Mobile Exergame Research Articles

The Rewardable Persuasive Model: A Mobile Exergame Conceptual Design Model that Facilitates Youths to Exercise through Mobile Gaming

This study seeks to assess current design models to propose a conceptual design model for a mobile exergame that promotes physical activity among youths. Encouraging youths to engage in physical activity rather than remaining sedentary is essential due to the numerous health benefits associated with regular exercise. Exercise is a subset of physical activity structured for fitness. Exergames have the potential to inspire youths to be active by combining exercise and gaming engagingly and enjoyably. The proliferation of mobile gaming has further broadened the availability and accessibility of exergames. In this study, we conducted four stages of information gathering to assess and propose a mobile exergame conceptual design model: a literature review, a user survey, expert reviews, and in-depth user interviews. Based on the study's findings, we identified appropriate components and their rationale by adapting an existing design model to our conceptual design model for a mobile exergame. This conceptual design model is called the Rewardable Persuasive Model (RPM). This model aims to help youths achieve their weekly physical activity targets using an engaging and functional mobile application (app). The app incentivizes exercise by integrating it as a key element for unlocking gameplay. With the introduction of these components, an exergame can be designed to engage youths and facilitate physical activity effectively. In a future study, youths will use an app to assess the RPM's effectiveness over time. This assessment will ascertain its appropriateness for facilitating exercise during inactivity.

The Application of a Serious Game Framework to Design and Develop an Exergame for Patients With Heart Failure.

Reducing inactivity in patients with chronic disease is vital since it can decrease the risk of disease progression and mortality. Exergames are an innovative approach to becoming more physically active and positively affecting physical health outcomes. Serious games are designed for purposes beyond entertainment and exergames are serious games for physical activity. However, current commercial exergames might not optimally meet the needs of patients with special needs. Developing tailored exergames is challenging and requires an appropriate process. The primary goal of this viewpoint is to describe significant lessons learned from designing and developing an exergame for patients with chronic heart failure using the player-centered, iterative, interdisciplinary, and integrated (P-III) framework for serious games. Four of the framework's pillars were used in the design and development of a mobile exergame: player-centered design, iterative development of the game, interdisciplinary teamwork, and integration of play and serious content. The mobile exergame was developed iteratively in 7 iterations by an interdisciplinary team involving users and stakeholders in all iterations. Stakeholders played various roles during the development process, making the team stay focused on the needs of the patients and creating an exergame that catered to these needs. Evaluations were conducted during each iteration by both the team and users or patients according to the player-centered design pillar. Since the exergame was created for a smartphone, the assessments were conducted both on the development computer and on the intended platforms. This required continuous deployment of the exergame to the platforms and smartphones that support augmented reality. Our findings show that the serious game P-III framework needs to be modified in order to be used for the design and development of exergames. In this viewpoint, we propose an updated version of the P-III framework for exergame development including (1) a separate and thorough design of the physical activity and physical interaction, and (2) early and continuous deployment of the exergame on the intended platform to enable evaluations and everyday life testing.

Exergaming in patients with heart failure. A pilot study of the HEART-EXERGAME (Heart-eXg) intervention

Abstract Background Physical activity in patients with heart failure (HF) can improve physical function, quality of life, reduce rehospitalization and mortality. A new approach increase physical activity for patients with heart failure (HF) is the use of exergames (games that requires physical activity to play). An international multi-centre RCT study, called the Heart-eXg study (clinicaltrials.gov ID: NCTxxx), is developed to determine the effectiveness of 3-months exergaming for patients with HF to decrease their sedentary time. The mobile exergame is co-designed for this study, entails a farming theme, and personalized on patients exercise capacity. The aim of this pilot study was to test the protocol of the intervention, in terms of recruitment, procedures of the intervention, assessment of outcomes and adherence to exergaming. Material and methods In the pilot study, the inclusion of patients was assessed. The randomization was tested but all patients were assigned to the exergame group. To further test the procedures the time was recorded of the installation/instructions to the exergame, the telephone follow-ups (to increase motivation) and outcome assessment. Outcomes were the 6-minute walk test (exercise capacity), Fried frailty test (frailty), VAS-Score EQ5D, 0-100 (quality of life), Canadian Occupational Performance Measure (occupational performance). Adherence (walking 10 minutes every day with the exergame) was assessed during the 3 months exergaming, as the time exergaming was recorded. Results Pilot study In total 13 patients were eligible and 5 included. Mean age was 71 (±10), 2 females, 1 patient in NYHA-class II and 4 patients in NYHA-class III. One patient dropped out directly after baseline (severe disease) and 1 never exergamed (time constraints). Result of exercise capacity, quality of life and occupational performance are presented in the Table. The procedures of the intervention were feasible, the visits to the hospital took between 1 hour and 1.5 hour and the telephone follow up approximately 5-10 minutes. Test of occupational performance took longer time than calculated (30 min instead of 15 min). Of the 3 patients who exergames, 1 patient played irregularly and stopped after 4 weeks. Two patients were adherent, see Figure. Conclusion The protocol of the intervention was feasible to use. In total, 38% of patients accepted to be included in the intervention and 20% of the patients dropped out (1 out of 5) and 50% were completely adherent to the intervention. Time for installation/introduction and telephone follow-ups were appropriate. As the occupational performance assessment took more time than then expected, we decided to test this in 100 out of the 600 patients planned to be included in the RCT study.TableFigure

Creating a treadmill running video game with smartwatch interaction

In recent years, indoor or at-home sports have experienced significant growth. However, monotony is a common challenge in these static physical activities. Exergames, a genre of video games that combines physical activity and entertainment, have emerged as an attractive solution. Nevertheless, running on a treadmill and engaging in other activities simultaneously presents additional challenges. The balance and concentration required during running while interacting with a video game demand a special focus on the design of the Exergame. This paper presents a mobile Exergame designed specifically for treadmill running, utilizing interaction with a smartwatch. The game offers natural environments where, through smartwatch technology, it interprets the player's movements, transforming them into running speed and interactive actions by detecting gestures within the game. The main objective is to provide users with a satisfying gaming experience tailored to the characteristics of treadmill running. Particular emphasis has been placed on prioritizing the playful component of this Exergame, recognizing its relevance in the context of treadmill running. To evaluate the achievement of objectives and the proposed hypothesis, a comparative study was conducted between the proposed Exergame and a treadmill running simulator. Participants experienced both experiences and subsequently completed the Game Experience Questionnaire (GEQ), specifically the In-game GEQ version. The results obtained indicate that participants had a better gaming experience in the Exergame than in the simulator. These findings highlight the importance of prioritizing the playful component in Exergames and provide guidelines for future improvements and developments in the field.

Player-centered, iterative, and interdisciplinary design and development of a mobile exergame for older cardiac patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Vetenskapsrådet Background Reducing inactivity in cardiac patients is vital since it can decrease the risk for disease progression and mortality. Current commercial available exergames (games where one has to be physically active to be able to play) might not optimally meet the needs of cardiac patients. The aim of this project was to design and develop a mobile exergame app involving end-users (elderly cardiac patients). Method The player-centered, iterative, interdisciplinary, and integrated (P-III) framework for designing and developing serious games has been modified and used for designing and developing the exergame involving end-users. This framework has 4 pillars: 1. Player-centered design process 2. Iterative development 3. Interdisciplinary teamwork 4. Integration of play and the serious content End-users involved in the project were patients from a local patient organization for patients with heart and lung diseases. Results In the player-centered design process cardiac patients were involved in the entire game design and development, not only during the usability testing phase. In the iterative development of the game, we had a visual game design of the game to understand the players’ group and the problem domain. Later the visual game concept was transformed into a prototype of the game. This prototype was adapted within seven iterations to a mobile exergame. The development was through interdisciplinary teamwork, where both cardiac patients, experts in cardiac care and game developers worked closely together in developing the game. The serious content in our project is physical activity and the integration is focused on exergame design guidelines for older adults and fitness application guidelines for cardiac patients. The mobile exergame that was developed, has as main goal to walk 10 minutes more a day. The concept of the game is based on taking care of a farm and expanding it by sowing, watering, and planting fruits and vegetables. To do activities in the farm the user has to walk in the physical world, this could be both done indoors or outdoors. Each activity is rewarded with experience points (see screenshot mobile exergame). Conclusion An exergame was successfully developed within an interdisciplinary team with as goal to encourage cardiac patients to walk 10 minutes more a day. This game will now be tested in a randomized control trial, called the Heart-eXg study.Screenshot exergame

Feasibility a mobile exergame intervention for patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish National Science Council (2020-01109) The Swedish Heart and Lung Foundation (20200190) Introduction People with heart failure often perceive difficulties performing physical activities due to their symptoms. However, physical activity is beneficial and recommended. Therefore, it is a need for interventions supporting patients to increase their physical activity in everyday life. Purpose This study aims to investigate the feasibility of a mobile exergame intervention for patients with heart failure. Methods Nine Swedish patients with heart failure, seven male and two female, median age 73 years (range 63-81) participated. Patients downloaded the exergaming application "Heart Farming" on their private smartphones. Patients were advised to increase daily walking based on their physical condition. Patients received introduction and telephone conversations on a predetermined schedule. Feasibility areas of Acceptability, Demand, Implementation, and Practicality were examined by interviews and data downloaded from the application. Results Patients used Heart farming for one month, their goal of daily walks was in mean 704 meters (range 417-900 meters). Patients increased daily walks and experienced improved health. The individual conversations were perceived supportive and encouraging. Heart farming was perceived easy to learn, use and adjustable to individual needs. Conclusions The study confirmed the impact of encouragement, and importance of tailoring the intervention to patients' personal situation, to achieve regularly daily walks.

The Rationale Behind the Design Decisions in an Augmented Reality Mobile eHealth Exergame to Increase Physical Activity for Inactive Older People With Heart Failure.

Physical activity is important for everyone to maintain and improve health, especially for people with chronic diseases. Mobile exergaming has the potential to increase physical activity and to specifically reach people with poor activity levels. However, commercial mobile exergames are not specially designed for older people with chronic illnesses such as heart failure. The primary aim of this viewpoint is to describe the underlying reasoning guiding the design choices made in developing a mobile exergame, Heart Farming, tailored specifically for sedentary older people diagnosed with heart failure. The goal of the exergame is to increase physical activity levels by increasing the daily walking duration of patients with heart failure by at least 10 minutes. The rationale guiding the design decisions of the mobile exergame is grounded in the thoughtful integration of gamification strategies tailored for application in cardiovascular care. This integration is achieved through applying gamification components, gamification elements, and gamification principles. The Heart Farming mobile exergame is about helping a farmer take care of and expand a virtual farm, with these activities taking place while the patient walks in the real world. The exergame can be adapted to individual preferences and physical condition regarding where, how, when, and how much to play and walk. The exergame is developed using augmented reality so it can be played both indoors and outdoors. Augmented reality technology is used to track the patients' movement in the real world and to interpret that movement into events in the exergame rather than to augment the mobile user interface.

Strategi Maximum Profit Algoritma Greedy dalam Kecerdasan Buatan Penentu Aktivitas Fisik pada Mobile Exergame

The Covid-19 pandemic has started to subside. However, after the pandemic subsided the obesity rate in Indonesia continued to increase. The new habits formed after the pandemic are activities that can be done at home. This is an opportunity to be able to reduce obesity by doing physical activity at home. Physical activity undertaken specifically to lose weight. However, various problems arise when doing physical activity. Such as requiring expensive fees, monotony, and others. Mobile exergame is one solution to this problem. In previous research, exergames that use the brute force algorithm in determining physical activity take a long time. This problem will be solved using a greedy algorithm which also uses a maximum profit strategy. Descriptive statistics are used to compare the average time needed by the two algorithms to select the physical activity to be performed in an exergame. The results of this study indicate that in terms of time the greedy algorithm that uses the maximum profit strategy is proven to be faster than the brute force algorithm.

Development of a mobile exergame for increasing physical activity in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Vetenskapsrådet Background A 10-minute increase a day in physical activity (PA) in patients with heart failure (HF) can have beneficial effects on symptoms, mortality, and hospitalisation risk. Many patients are physically inactive and find it challenging to leave home to participate in physical activity programs, due to symptoms, lack of easily accessible facilities or fear for being exposed to infection (during the pandemic or during flu season). Developing PA interventions that are tailored to the needs and preferences is challenging, as it needs an interdisciplinary approach and active collaboration with patients. A new approach to increase PA is the use of exergames. An exergame is defined as games that requires participants to be physically active or exercise where player’s body motion controls the game. Objective To develop a mobile exergame (called Heart Farming), test the usability of the exergame, and investigate the feasibility for increasing PA in patients with HF. Methods The study included three phases: (1) Development of a prototype of the exergame; (2) Usability testing and developing, and (3) Assess feasibility of using the exergame in a PA intervention for patients with HF. Results A prototype of an exergame was developed which has as main goal to walk 10 minutes more a day. Game elements such as goal setting, providing feedback, and social connectivity are included to motivate patients. The patients can play the exergame according to their needs and wishes, e.g., competition, strategic playing, and social interaction. The exergame was created (Figure), tested and refined through an iterative developmental process and by multidisciplinary team with game designers, HF specialists, user representatives and researchers. During usability testing, eight patients within the heart and lung patient organization were invited to test the exergame. Most patients found the game easy to play and enjoyable and thought the game could be helpful to increase their daily walking. The researchers observed that the patients needed support to be able to play the exergame. Proper familiarization and coaching are needed when introducing the game to patients with HF and this was included as an important part in the exergame intervention. The exergame is further developed iteratively by the multidisciplinary team with increased number of user representatives testing the game and giving feedback. In a feasibility study we will test how feasible the exergame is for a PA intervention in patients with HF. Ten patients will receive the game with structured familiarisation and telephone follow-up including coaching for one month. The results of this feasibility testing will be presented during the conference. Conclusion The exergame Heart Farming seems to be easy and enjoyable to play but needs proper familiarisation and coaching. The results of the feasibility study will show if this exergame can be used in a PA intervention for patients with HF.

HikePal: A mobile exergame to motivate people with intellectual disabilities to do outdoor physical activities

People with intellectual disabilities often have a sedentary lifestyle that can lead to long-term issues like cardiovascular diseases, diabetes, obesity and depression. Although literature shows that the main reason for this is the lack of motivation to do physical activity, scarce research has been done in accessible apps to track and foster physical activities that address motivation. This paper presents HikePal, a game-inspired app to motivate individuals with intellectual disabilities to do physical activity outdoors. We have followed a design and creation research strategy using 1) semi-structured interviews with five experts (health care workers, special education experts and software engineers); 2) a focus group with an occupational therapist, a physical therapist and four software engineers; 3) a pilot user test with three individuals with intellectual disabilities and their caregivers. Having social interaction during the physical activity turned out to be a major motivational aspect of the system, whereas reward systems did not attract much of the users’ attention. Regarding the adapted navigational assistance, we found out that easy-to-read text, visual communication and street-level pictures were the key features to achieve successful and understandable guidance outdoors for people with intellectual disabilities. It proved useful to perform a test on the field and to refine the design guidelines in view of a forthcoming large-scale experimental test involving a larger number of persons with intellectual, sensory and motor disabilities.

Does Dynamic Tailoring of A Narrative-Driven Exergame Result in Higher User Engagement among Adolescents? Results from A Cluster-Randomized Controlled Trial.

Physical activity interventions for youth are direly needed given low adherence to physical activity guidelines, but many interventions suffer from low user engagement. Exergames that require bodily movement while played may provide an engaging form of physical activity intervention but are not perceived as engaging to all. This study aimed to evaluate whether dynamic tailoring in a narrative-driven mobile exergame for adolescents played in leisure settings, can create higher user engagement compared to a non-tailored exergame. A cluster-randomized controlled trial assessed differences in user engagement between a dynamically tailored (based on an accelerometer sensor integrated in a T-shirt) and non-tailored condition. In total, 94 participants (M age = 14.61 ± 1.93; 35% female) participated and were assigned to one of the two conditions. User engagement was measured via a survey and game metric data. User engagement was low in both conditions. Narrative sensation was higher in the dynamically tailored condition, but the non-tailored condition showed longer play-time. User suggestions to create a more appealing game included simple and more colorful graphics, avoiding technical problems, more variety and shorter missions and multiplayer options. Less cumbersome or more attractive sensing options than the smart T-shirt may offer a more engaging solution, to be tested in future research.

User Personas: Discovering Factors That Influence Genz’s Sedentary Lifestyle for the Development of a Mobile Exergame Design Model

The use of mobile devices for youths in tertiary education is found to be linked to sedentary behaviour. This paper attempts to create user personas on these youths and finding the factors that affect their sedentary lifestyles, which could assist the development of a mobile exergame design model. An online survey consisting of sociodemographic and IPAQ questionnaires was used to collect data on students in a public university. Three user personas were derived, which are based on their weekly physical activity levels: Low, Moderate, and High. It was found that income status, time management, daily smartphone usage, and fitness self-rating has a direct relationship with physical activity levels. The user personas share a common factor in that smartphone usage is essential to manage the youths’ daily activities regardless of their physical activities. The derived user personas would assist future mobile exergame design model development by concentrating on the influencing factors from the Low and Moderate physical activity level groups.

Mobile Exergaming in Adolescents' Everyday Life-Contextual Design of Where, When, with Whom, and How: The SmartLife Case.

Exergames, more specifically console-based exergames, are generally enjoyed by adolescents and known to increase physical activity. Nevertheless, they have a reduced usage over time and demonstrate little effectiveness over the long term. In order to increase playing time, mobile exergames may increase potential playing time, but need to be engaging and integrated in everyday life. The goal of the present study was to examine the context of gameplay for mobile exergaming in adolescents’ everyday life to inform game design and the integration of gameplay into everyday life. Eight focus groups were conducted with 49 Flemish adolescents (11 to 17 years of age). The focus groups were audiotaped, transcribed, and analyzed by means of thematic analysis via Nvivo 11 software (QSR International Pty Ltd., Victoria, Australia). The adolescents indicated leisure time and travel time to and from school as suitable timeframes for playing a mobile exergame. Outdoor gameplay should be restricted to the personal living environment of adolescents. Besides outdoor locations, the game should also be adaptable to at-home activities. Activities could vary from running outside to fitness exercises inside. Furthermore, the social context of the game was important, e.g., playing in teams or meeting at (virtual) meeting points. Physical activity tracking via smart clothing was identified as a motivator for gameplay. By means of this study, game developers may be better equipped to develop mobile exergames that embed gameplay in adolescents’ everyday life.

A Multi-Week Assessment of a Mobile Exergame Intervention in an Elementary School.

Exergaming is potentially useful to promote physical activity in children; however, long-term effectiveness is unclear. MobileKids Monster Manor (MKMM) is a mobile exergame developed with the help of young advisors. The game wirelessly transmits physical activity data from an accelerometer to a mobile device. Players' steps are redeemed for in-game rewards, for example, new characters. First, to evaluate whether increased physical activity previously observed in a 1-week intervention is sustained over a 2-week intervention and 1-week follow-up, and second, to compare impact in schools within different socioeconomic environments. Thirty-seven elementary school students participated in a 4-week randomized controlled study (1-week baseline; 2-week intervention [with only the Game group receiving MKMM]; and 1-week follow-up). All participants wore a Tractivity® accelerometer throughout. Linear mixed models were applied to assess sustainability; a second 42-children-based dataset and age-/sex-adjusted linear regression models were used to compare effect across socioeconomic environments. In the first week of intervention, the Game group compared to the Control group showed a greater increase in physical activity (of 1,758 steps/day [95% confidence interval, CI = 133-3,385] and 31 active minutes/day [95% CI = 4-59]), relative to baseline (13,986 steps/day; 231 active minutes/day). However, this was not sustained in the second intervention week or follow-up. The school within a lower socioeconomic status environment showed lower baseline activity and the 1-week intervention resulted in a greater increase relative to baseline (3,633 steps/day more [95% CI = 1,281-5,985]). MKMM could be a useful short-term physical activity promotion tool; however, effectiveness may decrease as novelty diminishes.

Designing Mobile Augmented Reality Exergames

Exergames aim to make exercise more enjoyable, especially for children and young adults who are accustomed to digital technologies. Calory Battle augmented reality (AR) is a mobile exergame that utilizes context awareness and AR to enable interaction with virtual content. Designing mobile exergames and AR interaction has received little scholarly attention. This article has several contributions to the design discussion: (1) implementation of a mobile AR exergame, (2) discourse on the game design process, (3) evaluation with 29 South Korean elementary school children and university students who suggested a good reception of the game and generated ideas for improvements of usability and AR interaction, (4) analysis of the game with respect to established game motivators and the Immersion, Scientificalness, Competitiveness, Adaptability, and Learning (ISCAL) exergame design model, (5) design principles and lessons learned, and (6) discussion of the flow experience in exergames. These results can be used by designers to create motivating and interactive mobile AR games.

Evaluation of a Novel Mobile Exergame in a School-Based Environment.

Physical inactivity is increasing among children globally and has been directly linked to the growing problems of overweight and obesity. We aim to assess the impact of a new mobile exergame, MobileKids Monster Manor (MKMM), in a school-based setting. MKMM, developed with input from youth to enhance physical activity, is wirelessly connected to an accelerometer-based activity monitor. Forty-two healthy students (11.3 ± 1.2 years old and 0.28 ± 1.29 body-mass index [BMI] z-score) participated in a randomized 4-week crossover study to evaluate the game intervention. The two study arms consisted of week-long baseline, game intervention/control, washout, and control/game intervention phases. All participants were required to wear an activity monitor at all times to record steps and active minutes for the study duration. MKMM was used during each arm's respective intervention week, during which children were asked to play the game at their convenience. When children were exposed to the game, an increase compared with the control phase of 2,934 steps per day (p = 0.0004, 95% CI 1,434-4,434) and 46 active minutes per day (p = 0.001, 95% CI 20-72) from baseline (12,299 steps/day and 190 active minutes/day) was observed. A linear regression model showed that MKMM yielded a greater increase in steps and active minutes per day among children with a higher BMI z-score, showing 10 percent more steps per day and 14 percent more active minutes per day relative to baseline, per unit increase in BMI z-score. In conclusion, MKMM increased steps and active minutes in a school-based environment. This suggests that mobile exergames could be useful tools for schools to promote physical activity and combat obesity in adolescents.