Exergaming Intervention Research Articles

Examining older adults’ perceived workload, motivators, and barriers experienced during an exergame study — a mixed methods approach

AbstractBackgroundThere is increasing interest in using exergames to promote physical and cognitive functioning. Examining the perceived workload and various motivators/barriers associated with enrollment and retention in exergame studies is needed to design engaging and sustainable exergame interventions. In this study, we examined the perceived workload, motivators, barriers, and general feedback from older adults participating in an exergame study.MethodWe conducted 3 semi‐structured focus groups among 14 older adults from a senior living center to evaluate motivators and barriers associated with joining and remaining in the Stimulation with Intricate Movements (SWIM) study. The SWIM study was designed to assess the impact of an exergame called “Bandit the Dolphin” which simultaneously integrates cognitive and physical activity within an immersive, interactive environment. The NASA‐TLX scale was used to assess perceived workload during gameplay, and ratings ranged from 0‐100 (low to high workload). An exit survey assessed participants’ experiences and perceived changes in activity following the study (e.g., social, cognitive, physical).ResultMotivators for joining were self‐improvement, generativity, peer referrals, and curiosity. Motivators for retention involved immersion during gameplay, gaining a sense of accomplishment, and exercise. Barriers included exhaustion/pain from standing and frustration from lack of level advancement. Perceived effort [M=62.5,SD=13.0] and physical demand [M=57.9,SD=13.8] were the highest ranked categories on the NASA‐TLX scale, followed by mental demand [M=49.3,SD=17.2]. Frustration received the lowest ranking [M=37.9,SD=26.5]. From the exit survey, 100% would recommend the study to a friend, 53% said participating in the study changed their physical activity levels, and 40% reported changes in their comfort with video games/technology.ConclusionPrimary motivators for study initiation and retention align with the Self‐Determination Theory which posits intrinsic motivation arises when autonomy, competence, and social relatedness are achieved. NASA‐TLX results show that perceived effort and physical demand of gameplay ranked highest, followed by mental demand, with frustration ranking the lowest. Notably, all participants would recommend the study to a friend. Overall, participants perceived “Bandit the Dolphin” as a cognitively and physically demanding, enjoyable, and effortful exergame. These results will guide future efforts to design engaging and sustainable exergames aimed at improving cognitive and functional health among older adults.

Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study.

Objective: The aim of this pilot randomized clinical trial was to test the feasibility and efficacy of an exergame-based cognitive-motor training program in geriatric inpatients.Methods: The study participants were randomly allocated to either the exergame intervention group or the control group. The control group received the standard rehabilitation treatment offered in the clinic. In addition to the standard rehabilitation program, the intervention group conducted supervised exergame training on 5 days per week using the Dividat Senso, an exergame system specifically designed for older adults. The primary outcome was feasibility, as measured by e.g., adherence rate, attrition rate, occurrence of adverse events, System Usability Scale (SUS) and NASA-TLX score. Secondary outcomes included measures of physical and cognitive functioning such as comfortable walking speed, maximal walking speed, dual task walking speed, Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Color-Word Interference test (D-KEFS), Trail Making test A and B (TMT), Go/No-Go test and Step Reaction Time test (SRTT). All secondary outcome measures were assessed pre- and post-intervention.Results: Thirty-nine persons were included in the study. Average adherence rate was 99%, there were no intervention-related dropouts and no adverse events. The mean System Usability Scale (SUS) score was 83.6 and the mean NASA-TLX score 45.5. Significant time-group interaction effects were found for the dual task walking speed, the Go/No-Go test and Step Reaction Time test (SRTT).Conclusion: Exergaming is a feasible, safe and effective cognitive-motor training approach in inpatient rehabilitation of geriatric patients. Incorporating exergaming in the rehabilitation program of geriatric patients offers potential to reduce fall risk factors and to increase patients’ exercise motivation and rehabilitation success.

The effects of active game intervention and Exergames on the executive function of high-functioning Autistic children

Introduction: Autism spectrum disorder has been suggested as a neurological disorder that usually occurs in the early years of a child’s development. Aim: The aim of this study was to investigate the effects of active game intervention and Exergames on executive functions in children with autism. Method: The method of this research is quasi-experimental and applied in terms of purpose, which was done using a pretest-posttest design with a control group. The subjects of the present study were children with autism aged 7 to 10 years in Gorgan in 2021, from which 36 people were selected by convincing method from two centers of children with autism. The instruments used in this study included the Gilliam Autism Rating Scale and the Working Memory Test. The Stroop effect test was also used to measure selective attention. Data analysis was performed using analysis of covariance and SPSS software version 24. Results: The results showed that active game intervention had positive effects on working memory (P=0.001) and selective attention (P=0.001). In addition, Exergames intervention had positive effects on working memory (P=0.001) and selective attention (P=0.001). Conclusion: In general, the results of the present study emphasize the importance of using active games and Exergames interventions to improve and strengthen executive functions in highfunctioning autistic children.

Effects of gamified didactic with exergames on the psychological variables associated with promoting physical exercise: results of a natural experiment run in primary schools

ABSTRACT Background Exergames are a new socio-technological phenomenon consisting of digital motor games that aim to stimulate players’ motor skills. The physical-motor component of exergames has been well studied, but knowing more about their possible psychological effects in the school context is interesting to promote physical exercise practice. Gamification refers to the use of game-based elements in non-game contexts, whose aim is to motivate action by making activities more game-like. Gamification seems an innovative strategy to promote physical exercise habits at schools whose real effects are still poorly unknown. Physical education has significant direct and indirect influences on students’ physical exercise. Exergames and gamification are associated with psychological benefits related to physically active behaviour. Purpose The aim of this study was to analyse the effects of a gamified exergaming school intervention on the psychological variables associated with physical exercise (PEx) promotion. We hypothesised that the gamified exergaming school intervention will produce more achievement motivation, more enjoyment, a more positive attitude towards exergames, and more exergame and PEx intention in students. Participants and setting A natural experiment with a non-randomised controlled design. The participants were 417 Primary Education students (53.2% girls, n = 222; 46.8% boys, n = 195) recruited from two public and two non-public schools (control group, n = 191; experimental group, n = 226). Their mean age was 11.1 (SD = 1.7), and 50.4% of the sample studied Primary Education Year 6 (aged 10–11 years; n = 210) and 49.6% studied Primary Education Year 7 (11–12 years; n = 207). The control treatment (traditional didactic intervention) was designed based on usual didactic dance teaching in Spain. Another similar experimental treatment was designed as the control treatment, but with a gamified climate and an exergame (gamified exergaming intervention). The Just Dance Now exergame was used. The Mechanics-Dynamics-Aesthetics framework was applied to achieve mastery-oriented motivational climates and an inclusive gamified atmosphere for all student-player types. Moreover, to gamify each class the ClassDojo application was used. Data collection The students completed: the Achievement Motivation in Physical Education Test (AMPET); the Sport Satisfaction Instrument (SSI); the ‘Attitudes Toward Exergames’ scale; the ‘Exergame intention’ scale; the ‘Exercise Intention’ scale. Statistical analyses In order to test the research hypotheses, both study groups were compared using factorial ANOVAs 2 (time; pre-treatment condition vs. post-treatment condition) × 2 (treatment; traditional didactic intervention vs. gamified exergaming intervention). Findings As the analysis threshold was set at ≤0.0125 with Bonferroni adjustment, the results showed better positive gamified exergaming effects on enjoyment and attitude towards exergames. No interaction effects on achievement motivation, exergame intention or PEx intention were found. Conclusions This is the first study to examine an intervention combining Mechanics-Dynamics-Aesthetics (MDA) gamification framework as a didactic method and exergame as an educational resource, adopted as a strategy to promote the variables associated with encouraging PEx in primary schools. A gamified exergaming educational intervention might have some positive effects on variables associated with physical exercise promotion but its ability as an exercise promotion strategy is still unclear and future research should be conducted.

Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study.

BackgroundKinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames.ObjectiveWe aim to evaluate the effects of kinesiotherapy with exergaming on older women’s epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy.MethodsWe will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages.ResultsThe project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021.ConclusionsResearch on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions.Trial RegistrationBrazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw.International Registered Report Identifier (IRRID)DERR1-10.2196/32729

Factors associated with lack of improvement in submaximal exercise capacity of patients with heart failure.

AimsImprovement in exercise capacity is the primary goal of physical activity programmes for patients with heart failure (HF). Although activity programmes are effective for some patients, others do not benefit. Identifying factors related to a lack of improvement in submaximal exercise capacity may help us interpret findings and design new interventions. The aim of this study is to identify factors contributing to a lack of improvement in submaximal exercise capacity 3 months after physical activity advice or an exergame intervention in patients with HF. Additionally, we aimed to assess differences in lack of improvement in submaximal exercise capacity of patients whose baseline exercise capacity predicted a worse compared with better prognosis of HF.Methods and resultsThis secondary analysis of the HF‐Wii study analysed baseline and 3 month data of the 6 min walk test (6MWT) from 480 patients (mean age 67 years, 72% male). Data were analysed separately in patients with a pre‐defined 6 min walking distance at baseline of <300 m (n = 79) and ≥300 m (n = 401). Among patients with a baseline 6MWT of ≥300 m, 18% had deteriorated submaximal exercise capacity. In the multiple logistic regression analysis, lower baseline levels of self‐reported physical activity [odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60–0.97], lower baseline levels of cognitive function (OR = 0.87, 95%CI = 0.79–0.96) were significantly associated with lack of improvement in exercise capacity at 3 months. Not randomized to exergaming (OR = 0.63, 95%CI = 0.37–1.09) was likely (P = 0.097) to be associated with lack of improvement in exercise capacity at 3 months. Among the 79 patients with baseline 6MWT of <300 m, 41% (n = 32) did not improve 6MWT distance at 3 months. Independent predictors for the lack of improvement for 6MWT were New York Heart Association class III/IV (OR = 4.68, 95%CI = 1.08–20.35), higher levels of serum creatinine (OR = 1.02, 95%CI = 1.003–1.03), lower cognitive function (OR = 0.86, 95%CI = 0.75–0.99), and fewer anxiety symptoms (OR = 0.84, 95%CI = 0.72–0.98).ConclusionsLower self‐reported physical activity and cognitive impairment predict lack of improvement in submaximal exercise capacity in HF patients. Patients who have a worse prognosis (score <300 m at the 6MWT) are often frail and gain less in exercise capacity. These patients may need a more comprehensive approach to have an effect on exercise capacity, including an individually tailored exercise programme with aerobic exercise (if tolerated) and strength exercises.

The Efficacy of a Multicomponent Functional Fitness Program Based on Exergaming on Cognitive Functioning of Healthy Older Adults: A Randomized Controlled Trial.

Regular physical exercise can attenuate age-related cognitive decline. This study aimed to investigate the effect of a physical exercise multicomponent training based on exergames on cognitive functioning (CF) in older adults. This randomized controlled trial included older adults aged 61-78. Participants were randomly allocated to an intervention group (IG; n = 15) or active control group (CG; n = 16). The IG was exposed to a combined training with traditional exercise and exergaming, twice a week over a period of 12 weeks. The CG performed only traditional sessions. CF was assessed by the Cognitive Telephone Screening Instrument. The time points for assessment were at zero (pretest), 12 (posttest), and 17 weeks (follow-up). Active CG and IG increased from pretest to posttest in short-term memory (STM), long-term memory (LTM), and Cognitive Telephone Screening Instrument total score 1.98 > Z < 3.00, ps < .005, with moderately large positive effects (.36 > r < .54). A significant increase was seen from posttest to follow-up in STM, Z = 2.74, p = .006, and LTM, Z = 2.31, p < .021, only in IG. Across the two time periods posttest to follow-up, there were significant interaction effects between program type and time for STM (p = .022, ηp2=.17) and LTM (p = .004, ηp2=.25), demonstrating a more beneficial effect of the exergames intervention compared to the CG. Discussion and Implications: The integration of exergaming in a multicomponent functional fitness exercise might have the potential to maintain and improve CF (in particular, STM and LTM) in older adults.

Effectiveness of Exergame Intervention on Walking in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

ObjectiveThe objective of this review was to systematically evaluate the effectiveness of exergaming on walking in older adults. In addition, the aim was to investigate the relationship between the exergaming effect and age, baseline walking performance, exercise traits, technology used, and the risk of bias.MethodsA literature search was carried out in the databases MEDLINE, CINAHL, CENTRAL, EMBASE, WoS, PsycInfo, and PEDro up to January 10, 2020. Studies with a randomized controlled trial design, people ≥60 years of age without neurological disorders, comparison group with other exercise or no exercise, and walking-related outcomes were included. Cochrane RoB2, meta-analysis, meta-regression, and Grading of Recommendations, Assessment, Development and Evaluation were used to estimate quality, treatment effect, covariates’ effect, and the certainty of evidence, respectively.ResultsIn the studies included (n = 66), the overall risk of bias was low (n = 2), unclear (n = 48), or high (n = 16). Compared with comparison groups, exergaming interventions were more effective for walking improvements (standardized mean difference = −0.21; 95% CI = −0.36 to −0.06; 3102 participants, 58 studies; moderate-quality evidence) and more or equally effective (standardized mean difference = −0.32; 95% CI = −0.64 to 0.00; 1028 participants, 13 studies; low-quality evidence) after nonexergaming follow-up. The strongest effect for covariates was observed with the type of comparison group, explaining 18.6% of the variance.ConclusionFor older adults without neurological disorders, exergame-based training improved walking, and improvements were maintained at follow-up. Greater benefits were observed when exergaming groups were compared with inactive comparison groups. To strengthen the evidence, further randomized controlled trials on the effectiveness of gamified exercise intervention are needed.ImpactExergaming has an effect equivalent to other types of exercising on improving walking in older adults. Physical therapists and other rehabilitation professionals may consider exergaming as a promising form of exercise in this age group.

A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment.

We examined the feasibility (i.e., single-session attendance) of conducting 3 counselor-delivered nonpharmacological pain management intervention (NPMI) groups in methadone maintenance treatment (MMT): (1) Coping with Pain, an intervention based on cognitive-behavioral therapy, (2) Wii-Covery, an exergame intervention to facilitate exercise, and (3) Juggling Group, an intervention to promote social inclusion and reduce stress. We examined pre-post session changes in pain and mood associated with group attendance. Over 1 month at an MMT clinic with 1800 patients, each NPMI group was offered daily Monday-Friday and 1 was offered on Saturdays. A standardized but unvalidated measure was administered before and after sessions to assess acute changes in current pain intensity and mood states. Paired t-tests with Bonferroni corrections were performed for each NPMI group (P < 0.0007 [.05/7]). About 452 patients (67% male, 84% White, mean age, 40) attended at least 1 NPMI group. About 57% reported current chronic pain. Attendance at any NPMI group (for the whole sample and the subset with chronic pain) was significantly associated with acute reductions in current pain intensity, anxiety, depression, and stress, and acute increases in current energy and happiness. Attendance at Coping with Pain and Juggling Group was also associated with acute increases in compassion. Coping with Pain, Wii-Covery, and Juggling Group are feasible to conduct in MMT, and acute improvements in current pain intensity and specific mood states associated with a single session attendance point to the importance of examining systematically the efficacy of these and other NPMIs in MMT.

The effects of exergames on muscle strength: A systematic review and meta-analysis.

This systematic review and meta-analysis examined studies on the chronic effects of exergames on muscle strength in humans. PubMed, Scopus, CENTRAL, Web of Science, SciELO, Biblioteca Virtual em Saúde, and Google Scholar were searched, and manual searches of the reference lists of included studies and hand-searches on Physiotherapy Evidence Database and ResearchGate were conducted from inception to August 10, 2020. Randomized and non-randomized exergame intervention studies with or without a non-exercise group and/or a "usual care intervention group" (any other intervention that did not incorporate exergames), which evaluated muscle strength through direct measurements, were included. Forty-seven and 25 studies were included in the qualitative review and meta-analysis, respectively. The between-groups meta-analyses showed no significant differences between exergames and non-exercise control groups for handgrip strength in heathy/unhealthy middle-aged/older adults or knee extension maximum voluntary isometric contraction (MVIC) in healthy older adults. However, exergames provided a greater increase in handgrip strength, knee flexion MVIC, and elbow extension MVIC, but not knee extension MVIC or elbow flexion MVIC, in individuals with different health statuses when compared to usual care interventions. Also, there was a greater increase in handgrip strength in children with hemiplegic cerebral palsy favouring usual care plus exergames compared to usual care interventions. These results suggest that exergames may improve upper and lower limb muscle strength in individuals with different heath statuses compared to usual care interventions, but not muscle strength in middle age/older adults after accounting for random error. Also, exergames appear to be a useful tool for improving handgrip strength in children with hemiplegic cerebral palsy when added to usual care. However, as the exergame interventions were applied in different populations and there currently are many different approaches to perform exergames, future randomized controlled trials with high methodological quality and large sample sizes are needed to provide more compelling evidence in favour of a specific exergame protocol, or to elucidate exergame protocol design principles that appear to strongly influence outcomes.

Exergaming Platform for Older Adults Residing in Long-Term Care Homes: User-Centered Design, Development, and Usability Study.

BackgroundOlder adults (OAs) residing in long-term care (LTC) homes are often unable to engage in adequate amounts of physical activity because of multiple comorbidities, including frailty and severe cognitive impairments. This level of physical inactivity is associated with declines in cognitive and functional abilities and can be further compounded by social isolation. Exergaming, defined as a combination of exercise and gaming, has the potential to engage OAs in exercise and encourage social interaction. However, previously used systems such as the Nintendo Wii are no longer commercially available, and the physical design of other exergames is not suitable for OAs (ie, fall risks, accessibility issues, and games geared toward a younger population) with diverse physical and cognitive impairments. ObjectiveThis study aims to design and develop a novel, user-centered, evidence-based exergaming system for use among OAs in LTC homes. In addition, we aim to identify facilitators and barriers to the implementation of our exergaming intervention, the MouvMat, into LTC homes according to staff input.MethodsThis study used a user-centered design (UCD) process that consisted of 4 rounds of usability testing. The exergame was developed and finalized based on existing evidence, end user and stakeholder input, and user testing. Semistructured interviews and standardized and validated scales were used iteratively to evaluate the acceptability, usability, and physical activity enjoyment of the MouvMat. ResultsA total of 28 participants, 13 LTC residents, and 15 staff and family members participated in the UCD process for over 18 months to design and develop the novel exergaming intervention, the MouvMat. The iterative use of validated scales (System Usability Scale, 8-item Physical Activity Enjoyment Scale, and modified Treatment Evaluation Inventory) indicated an upward trend in the acceptability, usability, and enjoyment scores of MouvMat over 4 rounds of usability testing, suggesting that identified areas for refinement and improvement were appropriately addressed by the team. A qualitative analysis of semistructured interview data found that residents enjoyed engaging with the prototype and appreciated the opportunity to increase their PA. In addition, staff and stakeholders were drawn to MouvMat’s ability to increase residents’ autonomous PA. The intended and perceived benefits of MouvMat use, that is, improved physical and cognitive health, were the most common facilitators of its use identified by study participants. ConclusionsThis study was successful in applying UCD to collaborate with LTC residents, despite the high number of physical and sensory impairments that this population experiences. By following a UCD process, an exergaming intervention that meets diverse requirements (ie, hardware design features and motivation) and considers environmental barriers and residents’ physical and cognitive needs was developed. The effectiveness of MouvMat in improving physical and cognitive abilities should be explored in future multisite randomized controlled trials.

Small-Groups Versus Full-Class Exergaming on Urban Minority Adolescents' Physical Activity, Enjoyment, and Self-Efficacy.

The effects of school-based exergaming interventions on adolescents' physical activity (PA) and psychosocial outcomes have been mixed. Researchers speculate this may be attributed to design issues. Therefore, this study examined differences in urban minority adolescents' PA, enjoyment, and self-efficacy during small-groups and full-class exergaming. Forty-seven urban minority adolescents (83% black; X¯age=11.8+1.3 y) completed two 15-minute exergaming sessions on the Xbox One Kinect Just Dance: (1)small groups (n = 3-4) and (2)full class (n = 23-24). Participants' time in sedentary behavior, light PA, and moderate to vigorous PA and steps were retrieved from ActiGraph GT3X+ accelerometers with enjoyment and self-efficacy assessed using validated surveys. Participants spent significantly more time in sedentary behavior (5.9 [5.2] min vs 3.5 [2.7] min, respectively: P < .001, d = 0.57) and less time in moderate-to-vigorous PA (2.1 [2.8] min vs 5.5 [2.2]min, respectively: P < .001, d = 0.85) during the full-class versus the small-groups session. Moreover, small-groups exergaming resulted in significantly higher steps than the full-class exergaming (504.2 [132.1] vs 387.8 [122.1], respectively: P = .01, d = 0.50) and significantly greater enjoyment (3.5 [1.1] vs 3.2 [1.0], respectively: P = .02, d = 0.37). There were no significant differences between sessions for time in light PA and self-efficacy. Small-groups exergaming appears ideal for promoting enjoyable PA at higher intensities and lower sedentary time in underserved minority adolescents.

Efficacy of simultaneous aerobic exercise and cognitive training in subjective cognitive decline: study protocol for randomized controlled trial of the Exergames Study

BackgroundSubjective cognitive decline (SCD) is an early manifestation of Alzheimer’s disease (AD) and offers a therapeutic window where interventions have strong potential to prevent or delay the progression of AD. Aerobic exercise and cognitive training represent two promising interventions for AD prevention, but their synergistic effect has yet to be assessed in persons with SCD.Methods/designThe purpose of this single-blinded, 3-parallel group randomized controlled trial is to test the synergistic efficacy of an exergame intervention (simultaneous moderate-intensity aerobic cycling and cognitive training) on cognition and aerobic fitness in community-dwelling older adults with SCD. The Exergames Study will randomize 96 participants on a 2:1:1 allocation ratio to 3-month exergame, cycling only, or attention control (stretching). Primary outcomes include global cognition and aerobic fitness, which will be assessed at baseline and after 3 months. The specific aims of the Exergames Study are to (1) determine the efficacy of the exergame in older adults with SCD and (2) assess the distraction effect of exergame on aerobic fitness. Data will be analyzed using ANOVA following intention-to-treat.DiscussionThis study will test the synergistic effects of exergame on cognition and aerobic fitness. It has the potential to advance prevention research for AD by providing effect-size estimates for future trials.Trial registrationClinicalTrials.gov NCT04311736. Registered on 17 March 2020.

Older Adults’ Subjective Well-being Following an Exergame Intervention “Bandit the Dolphin”: Focus Group Findings

Due to generational mental illness stigma and under diagnosis of mental illness, older adults do not always receive the mental health help that they need. One unique technology that has the potential to improve mood in older adults is exergames, or exercise video games. The objective of this sub-study (main study: Stimulation With Intricate Movements “SWIM” Study) was to explore older adults’ mood following an exergame intervention called “Bandit the Dolphin,” created by the Johns Hopkins KATA Studio. Researchers conducted three focus groups with 14 community-dwelling older adult participants who took part in the SWIM Study exergame intervention. The semi-structured focus groups were transcribed, coded, and analyzed using deductive and inductive techniques described by Ray Maietta’s “sort and sift, think and shift” method. Three themes related to playing “Bandit the Dolphin” and mood emerged. First, participants described their perceived association between activity and mood. Participants felt that both active and passive activities, “Bandit the Dolphin” and otherwise, improved their mood through the “fun” factor, and through feelings of achievement. Second, the participants described that the competition and frustration of playing “Bandit the Dolphin” increased eventual feelings of achievement. Third, participants described how feelings of immersion, or being absorbed in the game, helped them forget their other life concerns. These findings provide a better understanding of older adults’ perceived relationship between an exergame intervention, “Bandit the Dolphin,” and short-term improved mood. Future health and engineering researchers should explore exergames as a potential tool to improve the mental health of older adults.

Exploring the Motivators and Barriers of Older Adults Participating in an Interactive Exergame Intervention

Cognitive and physical activity are important to maintaining daily functioning in older adults. While bidirectional associations between cognitive and physical activity magnify with increasing age, elucidating shared benefits has been difficult as few interventions explicitly train on cognition and mobility simultaneously. We conducted focus groups among 14 older adults residing in an independent-living center who participated in an interactive video game study called Bandit the Dolphin, where participants simultaneously incorporated cognitive exercise and physical activity while navigating within a complex spatial environment to help Bandit jump, eat fish, and stun sharks. Using ‘sneaky exercise’ tactics, participants utilized upper extremities in conjunction with slight lower extremity movement to move Bandit within a 3-D oceanic environment. We conducted 3 semi-structured focus groups and analyzed the data using the “Sort and Sift, Think and Shift” method to assess general likes and dislikes as well as the primary motivators, barriers, and reasons for remaining in the study. Participants enjoyed the immersive nature, challenge, and “fun factor” of the game. Primary motivators for joining were generativity/helping others, self-improvement, from peer referrals, and because the study looked interesting. Key barriers reported in the study were exhaustion from standing, learning how to play in 3-D space, and frustration from lack of level advancement. Reasons for retention were due to the game being fun, a sense of duty, and fulfilling commitments. This information will guide ongoing research efforts to design interactive video game interventions that are enjoyable for older adults and maintain high retention rates.

Innovative Movement Strategies for Adolescents with Autism Spectrum Disorder: A Review of Dance and Exergaming Interventions

Background: Given the types of symptoms present in individuals with autism spectrum disorder (ASD), interventions should address deficits in motor control, social interactions, and emotional intelligence. Alternative interventions, such as exercise video gaming (exergaming) and dance movement therapy, may address these deficits in an engaging, age-appropriate manner, thus meeting the unique needs of adolescents with ASD. Objectives: The purpose of this paper was first, to review the current literature on ASD for innovative movement strategies feasible to address emotional, social, cognitive, and physical outcomes for adolescents ages 11-18; and second, to determine the effectiveness of these interventions. Methods: The databases used were: Pubmed, Cochrane Library, Web of Science, EMBASE, CINAHL, Psycinfo, REHABDATA, Human Kinetics Journal, and PEDro. Search terms included: autism or autism spectrum disorder; and dance, dancing or dance therapy, or exergaming, exergame, video gaming or video game. Selected articles were published in the last 10 years, written in English, and included subjects with ASD who participated in dance or exergaming interventions. After the initial screening of articles with relevant titles and abstracts, we included studies with evidence levels of 1-4. Results: Five dance therapy intervention studies showed moderate effectiveness for social and emotional outcomes such as empathy skills, emotional regulation, and negative symptoms of ASD. Four exergaming studies had moderate effectiveness for motor and physical outcomes, such as energy expenditure and perceived object control. Implications: Based on the review of dance and exergaming intervention studies, the authors recommend providing the interventions to selected clients depending on individual circumstances. Both dance and exergaming may be cost-effective and feasible in school settings. Future studies should include larger and more diverse samples with rigorous randomization procedures

Innovative Movement Strategies for Adolescents with Autism Spectrum Disorder: A Review of Dance and Exergaming Interventions

Background: Given the types of symptoms present in individuals with autism spectrum disorder (ASD), interventions should address deficits in motor control, social interactions, and emotional intelligence. Alternative interventions, such as exercise video gaming (exergaming) and dance movement therapy, may address these deficits in an engaging, age-appropriate manner, thus meeting the unique needs of adolescents with ASD. Objectives: The purpose of this paper was first, to review the current literature on ASD for innovative movement strategies feasible to address emotional, social, cognitive, and physical outcomes for adolescents ages 11-18; and second, to determine the effectiveness of these interventions. Methods: The databases used were: Pubmed, Cochrane Library, Web of Science, EMBASE, CINAHL, Psycinfo, REHABDATA, Human Kinetics Journal, and PEDro. Search terms included: autism or autism spectrum disorder; and dance, dancing or dance therapy, or exergaming, exergame, video gaming or video game. Selected articles were published in the last 10 years, written in English, and included subjects with ASD who participated in dance or exergaming interventions. After the initial screening of articles with relevant titles and abstracts, we included studies with evidence levels of 1-4. Main results: Five dance therapy intervention studies showed moderate effectiveness for social and emotional outcomes such as empathy skills, emotional regulation, and negative symptoms of ASD. Four exergaming studies had moderate effectiveness for motor and physical outcomes, such as energy expenditure and perceived object control. Implications: Based on the review of dance and exergaming intervention studies, the authors recommend providing the interventions to selected clients depending on individual circumstances. Both dance and exergaming may be cost-effective and feasible in school settings. Future studies should include larger and more diverse samples with rigorous randomization procedures.

Exergaming for children with probable developmental coordination disorder (p-DCD)/DCD

LANGUAGE NOTE | Document text in English; abstract also in Chinese.&#x0D; The purpose of this study was to examine the effectiveness of exergaming for improving balance, eye–hand coordination (EHC), and exercise enjoyment among children with special educational needs (SEN) and probable developmental coordination disorder (p-DCD). This study adopted a single-group intervention with paired results. Nine primary school students (seven boys and two girls, aged 7–10 years) were recruited and underwent a 3-month exergaming intervention involving three 30-minute sessions per week. Xbox One Kinect was used under the supervision of the researchers and physical education (PE) teachers. Pre- and post-intervention scores were calculated for data analysis. Motor performance was assessed using the Movement Assessment Battery for Children – Second Edition Test. The participants’ gaming experiences were captured using Fun Toolkit. The Wilcoxon signed-rank test showed significant improvements in balance and EHC, but no significant differences in enjoyment scores. The findings indicated a positive impact of exergaming on primary school students with SEN and motor problems. The outcomes indicate that exergaming is an effective strategy for improving motor skills in children with SEN and p-DCD/DCD. Therefore, exergaming could be incorporated into PE curricula to motivate students to participate in physical activities in order to improve their physical health and well-being.&#x0D; 本研究探討虛擬遊戲對改善有特殊教育需要（SEN）和（潛在）發育協調障礙的兒童的平衡、眼手協調和享受運動的功效。九名小學生參加為期三個月，每週三次30分鐘的訓練。訓練前後的遊戲分數、運動表現和遊戲體驗都被分析。研究結果顯示平衡力和眼手協調顯著地改善，但享受度沒有明顯差異。這說明虛擬遊戲對有SEN和動作協調問題的小學生有積極影響，改善運動技能。因此，將這納入體育課程，可鼓勵學生參加體能活動，改善身心健康。

Can a group exergaming intervention impact balance, movement confidence, and cognitive function among people with cognitive impairment?

Can a group exergaming intervention impact balance, movement confidence, and cognitive function among people with cognitive impairment?

The effect of Wii Fit exergames on static balance and motor competence in obese and non-obese college women

Background: Exergames have recently been employed for a variety of purposes in different clinical and non-clinical environments. Objective: This study aimed to assess the effect of a 6-week Wii Fit exergames intervention on the static balance and motor competence in obese and non-obese college women. Methods: To this end, 20 obese (body mass index ≥ 30 kg/m2, age 19.10 ± 0.64 years) and 20 normal-weight women (body mass index 18.5-24.9 kg/m2, age 19.25 ± 0.78 years) were recruited. Both groups were randomly divided into intervention and control groups so that the following four groups (10 women each) were created: obese control (OC), obese Wii Fit intervention (OWFI), non-obese control (NOC) and non-obese Wii Fit intervention (NOWFI). Bruininks Oseretsky Test of Motor Proficiency (BOT-2) and static balance test using the Wii Balance Board were used to measure motor competence and static balance progression during the pretest and posttest. All the groups performed their common daily physical activities, and experimental groups had additional Wii Fit intervention for 6 weeks (2 sessions per week). Results: Analysis of covariance results showed a significant improvement in the static balance and motor competence of both obese and non-obese Wii Fit groups compared to their control group counterparts (Static balance: NOC < NOWFI, p = .04, OC < OWFI, p = .004; Motor competence: NOC < NOWFI, p = .007, OC < OWFI, p < .001). Besides, the improvement in the motor competence of the obese Wii Fit group was significantly greater than that of the non-obese one (NOWFI < OWFI, p = .04). Conclusions: In addition to the similar positive effect on the static balance of obese and non-obese college women, the use of Wii Fit exergames can improve the motor competence of obese college women more than non-obese ones.