Energy expended playing Xbox Kinect™ and Wii™ games: a preliminary study comparing single and multiplayer modes

Exergaming for physical activity: A systematic review

OBJECTIVE

This review evaluates current literature on intensity selection, perceptual responses, activity enjoyment and adherence rates of exergaming.

METHODS

The literature search identified manuscripts that investigated exercise intensity, perceptual responses, or exercise adherence of exergaming in young adults.

RESULTS

Based on results of 29 studies, the current review suggest some exergaming activities have the potential to elicit moderate to vigorous exercise intensity and could potentially be substituted for traditional exercise. Additionally, exergame activities may aid in the start of exercise adherence by lowering the individual's perceived exertion when playing exergames. Exergaming not only has the potential to enhance enjoyment through an exercise objective but also through the distracting nature of video games.

CONCLUSIONS

Exergaming shows potential to be substituted for traditional exercise and could offer a new, varied form of exercise for sedentary individuals. Future research should examine the influence of exergaming experience on intensity selection and adherence rates.

Xbox Kinect Sports vs. Nintendo Switch Sports and Their Effects on Body Composition and Physical Performance in Older Females: A Randomized Controlled Trial

Background/Objectives: This study aimed to compare the effects of Xbox Kinect Sports (XKS) regarding Nintendo Switch Sports (NSS) and an inactive control group (CG) on body composition (body fat percentage, BFP; and fat-free mass) and physical performance (maximal isometric handgrip strength, MIHS; 30-s chair stand, 30-S; timed up-and-go, TUG; sit-and-reach; and 2-min step) in physically inactive older females. Methods: A randomized controlled trial study was conducted with three parallel groups: XKS (n = 13), NSS (n = 14), and CG (n = 16) considering three weekly 60-min sessions for 12 weeks with pre- and post-assessments. Results: A two-factor mixed analysis of variance (ANOVA) model with repeated measures was performed to measure the time × group effect. Multiple comparisons revealed significant differences in BFP (F(2,18) = 6.12; p = 0.005; ηp2 = 0.226, large effect), 30-S (F(2,18) = 20.7; p = 0.000; ηp2 = 0.496, large effect), TUG (F(2,18) = 10.0; p = 0.000; ηp2 = 0.323, large effect), sit-and-reach (F(2,18) = 37.3; p = 0.000; ηp2 = 0.640, large effect), and 2-min step (F(2,18) = 9.85; p = 0.000; ηp2 = 0.319, large effect) in favor of XKS regarding NSS and CG. The intragroup results only present in XKS a significant decrease in BFP (p = 0.02; d = 0.98) and significant improvements in the 30-S (p = 0.000; d = 1.88), TUG (p < 0.01; d = 2.00), sit-and-reach (p = 0.003; d = 2.58), and 2-min step (p = 0.004; d = 1.05). Conclusions: training using XKS significantly decreases BFP and improves 30-S, TUG, sit-and-reach, and 2-min step in physically inactive older females.

Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study

BACKGROUND

Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation.

OBJECTIVE

This study aimed to compare the effects of VR games on chronic low back pain.

METHODS

This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P≤.05.

RESULTS

The study comprised a sample of 40 patients with low back pain; 12 (40%) were female and 28 (60%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were -.60 (P=.76), -2.30 (P<.001), and -1.80 (P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 (P=.21), 4.80 (P=.07), and 7.40 (P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P=.04), 5.20 (P<.001), and 4.80 (P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P<.001), 4.80 (P=.02), and 2.20 (P<.001). respectively, showing significant pre- and posttreatment effects.

CONCLUSIONS

VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups.

TRIAL REGISTRATION

Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916.

Factors for optimizing intervention programs for cognition in older adults: the value of exergames

This review presents factors that could optimize the effectiveness of an intervention program on cognitive health in older adults. Combined, multi-dimensional and interactive programs appear to be relevant. On one hand, for the characteristics to be implemented in the physical dimension of a program, multimodal interventions stimulating the aerobic pathway and muscle strengthening during the solicitation of gross motor activities, seem to be interesting. On the other hand, regarding the cognitive dimension of a program, complex and variable cognitive stimuli appear to hold the greatest promise for generating cognitive benefits and the broadest transfers to untrained tasks. The field of video games also brings interesting enrichment through the gamification of situations and the feeling of immersion. However, some gray areas remain to be clarified, notably the ideal response dose, the balance between physical and cognitive solicitation and the programs’ customization.

Alternative Model for Physical Activity: Active Video Games Lead to High Physiological Responses

Purpose: This study aimed to i) investigate the physiological and perceptual responses to two different active video games (AVGs), ii) compare the physiological and perceptual responses to AVGs with those encountered during classic exercise and daily sedentary routines, and iii) compare the examined variables between the sexes. Methods: Forty-three (n = 22 male, n = 21 female) volunteers participated in the study and were tested in five different conditions (resting, watching television (TV), brisk walking, AVG dancing, and AVG fighting). Oxygen consumption (VO₂) and heart rate (HR) were measured continuously, whereas energy expenditure (EE) and metabolic equivalent (MET) were calculated. Rating of perceived exertion (RPE) and enjoyment scores were recorded. Results: AVG dancing and AVG fighting significantly increased VO₂, MET, EE, and HR compared with brisk walking, resting, and watching TV. Comparing with brisk walking the AVG dancing yielded similar RPE and higher enjoyment scores. However, the highest physiological responses, RPE, and enjoyment scores were obtained during AVG fighting. There were significant sex x condition interactions for VO₂, MET, EE, and HR. VO₂, MET, and EE were significantly higher in males for all conditions, whereas HR was significantly higher in females. The mean EE values during AVG fighting and AVG dancing were 13.12 ± 2.2 kcal.min^-1 and 9.69 ± 2.0 kcal.min^-1, respectively in males, and 9.31 ± 1.9 kcal.min^-1 and 7.07 ± 1.3 kcal.min^-1, respectively in females. Conclusions: AVG dancing (MET >7) and AVG fighting (MET >9) are enjoyable, vigorous physical activities that can be recommended as an alternative home-based physical activity.

Strength-Cognitive Training: A Systemic Review in Adults and Older Adults, and Guidelines to Promote "Strength Exergaming" Innovations

Background

Despite functional and cognitive benefits, few adults and older adults do strength training twice per week with sufficient intensity. Exercise-based active video games (exergaming) may amplify the cognitive benefits of exercise and increase adherence and motivation toward training. However, the benefits of a well-defined and monitored dose of strength training, executed simultaneously or sequentially with a cognitive element, has received little attention. In this study we have two aims: First, to systematically gather the available evidence; second, to suggest possible ways to promote strength exergaming innovations.

Methods

We systematically reviewed randomized controlled trials using simultaneous or sequent combined strength and cognitive training or strength exergaming to improve cognitive or functional outcomes in adults and older adults.

Results

After screening 1,785 studies (Google Scholar, ACM Digital Library, IEEE Xplore Library, PsycARTICLES, Scopus, Cochrane Library and PubMed) we found three eligible studies. Of the two studies using sequent strength and cognitive training, one showed improved functionality, but the other showed negative effects on cognition. The third study using simultaneous intervention, reported a positive influence on both cognition and function, when compared with either strength training alone or a control group. Moderate level of evidence was showed on GRADE analysis.

Conclusion

The existing little evidence suggests that strength and cognitive training improves cognition and function in adults and older adults. The following suggestions may help to promote further innovation: (1) ensure minimal dosage of strength training (30-60 min, 2 × /week), (2) use machine-based strength training devices to control volume and intensity (to prevent cognitive components from interfering with strength training), (3) include power training by using cognitive tasks requiring rapid reactions, and (4) add cognitive memory tasks (to extend the cognitive benefits of strength training per se), and (5) include motivational exergame elements to increase adherence.

Promoting Sports Engagement during the COVID-19 Pandemic via Virtual Reality Games

Objective

To examine sports engagement and health changes of young adults when utilizing a VR sports game and investigate the relationship between sports engagement and health.

Method

This study used a single-group design with 20 participants, aged 19–29 years, with no preexisting health conditions. The VR game “Sports Scramble” was used thrice within a span of one week. Outcomes sought include sports engagement and health, measured through the Sports Engagement Scale (SES) and Short Form 36 (SF-36), respectively.

Results

A significant difference (p < 0.001) was found between the pre-posttest scores of the SES. Moreover, a positive trend was observed in terms of health with a significant difference (p < 0.05) between pre-posttest scores of the SF-36's vitality dimension. There were positive correlations among the dedication and vigor subscales of the SES with the dimensions of health.

Conclusion

This study showed the potential of VR sports games in positively influencing sports engagement and health among participants with the vigor and dedication positively influencing health. Future studies may involve the exploration of the effectiveness of VR to promote engagement and health through a randomized controlled trial with a longer timeframe and across various populations.

Exergaming to improve physical, psychological and cognitive health among home office workers: A COVID-19 pandemic commentary

BACKGROUND

The COVID-19 pandemic has resulted in increased sedentary behaviour and poorer health among office workers. Exergaming is a technology-driven mode of exercise that can improve health while physically distancing.

OBJECTIVE

The purpose of this commentary was to explain the benefits of exergaming on physical function, psychological health, and cognition among office workers.

RESULTS

Exergaming improves these health outcomes, reduces pain, and decreases the risk for chronic disease. It is easily accessible on smart devices and can be performed both indoors and outdoors.

CONCLUSIONS

Twenty-one minutes of exergaming per day can improve health outcomes and reduce the risk of pain and disease. Employers and policy-makers should consider promoting exergaming among office workers.

Wii or Kinect? A Pilot Study of the Exergame Effects on Older Adults' Physical Fitness and Psychological Perception

Exergames are now often implemented among older adults for health purposes. This study aimed to investigate whether playing Kinect and Wii exergames has effects on older adults’ physical fitness and psychological perceptions towards exergames. A total of 23 older participants aged above 60 years were recruited and randomly assigned into two groups, in which they played either Kinect or Wii Bowling exergames for three sessions in one week. Physiological and psychological measures were collected including heart rate, blood pressure, shoulder flexibility, as well as perceived benefits and intentions for future use. Findings indicated that exergames are equivalent to light-intensity exercises, and hence pose no or minimal risk to older adults. Older adults had a positive attitude towards exergames and have a strong willingness to engage in exergaming on a regular basis. Although no significant platform difference was identified, observation and qualitative findings suggested that Wii might provide a more intense physical activity than Kinect, while Kinect might obtain a higher perception among older adults than Wii. The study has several practical implications for both health professionals and exergame designers targeting the ageing population.

State Anxiety after Exergame Beach Volleyball Did Not Differ between the Single and Multiplayer Modes in Adult Men

This study compared the exergame beach volleyball’s acute effects on state anxiety level in single vs. multiplayer mode in adult men. Sixty adult men (age: 21.98 [4.58] years, body mass: 75.40 [15.70] kg, height: 1.77 [0.09] m, and body mass index: 24.19 [5.44] kg/m²; data are expressed as median [interquartile range]) were assigned to play exergame of beach volleyball in single- or multiplayer mode for approximately 30 min using the Xbox 360 Kinect^®. The state anxiety level was evaluated before and after the intervention. There was no significant difference in the state anxiety levels after an exergame session between the single and multiplayer modes (p-value = 0.407, effect size (r_B) = −0.12, defined as small). Furthermore, there was no significant difference in the state anxiety levels before and after an exergame session in single-player mode (p-value = 0.516, effect size (d) = 0.14, defined as trivial) and multiplayer mode (p-value = 0.053, r_B = 0.43, defined as medium). In conclusion, state anxiety level after exergame beach volleyball did not differ between the single and multiplayer modes in adult men.

Comment on: Problematic online gaming and the COVID-19 pandemic - The role of exergames

Although significant increases in gaming may not always be beneficial, exergames (a new generation of video games also known as exergaming or active video games) appear as an alternative, feasible, attractive, and safe way to perform physical exercise for most clinical and nonclinical populations. Therefore, it is important to recognize that exergames can be considered a useful tool for coping with the COVID-19 outbreak and the recommended social distancing period.

High-intensity interval training and active video gaming improve neurocognition in schizophrenia: a randomized controlled trial

There is a need for treatments targeting neurocognitive dysfunctions in schizophrenia. The aim of this study was to investigate the neurocognitive effect of aerobic high-intensity interval training (HIIT). A comparison group performed sport simulating active video gaming (AVG). We anticipated that HIIT would improve neurocognition beyond any effect of AVG, due to engagement in higher intensity cardiorespiratory demands. Recent research on the beneficial neurocognitive effect of AVG challenges this expectation but added new relevance to comparing the two interventions. This is an observer-blinded randomized controlled trial. Eighty-two outpatients diagnosed with schizophrenia were allocated to HIIT (n = 43) or AVG (n = 39). Both groups received two supervised sessions per week for 12 weeks. The attrition rate was 31%, and 65% of the participants were defined as protocol compliant study completers. Intention-to-treat analyses showed significant improvements in the neurocognitive composite score from baseline to post-intervention and from baseline to 4 months follow-up in the total sample. The same pattern of results was found in several subdomains. Contrary to our hypothesis, we found no interaction effects of time and group, indicating equal effects in both groups. Separate within-group analysis unexpectedly showed trends of differential effects in the learning domain, as HIIT showed post-intervention improvement in verbal but not visual learning, while AVG showed improvement in visual but not verbal learning. HIIT and AVG improve neurocognition equally, suggesting that both interventions may be applied to target neurocognition in schizophrenia. Future research should investigate trends towards possible differential effects of exercise modes on neurocognitive subdomains. NCT02205684, 31.07.14.

Physiological Responses of Exergaming Boxing in Adults: A Systematic Review and Meta-Analysis

Objective: Studies investigating the effects of exergaming in available platforms are still limited. This review aims to systematically identify available studies on physiological intensities of exergaming boxing in able-bodied adults and recategorize them based on different platforms or environments. The meta-analysis further analyzes the physiological responses during exergaming boxing into a set of pooled data for any evidence of outliers, heterogeneity, or publication bias. Materials and Methods: A systematic search was conducted by using databases from Google Scholar, PubMed, and Web of Science. Population, intervention, comparison, and outcomes (PICO) and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used in the study selection process for the review. Results: From the 1534 articles examined, 16 articles were included for further analyses. Results indicated that exergaming boxing exhibits a wide range of metabolic equivalent of task (MET) values and intensity, from very light to vigorous, with elements of heterogeneity and bias detected. The Xbox^® Kinect boxing platform produced higher MET (mean = 5.3) compared with the Nintendo^® Wii^™ boxing (mean = 3.8). Conclusion: The results of this review suggest that boxing exergames can produce intensity-adequate physical activity among younger adults that are beneficial for cardiometabolic improvements, regardless of platforms used. Exergaming boxing may be employed as an effective exercise tool to increase energy expenditure and physical activity level in young adults.

The Acute Effects of Cognitive-Based Neuromuscular Training and Game-Based Training on the Dynamic Balance and Speed Performance of Healthy Young Soccer Players: A Randomized Controlled Trial

Objective: The aim of this study was to investigate the acute effects of cognitive and game-based trainings (GBT) on dynamic balance (DB) and speed performance (SP) in healthy young soccer players. Materials and Methods: Forty-nine male soccer players were divided into three groups: cognitive-based neuromuscular training (CBNT; n = 16; age = 16.93 ± 1.18 years; body mass index [BMI] = 21.37 ± 1.57 kg/m²) group, GBT (n = 17; age = 17.05 ± 1.39 years; BMI = 21.10 ± 0.97 kg/m²) group, and control group (n = 16; age = 16.75 ± 1.12 years; BMI = 21.95 ± 1.36 kg/m²). The athletes in CBNT and GBT groups took part in one session lasting 1 hour. The Star Excursion Balance Test and the Speed Dribbling Test were used to evaluate DB and SP, respectively. The measurements were taken just before and after the trainings. Statistical analysis of the study was performed using SPSS 22.0 software (Statistical Package for Social Sciences, Inc., Chicago, IL). The Paired Student's t-test and Wilcoxon test were used. For in-group evaluation the ANOVA test was used for comparisons between the three groups. The Tukey's test was used for post hoc analysis. Results: DB significantly improved in all directions in the GBT group (P < 0.05). Also, significant improvements were observed in DB in all directions except anterior, anterolateral, and anteromedial in the CBNT group, and except anterior, medial, and anteromedial directons in the control group (P < 0.05). SP significantly developed just in the CBNT and GBT groups (P = 0.001, P = 0.003, respectively). CBNT and GBT improved the DB of soccer players by 9.6% and 9.5%, respectively. Also, trainings improved the SP by 3.1% and 2.6%, respectively. Conclusion: CBNT and GBT are promising trainings that can improve DB and SP of healthy young soccer players. Trial number: NCT03739658 (ClinicalTrials.gov Identifier).

Play Mode Effect of Exergames on Subthreshold Depression Older Adults: A Randomized Pilot Trial

BACKGROUND

Subthreshold depression is a common mental disorder in late life. Increasing studies have supported the positive effects of exergames to subthreshold depression. The current study aims to investigate how play mode potentially affects exergames' effects on subthreshold depression among older adults.

METHOD

A between-group experiment was carried out to compare the effect of exergames with different play modes. Fifty-two Singaporean older adults with subthreshold depression were randomly assigned into two conditions, and performed either single-player or multiple-player Nintendo Wii Tennis exergames for 6 weeks, while the key variables of depression, social support and loneliness were measured at both pre- and post-study period.

RESULTS

Findings from path analysis suggested that older adults in multiple-player exergames experienced lower levels of loneliness, and further more reduction on subthreshold depression, when compared to those in single-player exergames. Although social support was not affected by play mode, the significant relationship among social support, loneliness, and depression was found in the context of exergaming.

CONCLUSION

This study not only provides additional insight into a possible causal association lining play mode and health outcomes of exergames, but also opens the discussion of how to optimize antidepressive effect of exergames for older adults.

Active Video Games Versus Traditional Exercises: Energy Expenditure and Blood Lactate Responses

Purpose: The current study aimed to investigate the exercise intensity and exercise characteristics of active video games (AVGs) by measuring various physiological responses, and to test whether AVGs can be used in components of training in sports branches. Methods: Twenty-two male athletes with good aerobic fitness level (age = 20.6 ± 2.2 years; maximum oxygen consumption (VO₂max) = 52.2 ± 3.5 ml.kg^-1.min^-1) visited the laboratory three times (D1, D2, and D3). After taking measurements during rest, the VO₂max was assessed (D1). Traditional brisk walking and running exercises were performed consecutively (D2), and AVGs-dancing and fighting-were performed at random (D3); each exercise session lasted 20 minutes, and for each experiment session oxygen consumption (VO₂), heart rate (HR) were recorded, VO₂max%, metabolic equivalent (MET), and energy expenditure (EE) were calculated. Results: No significant differences were found between AVG-dancing and brisk walking (p > .05) for VO₂ (25.96 ± 3.3 vs. 24.39 ± 2.3 ml.kg^-1.min^-1), HR (137.02 ± 20.15 vs. 125.61 ± 6.49 beats.min^-1) VO₂max% (49.99 ± 7.00 vs. 46.84 ± 4.06), MET (7.49 ± 0.94 vs. 6.96 ± 0.65), and EE (181.19 ± 27.65 vs. 171.21 ± 22.51 Kcal). Additionally, no significant differences were found between AVG-fighting and running (p > .05) for VO₂ (33.96 ± 5.88 vs. 33.13 ± 2.52 ml.kg^-1.min^-1), HR (155.66 ± 15.05 vs. 153.30 ± 6.83 beats.min^-1), VO₂max% (65.05 ± 9.76 vs. 63.60 ± 3.51), MET (9.70 ± 1.68 vs. 9.47 ± 0.72), and EE (236.75 ± 37.20 vs. 232.70 ± 27.06). Conclusions: AVG-dancing and fighting were defined as moderate (MET>7) and high (MET>9) intensity intermittent exercises, respectively. Consequently, AVGs can be a part of training for athletes; as a block, modified block or a traditional training cycle involving enjoyable alternative exercises, especially when the appropriate AVGs are chosen.

Exergames for Children and Adolescents with Autism Spectrum Disorder: An Overview

Autistic Spectrum Disorder (ASD) is a complex neurodevelopmental disorder associated with various etiologies and characterized by deficits in social interaction, emotional reciprocity, communication, motor skills and cognitive functions. Studies have proposed that limited levels of physical activity and late motor skills and fitness, particularly in children and adolescents with ASD, may accentuate social and emotional deficits. In view of this, exergames, which are active video-games, can be considered a low-cost and safe type of exercise for children and adolescents with ASD, since they are more enjoyable than ordinary physical activities, influencing on treatment adherence. Thus, our study aims to evidence the effects of exergames on physical fitness, cognitive functions, and repetitive behaviors in children and adolescents with ASD. Despite the small number of studies investigating the effects of exergames as new strategy in children and adolescents with ASD, results suggest exergames as potential tool for the treatment of children and adolescents with ASD for improvement in physical fitness, cognitive functions and repetitive behavior. Our review pointed towards the importance of exergames for children and adolescents with ASD. Despite few studies conducted about this issue, we can consider exergames a potential tool to increase physical fitness, cognitive functions and to decrease repetitive behavior in children and adolescents with ASD. Moreover, health professionals should be careful when attempting to help this population, because the current literature is unclear yet about the improvement of ASD features through exergames.

A Systematic Review on the Cognitive Benefits and Neurophysiological Correlates of Exergaming in Healthy Older Adults

Human aging is associated with structural and functional brain deteriorations and a corresponding cognitive decline. Exergaming (i.e., physically active video-gaming) has been supposed to attenuate age-related brain deteriorations and may even improve cognitive functions in healthy older adults. Effects of exergaming, however, vary largely across studies. Moreover, the underlying neurophysiological mechanisms by which exergaming may affect cognitive and brain function are still poorly understood. Therefore, we systematically reviewed the effects of exergame interventions on cognitive outcomes and neurophysiological correlates in healthy older adults (>60 years). After screening 2709 studies (Cochrane Library, PsycINFO, Pubmed, Scopus), we found 15 eligible studies, four of which comprised neurophysiological measures. Most studies reported within group improvements in exergamers and favorable interaction effects compared to passive controls. Fewer studies found superior effects of exergaming over physically active control groups and, if so, solely for executive functions. Regarding individual cognitive domains, results showed no consistence. Positive effects on neurophysiological outcomes were present in all respective studies. In summary, exergaming seems to be equally or slightly more effective than other physical interventions on cognitive functions in healthy older adults. Tailored interventions using well-considered exergames and intervention designs, however, may result in more distinct effects on cognitive functions.

Frailty Level Monitoring and Analysis after a Pilot Six-Week Randomized Controlled Clinical Trial Using the FRED Exergame Including Biofeedback Supervision in an Elderly Day Care Centre

Background: Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the individual to a higher risk of negative health-related outcomes. Exercise using interactive videos, known as exergames, is being increasingly used to increase physical activity by improving health and the physical function in elderly adults. The purpose of this study is to ascertain the reduction in the degree of frailty, the degree of independence in activities of daily living, the perception of one's state of health, safety and cardiac healthiness by the exercise done using FRED over a 6-week period in elderly day care centre. Material and Methods: Frail volunteers >65 years of age, with a score of <10 points (SPPB), took part in the study. A study group and a control group of 20 participants respectively were obtained. Following randomisation, the study group (20) took part in 18 sessions in total over 6 months, and biofeedback was recorded in each session. Results: After 6 weeks, 100% of patients from the control group continued evidencing frailty risk, whereas only 5% of patients from the study group did so, with p < 0.001 statistical significance. In the case of the EQ-VAS, the control group worsened (-12.63 points) whereas the study group improved (12.05 points). The Barthel Index showed an improvement in the study group after 6 weeks, with statistically significant evidence and a value of p < 0.003906. Safety compliance with the physical activity exceeded 87% and even improved as the days went by. Discussion: Our results stand out from those obtained by other authors in that FRED is an ad hoc-designed exergame, significantly reduced the presence and severity of frailty in a sample of sedentary elders, thus potentially modifying their risk profile. It in turn improves the degree of independence in activities of daily living and the perception of one's state of health, proving to be a safe and cardiac healthy exercise. Conclusions: The study undertaken confirms the fact that the FRED game proves to be a valid technological solution for reducing frailty risk. Based on the study conducted, the exergame may be considered an effective, safe and entertaining alternative.

Game analysis and clinical use of the Xbox-Kinect for stroke rehabilitation

Whole-body movement is required to interact (play) with Microsoft Xbox with the 3D Kinect sensor (Xbox-Kinect) and, therefore, may be suitable for encouraging and practicing movements as part of stroke rehabilitation. We aimed to describe (i) game analysis, (ii) clinical use, and (iii) to characterize the Xbox-Kinect game experience with individuals with chronic stroke. Four therapists played the Xbox-Kinect games and then carried out a games analysis on the basis of the categories suggested by Deutsch. Eleven participants (age 29-69 years) with chronic stroke and varying motor deficits played Xbox-Kinect games for 4-22 sessions as part of a video-game group intervention and the clinical use was documented. The game experience of 'Bowling' (Kinect-Sport) and '20 000 leaks' (Kinect Adventures) was characterized by self-report questionnaires. Detailed tables of game analysis are provided. The clinical use of the console with the participants is presented. Participants reported high enjoyment and 'somewhat-high' perceived exertion after playing the two games and stated that overall the console suited their therapeutic goals. This information can assist clinicians with their clinical reasoning and decision-making for incorporating the Xbox-Kinect into stroke rehabilitation. Potentially, the Xbox-Kinect could be used as an on-going tool to facilitate whole-body movement and physical activity of individuals with chronic stroke.

Exergaming for Children and Adolescents: Strengths, Weaknesses, Opportunities and Threats

Exergaming, or active video gaming, has become an emerging trend in fitness, education and health sectors. It is defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). Since exergaming is becoming more popular, claims have been made on the usefulness of exergaming. It has, for example, been entitled as being "the future of fitness" by the American College of Sports Medicine, promoting PA and health in children and adolescents. However, research also suggests that long-term engagement in exergaming is difficult to achieve, and there is a noticeable reservation towards exergaming by parents, teachers and caregivers. To provide an overview and to outline the future directions of exergaming, the aim of this review was to critically illustrate the strengths, weaknesses, opportunities and threats of exergaming to promote PA and health in children and youth. The available evidence indicates that exergaming has the potential to improve health via an increase in PA. However, it seems that this potential is frequently underexploited, and further developments such as customized exergames are needed.

Effect of in-seat exercising on comfort perception of airplane passengers

Sitting still for extended periods of time can lead to physical discomfort and even serious health risks. Due to safety regulations, reducing passenger' sitting time in aircrafts is not feasible. This paper presents the results of a laboratory study, in where an interactive airplane seat was compared with a current economy class seat. Participants used both seats for 3.5 h, and performed significantly more in-seat movements when using the interactive seating system. Furthermore, this interactive seat predominantly lead to significantly better comfort experiences and reduced discomfort experiences, however no significant differences have been found in self-reported localized musculoskeletal discomfort. Passengers indicated that they would prefer this interactive seat over a standard aircraft seat.

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.

FRED: Exergame to Prevent Dependence and Functional Deterioration Associated with Ageing. A Pilot Three-Week Randomized Controlled Clinical Trial

Introduction: Frailty syndrome and advanced age may decrease the acceptance of illness and quality of life, and worsen patients' existing health conditions, as well as leading to an increase in health care expenses. Purpose: The purpose of this study is to reduce frailty risk via the use of a FRED game which has been expressly designed and put together for the study. Materials and methods: A total of 40 frail volunteers with a score of <10 points in the short physical performance battery (SPPB) took part in a feasibility study in order to validate the FRED game. Following randomisation, the study group (20 subjects) took part in nine sessions of 20 min each over a three-week period. The control group (19 subjects) continued to lead their daily lives in the course of which they had no physical activity scheduled; Results: After three weeks and having taken part in nine physical activity sessions with the FRED game, 60% of subjects from the study group (12/20) obtained a score of ≥10 points at the end of the study, i.e., less risk of evidencing frailty. This result proved to be statistically significant (p < 0.001). The degree of compliance with and adherence to the game was confirmed by 100% attendance of the sessions. Discussion: Our findings support the hypothesis that FRED, an ad hoc designed exergame, significantly reduced the presence and severity of frailty in a sample of sedentary elders, thus potentially modifying their risk profile. Conclusions: The FRED game is a tool that shows a 99% certain improvement in the degree of frailty in frail elderly subjects. The effectiveness of the design of ad hoc games in a certain pathology or population group is therefore evidenced.

The Effects of Active Videogame Feedback and Practicing Experience on Children's Physical Activity Intensity and Enjoyment

OBJECTIVE

The study aims to explore the effects of receiving active videogame (AVG) feedback and playing experience on individuals' moderate-to-vigorous physical activity (MVPA) and perceived enjoyment.

MATERIALS AND METHODS

This was a within-subject design study. The participants included 36 (n = 15 and 21 for boys and girls, respectively) fourth graders enrolled in a rural elementary school in southern Georgia area. The experiment lasted for 6 weeks with each week including three sessions. The participants were assigned in either front row (sensor feedback) or back row (no sensor feedback) during practice, which was alternated in different sessions. Two different dance games were played during the study with each game implemented for 3 weeks. The MVPA was measured with GT3X+ accelerometers. Physical activity (PA) enjoyment was assessed after the completion of the first two and last two sessions of each game. A repeated one-way ANOVA (analysis of variance) was used to examine the effects of AVG feedback and game on MVPA. A repeated one-way MANOVA (multivariate analysis of variance) was conducted for each game to examine the effects of experience and AVG feedback on enjoyment and MVPA.

RESULTS

No effects of AVG feedback were found for MVPA or enjoyment (P > 0.05). The effects of experience on MVPA were found for Just Dance Kids 2014 with experience decreased MVPA (P < 0.05).

CONCLUSION

Students who practiced dance AVG without receiving feedback still demonstrated positive affection and accumulated similar MVPA than when practicing while receiving feedback. Experience for certain dance games tends to decrease PA intensity.

Effects of Active Videogame and Sports, Play, and Active Recreation for Kids Physical Education on Children's Health-Related Fitness and Enjoyment

OBJECTIVE

The purpose of the study was to compare the effects of a Kinect active videogame (AVG) and the Sports, Play, and Active Recreation for Kids (SPARK) intervention in improving children's health-related fitness and physical activity (PA) enjoyment.

MATERIALS AND METHODS

A total of 65 students from both third and fourth grade in a rural elementary school participated in the study. The third graders (N = 29, mean age = 9.1 years, 10 boys, mean body mass index [BMI] = 20.1) were assigned to a SPARK physical education group, while the fourth graders (N = 36, mean age = 10.2 years, 15 boys, mean BMI = 20.3) were enrolled in the Kinect AVG group. The intervention lasted for 6 weeks, with each week including three practice sessions (∼40 minutes per session). All participants were measured on their health-related fitness by testing their performance in the 15-m Progressive Aerobic Cardiovascular Endurance Run (PACER), curl-ups, and push-ups both before and after the interventions. Participants' PA enjoyment was measured immediately after the first and last session's practice. Various ANCOVA tests were conducted to analyze the intervention effects on the changes of health-related fitness performances and enjoyment while controlling for baseline values, gender, and BMI. Various MANOVA tests were used to examine the intervention effects on PA levels during three practice sessions.

RESULTS

Participants in AVG group had greater improvement in 15-m PACER test (P < 0.001), as well as PA enjoyment (P < 0.05), than those in SPARK group. The AVG group generated higher light PA and lower sedentary time for three (P < 0.05 to P < 0.001) and two sessions (P < 0.05 and P < 0.001), respectively. In addition, the AVG group accumulated higher moderate-to-vigorous physical activity (MVPA) for the first session (P < 0.01), while the SPARK group generated higher MVPA for the third session (P < 0.001). No MVPA difference was found between groups for another session.

CONCLUSION

A 6-week (40 minutes × 3 times/week) program using AVG could be an effective strategy in improving children's cardiorespiratory fitness while maintaining PA enjoyment.

Energy expenditure and affect responses to different types of active video game and exercise

BACKGROUND

The purpose of this study was to compare entertainment-themed active video game (AVG) and fitness-themed AVG play with traditional exercise to examine the interaction between physiological and psychological responses.

METHODS

Participants (N = 23) were randomly assigned to 30-min of (i) self-selected intensity exercise (SS-EX), (ii) moderate intensity exercise (MOD-EX), (iii) entertainment-themed video game (ET-VG) and (iv) fitness-themed video game (FT-VG). Physiological and psychological outcomes were recorded before, during and after each trial.

RESULTS

All trials met the ACSM criteria for moderate or vigorous physical activity. The [Formula: see text] (68.3±13.9%) and rate of energy expenditure (10.3±3.1kcal/min) was significantly higher in the SS-EX trial with lowest values reported for ET-VG (p<0.05). No differences were found in % heart rate reserve between SS-EX and FT-VG (66.9±12.5% and 67.1±6% respectively). The AVG's were significantly more enjoyable than the exercise trials (p<0.05) and the ET-VG resulted in the highest core flow and psychological well-being (p<0.05).

CONCLUSION

AVG's can elicit physiological responses that meet recommended exercise intensities but are more enjoyable than conventional exercise in young inactive adults. While further work is required, this study highlights the importance of examining the interaction between physiological outcomes and psychological states to increase physical activity and reduce sedentary time.

Effects of Exergaming on Physical Activity in Overweight Individuals

BACKGROUND

The majority of patients with overweight and type 2 diabetes show insufficient levels of daily physical activity (PA) and usually are among the least likely to engage in or adhere to any form of generic PA. Active video games (exergames) may be a solution to motivate these individuals to overcome their sedentary lifestyle.

OBJECTIVES

This systematic review was conducted to review the current evidence for the effectiveness of exergaming in overweight and type 2 diabetes mellitus and thus to evaluate the suitability of these games to be used as tools for exercise promotion that meet current PA guidelines.

METHODS

We searched electronic bibliographic databases (PubMed, Embase, Web of Science, OpenGrey, and the Cochrane Central Register of Controlled Trials) up to March 2015. Randomized controlled trials (RCT) and cross-sectional studies published in English in a peer-reviewed journal and analyzing the effects of exergames on objectively measured intensity parameters of PA in overweight (body mass index [BMI] ≥25 kg/m(2)) adults (mean age ≥18 years) with and without type 2 diabetes were included. Study selection, data extraction, and quality assessment were performed independently by two review authors. Primary outcomes included changes in oxygen uptake (VO2), energy expenditure (EE), heart rate (HR), or activity counts. Secondary outcomes were enjoyment of treatment, exercise adherence, ratings of perceived exertion (RPE), changes in body composition, and changes in blood parameters (serum glucose, long-term blood glucose, blood cholesterol, triglycerides, or serum lactate).

RESULTS

Of 2845 records, 14 publications (11 studies) met the inclusion criteria. All included studies (ten experimental, cross-sectional laboratory studies and one RCT) were able to show increases in either VO2, EE, HR, or activity counts. However, effects of exergaming in terms of changes in these intensity parameters varied significantly between game modes and consoles as well as because of the vastly differing durations of exergame activity between studies. One of the included studies had a low risk of bias, and three had a high risk of bias; seven studies had an unclear risk of bias as the study description was insufficient. No studies were found investigating the changes in objectively measured PA intensity parameters in patients with type 2 diabetes.

CONCLUSION

This review suggests that exergames are able to increase PA among overweight individuals. However, the inconsistent results and the overall poor or moderate methodological quality do not permit judgment on whether exergames are suitable to meet PA guidelines in this target group. The lack of research regarding the effects of exergames in type 2 diabetes indicates a great need for future research.

Physical Activity Levels in Children With and Without Autism Spectrum Disorder When Playing Active and Sedentary Xbox Kinect Videogames

OBJECTIVE

We compare physical activity during bouts of sedentary videogaming (SVG), active videogaming (AVG), and paced walking in children with and without autism spectrum disorder (ASD) to determine the effectiveness of AVG in providing moderate-to-vigorous physical activity.

MATERIALS AND METHOD

Participants included nine males (8-11 years old) with ASD and eight age-matched males who were typically developing. Both groups had anthropometric and motor proficiency (Movement Assessment Battery for Children II) measures taken before testing. Participants attended three randomly assigned acquisition sessions: 20 minutes of paced walking at 4.5 metabolic equivalents, AVG, and SVG. Videogaming occurred on an Xbox^® Kinect. An Actical accelerometer provided activity counts (AC) and percentage of time in moderate-to-vigorous physical activity (%MVPA). These were compared using 3 × 2 repeated measures analysis of variance for each measure.

RESULTS

Main effects for conditions existed for %MVPA (P < 0.0001) and AC (P < 0.0001). Post hoc Bonferroni comparisons indicated that AVG had significantly higher AC (P < 0.001) and % MVPA (P < 0.001) than SVG, but was significantly lower than paced walking (AC P < 0.001; %MVPA P < 0.01). Overall, participants spent 76.25% of their time in MVPA during AVG compared to 99.4% during paced walking and 2.31% in SVG. No main effects for groups or group by condition interaction effects were found for either measure.

CONCLUSIONS

AVG may provide an appealing means by which all individuals can increase their overall physical activity levels, although AVG should not be seen as a replacement for walking or other forms of PA. Although further research is necessary, the finding that both groups performed similarly in AVG suggests that games can potentially be played without modifications or adaptations to gaming units, which may provide several advantages in terms of social/cost/ease of accessing unit.

Elderly people's perceptions of using Wii sports bowling - A qualitative study

The Nintendo Wii is a gaming console with motion-sensitive controls that is making inroads into health care and rehabilitation. However, there is still limited knowledge on how elderly people perceive the use of such a product. The aim of this study was to examine how the use of the Wii Sports Bowling in an activity group was perceived by elderly people. The data consisted of observations and interviews with participants who used Wii Sports Bowling and was analysed with content analysis. The findings are described in three themes; 'The use of the Wii Sports game', 'Engagement in the game' and 'Social interaction around the activity'. Wii Sports Bowling was described as easier to play compared to real-life bowling and was enjoyable and a social activity. The opportunity to meet the group each week was important for the participants. Playing the game resulted in signs of immersion and a flow-like state. The Wii was perceived to be easy to use, to provide a way to socialize with peers and to give opportunities to participate in activities in a new way. More studies regarding elderly people's experiences and apprehensions regarding new technology such as gaming consoles and virtual reality are needed.

Investigating the Physiological and Psychosocial Responses of Single- and Dual-Player Exergaming in Young Adults

OBJECTIVE

This study investigated the effect of acute exergaming on the physiological and psychosocial responses of young adults and the modulatory effect of a single- or dual-player game play situation.

MATERIALS AND METHODS

Thirty-six participants (19 male; 21.7 ± 3.8 years; 23.65 ± 3.17 kg/m2) each completed two 30-minute exergame sessions in a randomized order (single and dual player) while wearing an Actiheart® to estimate energy expenditure. Positive and negative affect, subjective vitality, and indices of intrinsic motivation were assessed directly after each gaming bout.

RESULTS

There was no significant difference in energy expenditure or psychosocial outcomes between conditions. Although males expended more energy than females in both single- (z = -2.124, P = 0.033) and dual-player situations (z = -2.679, P = 0.007), females reported significantly greater vitality (z = -2.219, P = 0.026) and effort/importance than males (z = -2.001, P = 0.045). Conversely, males reported a greater negative affect (z = -2.872, P = 0.004) and pressure/tension (z = -3.295, P = 0.001). A linear mixed effects model revealed that energy expenditure during exergaming was a significant predictor of interest and enjoyment (P = 0.001) and effort and importance (P = 0.001). This relationship between energy expenditure and psychosocial variables was not modulated by sex or order of gameplay (single or dual player first).

CONCLUSION

The present results suggest that females have a more positive psychosocial response to exergaming relative to males, highlighting exergames such as Wii™ boxing as a potential avenue for future interventions seeking to address the low physical activity levels that characterize the young adult population.

Effect of Prior Game Experience on Energy Expenditure During Xbox Kinect in Children and Teens

OBJECTIVE

To examine the effect of game-specific and overall Kinect experience and overall gaming habits on energy expenditure (EE) and enjoyment of children and adolescents (8-17 years) while playing Xbox^® Kinect exergames.

MATERIALS AND METHODS

Participants (N = 55) played four active videogames for 6-10 minutes. Height, weight, and resting metabolic rate were measured and participants completed a survey on gaming habits and previous experience. Habit (none, low, moderate, or high) was based on the number of game systems at home, frequency, and duration of game play. Game-specific experience was classified as either inexperienced or experienced. A composite score was created for how much experience they had with each game, classified as none, low, or high. The participant wore a portable metabolic analyzer (total and physical activity energy expenditure [PAEE]), heart rate (HR) monitor, and accelerometer (waist, counts/min). Enjoyment was measured after each game using a three-item face scale. Bonferroni-adjusted three-way ANOVA assessed PAEE, intensity, and enjoyment across overall and game-specific experience and habits (P < 0.05).

RESULTS

Intensity, PAEE, and HR were greater in experienced versus inexperienced players (5.1 ± 0.2 vs. 4.4 ± 0.2 metabolic equivalents [METs]; 4.1 ± 0.2 vs. 3.3 ± 0.2 kcal/min; 138 ± 2.5 vs. 130 ± 1.9 bpm). Higher game-specific experience levels elicited greater counts/min compared with no experience. Moderate gaming habits elicited greater PAEE and METs than low gaming habits. Enjoyment was equal in all groups.

CONCLUSION

Participants with more game-specific Kinect experience or overall gaming habits elicited greater PA energy and intensity. This study supports that children and adolescents can play Xbox Kinect without decrements in PAEE or enjoyment.

Effect of Exergaming on Physiological Response and Enjoyment During Recess in Elementary School-Aged Children: A Pilot Study

OBJECTIVE

With an increasing rate of childhood obesity, it is critical to find fun and effective ways of providing children with opportunities to be physically active while at school to mediate this outcome. Using games as a mode of exercise (Exergaming) could be one such way. We aimed to compare the physiologic response and enjoyment of elementary school children when playing Xbox^® Kinect^® versus participating in regular activities during recess.

MATERIALS AND METHODS

Twenty-four children participated individually once in Kinect and once in regular activity sessions on separate days during recess for the allotted time. Sessions were at least 1 week apart, and the order of the sessions was randomized. During the Kinect session, participants played the Reflex Ridge game. During the regular session, participants engaged in self-selected activities. Energy expenditure, metabolic equivalents of task (METS), time in moderate to vigorous activity, percentage of activity in sedentary, light, moderate, vigorous and very vigorous levels, heart rate, rate of perceived exertion (RPE), and Physical Activity Enjoyment Scale were measured for each session and compared using a paired samples t-test.

RESULTS

Significantly greater RPE (P = 0.024), percentage of activity at sedentary (P = 0.019), very vigorous (P < 0.001) levels, and lesser percentage of activity at moderate level (P = 0.008) were noted during the Kinect session.

CONCLUSION

Playing Kinect was comparable to playing outside with classmates. When necessary, such as in inclement weather, whole-body interactive videogames can be a viable alternative physical activity. However, this has to be validated with a larger sample study.

Effects of Exergaming and Message Framing in School Environments on Physical Activity Attitudes and Intentions of Children and Adolescents

Although interventions targeting the health of students in schools are becoming common, few studies have examined how health messages operate at the group level in school environments. This study examines the effects of message-based health interventions (extrinsic vs. intrinsic goal framing) in group environments (exergame competitive vs. exergame noncompetitive) on eliciting attitudes and intentions toward physical activity among children and adolescents. We conducted a 7-week school-based intervention program involving 336 children and 259 adolescents in Singapore in which pre- and post-intervention responses were recorded. Our findings revealed the difference in responses between child and adolescent groups. Children who participated in noncompetitive exergames with extrinsically framed health messages and those who participated in competitive exergames with intrinsically framed health messages demonstrated more favorable attitudes toward physical activity. However, the same effects were absent in our adolescent group. These findings suggest that the integration of exergames into competitive and noncompetitive environments can serve as a gateway to traditional physical activity in schools when strategically combined with intrinsically and extrinsically framed messages. Practical and theoretical implications for schools and health educators are discussed.

Development of a Kinect Software Tool to Classify Movements during Active Video Gaming

While it has been established that using full body motion to play active video games results in increased levels of energy expenditure, there is little information on the classification of human movement during active video game play in relationship to fundamental movement skills. The aim of this study was to validate software utilising Kinect sensor motion capture technology to recognise fundamental movement skills (FMS), during active video game play. Two human assessors rated jumping and side-stepping and these assessments were compared to the Kinect Action Recognition Tool (KART), to establish a level of agreement and determine the number of movements completed during five minutes of active video game play, for 43 children (m = 12 years 7 months ± 1 year 6 months). During five minutes of active video game play, inter-rater reliability, when examining the two human raters, was found to be higher for the jump (r = 0.94, p < .01) than the sidestep (r = 0.87, p < .01), although both were excellent. Excellent reliability was also found between human raters and the KART system for the jump (r = 0.84, p, .01) and moderate reliability for sidestep (r = 0.6983, p < .01) during game play, demonstrating that both humans and KART had higher agreement for jumps than sidesteps in the game play condition. The results of the study provide confidence that the Kinect sensor can be used to count the number of jumps and sidestep during five minutes of active video game play with a similar level of accuracy as human raters. However, in contrast to humans, the KART system required a fraction of the time to analyse and tabulate the results.

Investigating the Relative Exercise Intensity of Exergames in Prepubertal Children

OBJECTIVE

The literature remains equivocal as to whether exergames elicit energy expenditure (EE) commensurate with physical activity guidelines. Such discrepancies may be attributable to a reliance on absolute exercise intensities, which fail to account for differences in cardiorespiratory fitness levels.

MATERIALS AND METHODS

Thirty-four prepubertal children (20 boys, 14 girls; 10.8 ± 1.0 years old) completed a 30-minute exergame (two 15-minute games from "Kinect Adventures! Xbox 360" [Microsoft, Redmond, WA]) and an incremental treadmill test to determine peak oxygen uptake ( [Formula: see text]) throughout which breath-by-breath gas exchange was measured.

RESULTS

Both games elicited moderate-intensity physical activity (5.7 ± 1.5 and 5.5 ± 1.4 metabolic equivalents [METs]), with 36 percent demonstrating a mean EE in excess of 6.0 METs, commensurate with vigorous intensity. Furthermore, boys demonstrated higher EE during both games (boys versus girls: Game 1, 6.0 ± 1.7 versus 5.2 ± 1.0 METs; Game 2, 6.0 ± 1.4 versus girls, 4.9 ± 1.2 METs; P < 0.05). Hierarchical linear regression revealed sex, maturity, and fitness to be significant predictors of EE, accounting for 24 percent of the variance: relative exergame [Formula: see text] = 24.53 + (2.12 × Sex) - (0.42 × Maturity offset) - (0.16 × Relative peak [Formula: see text]). There was no correlation between absolute [Formula: see text] during the exergames and peak [Formula: see text], but [Formula: see text] expressed as a percentage of peak [Formula: see text] was correlated with peak [Formula: see text] during both Game 1 (r = -0.62, P < 0.01) and Game 2 (r = -0.59, P < 0.01).

CONCLUSIONS

The present findings provide further evidence that exergames can elicit EE values commensurate with national physical activity guidelines and extend our understanding of the mediators of EE. Specifically, cardiorespiratory fitness and sex must both be considered in the design and implementation of future interventions seeking to use exergames to enhance physical activity levels and/or cardiorespiratory fitness.

Impact of Nintendo Wii Games on Physical Literacy in Children: Motor Skills, Physical Fitness, Activity Behaviors, and Knowledge

Physical literacy is the degree of fitness, behaviors, knowledge, and fundamental movement skills (agility, balance, and coordination) a child has to confidently participate in physical activity. Active video games (AVG), like the Nintendo Wii, have emerged as alternatives to traditional physical activity by providing a non-threatening environment to develop physical literacy. This study examined the impact of AVGs on children’s (age 6–12, N = 15) physical literacy. For six weeks children played one of four pre-selected AVGs (minimum 20 min, twice per week). Pre and post measures of motivation, enjoyment, and physical literacy were completed. Results indicated a near significant improvement in aiming and catching (p = 0.06). Manual dexterity significantly improved in males (p = 0.001), and females felt significantly less pressured to engage in PA (p = 0.008). Overall, there appears to be some positive impact of an AVG intervention on components of physical literacy.

Pediatric Obesity: Is There Room for Active Video Games in Prevention or Management?

Children and adolescents spend a considerable amount of time engaged in sedentary behaviors that have been shown to favor weight gain and impaired physical fitness. Active video games have been proposed to increase physical activity levels. Although active video games may offer an interesting alternative to reducing sedentary time for children, the present commentary aimed to determine whether there is adequate evidence that compared active video gaming to real-life play and exercise. Given the dearth of data, it is not possible at present to support the use of active video games as substitutes for traditional forms of active play and health-enhancing physical activity. Further research should be encouraged and therapists should not consider active video games exclusively for intervention in children with obesity.

Children's Movement Skills When Playing Active Video Games

Active video games (AVGs) may be useful for movement skill practice. This study examined children's skill execution while playing Xbox Kinect™ and during movement skill assessment. Nineteen children (10 boys, 9 girls; M age = 7.9yr., SD = 1.4) had their skills assessed before AVG play and then were observed once a week for 6 wk. while playing AVGs for 50min. While AVG play showed evidence of correct skill performance (at least 30–50% of the time when playing table tennis, tennis, and baseball), nearly all skills were more correctly performed during skill assessment (generally more than 50% of the time). This study may help researchers to better understand the role AVGs could play in enhancing real life movement skills.

Assessing the Physiological Cost of Active Videogames (Xbox Kinect) Versus Sedentary Videogames in Young Healthy Males

OBJECTIVES

The aims of this study were twofold: (1) to compare the physiological costs of active videogames (AVGs) and sedentary videogames (SVGs) and (2) to compare the exercise intensities attained during AVGs with the exercise intensity criteria for moderate and vigorous physical activity, as stated in current physical activity recommendations for improving public health.

MATERIALS AND METHODS

Nineteen young males participated in the study (age, 23 ± 3 years; height, 178 ± 6 cm; weight, 78 ± 15 kg). Participants completed a maximum oxygen uptake ([Formula: see text]) test and a gaming session, including AVGs ("Reflex Ridge," "River Rush," and "Boxing" for the Microsoft [Redmond, WA] Kinect™) and SVGs ("FIFA 14" [Electronic Arts, Burnaby, BC, Canada] and "Call of Duty" [Activision, Santa Monica, CA]). Heart rate (HR) and oxygen uptake [Formula: see text]) were recorded continuously during all videogames. Rating of perceived exertion (RPE) was taken every 3 minutes during AVGs and SVGs. Energy expenditure (EE), expressed as metabolic equivalents (METs), was calculated. One MET was defined as the volume of oxygen consumed at rest in a seated position and is equal to 3.5 mL of O2/kg of body mass/minute. The exercise intensity for each game was expressed as a percentage of [Formula: see text] and percentage of age-predicted maximum HR (HRmax).

RESULTS

Exercise intensity (percentage HRmax, percentage [Formula: see text], and RPE) and EE (METs) were significantly higher during active gaming compared with sedentary gameplay (P < 0.01). AVGs elicited moderate levels of exercise intensity (64-72 percent HRmax) in line with current recommended physical activity guidelines.

CONCLUSIONS

Our results indicate AVGs provoke physiological responses equivalent to a moderate-intensity physical activity.

Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomized Controlled Trial

OBJECTIVE

The aim of the present study was to determine whether aerobic exercise involving an active video game system improved asthma control, airway inflammation and exercise capacity in children with moderate to severe asthma.

DESIGN

A randomized, controlled, single-blinded clinical trial was carried out. Thirty-six children with moderate to severe asthma were randomly allocated to either a video game group (VGG; N = 20) or a treadmill group (TG; n = 16). Both groups completed an eight-week supervised program with two weekly 40-minute sessions. Pre-training and post-training evaluations involved the Asthma Control Questionnaire, exhaled nitric oxide levels (FeNO), maximum exercise testing (Bruce protocol) and lung function.

RESULTS

No differences between the VGG and TG were found at the baseline. Improvements occurred in both groups with regard to asthma control and exercise capacity. Moreover, a significant reduction in FeNO was found in the VGG (p < 0.05). Although the mean energy expenditure at rest and during exercise training was similar for both groups, the maximum energy expenditure was higher in the VGG.

CONCLUSION

The present findings strongly suggest that aerobic training promoted by an active video game had a positive impact on children with asthma in terms of clinical control, improvement in their exercise capacity and a reduction in pulmonary inflammation.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01438294.

Physiological Responses During Multiplay Exergaming in Young Adult Males are Game-Dependent

Regular moderate-intensity exercise provides health benefits. The aim of this study was to examine whether the selected exercise intensity and physiological responses during exergaming in a single and multiplayer mode in the same physical space were game-dependent. Ten males (mean ±SD, age: 23 ±5 years, body mass: 84.2 ±15.6 kg, body height: 180 ±7 cm, body mass index: 26.0 ±4.0 kg·m(-2)) played the games Kinect football, boxing and track & field (3 × ∼10 min, ∼ 2 min rest periods) in similar time sequence in two sessions. Physiological responses were measured with the portable Cosmed K4b(2) pulmonary gas exchange system. Single play demands were used to match with a competitive opponent in a multiplay mode. A within-subjects crossover design was used with one-way ANOVA and a post-hoc t-test for analysis (p<0.05). Minute ventilation, oxygen uptake and the heart rate were at least 18% higher during a multiplayer mode for Kinect football and boxing but not for track & field. Energy expenditure was 21% higher during multiplay football. Single play track & field had higher metabolic equivalent than single play football (5.7 ±1.6, range: 3.2-8.6 vs 4.1 ±1.0, range: 3.0-6.1, p<0.05). Exergaming in a multiplayer mode can provide higher physiological demands but the effects are game-dependent. It seems that exergaming with low intensity in a multiplayer mode may provide a greater physical challenge for participants than in a single play mode but may not consistently provide sufficient intensity to acquire health benefits when played regularly as part of a programme to promote and maintain health in young adults.