment for the elderly users for further practical and wider usage of emerging digital healthcare applications.

Influences of Recreational Tennis-Playing Exercise Time on Cardiometabolic Health Parameters in Healthy Elderly: The ExAMIN AGE Study.

Background: Aging and chronic degeneration are the primary threats to cardiometabolic health in elderly populations. Regular appropriate exercise would benefit the advanced aging population. Purpose: This study investigates whether the degree of weekly tennis participation exhibits differences in primary cardiometabolic parameters, including arterial stiffness, inflammation, and metabolic biomarkers in elderly tennis players. Methods: One hundred thirty-five long-term participants in elder tennis (>50 years old) were initially screened. Twenty-six eligible and voluntary subjects were divided into high tennis time group (HT) (14 ± 1.3 h/week) and low tennis time group (LT) (4.5 ± 0.7 h/week) by stratification analysis based on the amount of tennis playing activity time. The brachial-ankle pulse wave velocity (baPWV), blood pressure, ankle-brachial index (ABI), blood metabolic biomarkers, and insulin resistance were measured to compare the difference between HT and LT groups. Results: The baPWV was significantly lower in the HT group than that in the LT group (1283.92 ± 37.01 vs. 1403.69 ± 53.71 cm/s, p < 0.05). We also found that the HT insulin-resistant homeostasis model assessment (HOMA-IR) was significantly lower than that of LT (1.41 ± 0.11 vs. 2.27 ± 0.48 μIU/mL, p < 0.05). However, the blood lipid biomarkers (glucose, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride) were not statistical different between HT and LT groups (p > 0.05). Conclusion: We demonstrated that under the condition of similar daily physical activity level, elderly with a higher time of tennis-playing (HT group) exhibited relatively lower arterial stiffness (lower PWV) and lower insulin resistance compared to those with lower time tennis-playing (LT).

Football - Novel Approaches to Tackle Diabetes.

Balanced diet and regular physical activity are of key importance to the prevention of the development and progression of non-communicable diseases. In 2050, 50% of the European population is expected to be obese. Cardiovascular diseases, diabetes mellitus, cancer, as well as joint impairments, will further increase. Therefore, programmes are critical to the improvement of the population's health status in the long run. New ways have to be found that allow addressing more people than with the current approaches. Football has a great potential to attract people at risk for or with already existing non-communicable diseases, such as type 2 diabetes, to participate in health-promoting programmes. The novel football version, walking football was developed for elderly players, aiming at avoiding injuries and physical overload. The present article gives a brief overview on the metabolic effects of recreational football, particularly walking football, as well as health-promoting programmes offered by professional football clubs in humans at risk for or with already existing non-communicable diseases.

Different performance, full experience: a learning game applied throughout adulthood

Gaming may not primarily be associated with the elderly part of the population, but senior gamers represent a growing proportion. Evaluating the applicability of educational games across the lifespan is therefore crucial to better understand potential requirements in different domains and age groups. The current study applied a math learning game to participants from 19 to 79 years of age. We examined age-related differences along three domains: cognition, as measured by in-game performance, basic player experience with the game, and general player attitudes towards technology. Analyses of performance metrics related to speed clearly reflected an age-related decline, well in line with known effects from cognitive ageing. In contrast, error-metrics were associated with educational background. At the player experience level, however, we found no differences across the lifespan. All participants rated the game equally (positive). Furthermore, our results showed that attitudes towards technology only differed occasionally, for instance, senior participants seemed to be more technologically interested. Taken together, scoring systems as well as other in-game metrics based on performance, especially related to speed, should be adapted appropriately to player’s age. Finally, elderly players’ experience with the game and overall attitudes towards technology appeared comparable to other younger age groups.

Efficiency of psychopharmacological correction of functional state of elderly hockey players

Efficiency of psychopharmacological correction of functional state of elderly hockey players

Step Counts of Middle-Aged and Elderly Adults for 10 Months Before and After the Release of Pokémon GO in Yokohama, Japan.

BackgroundSmartphones have been integrated into our society and are expected to serve as tools to improve health outcomes. In the summer of 2016, Pokémon GO, a location-based augmented reality game for smartphones was released; it attracted attention from the perspective of health, especially with its potential to increase physical activity (PA). A few studies have compared objectively measured step counts before and after the release of the game; however, they were conducted over a short study period and evaluated only young people.ObjectiveThe objective of this study was to confirm whether there was a difference in step counts between middle-aged and elderly players and nonplayers before and after the release of Pokémon GO.MethodsA total of 46 players and 184 nonplayers aged ≥40 years were matched for sex, age group, and PA level; they were respondents to a questionnaire randomly sent to citizens who were given free pedometers by Yokohama city. Their play status was identified through the questionnaire. To investigate the change in step counts before and after the release of Pokémon GO according to play status, a 2-way repeated-measures analysis of variance was performed. Step counts 1 month before the release of the game were compared with those 8 months after the release. In addition, subgroup analyses according to sex, age group, PA level, and subjective health status were performed.ResultsThe mean ages of players and nonplayers were 56.5 (SD 9.9) years and 57.3 (SD 9.6) years, respectively, and the mean baseline step counts of players and nonplayers were 7641.8 (SD 2754.5) and 7903.3 (SD 2674.7), respectively. There was no significant difference in the age and baseline step counts according to a t test (2-tailed). In the analysis of all samples, the interaction between play status and time effect was significant for 3 of 8 months after release. In the subgroup analyses, the interaction was significant for 3 months in men, 7 months in the 55-64-year-old group, 2 months in workers, 4 months in the active group in PA level, and 2 months in participants with subjectively good health. The interaction was significant for only 1 month, at most, in other subgroups.ConclusionsThe present study confirmed a difference in step counts between players and nonplayers before and after the release of Pokémon GO. According to our analysis, step counts were higher until 7 months after the release. The player group maintained their step counts in winter, despite the decrease in step counts of nonplayers. In subgroup analyses, players were more likely to be men, aged <55 years, workers, active, and subjectively in good health.

Smartkuber: A Serious Game for Cognitive Health Screening of Elderly Players.

The goal of this study was to design and develop a serious game for cognitive health screening of the elderly, namely Smartkuber, and evaluate its construct, criteria (concurrent and predictive), and content validity, assessing its relationship with the Montreal Cognitive Assessment (MoCA) test. Furthermore, the study aims to evaluate the elderly players' game experience with Smartkuber. Thirteen older adults were enrolled in the study. The game was designed and developed by a multidisciplinary team. The study follows a mixed methodological approach, utilizing the In-Game Experience Questionnaire to assess the players' game experience and a correlational study, to examine the relationship between the Smartkuber and MoCA scores. The learning effect is also examined by comparing the mean game scores of the first and last game sessions of each player (Delta scores). All 13 participants (mean age: 68.69, SD: 7.24) successfully completed the study. Smartkuber demonstrated high concurrent validity with the MoCA test (r = 0.81, P = 0.001) and satisfying levels of predictive and content validity. The Delta scores showed no statistically significant differences in scoring, thus indicating no learning effects during the Smartkuber game sessions. The study shows that Smartkuber is a promising tool for cognitive health screening, providing an entertaining and motivating gaming experience to elderly players. Limitations of the study and future directions are discussed.

Augmented Reality Cubes for Cognitive Gaming: Preliminary Usability and Game Experience Testing

Early detection is important in dementia care; however, cognitive impairment is still under-recognised and under-diagnosed. Cognitive screening and training are two important preventative treatments, which can lead to early detection of cognitive decline. In this work, the “Cognitive Augmented Reality Cubes” (CogARC) system is presented, i.e. a serious game for cognitive training and screening, utilising an interaction technique based on Augmented Reality and the manipulation of tangible, physical objects (cubes). The game is a collection of cognitive mini-games of preventative nature and is, primarily, targeting elderly players (≥60 years old). A preliminary testing was conducted focusing on the game experience that CogARC offers (utilising the In-Game Experience Questionnaire), the usability of the system (using the System Usability Scale), and the specific user observations and remarks, as documented by open, semi-structured interviews. Overall, CogARC demonstrated satisfying positive responses, however, the negative reactions indicated that there are specific problems with aspects of the interaction technique and a number of mini-games. The open interview shed more light on the specific issues of each mini-game and further interpretation of user interactions. The current study managed to provide interesting insights into the game design elements, integration of Augmented Reality, tangible interaction of the system, and on how elderly players perceive and use those interaction components.

Towards a Gerontoludic Manifesto

Digital games have become an important part of the technoscape, not only for youngsters, but for players of all ages. Older adults are a large, currently still largely untapped market for innovative game research and development. However, the current discourse on games and ageing can largely be categorized into two themes. The first theme refers to digital games framed as a way for older adults to improve certain skills. The useful, pragmatic qualities, rather than the fun, hedonic aspects of games are emphasized. The second theme identifies the various age-related constraints that prevent older adults from playing. It focuses on the cognitive and physical limitations of older adults. Underlying both themes is a reductionist perspective on ageing as merely a process of decline and debilitation. In this article, we present a “gerontoludic” manifesto. Firstly, games should not be marketed solely as having the purpose of dealing with or mitigating age-related decline and focus on positive aspects of older age (adagio 1: growth over decline). Secondly, age-related adjustments should never interfere with the actual gameplay of the game (adagio 2: playfulness over usefulness). Finally, game researchers and game industry should put more efforts in understanding what differentiates elderly players, rather than seeing them as united in their age-related impairments (adagio 3: heterogeneity over unification). As this manifesto is a first step that needs further abutment by a wider community, we welcome debate and additions from game designers and researchers to further this manifesto and to move beyond ageism in games.

Custom-designed motion-based games for older adults: A review of literature in human-computer interaction

Many older adults, particularly persons living in senior residences and care homes, lead sedentary lifestyles, which reduces their life expectancy. Motion-based video games encourage physical activity and might be an opportunity for these adults to remain active and engaged; however, research efforts in the field have frequently focused on younger audiences and little is known about the requirements and benefits of motion-based games for elderly players. In this paper, we present an overview of motion-based video games and other interactive technologies for older adults. First, we summarize existing approaches towards the definition of motion-based video games – often referred to as exergames – and suggest a categorization of motion-based applications into active video games, exergames, and augmented sports. Second, we use this scheme to classify case studies addressing design efforts particularly directed towards older adults. Third, we analyze these case studies with a focus on potential target audiences, benefits, challenges in their deployment, and future design opportunities to investigate whether motion-based video games can be applied to encourage physical activity among older adults. In this context, special attention is paid to evaluation routines and their implications regarding the deployment of such games in the daily lives of older adults. The results show that many case studies examine isolated aspects of motion-based game design for older adults, and despite the broad range of issues in motion-based interaction for older adults covered by the sum of all research projects, there appears to be a disconnect between laboratory-based research and the deployment of motion-based video games in the daily lives of senior citizens. Our literature review suggests that despite research results suggesting various benefits of motion-based play for older adults, most work in the field of game design for senior citizens has focused on the implementation of accessible user interfaces, and that little is known about the long-term deployment of video games for this audience, which is a crucial step if these games are to be implemented in activity programs of senior residences, care homes, or in therapy.

Exercise performance and cardiovascular health variables in 70-year-old male soccer players compared to endurance-trained, strength-trained and untrained age-matched men

The aim was to investigate performance variables and indicators of cardiovascular health profile in elderly soccer players (SP, n = 11) compared to endurance-trained (ET, n = 8), strength-trained (ST, n = 7) and untrained (UT, n = 7) age-matched men. The 33 men aged 65–85 years underwent a testing protocol including measurements of cycle performance, maximal oxygen uptake (VO2max) and body composition, and muscle fibre types and capillarisation were determined from m. vastus lateralis biopsy. In SP, time to exhaustion was longer (16.3 ± 2.0 min; P < 0.01) than in UT (+48%) and ST (+41%), but similar to ET (+1%). Fat percentage was lower (P < 0.05) in SP (–6.5% points) than UT but not ET and ST. Heart rate reserve was higher (P < 0.05) in SP (104 ± 16 bpm) than UT (+21 bpm) and ST (+24 bpm), but similar to ET (+2 bpm), whereas VO2max was not significantly different in SP (30.2 ± 4.9 ml O2 · min−1 · kg−1) compared to UT (+14%) and ST (+9%), but lower (P < 0.05) than ET (−22%). The number of capillaries per fibre was higher (P < 0.05) in SP than UT (53%) and ST (42%) but similar to ET. SP had less type IIx fibres than UT (−12% points). In conclusion, the exercise performance and cardiovascular health profile are markedly better for lifelong trained SP than for age-matched UT controls. Incremental exercise capacity and muscle aerobic capacity of SP are also superior to lifelong ST athletes and comparable to endurance athletes.

Did Anyone Say BINGO: A Socially Assistive Robot to Promote Stimulating Recreational Activities at Long-Term Care Facilities

Did Anyone Say BINGO: A Socially Assistive Robot to Promote Stimulating Recreational Activities at Long-Term Care Facilities

Using Game Theory to Examine Incentives in Influenza Vaccination Behavior

The social good often depends on the altruistic behavior of specific individuals. For example, epidemiological studies of influenza indicate that elderly individuals, who face the highest mortality risk, are best protected by vaccination of young individuals, who contribute most to disease transmission. To examine the conditions under which young people would get vaccinated to protect elderly people, we conducted a game-theory experiment that mirrored real-world influenza transmission, with “young” players contributing more than “elderly” players to herd immunity. Participants could spend points to get vaccinated and reduce the risk of influenza. When players were paid according to individual point totals, more elderly than young players got vaccinated, a finding consistent with the Nash equilibrium predicting self-interested behavior. When players were paid according to group point totals, however, more young than elderly players got vaccinated—a finding consistent with the utilitarian equilibrium predicting group-optimal behavior—which resulted in higher point totals than when players were paid for their individual totals. Thus, payout structure affected whether individuals got vaccinated for self-interest or group benefit.

Golf: a high intensity interval activity for elderly men

The aim was to quantify the time spent at different exercise intensities for male golfers, in relation to age, while walking a "normal" 18-hole golf course. 19 healthy male golfers (six 27 (5) years old, seven of 50 (7) and six of 75 (4) years) performed a maximal exercise test on a treadmill (maximal oxygen uptake and maximal heart rate were measured). Within one week, they played an "average" 18-hole course starting at 7:00 a.m. During the round, their heart rate was monitored with a Polar Vantage heart rate monitor, which sampled the heart rate every 5 seconds. Body weight was measured before and after the round. Blood glucose was taken at rest before the round and after each 3rd hole. Perceived exertion and perceived pain in muscles and joints were rated using the CR 10 Borg scale just before reaching each green and after a few selected uphill parts of the course. High intensity of exercise was reached during 6% of the total playing time for the young, 30% for the middle-aged and 70% for the elderly golfers, playing 18 holes (p < 0.05). The golfers' heart rate was below 50% of their individual maximal heart rate, 18% of total time for young golfers, 16% for the middle-aged, and not at all for the elderly. Perceived exertion, breathlessness and leg fatigue were rated in a similar manner for all three groups. Perceived pain in joints and muscles was rated extremely weak except in a few players who had some known joint or muscle problem. The mean blood glucose level fell by 20% for the young (p < 0.05), 10% for the middle-aged, and 30% for the elderly players (p < 0.05) after 18 holes of play. Body weight was reduced 0.7% similarly for all three groups (p < 0.05). Walking an 18-hole golf course corresponds to an exercise intensity which is moderate and high for the elderly, mainly low to moderate for the middle-aged, and low for young male golfers. All golfers, regardless of age, perceived their exertion similarly as weak to moderate.

Representations of knowledge about dominoes in demented and normal elderly players

1. 1. Dementia patients who retain musical and game-playing skills exhibit impaired performance on explicit memory tests of knowledge about their retained skill. 2. 2. Dementia patients who retain skill at playing dominoes can answer complex questions about the play of the game almost as well as normal elderly domino players when the questions are presented with real dominoes. 3. 3. The aim of this study was to determine if skilled dementia patients could answer questions about domino play when the stimuli were two-dimensional drawings of dominoes. 4. 4. Seventeen dementia patients and eight normal elderly domino players were tested on two forms of the Domino Quiz: first with real dominoes, then with two-dimensional drawings; other neuropsychological tests were given at the same time. 5. 5. Fourteen of the 17 patients and all of the controls showed no decline in answering questions about domino play when two-dimensional drawings were used. These patients showed retained symbolic processing of information about dominoes despite declines in overall mental status, generation of words from specific semantic categories and recognition memory for domino terminology. 6. 6. Because the 14 patients with retained domino skill performed as accurately as controls on both administrations of a letter cancellation task, the ability to process familiar symbols may be important to their game-playing skill.

Knee Pain in Tennis Players

Knee injuries are relatively common in tennis, comprising about one fifth of all tennis injuries. The most common injuries are meniscus injuries and degenerative cartilage problems in middle aged and elderly recreational players. In younger individuals, patellofemoral pain syndromes are the most frequent and intriguing problems. Knee overuse syndromes occur more commonly on surfaces such as all weather concrete because they are more fatiguing and have higher friction than clay surfaces do.