Virtual Reality Exergames Research Articles

Effects of an Immersive Virtual Reality Exergame on University Students' Anxiety, Depression, and Perceived Stress: Pilot Feasibility and Usability Study.

BackgroundIn recent years, there has been an increase in the number of students with depression, anxiety, and perceived stress. A solution that has been increasingly used for improving health and well-being is exergaming. The effects and acceptability of exergames have been studied widely but mostly with older adults. The feasibility and usability of exergames among university students, especially those of immersive virtual reality (iVR) exergames, remain unexplored.ObjectiveThis study aimed to explore the feasibility of a 6-week iVR exergame–based intervention in reducing anxiety, depression, and perceived stress among university students and to examine the usability and acceptability of such games.MethodsA total of 31 university students were recruited to participate in a 6-week study in which they needed to play a boxing-style iVR exergame called FitXR (FitXR Limited) twice per week (30 minutes per session). Their anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), and perceived stress (Perceived Stress Scale) levels were measured before and after intervention.ResultsA total of 15 participants completed the 6-week study. Our results suggested that participants’ mean depression scores decreased significantly from 8.33 (SD 5.98) to 5.40 (SD 5.14) after the intervention (P=.01). In addition, most participants (14/15, 93%) believed that the iVR exergame has good usability. Furthermore, most participants (14/15, 93%) were satisfied with the iVR gameplay experience and would play the iVR exergame again in the future. Of the 15 participants, 11 (73%) would recommend the iVR exergame to their friends.ConclusionsThe results gained from this study show that the iVR exergame has good usability, is highly acceptable, and has the potential to reduce depression levels among university students.

Effects of different types of augmented feedback on intrinsic motivation and walking speed performance in post-stroke: A study protocol

IntroductionDuring recovery from stroke, augmented performance feedback can be applied with simple displays of metrics, as well as enhanced with virtual reality (VR) and exergames. VR, as augmented feedback, can provided to enhance walking speed after six months of stroke onset. There are several mechanisms to induce improved motor performance and motivation. Our objective is to design a study to demonstrate the different effects of augmented feedback, simple VR and exergaming applications on motivation and walking speed performance in post stroke. MethodsEighteen individuals with chronic stroke will be recruited and asked to walk as fast and safely as they can while on a robotic, user speed-driven treadmill (KineAssist-MX®) in three conditions: (1) with simple visual augmented feedback, but without a VR interface, (2) with a basic VR interface and (3) with a VR exergame. The main outcome measures are 30 s of fast walking speed and intrinsic motivation measured using the Intrinsic Motivation Inventory-Interest and Enjoyment Subscale. A within-subjects repeated measure ANOVA test and post hoc analysis will be used to determine the differences in changes of maximum walking speeds among the three performance conditions. DiscussionThe additive impact of augmented feedback with or without VR and VR-exergames on motivation and walking speed during stroke rehabilitation is unknown, a gap we aim to address. Our findings will contribute key details regarding the effects of different types of augmented feedback on walking speed and intrinsic motivation and to the refinement of theoretical frameworks that guide the design and implementation of augmented feedback during recovery after stroke.

Enabling Immersive Exercise Activities for Older Adults: A Comparison of Virtual Reality Exergames and Traditional Video Exercises

Participating in cognitive and physical activities can help older adults to live a healthy and independent life. However, with the ongoing pandemic, face-to-face training options became unavailable or limited, yielding a need for alternatives. In this paper, we conducted a user study with older adults (N = 25) to compare a traditional, recorded 2D gymnastics video with an immersive virtual reality (VR) exergame. We evaluated the movement and heart rate of the participants, as well as their enjoyment, attention to the task, and perceived workload. In the VR condition, we additionally assessed their feeling of cybersickness. Finally, qualitative feedback about their preferences was collected. The results indicate that our immersive VR exergame can be a suitable alternative, but not a replacement for traditional 2D video-based exercise activities. Furthermore, the cognitive aspect of exergames can lead to the feeling of physical workload, even if easy movements are performed. Finally, we discuss the implications of our results for future VR exergames and point out advantages and disadvantages of the systems.

Lessons Learned from a Human-Centered Design of an Immersive Exergame for People with Dementia

Cognitive-physical exercises can reduce the progression of dementia. However, traditional methods often induce problems (e.g., lack of motivation), whereas the success of recent virtual reality (VR) exergames such as Beat Saber may provide a playful, motivational, and immersive alternative. Yet, until now, it remains unclear which game mechanics, concepts, and designs work best for people with dementia, and how to implement exergames for and with this user group. In this paper, we adapted a human-centered design approach to address the specifics of developing VR exergames for people with dementia. This includes semi-structured interviews with stakeholders and contextual inquiries to better analyze the user requirements. Based on our analysis, we present Memory Journalist VR - a novel VR exergame specifically designed for people with dementia in a participatory design process. We report the qualitative evaluation based on the feedback gathered in five focus group sessions. Finally, we discuss the lessons learned, which provide important insights for the design of future VR exergames for people with dementia: (i) creating social gaming activities with a focus on shared aspects, (ii) support of an inverse game flow channel addressing decline and variance in cognitive-physical abilities, and (iii) ensuring a safe VR exergame experience.

Влияние тренировок в виртуальной реальности на психофизиологические и постуральные нарушения у пожилых

Balance impairment at advanced age is a serious medical problem that often has significant implications and affects the quality of the patient’s life. Among the underlying causes are overall slowness of motor response and vestibular syndrome. Virtual reality exergames, including reaction and balance training, hold promise for managing balance dysfunction. The aim of this study was to investigate the effects of a combination rehabilitation program containing elements of virtual reality exergame on the postural and psychophysiological parameters of elderly patients with small vascular disease The study was conducted in 24 patients with small vascular disease (median age: 66 years). All patients underwent a virtual reality rehabilitation program. Psychophysiological, postural and clinical evaluations were performed at baseline and after the program was completed. Balance function measured on the Berg scale improved significantly and was 53 [52; 55] after the training program vs 50 [45; 54] at baseline (p < 0.05). The strategy of balance control also changed: the Romberg ratio was 266 [199.5; 478.5] before rehabilitation and 221 [149.25; 404] after the program was completed (p < 0.05). The most pronounced changes in the measured psychophysiological parameters occurred in the simple audiomotor reaction, which improved from 210 [174.25; 245.5] at baseline to 180.5 [170.5; 208] after rehabilitation (p < 0.05). Thus, the combination balance and reaction virtual reality training is an effective rehabilitation method for advanced-age patients with balance impairment.

Immersive Virtual Reality Exergame Promotes the Practice of Physical Activity in Older People: An Opportunity during COVID-19

Life expectancy has increased in recent years. Physical activity has been postulated as a key element in active aging strategies. However, adherence to physical exercise programs has traditionally been low among the elderly, and the current situation of the COVID-19 pandemic has added extra impediments. Immersive virtual reality (IVR) devices could motivate this population to practice exercise. This study aimed to analyse the use of IVR exergames as a tool to facilitate physical exercise in older people. Four healthy older adults (males, 65–77 years) participated in the study. They carried out two exergaming sessions with HTC Vive ProTM. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), System Usability Scale (SUS), Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. All participants completed the sessions without adverse effects, with no SSQ symptoms reported. SUS scores were high in both sessions (SUS > 85/100). Post-game GEQ scores were 3.08–3.41/4 (positive experiences) and 0.08–0.16/4 (negative experiences). Opinions showed high levels of satisfaction with the experience. Exergaming programs, based on commercial head-mounted displays, are a feasible alternative to traditional senior exercise, and could be a solution to the current situation that has arisen from the impact of the COVID-19 pandemic.

A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study.

BackgroundIn Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program.ObjectiveThis study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment.MethodsA 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment–upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week.ResultsThe participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels.ConclusionsVirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising. International Registered Report Identifier (IRRID)RR2-10.2196/14629

Correction to: Buddy biking: a user study on social collaboration in a virtual reality exergame for rehabilitation

Correction to: Buddy biking: a user study on social collaboration in a virtual reality exergame for rehabilitation

Physiological and Metabolic Requirements, and User-Perceived Exertion of Immersive Virtual Reality Exergaming Incorporating an Adaptive Cable Resistance System: An Exploratory Study.

Objective: To measure metabolic and physiological demand, subjective fatigue, and enjoyment during a signature 30-minute immersive virtual reality (IVR) adaptive cable resistance exergaming session. Methods: Fourteen healthy college-aged individuals (seven females) were initially acquainted with the IVR equipment and gameplay dynamics. Participants then underwent a 30-minute IVR exergaming session performing six different cable resistance exercises. A portable metabolic gas exchange analyzer concurrently assessed energy expenditure (EE) through indirect calorimetry while a chest-worn monitor captured heart rate (HR). Participants subsequently completed questionnaires, including the Borg scale for rating of perceived exertion (RPE), Physical Activity Enjoyment Scale (PACES), and Simulator Sickness Questionnaire (SSQ). Results: The mean EE, mean metabolic equivalent, and average total calories expended during the 30-minute session were 14.7 (standard deviation [SD] 2.8) kcal/minute, 12.9 (SD 0.5), and 440 (SD 84) kcals respectively. The mean HR was 176 (SD 3.1) beats per minute (bpm) with a mean max HR of 188 SD (SD 2.9) bpm. The combined training volume among all participants was 16,102 kg (SD 4137). Participants classified the IVR training session to be "somewhat hard-to-hard" with a RPE score of 14 (SD 1) while indicating the session to be "enjoyable" with a PACES score of 4.31 (SD 0.36). The participants did not report any cybersickness symptoms, demonstrating an average total SSQ score of 24.04 (SD 24.13). Conclusions: IVR exergaming incorporating cable resistance training elicits high EE and physiological demand with high enjoyment scores while attenuating perceived fatigue. The potential for IVR to elicit these acute training effects over long-term training periods warrants further investigation into its contribution to fitness and health.

Buddy biking: a user study on social collaboration in a virtual reality exergame for rehabilitation

Virtual reality (VR)-based rehabilitation is a growing technological field, which gradually becomes integrated into existing programs. However, technology has to support human behavior and -needs, including social relatedness, to achieve health-related outcomes. Elderly people have high risk of loneliness, and VR has technological affinity for natural social interaction. Previous studies have relied on competitiveness rather than collaborative elements, but research shows that competitiveness can lead to (feelings of) stress and aggressive behavior in some individuals. This article presents a mixed methods study to gather end-user feedback on a social VR scenario that encourages inter-player collaboration on a virtual tandem bike. Outpatients (n=11, 64% males, 60pm 11 years) were invited to participate with a co-player (friend or family). Participants biked on average 10.7 (± 3) minutes with a mean speed of 14.8 kmph (± 5.8). The results indicate potential and feasibility for the collaborative social biking application. Participants reported excellent usability-scores (85 ± 5), high intrinsic motivation in all categories: enjoyment (6.5 ± 0.5), effort/importance (6.4 ± 0.3), relatedness (6.3 ± 0.7) and minimal increase in symptoms of nausea, oculomotor and disorientation. Furthermore, participants found the social aspect enjoyable, agreed that collaboration eased tasks and that they lost track of exercise duration. Interpersonal interaction between participants varied, but was mostly positively rated valence, even if the sense of copresence was limited by physical constraints and avatar representation. Most participants expressed that they would use the program again, but future studies should explore how to improve location and appearance of the virtual coactor, as well as implement additional tasks.

A Study of Physical Fitness and Enjoyment on Virtual Running for Exergames

Virtual Reality (VR) technology has advanced forward in everyday life where virtual fitness is possible through physically moving around in the real world. Exergame is a video game for exercise aimed at making exercise more fun. VR exergame applies these trends together for virtual fitness with immersive game play. The VR locomotion is traveling in VR, which is commonly used in adventure role-playing games (RPG). Virtual running can be applied as a locomotion technique for VR exergames. The design of virtual running in VR exergames should be considered as an exercise for fitness and also for enjoyment. This paper proposed two motion-based locomotion techniques: ArmSwing and Squat for virtual running, which are considered as aerobic and strength exercise. These two postures were used to study how physical exertion affected players while interacting in the test scene. Usability, motion sickness, and enjoyment were assessed to analyze the differences of each posture. The results showed that motion sickness and enjoyment of ArmSwing and Squat were not different, while usability was different where ArmSwing was rated higher than Squat. The results from the interviews suggest that most players preferred aerobic exercise (ArmSwing) more than strength exercise (Squat) for a long period of exercise. However, for a short period of exercise, players preferred strength exercise more than aerobic exercise. The adventure-based RPG for exercise needs a solution design appropriate for virtual running in VR, and our results can be a guideline for developers in order to handle motion-based locomotion for VR exergames.

Upper Limb Muscles Activity during Punches in Virtual Reality Exergame on Standing and Sitting Position

Background: Physical activity (PA) provides various health benefits. Unfortunately, individuals with disabilities may experience health problems and greater obstacles to PA participation. Boxing exergame (EXG) based on virtual reality (VR) can be an alternative option to increase physical activity level because it is fun, relatively affordable and accessible. Punching in boxing requires complex movements, wherein the lower limbs are contributor for effective punches. An understanding of muscles activity is important to uncover the potential benefits of VR EXG.Aim: To evaluate the differences in upper limb muscles activity of the dominant side in standing compared to sitting position during punches.Material and methods: This was a cross-sectional study involving 15 healthy adult men. Surface electromyography examinations was performed on four upper limb muscles of the dominant side (upper trapezius, anterior deltoid, biceps, triceps) when delivering straight, hook and uppercut punches while playing VR EXG "Fitness Boxing" Nintendo Switch™ in standing and sitting position.Results: Fifteen healthy men (age 31.87±3.14 years old, BMI 23.77±2.47 kg.m-2) were participated in this study. No significant difference found in the percentage of maximum voluntary isometric contraction (%MVIC) values of the upper trapezius, anterior deltoid, biceps and triceps muscles of the dominant sides when the subjects delivered straight, hook and uppercut punches (p>0.05), except for upper trapezius muscle during uppercut punch in standing compared to sitting position (p=0.041).Conclusion: The VR EXG "Fitness Boxing" Nintendo Switch™ can be done in a standing or sitting position to get similar effect on the upper limb muscles.

A Virtual Reality Exergame to Engage Adolescents in Physical Activity: Mixed Methods Study Describing the Formative Intervention Development Process

BackgroundEarly adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity.ObjectiveThe vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration.MethodsThe formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group.ResultsVR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback.ConclusionsThis is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial.

Sanal Gerçeklik Egzersizlerinin Omuz Sıkışma Sendromlu Hastalarda Ağrı, Fonksiyonellik ve Akromiohumeral Aralık Üzerine Etkisi: Tek Kör Randomize Kontrollü Bir Çalışma

Sanal Gerçeklik Egzersizlerinin Omuz Sıkışma Sendromlu Hastalarda Ağrı, Fonksiyonellik ve Akromiohumeral Aralık Üzerine Etkisi: Tek Kör Randomize Kontrollü Bir Çalışma

가상현실 운동게임의 화면 속도에 따른 사용자 반응

최근 가상현실 운동게임이 큰 주목을 받고 있다는 점에 기반하여, 본 연구는 가상현실 운동 게임 내 다양한 디자인 요소 중에서 화면 속도 변화가 게임 사용자의 경험에 미치는 영향을 측정했다. 40명을 대상으로 가상현실 걷기 콘텐츠 내 화면 속도의 빠르기 변화에 따른 사용자 경험 변화를 반복측정실험한 결과, 운동에 대한 내재적 동기를 통계적으로 통제할 경우 플로우, 태도 및 게임 재사용 의도가 5km/h 화면 속도와 비교하여 7km/h와 9km/h 화면 속도에서 유의미하게 증가하는 것으로 나타났다. 이 결과는 가상현실 운동게임 내 화면 속도의 변화에 따른 사용자 경험이 게임 사용자의 운동에 대한 내재적 동기 수준에 따라 조절될 수 있음을 설명하며, 이는 가상현실 운동게임 콘텐츠의 디자인을 효과적으로 만들기 위한 시사점을 제시한다.

Virtual reality in pain therapy: a requirements analysis for older adults with chronic back pain

BackgroundToday immersive environments such as Virtual Reality (VR) offer new opportunities for serious gaming in exercise therapy and psychoeducation. Chronic back pain (CBP) patients could benefit from exergames in VR. The requirements in older CBP patients for a VR pain therapy have not yet been determined in studies. The aim of the study was to perform a requirements analysis for the user group of geriatric patients with CBP for a VR exergame. The objective was to find out the expectations, desires, preferences and barriers in order to collect them as requirements for this vulnerable group and to determine frameworks of therapy by physiotherapists and psychotherapists.MethodsWe conducted a requirements analysis through semi-structured interviews with 10 elderly participants with CBP. Furthermore, two focus groups were conducted with three physiotherapists and two psychotherapists to determine frameworks of therapy programs for the target group. The qualitative data were transcribed and examined through a structuring content analysis. Subsequently, the results of the analysis were prioritized by all participants of the study.ResultsThe results of the requirements analysis indicate mandatory requirements for the overall system, hardware, software and gamification elements. The key requirements were target-group-specific applications of the VR exergame through e.g. individual briefing, user-friendly handling, inclusion of movement limitations, presentation of everyday scenarios in combination with biofeedback, age-appropriate feedback through praise and awards and a maximum exercise duration of 30 min and 15 min of relaxation.ConclusionIt should be possible to use the determined requirements productively to create user-friendly VR exergames that motivate elderly chronic back pain patients to perform exercises regularly.Trial registrationThe study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00015294 12.10.2018).

Results and Guidelines From a Repeated-Measures Design Experiment Comparing Standing and Seated Full-Body Gesture-Based Immersive Virtual Reality Exergames: Within-Subjects Evaluation.

BackgroundAlthough full-body seated exercises have been studied in a wide range of settings (ie, homes, hospitals, and daycare centers), they have rarely been converted to seated exergames. In addition, there is an increasing number of studies on immersive virtual reality (iVR) full-body gesture-based standing exergames, but the suitability and usefulness of seated exergames remain largely unexplored.ObjectiveThis study aimed to evaluate the difference between playing a full-body gesture-based iVR standing exergame and seated exergame in terms of gameplay performance, intrinsic motivation, and motion sickness.MethodsA total of 52 participants completed the experiment. The order of the game mode (standing and sitting) was counterbalanced. Gameplay performance was evaluated by action or gesture completion time and the number of missed gestures. Exertion was measured by the average heart rate (HR) percentage (AvgHR%), increased HR%, calories burned, and the Borg 6-20 questionnaire. Intrinsic motivation was assessed with the Intrinsic Motivation Inventory (IMI), whereas motion sickness was assessed via the Motion Sickness Assessment Questionnaire (MSAQ). In addition, we measured the fear of falling using a 10-point Likert scale questionnaire.ResultsPlayers missed more gestures in the seated exergame than in the standing exergame, but the overall miss rate was low (2.3/120, 1.9%). The analysis yielded significantly higher AvgHR%, increased HR%, calories burned, and Borg 6-20 rating of perceived exertion values for the seated exergame (all P<.001). The seated exergame was rated significantly higher on peripheral sickness (P=.02) and sopite-related sickness (MSAQ) (P=.004) than the standing exergame. The score of the subscale “value/usefulness” from IMI was reported to be higher for the seated exergame than the standing exergame. There was no significant difference between the seated exergame and standing exergame in terms of intrinsic motivation (interest/enjoyment, P=.96; perceived competence, P=.26; pressure/tension, P=.42) and the fear of falling (P=.25).ConclusionsSeated iVR full-body gesture-based exergames can be valuable complements to standing exergames. Seated exergames have the potential to lead to higher exertion, provide higher value to players, and be more applicable in small spaces compared with standing exergames. However, gestures for seated exergames need to be designed carefully to minimize motion sickness, and more time should be given to users to perform gestures in seated exergames compared with standing exergames.

Movement analysis of pick-and-place virtual reality exergaming in patients with Parkinson's disease.

Reduced coordination of precise small movements of the hand, wrist and fingers in Parkinson's disease (PD) has been mostly solved by medications and deep brain stimulation. The effects have been evaluated by clinical tests only. Virtual reality-based exergaming may enhance fine movements, decrease the medications dosage and provide an additional non-subjective evaluation. 3D pick-and-place task (10Cubes) has been developed in a virtual world. The person placed the virtual cubes by the virtual hand, an avatar of the real hand tracked by a Leap Motion Controller (LMC). The system computed the time of manipulating the cube, the total time, the average time, the speed, and the distance. It counted and managed the number of cubes touched, and calculated the hand shake level, i.e. the average tremor index. A pilot test was carried out in a healthy neurologically intact person and a patient with PD using a 3D head-mounted device (HMD) or LCD screen. The results indicate that substantial and also statistically significant (p< 0.05) differences exist between both participants in all objective parameters; the most noteworthy is the average tremor index. However, we found the parameters only marginally different with 2D equipment. The evaluation system of 10Cubes has proved applicable at an unchanged medication plan, but its clinical effectiveness could be confirmed with a randomized study.

VR‐Rides: An object‐oriented application framework for immersive virtual reality exergames

SUMMARYExercise can improve health and well‐being. With this in mind, immersive virtual reality (VR) games are being developed to promote physical activity, and are generally evaluated through user studies. However, building such applications is time consuming and expensive. This paper introduces VR‐Rides, an object‐oriented application framework focused on the development of experiment‐oriented VR exergames. Following the modular programming pattern, this framework facilitates the integration of different hardware (such as VR devices, sensors, and physical activity devices) within immersive VR experiences that overlay game narratives on Google Street View panoramas. Combining software engineering and interaction patterns, modules of VR‐Rides can be easily added and managed in the Unity game engine. We evaluate the code efficiency and development effort across our VR exergames developed using VR‐Rides. The reliability, maintainability, and usability of our framework are also demonstrated via code metrics analysis and user studies. The results show that investing in a systematic approach to reusing code and design can be a worthwhile effort for researchers beyond software engineering.

Studying the Effect of Display Type and Viewing Perspective on User Experience in Virtual Reality Exergames.

Background: Physical inactivity has been identified as the fourth leading cause of death globally. It is now well established that a sedentary lifestyle is a unique risk factor for several diseases such as type 2 diabetes and cardiovascular disease, which account for about 30% of global mortality. Diabetes is a major preventable cause of costly and debilitating renal failure, heart disease, lower limb amputation, and avoidable blindness. In recent years, the idea of using interactive computing systems that leverage gamification to promote physical activity has been widely researched. Prior studies have shown that exergames, that is those that encourage physical activity, can increase enjoyment and intrinsic motivation compared with conventional exercises; as such, they can be effective in promoting physical and mental health. There has been some research on immersive virtual reality (VR) exergames; however, to the best of our knowledge, it is limited and preliminary. This work aims at filling the gap and investigates the effect of display type (DT) and viewing perspective (VP) on players' exertion, engagement, and overall game experience in immersive VR exergames. Objective: This article aims at examining whether DT and VP can affect gameplay performance, players' exertion, game experience, cybersickness, and electroencephalography (EEG) engagement index when playing a gesture-based (i.e., body motion) exergame. Materials and Methods: Study 1 employed a one-way between-subjects design with 24 participants equally distributed in two groups (immersive VR and 50-inch TV) to perform 12 pre-defined gestures. The main outcome measures were National Aeronautics and Space Administration-Task Load Index (NASA-TLX) workload for each group as well as 7 Likert scale and EEG engagement index for each gesture. Study 2 included 16 participants in playing a game with the gestures selected from study 1. All participants played 4 versions based on combinations of DT (immersive VR and 50-inch TV) and VP (first-person and third-person) to assess exertion (%HRmax, calories consumption, and Borg RPE 6-20), game experience, cybersickness, and EEG engagement index. Results: Study 1 results showed that DT had no effect on the ratings of the gestures, NASA-TLX workload, and EEG engagement index. Study 2 results showed that immersive VR not only resulted in a significantly higher exertion (%HRmax, calories consumption, and Borg RPE) but also helped achieve better positive game experience in challenge, flow, sensory and imaginative immersion, as well as lower negative affect. We also found that nausea and oculomotor were significantly higher in immersive VR. Conclusion: This pilot study demonstrates that youth who played gesture-based exergame in immersive VR had a higher level of exertion (%HRmax, calories consumption, and Borg RPE), although the number of performed gestures were not significantly different. They also felt that immersive VR was much more challenging, immersive (flow, sensory and imaginative immersion), and had a lower negative affect than a 50-inch TV; however, immersive VR was more likely to make youth have higher cybersickness.